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Objective: This cross-sectional study aims to examine the effect of marijuana-smoking on dental caries experience and to explore the potential combined effects of tobacco and marijuana cigarette-smoking., Methods: We used data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES). We examined demographics, tobacco- and marijuana-smoking, dental examination, and dietary intake. Caries was measured as decayed, missing, filled teeth (DMFT). Data analysis included univariate, bivariate analyses, and linear regression model (LRM) to examine the association between marijuana-smoking and DMFT., Results: Mean DMFT score was lowest for nonsmokers (8.72) and highest for current marijuana smokers (9.87) (P < .0001); however, LRM results revealed that marijuana-smoking was not associated with caries. Adjusted DMFT was the highest for current tobacco and former marijuana smokers (β estimate = 1.18; 95% CI, -0.27 to 2.62), but the relationship was not statistically significant., Conclusions: After controlling for potential confounders, there was no significant association between marijuana-smoking and dental caries experience. However, when marijuana and tobacco were smoked concurrently, there was a notable increase in DMFT, although the difference was not statistically significant. Future research should be directed towards exploring the effects of different forms of marijuana consumption, such as edibles and drinkables, on caries development. Health promotion programmes should be aimed at educating the public regarding the combined health impacts of smoking both marijuana and tobacco, considering the potential heightened caries risk., Competing Interests: Conflict of interest None disclosed., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Buprenorphine is under scrutiny because of the development of xerostomia and caries. The purpose of this article was to inform dental care professionals about the oral effects of buprenorphine and to increase knowledge and awareness of medication-assisted treatment in the management of opioid use disorder (OUD)., Case Description: In 2022, the US Food and Drug Administration issued a warning about xerostomia and caries associated with the use of transmucosal (sublingual and buccal formulations) buprenorphine. Dental health care professionals should instruct patients taking buprenorphine on how to prevent these dental issues by means of rinsing with water and swallowing once the drug has been completely dissolved, followed by toothbrushing at least 1 hour after taking the drug. In addition, a fluoride supplement should be prescribed., Practical Implications: It is imperative for dentists to recognize buprenorphine as medication-assisted treatment and to recognize a patient as having an OUD. While taking buprenorphine, the patient should have more frequent oral health care appointments, including home care instructions and caries risk assessment to monitor for caries and xerostomia so that treatment, if indicated, could be initiated as soon as possible. In addition, the dentist's role in OUD is to make sure patients follow the treatment recommendations and use the buprenorphine and to not have them discontinue because of potential caries risk., Competing Interests: Disclosures Drs. Segelnick and Weinberg did not report any disclosures., (Copyright © 2024 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Untreated caries is a prevalent disease that is associated with a substantial health and economic burden. Many past efforts have assessed the epidemiology of untreated caries, and this study provides the most up-to-date figures on the distribution and determinants of the disease in the adult US population for the period 2017 through 2020. Using data from the 2017-2020 National Health and Nutrition Examination Survey, the author derived estimates for untreated caries prevalence in the adult US population. The author conducted subgroup analyses to assess how the epidemiology differed between coronal and root caries and how the disease was distributed among population subgroups. On the basis of a weighted sample representative of 193.5 million adults, the prevalence of untreated caries was found to be 21.3%. Specific prevalence of coronal and root caries were 17.9% and 10.1%, respectively. Caries was most prevalent in those aged 30 through 39 years (25.2%) and 40 through 49 years (22.3%), men (23.5%), those of other (36.5%) or non-Hispanic Black (35.6%) race or ethnicity, those with family income to poverty ratio of 0.5 through 1.0 (46.2%) or less than 0.5 (37.3%), those with educational attainment less than high school graduation (39.6%), those who did not have health insurance (42.1%), and those who were underweight (25.1%) or obese (23.5%). Untreated caries is present in more than 1 in 5 adults within the US population and is disproportionately distributed among those of lower socioeconomic status. There is a substantial unmet health care need in the US adult population for the prevention and management of untreated caries, and public health efforts should aim particularly to address disease within those subgroups who are at a disproportionately high risk. [ABSTRACT FROM AUTHOR]

Objective: For more than 150 years, dental amalgam fillings (50% metallic mercury (Hg0) by weight) have been used in American dentistry. The US Food and Drug Administration (FDA) acknowledged that amalgams release Hg vapor that may be harmful to certain patients. This study examined the impact of Hg vapor exposure from amalgams in American adults. Methods: Amalgam-Hg vapor exposure among 158,274,824 weighted-adult Americans was examined in the 2015–2018 National Health and Nutrition Examination Survey (NHANES). Beta (β)-coefficients were calculated for the correlation between the number of amalgam surfaces and daily micrograms (μg) of urinary Hg and daily μg of Hg vapor exposure from amalgams per kilogram (Kg) bodyweight. Results: About 91 million (57.8%) adults had ≥1 amalgam surface and about 67 million (42.2%) had no amalgams. A β-coefficient = 0.041 significantly correlated the number of amalgam surfaces to daily amounts of urinary Hg. Differences were observed for gender and racial groups. Daily Hg vapor doses from amalgams were in excess of the most restrictive California's Environmental Protection Agency (EPA) safety limit for about 86 million (54.3%) adults and in excess of the least restrictive US EPA safety limit among about 16 million (10.4%) adults. The mean allowable number of amalgam surfaces ranged from 1.28 for adult females under the California's EPA safety limit to 16.23 for adult males under the US EPA safety limit. Conclusion: Given that American adults are receiving significant, ongoing exposure to Hg vapor from amalgams, careful evaluation of the need to reduce use of amalgams should be considered. [ABSTRACT FROM AUTHOR]

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

Objective: To examine the association of social support with dental caries experience in Hispanics/Latinos living in the United States (US) and to assess whether the relationship is modified by nativity status. Methods: This cross‐sectional study analysed data for 4459 dentate men and women aged 18‐74 years in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. At baseline (2008‐2011), dentists quantified dental caries experience as the number of decayed, missing, and filled permanent tooth surfaces (DMFS) for all teeth excluding third molars. Social support was assessed according to measures of structural support (Social Network Index) and functional support (Interpersonal Support Evaluation List). Covariate‐adjusted multiple linear regression estimated the relationship between social support and dental caries experience and tested whether the association was modified by nativity status (born within the 50 US states, foreign‐born <10 years in the United States, foreign‐born >10 years or more in the United States). Results: In covariate‐adjusted models, each additional role in the social network was associated with 1.39 fewer DMF tooth surfaces (95% CI: −2.21, −0.58) among foreign‐born Hispanics/Latinos with fewer than 10 years lived in the US. For foreign‐born Hispanics/Latinos with 10 years or more in the United States, each additional social network role was associated with 0.57 fewer DMF tooth surfaces (95% CI: −1.19, 0.04). No association was observed between functional social support and dental caries experience regardless of nativity status. Conclusions: Our findings suggest that structural social support is protective against dental caries experience among recent immigrants of Hispanic/Latino background. This association may reflect the importance of social support to integration into the medical and dental infrastructure and thus receipt of dental care. Future research that examines the behavioural and cultural factors that moderate the relationship between social support and dental caries experience will inform development of culturally sensitive dental caries prevention programs for Hispanics/Latinos in the United States. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the association between food insecurity and untreated caries among US children and the potential role of diet quality as a mediator in this relationship. The authors analyzed data for 4,822 children aged 5 through 17 years from the National Health and Nutrition Examination Survey cycles from 2011 through 2014. The authors measured food security as household-level food security status (full, marginal, low, very low) and overall food security status (full food secure, food insecure). They measured diet quality using the Healthy Eating Index. The primary outcome measure was untreated caries (none, ≥ 1). The authors used multiple logistic regression analysis to evaluate the relationships among food insecurity, diet quality, and untreated caries. They conducted mediation analysis using the Baron and Kenny approach. Food-insecure children were more likely to have untreated caries compared with their fully food-secure counterparts, after controlling for confounding variables (odds ratio [OR], 1.38; 95% [CI, 1.11 to 1.72). Specifically, children from marginal and very low food-secure households had significantly higher odds of untreated caries (OR, 1.48; 95% CI, 1.10 to 2.01) compared with children from fully food-secure households (OR, 1.59; 95% CI, 1.12 to 2.26). Diet quality was not significantly associated with untreated caries. Food insecurity was negatively associated with untreated caries among US children. Diet quality was not associated with untreated caries. Social factors such as food insecurity should be taken into consideration when dental clinicians perform caries risk assessment because caries risk is shown to be associated with overall health and dental health. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between added sugar intake above the daily limit for the risk of noncommunicable diseases (NCDs) and the Chronic Oral Disease Burden in adolescents., Methods: This was a population-based study using cross-sectional data nested to RPS Cohorts Consortium, São Luís, Brazil, from the 18-19-year-old follow-up (n = 2515). High consumption of added sugars was estimated according to the limits of the World Health Organization guidelines (WHO) (≥5% of total energy/day) and the American Heart Association statement (AHA) (≥25 g/day). The Chronic Oral Disease Burden was a latent variable (number of decayed teeth, periodontal probing depth ≥4 mm, clinical attachment level ≥3 mm, and bleeding on probing). Models were adjusted for Socioeconomic Status, sex, obesity, and plaque index and analyzed through structural equation modeling., Results: Adolescents had high sugar consumption according to the WHO (78.6%) and AHA (81.4%) recommendations. High sugar intake, according to WHO (SC = 0.096; p = 0.007) and AHA (SC = 0.056; p = 0.027), was associated with a heavier Chronic Oral Disease Burden. Even half of the recommended dose was sufficient to affect some oral disease indicators., Conclusion: Sugar intake over international statements to prevent NCDs is associated with higher Chronic Oral Disease Burden among adolescents., (© 2022 Wiley Periodicals LLC.)

The authors' aim was to examine the association between sugar-sweetened beverage (SSB) consumption and the prevalence and severity of the caries experience in children and adults in the United States. The authors analyzed data obtained from 14,192 people aged 2 through 74 years, who participated in the National Health and Nutrition Examination Survey from 2011 through 2014. Using descriptive analyses, the authors assessed the distributions of sociodemographic characteristics overall and via SSB intake. The authors used multivariable logistic regression to estimate the association of untreated and severe untreated caries with SSB consumption in all age groups. Across all ages, male participants were more likely than female participants to consume SSBs, and consumption was higher in non-Hispanic black and Hispanic populations. Relative to those who did not consume SSBs, people aged 20 through 44 years who consumed SSBs had significantly higher odds of having untreated caries (adjusted odds ratio [AOR], 1.27; 95% confidence interval [CI], 1.04 to 1.55) and severe untreated caries (AOR, 1.36; 95% CI, 1.15 to 1.60). Adolescents aged 9 through 19 years had significantly higher odds of having untreated caries (AOR, 1.37; 95% CI, 1.05 to 1.80), and middle-aged adults (45-64 years) had significantly higher odds of severe untreated caries (AOR, 1.46; 95% CI, 1.10 to 1.92) relative to those who did not consume SSBs. Consumption of SSBs was associated with increased caries experience among young children and increased risk of developing untreated caries in all age groups of children and adults. Continued efforts by policy makers, public health leaders, and clinicians to reduce consumption of SSBs across the life span are paramount. [ABSTRACT FROM AUTHOR]

The effect of sugared beverages on dental caries has been widely studied in dental literature. A major limitation of these studies was examining the beverages as a single source. To overcome this limitation, a few studies used cluster analysis to group people into similar beverage consumption patterns. These studies did not differentiate between sugared beverages and diet drinks. Therefore the aim of this study is to examine the effect of consuming diet drinks on dental caries among US children by using cluster analysis. In this cross-sectional study, the authors analyzed the dietary data of children aged 3 through 10 years, using 2 24-hour recall interviews in the 2011-2014 National Health and Nutrition Examination Survey data. Cluster analysis has been used to overcome the limitations of examining the beverages as a single source. Clusters were identified based on the R 2 statistic and the local peak of pseudo- F statistics. Survey procedure and sample weights were used to account for the complex National Health and Nutrition Examination Survey sampling design. Six beverage consumption clusters were identified: high soda, high 100% juice, high juice drinks, high diet drinks, high milk, and high water. Regression analysis showed that the high soda cluster had a tendency to increase caries risk (odds ratio [OR], 1.69, 95% confidence interval [CI], 0.9 to 3.1), while the high diet drinks cluster had neutral effect compared with the high water cluster (OR, 0.94, 95% CI, 0.5 to 1.8). The results of this study suggest that diet drinks have no adverse effect on teeth among US children. Additional well-designed longitudinal studies should be conducted to establish the effect of diet drinks on caries when consumed during childhood. Although this study did not show an association between caries and diet drinks, dental practitioners should be cautious about recommending these drinks, as they have been linked to systemic diseases. In addition, the American Academy of Pediatrics and National Academy of Medicine do not recommend that children consume these beverages. [ABSTRACT FROM AUTHOR]

Although dietary fluoride (F) supplements (DFS) are recommended for children who use F-deficient drinking water, no studies have examined filled DFS prescriptions across multiple states to examine the dosage consistency with current recommendations or prescription length. This sequential cross-sectional analysis used Medicaid claims data for children aged 0.5 through 16 years who in 2011 lived in the 6 states with the lowest and the highest fluoridation coverage (≤ 34% and ≥ 95% of the public water system population fluoridated, respectively). For 2011, the authors calculated the mean percentage of children with filled DFS prescriptions and the change since 2000 across states with high and low fluoridation coverage, the percentage of children with filled DFS prescriptions containing F dosage consistent with current recommendations, and filled DFS prescription length and cost across states. In states with high fluoridation coverage, the mean percentage of children with a filled prescription was < 1% in both years; in states with low fluoridation coverage, this value increased from 0.9% to 10.3%, the highest increase (16.4 percentage points) since 2000 among children aged 0.5 through 2 years. The average prescription length was 72 days. Across states, the mean costs per child prescribed supplements and per enrollee were $17.60 and $1.05, respectively. Filled prescriptions largely followed current recommendations but reached only a small percentage of children in low-coverage states. The short prescription length indicated limited exposure for caries prevention. Results from these states suggest more children could have longer exposure to the caries-preventive benefits of F at a similar cost with water fluoridation as with DFS. [ABSTRACT FROM AUTHOR]

Body mass index has been traditionally used to determine the nutritional status of children in studies on obesity and caries. Imaging methods provide a superior assessment of body fat. This study investigated the relationship between measures of adiposity and caries in permanent teeth in children and adolescents. The analysis included 5,694 participants in the National Health and Nutrition Examination Survey from 2011 through 2018, aged 8 through 19 years. The body fat percentage (BF%) and fat mass index (FMI) were determined from whole-body dual-energy x-ray absorptiometry scans. Excess adiposity was defined as a sex- and age-specific value at or above the 75th percentile according to the US reference standards for BF% or FMI. Caries was measured with the decayed teeth and decayed, missing, and filled teeth indexes; prevalence of untreated dentin caries; and lifetime caries prevalence. The associations between adiposity and caries were tested in confounding variables–adjusted regression models. The FMI score was associated with the decayed, missing, and filled teeth score (rate ratio, 1.03; 95% CI, 1.01 to 1.05) and lifetime caries prevalence (odds ratio, 1.06; 95% CI, 1.03 to 1.08), but the associations attenuated after adjustment for confounding variables. Neither the BF% score nor the presence of excess adiposity, defined according to the BF% or FMI reference standards, were associated with caries. The authors found no association between measures of adiposity and caries among US children and adolescents. Caries is a multifactorial disease, and any observed association between obesity and caries is most likely due to the shared determinants and risk factors of both conditions. [ABSTRACT FROM AUTHOR]

Background. As silver diamine fluoride (SDF) gains popularity for caries arrest, the authors aimed to investigate the content of fluoride and silver in 38% SDF produced for the US market and its short-term stability. Methods. Five samples of 38% SDF were evaluated when the bottle was first opened, and at 7 and 28 days. Fluoride concentrations were determined with a fluoride ion-selective electrode, and silver concentrations were determined with a simultaneous inductively coupled plasma mass spectrometer. pH was measured with a pH probe. Weight and volume of individual drops were measured. Results. At day 0, 40% of individual measured values were above the expected fluoride concentration, and at day 28, 93% were above the expected fluoride concentration (P = .005). At day 0, 19% of individual measured values were below the lowest expected silver concentration, and at day 28, 93% were below (P < .001). Acidity (pH 10) was consistent over the 3 periods. Mean (standard deviation) weight of a drop was 40 (4.0) milligrams, and mean (standard deviation) volume was 32.55 (1.89) microliters, 30% more than the reported value of 25 /rL. Conclusion. Over 28 days, the product pH is stable, whereas the fluoride content tends to increase and the silver content tends to decrease. Drops were larger than expected when dispensed from the bottle. Practical Implications. Drops are larger than expected, so each delivers higher than expected quantities of silver and fluoride. Clinicians should exercise caution when using this product on young children, replace the cap immediately, and use as soon as dispensed. [ABSTRACT FROM AUTHOR]

Background. An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated evidence-based clinical recommendations for the arrest or reversal of noncavitated and cavitated dental caries using nonrestorative treatments in children and adults. Types of Studies Reviewed. The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane database of systematic reviews to identify randomized controlled trials reporting on nonrestorative treatments for noncavitated and cavitated carious lesions. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and move from the evidence to the decisions. Results. The expert panel formulated 11 clinical recommendations, each specific to lesion type, tooth surface, and dentition. Of the most effective interventions, the panel provided recommendations for the use of 38% silver diamine fluoride, sealants, 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride gel, and 5,000 parts per million fluoride (1.1% sodium fluoride) toothpaste or gel, among others. The panel also provided a recommendation against the use of 10% casein phosphopeptide--amorphous calcium phosphate. Conclusions and Practical Implications. Although the recommended interventions are often used for caries prevention, or in conjunction with restorative treatment options, these approaches have shown to be effective in arresting or reversing carious lesions. Clinicians are encouraged to prioritize use of these interventions based on effectiveness, safety, and feasibility. [ABSTRACT FROM AUTHOR]

An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs together with the ADA Science and Research Institute's program for Clinical and Translational Research conducted a systematic review and developed recommendations for the treatment of moderate and advanced cavitated caries lesions in patients with vital, nonendodontically treated primary and permanent teeth. The authors searched for systematic reviews comparing carious tissue removal (CTR) approaches in Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Trip Medical Database. The authors also conducted a systematic search for randomized controlled trials comparing direct restorative materials in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov , and the World Health Organization International Clinical Trials Registry Platform. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of the evidence and formulate recommendations. The panel formulated 16 recommendations and good practice statements: 4 on CTR approaches specific to lesion depth and 12 on direct restorative materials specific to tooth location and surfaces involved. The panel conditionally recommended for the use of conservative CTR approaches, especially for advanced lesions. Although the panel conditionally recommended for the use of all direct restorative materials, they prioritized some materials over the use of others for certain clinical scenarios. The evidence suggests that more conservative CTR approaches may decrease the risk of adverse effects. All included direct restorative materials may be effective in treating moderate and advanced caries lesions on vital, nonendodontically treated primary and permanent teeth. [ABSTRACT FROM AUTHOR]

Background. Few investigators have explored differences in oral health status between immigrants and natives. To address this gap, the authors used nationally representative data to characterize disparities in oral health among noncitizens, naturalized citizens, and native adults. Methods. The 2013 to 2014 National Health and Nutrition Examination Survey, a nationally representative in-person survey, provides oral health data for US natives, naturalized citizens, and noncitizens. Univariate and multivariate regression analyses were conducted to compare evidence of caries and periodontal disease, as well as recommendations for oral health care, stratified by immigration status for adults. Results. More than one-half of noncitizens (50.5%) received a diagnosis of periodontal disease, and 38.0% had caries; for natives, these rates were 34.4% and 27.0%, respectively. Differences between natives and naturalized citizens were not statistically significant. After adjusting for age, sex, race or ethnicity, education, poverty, tobacco smoking status, and number of permanent teeth, noncitizens still had 45% higher adjusted odds of periodontal disease and 60% higher odds of receiving recommendations for oral health care than natives. However, differences between noncitizens and natives were no longer important after adjusting for insurance. Conclusions. Noncitizen immigrants reported having substantially poorer oral health than natives in the United States. However, disparities between noncitizens and natives are no longer important when accounting for health insurance. Practical Implications. Although noncitizen adults have a higher likelihood of poor oral health than native adults, having insurance may close this gap. Health care reform initiatives should provide dental benefits for adults to help mitigate the current economic and legal barriers that many immigrants face when accessing oral health care. [ABSTRACT FROM AUTHOR]

The purpose of this report is to examine critically the appropriateness of the current guidance for fluoride intake in the population (0.05-0.07 mg F/kg bodyweight/d), consider whether changes to the current guidance are desirable, and suggest further research that will strengthen the evidence base for future decisions on guidance/advice in this area. The benefits and the risks of using fluoride particularly concern preschool children because it is at this age that excessive fluoride intake may result in dental fluorosis. Data from mostly cross-sectional studies show a wide variation in exposure and a considerable variation in the amount of fluoride ingested. Fluorosis, mostly mild, is commonly observed. For considering changes in current guidance, there is a need for more knowledge on the relationship between exposure to fluoride at an early age and the development of fluorosis. For that, prospective epidemiological studies with sufficiently large and representative samples of children are required. It is also important to study children in communities both with and without water fluoridation and to include populations where salt or milk fluoridation is used. There is also a need for professional agreement on acceptable levels of mild and moderate/severe fluorosis and a more comprehensive knowledge on the appreciation of mild fluorosis among the public. [ABSTRACT FROM AUTHOR]

Since the classical epidemiological studies by Dean, it has been known that there should be an optimum level of exposure to fluoride that would be able to provide the maximum protection against caries, with minimum dental fluorosis. The "optimal" daily intake of fluoride for children (0.05-0.07 mg per kilogram bodyweight) that is still accepted worldwide was empirically determined. In the present review, we discuss the appropriateness of the current guidance for fluoride intake, in light of the windows of susceptibility to caries and fluorosis, the modern trends of fluoride intake from multiple sources, individual variations in fluoride metabolism, and recent epidemiological data. The main conclusion is that it is very difficult to think about a strict recommendation for an "optimal" range of fluoride intake at the individual level in light of existing knowledge of 1) the mechanisms of action of fluoride to control caries, 2) the mechanisms involved in dental fluorosis development, 3) the distinct factors that interfere in the metabolism of fluoride, and 4) the windows of susceptibility to both dental caries and fluorosis development. An "optimal" range of fluoride intake is, however, desirable at the population level to guide programs of community fluoridation, but further research is necessary to provide additional support for future decisions on guidance in this area. This list includes the effect of factors affecting fluoride metabolism, clinical trials on the effectiveness of low-fluoride dentifrices to prevent caries in the primary dentition, and validation of biomarkers of exposure to fluoride. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to assess the negative impact of dental caries on the OHRQoL of 8- to 10-year-old Brazilian children. Methods: This population-based case-control study involved 546 children (8–10 years old), 182 cases with a high negative impact on OHRQoL and 364 controls with a low negative impact on OHRQoL. Children’s OHRQOL was measured using the Child Perceptions Questionnaire (CPQ8-10). Cases and controls (1x2 ratio) were individually matched by school and gender. Dental caries experience, malocclusion, and traumatic dental injuries were used as independent variables. Dental examinations were carried out at school during daytime hours by two calibrated examiners (Kappa = 0.93-interexaminer and 0.95- intraexaminer). The data were analyzed by descriptive statistics, conditional bivariate and multiple logistic regression, with the significance level set at 5%. Results: There was no significant difference in traumatic dental injuries and malocclusion between the case and control groups (p>0.05). Children with DMFT/dmft ≥3 had a 2.06-fold (95%CI = 1.28–3.31, p = 0.003) greater chance of experiencing a high negative impact on OHRQoL than those with DMFT/dmft = 0 Conclusion: Children with high dental caries experience are more likely to present a high negative impact on OHRQoL than those with no dental caries experience. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the accuracy of dental faculty members' utilization of diagnostic codes and resulting treatment planning based on radiographic interproximal tooth radiolucencies. In 2015, 50 full-time and part-time general dentistry faculty members at one U.S. dental school were shown a sequence of 15 bitewing radiographs; one interproximal radiolucency was highlighted on each bitewing. For each radiographic lesion, participants were asked to choose the most appropriate diagnostic code (from a concise list of five codes, corresponding to lesion progression to outer/inner halves of enamel and outer/middle/pulpal thirds of dentin), acute treatment (attempt to arrest/remineralize non-invasively, operative intervention, or no treatment), and level of confidence in choices. Diagnostic and treatment choices of participants were compared to "gold standard" correct responses, as determined by expert radiology and operative faculty members, respectively. The majority of the participants selected the correct diagnostic code for lesions in the outer one-third of dentin (p<0.0001) and the pulpal one-third of dentin (p<0.0001). For lesions in the outer and inner halves of enamel and the middle one-third of dentin, the correct rates were moderate. However, the majority of the participants chose correct treatments on all types of lesions (correct rate 63.6-100%). Faculty members' confidence in their responses was generally high for all lesions, all above 90%. Diagnostic codes were appropriately assigned by participants for the very deepest lesions, but they were not assigned accurately for more incipient lesions (limited to enamel). Paradoxically, treatment choices were generally correct, regardless of diagnostic choices. Further calibration is needed to improve faculty use and teaching of diagnostic codes. [ABSTRACT FROM AUTHOR]

Compared to other population groups in the United States, caries (tooth decay) is a disproportionately prevalent disease among Latino populations, especially among low-income and rural sub-groups and children under five years of age. Fluoride is a primary preventive for caries. While water fluoridation is a major and effective public health means for delivering fluoride on a mass scale, it does not reach many rural areas or population groups such as Latinos who eschew drinking water from municipal sources. This study examines the acceptability to such groups of salt fluoridation, an alternate means of delivering fluoride long used on a global scale. An ethnographic study in California’s rural Central Valley was performed. Thirty individual interviews and 5 focus groups (N = 61) were conducted in Spanish to investigate low-income Latino migrant caregivers’ experiences, views and understandings of domestic salt, oral health, caries prevention and fluoride. Audio data were transcribed, translated, coded and thematically analyzed. Table salt was readily available and frequently consumed. Both adult and child daily sodium consumption was high. Despite a general feeling that it was good, and present in dentifrices or dietary supplements, most participants had little knowledge about fluoride. Concerns were raised about cardio-vascular and other possibly deleterious effects if an increase in salt consumption occurred because fluoridated salt was viewed as having ‘extra’ benefits. Once informed about fluoride’s safety and role in caries prevention, most participants expressed willingness to use fluoridated salt, especially if it benefitted children. Reassurance about its safety and benefits, and demonstration of its taste, were important aspects of acceptance. Taste was paramount. Participants would not consume more fluoridated salt than their current salt as that would result in unpleasant changes in food flavor and taste. While salt fluoridation is acceptable, the feasibility of producing and distributing fluoridated salt in the United States is, however, complex and challenging. [ABSTRACT FROM AUTHOR]

The US Public Health Service has finalized its recommendation relating to community water fluoridation (Federal Panel on Community Water Fluoridation, US Department of Health and Human Services, 2015). It recommends an optimal concentration of 0.7 mg/l F based on their argument that this concentration provides the best balance of protection from dental caries while limiting the risk of dental fluorosis. The rationale for this recommendation can be questioned, particularly given the contrasting etiologies and impact on the community. Uncertainty surrounds the key evidence considered by the panel. This study argues that the panel should have exercised more caution and called for further research before reducing the 'optimal' concentration of fluoride in water supplies. Up-to-date data on caries and fluorosis trend by age group or birth cohort, analyses on attributable risk for fluorosis, data on individual and population impact of caries and fluorosis, water intake over an extended period across the seasons, and the curvilinear relationship of fluoride concentration in water supplies and caries protection would have all been desirable to inform the panel, given the foreshadowing of the recommendation in late 2011. Further, a wider range of policy directions to achieve the best balance of protection from dental caries while limiting the risk of dental fluorosis are available from the international literature. Assessment of these should have been more evident. There is a public health policy responsibility to monitor water fluoridation programs so as to achieve a near maximum reduction in dental caries without unacceptable levels of dental fluorosis. However, recommendations to alter existing policy need to be cognizant of the balancing of risk and protective exposures across the entire population and potentially all ages and to be based on recent data that are purposefully collected, critically analyzed and carefully interpreted. [ABSTRACT FROM AUTHOR]

Objective The goal of this analysis was to describe income-related inequality in untreated caries among children in the United States over time. Methods The analysis focuses on children ages 2-12 years in three nationally representative U.S. surveys: the National Health and Nutrition Examination Survey ( NHANES) 1971-1974, NHANES 1988-1994, and NHANES 1999-2004. The outcome of interest is untreated dental caries. Various methods are employed to measure absolute and relative inequality within each survey such as pair-wise comparisons, measures of association (odds ratios), and three summary measures of overall inequality: the slope index of inequality, the relative index of inequality, and the concentration index. Inequality trends are then assessed by comparing these estimates across the three surveys. Results Inequality was present in each of the three surveys analyzed. Whether measured on an absolute or relative scale, untreated caries disproportionately affected those with lower income. Trend analysis shows that, despite population-wide reductions in untreated caries between NHANES I and NHANES III, overall absolute inequality slightly increased, while overall relative inequality significantly increased. Between NHANES III and NHANES 1999-2004, both absolute and relative inequality tended to decrease; however, these changes were not statistically significant. Conclusions Socioeconomic inequality in oral health is an important measure of progress in overall population health and a key input to inform health policies. This analysis shows the presence of socioeconomic inequality in oral health in the American child population, as well as changes in its magnitude over time. Further research is needed to determine the factors related to these changes and their relative contribution to inequality trends. [ABSTRACT FROM AUTHOR]

During the late prehistoric period (AD 1250-1550) in the southeast USA, when native populations transitioned to living in permanent, nucleated settlements practicing maize agriculture, most experienced a decline in health. However, some research shows that not all groups experienced the decline in the same way as there were regional differences in dental caries and iron deficiency anaemia frequencies and patterns of physical activity. Therefore, the purpose of this study is to determine if regional differences in health also existed between late prehistoric upland and coastal inhabitants from one part of the southeastern USA. Pathological lesion frequencies were calculated for 441 individuals from 23 upland archaeological sites and compared with previously published data for 340 individuals from 11 coastal sites. Significant differences in lesion frequencies were observed between upland and coastal groups. For example, upland adult men have more carious teeth among the maxillary first incisors, maxillary second molars, mandibular canines, and mandibular second molars. For women, greater caries frequencies are found among the maxillary first and third molars, mandibular first incisors, and mandibular third premolars. Upland children show higher percentages of caries for 14 tooth classes. Coastal juveniles have a greater frequency of porotic hyperostosis, and more of them exhibit an enamel hypoplasia. Periosteal lesion frequency is greater for the coastal group at the humerus, radius, femur, and tibia. Lesions indicative of degenerative joint disease are more often found on the thoracic spinal segment, sacrum and shoulder of upland men with upland women having more lesions at the cervical, thoracic, and lumbar spinal segments, the sacrum, and the shoulder. Taken together, these results show that adults from the upland region consumed more maize and lived a more physically demanding life while coastal adults struggled more with infection. Among children, more coastal inhabitants were anaemic and more of the experienced significant growth disturbances. [ABSTRACT FROM AUTHOR]

The article offers information on the topics discussed at a symposium of the International Association for Dental Research (IADR). Topics discussed include the need for a Dietary Reference Value (DRV) for fluoride intake in dental care; the toxicity resulting from high amount of fluoride intake; and the disease such as dental caries and fluorosis.

Given equivocal findings from existing nationally representative studies, the authors sought to determine associations between vitamin D levels and caries experience in US children using updated National Health and Nutrition Examination Survey data. The authors used data from 2011-2016 National Health and Nutrition Examination Survey. Vitamin D status was assessed on the basis of the sufficiency thresholds of 50 and 75 nmol/L for serum 25-hydroxyvitamin D (25[OH]D) recommended by the Institute of Medicine (now National Academy of Medicine) and Endocrine Society, respectively. Caries experience was defined as the total number of decayed or filled tooth surfaces (dfs) and decayed, missing, or filled tooth surfaces (DMFS) and a binary measure of any dfs and DMFS. Associations between 25(OH)D and any or total dfs and DMFS were examined in children aged 2 through 5, 6 through 8, 9 through 11, and 12 through 18 years, using multivariable logistic and linear regression models after adjustment for covariates. Children aged 2 through 5 years with 25(OH)D above 75 nmol/L experienced fewer total dfs (β = –1.94; 95% CI, –3.60 to –0.28) than those with 25(OH)D below 75 nmol/L. Children 6 through 8 years with 25(OH)D above 75 nmol/L had lower presence of any dfs (odds ratio, 0.59; 95% CI, 0.36 to 0.95) than those with 25(OH)D below 75 nmol/L, and those with 25(OH)D above 50 nmol/L had lower presence of any DMFS (odds ratio, 0.38; 95% CI, 0.19 to 0.79) than those with 25(OH)D below 50 nmol/L. There were no associations of 25(OH)D status with either any or total DMFS in children 12 through 18 years There were no consistent associations of 25(OH)D status with caries experience across age groups. Vitamin D status was not associated consistently with reduced caries experience. [ABSTRACT FROM AUTHOR]

Objective To describe the full range of behavior of the visible, noncavitated, early caries lesion in caries-active adults with substantial fluoride exposure, and to consider implications. Methods The data were from the Xylitol for Adult Caries Trial (X- ACT) collected annually for 33 months using condensed ICDAS caries threshold criteria. Individual tooth surfaces having a noncavitated caries lesion were included, and the patterns of transition to each subsequent annual clinical examination to sound, noncavitated or cavitated, filled or crowned were determined. The resulting sets of patterns for an individual tooth surface, looking forward from its first appearance as a noncavitated lesion, were combined into one of four behavior profiles classified as reversing, stable, oscillating, or continuously progressing, or were excluded if not part of the caries continuum. The distributions of profile types were assessed using the Rao-Scott chi-square test, which adjusts for clustering of tooth surfaces within teeth. Results Inter- and intra-examiner kappa scores demonstrated acceptable calibration at baseline and annually. 8084 tooth surfaces from 543 subjects were included. The distribution of profile types differed significantly between coronal and root surfaces. Overall, two-thirds of all coronal noncavitated lesions were first seen at baseline, half reversed, over a fifth were stable, 15% oscillated, and only 8.3% progressed to cavitation, filled, or crowned in 33 months or less (6.3% consistently Progressed plus 2.0% inconsistently, a subset of oscillating, which oscillated before progressing to cavitation). Approximal, smooth, and occlusal coronal surfaces each were significantly different in their individual distributions of profile types. Xylitol showed no significant and consistent effect on this distribution by tooth surface type. This was in keeping with the X- ACT's lack of effect of xylitol at the noncavitated plus cavitated lesion thresholds combined. Conclusions This study demonstrated the full dynamic range of early caries lesion behavior. The great majority were not progressive, and few (8.3%) became cavitated over 33 months in caries-active adults using fluorides. Important caries management implications favoring recorded longitudinal monitoring, prevention of active risks, and minimal restoration only after direct visual determination of cavitation are discussed. [ABSTRACT FROM AUTHOR]

Background. Despite early childhood caries (ECC) being largely preventable, its repair accounts for a disproportionate share of Medicaid expenditures. In this study, the authors model disease reductions and cost savings from ECC management alternatives. Methods. The authors apply system dynamics modeling to the New York State Medicaid population of young children to compare potential outcomes of 9 preventive interventions (water fluoridation, fluoride varnish, fluoride toothpaste, medical screening and fluoride varnish application, bacterial transmission reduction, motivational interviewing, dental prevention visits, secondary prevention, and combinations) and the effect of defluoridating New York City. Results. Model simulations help project 10-year disease reductions and net savings from water fluoridation, motivational interviewing, and fluoride toothpaste. Interventions requiring health professionals cost more than they save. Interventions that target children at high risk, begin early, and combine multiple strategies hold greatest potential. Defluoridating New York City would increase disease and costs dramatically. Conclusions. The variety of population-level and individual-level interventions available to control ECC differ substantially in their capacity to improve children's oral health and reduce state Medicaid expenditures. Practical Implications. Using Medicaid and health department dollars to deliver ECC preventive and management interventions holds strong promise to improve children's oral health while reducing state dental expenditures in Medicaid. [ABSTRACT FROM AUTHOR]

Background and Overview. The World Health Organization has recommended a reduction in free sugars intake throughout one's life span to decrease the burden of noncommunicable diseases, including caries and obesity. The author defines sugars' nomenclature, describes sugars' roles in food, and identifies current sugars intake. Conclusions. The oral health care practitioner can identify added sugars intake and provide guidance to patients to decrease their intake of added sugars while improving nutrient intake and reducing caries risk. Practical Implications. Intake of added sugars increases the burden of chronic diseases in the United States. The oral health care practitioner is in a position to provide dietary guidance to patients to reduce both oral and systemic diseases. [ABSTRACT FROM AUTHOR]

Background. The results of several studies conducted in the United States show no association between intake of 100 percent fruit juice and early childhood caries (ECC). The authors examined this association according to poverty and race/ethnicity among U.S. preschool children. Methods. The authors analyzed data from the 1999- 2004 National Health and Nutrition Examination Survey (NHANES) for 2,290 children aged 2 through 5 years. They used logistic models for caries (yes or no) to assess the association between caries and intake of 100 percent fruit juice, defined as consumption (yes or no), ounces (categories) consumed in the previous 24 hours or usual intake (by means of a statistical method from the National Cancer Institute). Results. The association between caries and consumption of 100 percent fruit juice (yes or no) was not statistically significant in an unadjusted logistic model (odds ratio [OR], 0.76; 95 percent confidence interval [CI], 0.57-1.01), and it remained nonsignificant after covariate adjustment (OR, 0.89; 95 percent CI, 0.63-1.24). Similarly, models in which we evaluated categorical consumption of 100 percent juice (that is, 0 oz; > 0 and ≤ 6 oz; and > 6 oz), unadjusted and adjusted by covariates, did not indicate an association with ECC. Conclusions. Our study findings are consistent with those of other studies that show consumption of 100 percent fruit juice is not associated with ECC. Practical Implications. Dental practitioners should educate their patients and communities about the low risk of developing caries associated with consumption of 100 percent fruit juice. Limiting consumption of 100 percent fruit juice to 4 to 6 oz per day among children 1 through 5 years of age should be taught as part of general health education. [ABSTRACT FROM AUTHOR]

Background. A questionable occlusal caries (QOC) lesion can be defined as an occlusal surface with no radiographic evidence of caries, but caries is suspected because of clinical appearance. In this study, the authors report the results of a 20-month follow-up of these lesions. Methods. Fifty-three clinicians from The National Dental Practice- Based Research Network participated in this study, recording lesion characteristics at baseline and lesion status at 20 months. Results. At baseline, 1,341 QOC lesions were examined; the treatment that was planned for 1,033 of those at baseline was monitoring (oral hygiene instruction, applying or prescribing fluoride or varnish, or both), and the remaining 308 received a sealant (n = 192) or invasive therapy (n = 116). At the 20-month visit, clinicians continued to monitor 927 (90 percent) of the 1,033 monitored lesions. Clinicians decided to seal 61 (6 percent) of the 1,033 lesions (mean follow-up, 19 months) and invasively treat 45 (4 percent) of them (mean follow-up, 15 months). Young patient age (< 18 years) (odds ratio = 3.4; 95 percent confidence interval, 1.7-6.8) and the lesion’s being on a molar (odds ratio = 1.8; 95 percent confidence interval, 1.3-2.6) were associated with the clinicians deciding at some point after follow-up to seal the lesion or treat it invasively. Conclusions. Almost all (90 percent) QOC lesions for which the treatment planned at baseline was monitoring still were planned to undergo monitoring after 20 months. This finding suggests that noninvasive management is appropriate for these lesions. Practical Implications. Previous study results from baseline indicated a high prevalence of QOC lesions (34 percent). Clinicians should consider long-term monitoring when making treatment decisions about these lesions. [ABSTRACT FROM AUTHOR]

The authors examined potential benefits and difficulties in integrating oral health care and medical care for adults with chronic conditions (CCs). The authors used National Health and Nutrition Examination Survey 2009-2016 data to estimate crude (age- and sex-standardized) and model-adjusted estimates to examine the association between dental disease (severe tooth loss, untreated caries) and chronic disease (≥ 3 CCs, fair or poor health) and Medical Expenditure Panel Survey 2014-2016 data to estimate crude estimates of past-year medical and dental use and financial access according to CC status. Reported differences are significant at P <.05. National prevalences of reporting fair or poor health and 3 or more CCs were both approximately 15%. Standardized prevalence of dental disease was notably higher among adults reporting CCs than those not reporting. After controlling for covariates, the magnitude of the association was substantially lower, although the association remained significant. Adults with CCs were approximately 50% more likely to report having a past-year medical visit and no dental visit than those not reporting CCs. Among adults reporting CCs, prevalence of having no private dental insurance and low income was approximately 20% and 60% higher, respectively, than that among adults not reporting CCs. Adults with CCs had higher prevalence of dental disease, past-year medical visit and no dental visit, and limited financial access. Medical visits may be the only opportunity to provide dental education and referrals to adults with CCs. Improved medical-dental integration could improve oral health care access and oral health among these adults who are at higher risk of dental disease. [ABSTRACT FROM AUTHOR]

Background. The Hispanic and Latino population is projected to increase from 16.7 percent to 30.0 percent by 2050. Previous U.S. national surveys had minimal representation of Hispanic and Latino participants other than Mexicans, despite evidence suggesting that Hispanic or Latino country of origin and degree of acculturation influence health outcomes in this population. In this article, the authors describe the prevalence and mean number of cavitated, decayed and filled surfaces, missing teeth and edentulism among Hispanics and Latinos of different national origins. Methods. Investigators in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)--a multicenter epidemiologic study funded by the National Heart, Lung, and Blood Institute with funds transferred from six other institutes, including the National Institute of Dental and Craniofacial Research--conducted in-person examinations and interviews with more than 16,000 participants aged 18 to 74 years in four U.S. cities between March 2008 and June 2011. The investigators identified missing, filled and decayed teeth according to a modified version of methods used in the National Health and Nutrition Examination Survey. The authors computed prevalence estimates (weighted percentages), weighted means and standard errors for measures. Results. The prevalence of decayed surfaces ranged from 20.2 percent to 35.5 percent, depending on Hispanic or Latino background, whereas the prevalence of decayed and filled surfaces ranged from 82.7 percent to 87.0 percent, indicating substantial amounts of dental treatment. The prevalence of missing teeth ranged from 49.8 percent to 63.8 percent and differed according to Hispanic or Latino background. Significant differences in the mean number of decayed surfaces, decayed or filled surfaces and missing teeth according to Hispanic and Latino background existed within each of the age groups and between women and men. Conclusions. Oral health status differs according to Hispanic or Latino background, even with adjustment for age, sex and other characteristics. Practical Implications. These data indicate that Hispanics and Latinos in the United States receive restorative dental treatment and that practitioners should consider the association between Hispanic or Latino origin and oral health status. This could mean that dental practices in areas dominated by patients from a single Hispanic or Latino background can anticipate a practice based on a specific pattern of treatment needs. [ABSTRACT FROM AUTHOR]

Background. There is a paucity of knowledge regarding nationally representative estimates of hospital-based emergency department (ED) visits for dental problems made by people with mental health conditions. The authors conducted a study to provide nationwide estimates of hospital-based ED visits attributed to dental caries, pulpal and periapical lesions, gingival and periodontal lesions and mouth cellulitis/abscess made by people with mental health conditions. Methods. The authors used the Nationwide Emergency Department Sample, which is a component of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. ED visits attributable to dental caries, pulpal and periapical lesions, gingival and periodontal lesions and mouth cellulitis/abscess were identified by the emergency care provider by using diagnostic codes in International Classification of Diseases, Ninth Revision, Clinical Modification. The authors examined outcomes, including hospital charges. They used simple descriptive statistics to summarize the data. Results. In 2008, people with mental health conditions made 15,635,253 visits to hospital-based ED in the United States. A diagnosis of dental caries, pulpal and periapical lesions, gingival and periodontal lesions and mouth cellulitis/ abscess represented 63,164 of these ED visits. The breakdown of the ED visits was 34,574 with dental caries, 25,352 with pulpal and periapical lesions, 9,657 with gingival and periodontal lesions, and 2,776 with mouth cellulitis/abscess. The total charge for ED visits in the United States was $55.46 million in 2008. Conclusions. In 2008, people with mental health conditions made 63,164 visits to hospital-based EDs and received a diagnosis of dental caries, pulpal and periapical lesions, gingival and periodontal lesions or mouth cellulitis/abscess. These ED visits incurred substantial hospital charges. Programs designed to reduce the number of ED visits made by this population for common dental problems could have a substantial impact in reducing the use of hospital resources. Practical Implications. Clinicians should implement preventive practices for patients with mental health conditions. The authors identified combinations of mental health conditions and dental problems that led to patients with mental health conditions making visits to hospital-based EDs for dental problems more frequently than did patients in the general population. [ABSTRACT FROM AUTHOR]

Riley JL III, Gordan VV, Rindal DB, Fellows JL, Ajmo CT, Amundson C, Anderson GA, Gilbert GH and for The Dental PBRN Collaborative Group. Preferences for caries prevention agents in adult patients: findings from the dental practice–based research network. Community Dent Oral Epidemiol 2010; 38: 360–370. © 2010 John Wiley & Sons A/S Objectives: To identify factors that are significantly associated with dentists’ use of specific caries preventive agents in adult patients, and whether dentists who use one preventive agent are also more likely to use certain others. Methods: Data were collected from 564 practitioners in The Dental Practice–Based Research Network, a multi-region consortium of participating practices and dental organizations. Results: In-office topical fluoride was the method most frequently used. Regarding at-home preventive agents, there was little difference in preference between nonprescription fluoride, prescription fluoride, or chlorhexidine rinse. Dentists who most frequently used caries prevention were also those who regularly perform caries risk assessment and individualize caries prevention at the patient level. Higher percentages of patients with dental insurance were significantly associated with more use of in-office prevention modalities. Female dentists and dentists with more-recent training were more likely to recommend preventive agents that are applied by the patient. Dentists who reported more-conservative decisions in clinical treatment scenarios were also more likely to use caries preventive agents. Groups of dentist who shared a common preference for certain preventive agents were identified. One group used preventive agents selectively, whereas the other groups predominately used either in-office or at-home fluorides. Conclusions: Caries prevention is commonly used with adult patients. However, these results suggest that only a subset of dentists base preventive treatments on caries risk at the individual patient level. [ABSTRACT FROM AUTHOR]

Hoeft KS, Barker JC, Masterson EE. Urban Mexican-American mothers’ beliefs about caries etiology in children. Community Dent Oral Epidemiol 2010; 38: 244–255. © 2010 John Wiley & Sons A/S Objectives: Caries is a severe condition which disproportionately affects Latino children in the US. This study sought contextual understanding of urban, low-income Mexican-American mothers’ beliefs, perceptions, knowledge and behavior surrounding causes of caries. Methods: In urban San José, CA, a qualitative study was conducted with a convenience sample of Mexican-American mothers of young children about their beliefs and knowledge about the causes of caries. Audio-taped in-depth interviews with open-ended questions, primarily in Spanish, were translated to English and then transcribed verbatim. Texts were independently read and thematically analyzed by two researchers. Results: Even while expressing uncertainty, all 48 mothers mentioned specific causes of caries, most frequently citing candy or juice consumption (85%), poor oral hygiene (65%) and use of the bottle (52%). Mothers rarely recognized cariogenic foods beyond candy, did not know or perform recommended oral hygiene routines, and demonstrated confusion and uncertainty about exactly how baby bottles are detrimental to teeth. Nearly half of these mothers also mentioned secondary cavity causes, such as genetics, lack of calcium, not going to the dentist or lack of fluoride. Mothers did not mention the role of bacteria. While mothers recognized that oral hygiene can counteract the detrimental effects of candy consumption, they did not recognize its beneficial effects in other contexts. Nor did they know about other preventive activities. Conclusions: Mothers recognized the three major important factors causing caries: sugar consumption, poor oral hygiene and bottle use. However, their knowledge is limited in depth and specificity which restricts development of caries prevention behaviors. More comprehensive education is needed, including about caries prevention (oral hygiene) behaviors, which could lead to an increased sense of self-efficacy with respect to their children’s oral health. [ABSTRACT FROM AUTHOR]

The article presents an analysis of methods for remineralizing dental enamel and preventing dental caries, and some of the challenges faced in bringing these techniques to the level of commercially viable products. The use of fluoride is said to be the standard in terms of its efficacy and acceptance. The regulatory requirements of the American Dental Association and the U.S. Food and Drug Administration are discussed. Challenges posed by formulation requirements, data handling and statistics documentation are also analyzed.

Dental caries is the most common chronic disease in US children. Early childhood caries (ECC) is particularly virulent and can interfere with a child's ability to eat, grow, speak, and communicate. Studies on whether breast-feeding or bottle-feeding are more likely to reduce ECC have proven inconclusive. The study population included 175 children, aged 1 to 5, receiving dental care at the Hughes Spalding Children's Hospital in Atlanta, GA. Participation included a dental exam, chart data abstraction, and a personal interview with the mother. : Too few exclusively breast-fed children prevented the adequate study of breast-feeding. However, children exclusively bottle-fed for at least 1.5 years had more decayed or filled tooth surfaces than children breast-fed part of that time but well short of a year. No bottle at night nor juice at irregular times, the mother's brushing of her child's teeth, and adequate dental care in the mother seemed to reduce ECC. : Our results suggest measures that might reduce ECC risk. Medical providers must discuss oral health with new mothers and educate them on the important role they play in keeping their babies' teeth healthy. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the oral health status and dental needs of a nationally representative sample of 1- to 17-year-old children with or without autism. Methods: In the 2003 National Survey of Children's Health, parents reported their child's oral health status and needs. The condition of the child's teeth, demographics, time since last dental visit, and dental needs were assessed in autistic children (N=495) and nonautistic children (N=95,059). Far a subset of children with reported fair or poor teeth, specific problems about their dentition were assessed far autistic children (N=69) and nonautistic children (N=7,002). Weighted percentages and chi-square statistics were calculated. Results: According to parents, 69% of nonautistic children and 52% of autistic children had their teeth in excellent or very goad condition (P<.001). The dental status of children with autism and without autism, identified with fair or poor teeth, was comparable. Conclusions: Overall, parents of US autistic children were mare likely to report their children's dentition to be in fair or poor condition than parents of US nonautistic children. Children with or without autism who had fair or poor teeth are faced with similar dental problems. [ABSTRACT FROM AUTHOR]

With the dramatic increase in the amount of scientific information available about oral health, an evidence-based approach to oral health care and the practice of dentistry is necessary. There is a need to summarize, critique, and disseminate scientific evidence and to translate the evidence into a practical format that is used easily by dentists. The evidence-based clinical recommendations in this report were developed by an expert panel established by the American Dental Association Council on Scientific Affairs that evaluated the collective body of scientific evidence on the effectiveness of professionally applied topical fluoride for caries prevention. The recommendations are intended to assist dentists in clinical decision making. MEDLINE and the Cochrane Library were searched for systematic reviews and clinical studies of professionally applied topical fluoride including gel, foam, and varnish through October 2005. Panelists were selected on the basis of their expertise in the relevant subject matter. The recommendations are stratified by age groups and caries risk and indicate that periodic fluoride treatments should be considered for both children and adults who are al moderate or high risk of developing caries. Included in the clinical recommendations is a summary table that can be used as a chairside resource. The dentist, knowing the patient's health history and vulnerability to oral disease, is in the best position to make treatment decisions in the interest of each patient. These clinical recommendations must be balanced with the practitioner's professional expertise and the individual patient's preferences. [ABSTRACT FROM AUTHOR]

Results from several epidemiologic studies have shown that there are large differences in the prevalence of dental caries from one region to another within the United States as well as in other countries. It has been postulated that the observed differences may be attributed in part at least to exposure to trace elements such as selenium, vanadium, molybdenum, strontium, and lead. Although data from epidemiologic studies usually support this hypothesis, direct evidence is sparse with the possible exception of exposure to lead. Data from several epidemiologic studies and animal-based research support the concept that lead is a caries-promoting element. Lead mimics calcium in several respects and may affect development of teeth and salivary glands, clearly enhancing susceptibility to dental caries. Elevated blood levels are found most commonly in persons residing in inner cities, particularly among the poor. Many states require blood lead level to be monitored in young children. Where feasible, these records should form part of health history and be available to the treating dental practitioner to ensure that extra preventive procedures may be implemented. [ABSTRACT FROM AUTHOR]

Background: Life course theory creates a better framework to understand how oral health care needs and challenges align with specific phases of the life span, care models, social programs, and changes in policy., Methods: The authors obtained data from the 2018 IBM Watson Multi-State Medicaid MarketScan Database (31 million claims) and the 2018 IBM Watson Dental Commercial and Medicare Supplemental Claims Database (45 million claims). The authors conducted analysis comparing per enrollee spending on fee-for-service dental claims and medical spending on oral health care for patients from ages 0 through 89 years., Results: Oral health care use rate and spending are lower during the first 4 years of life and in young adulthood than in other periods of life. Stark differences in the timing, impact, and severity of caries, periodontal disease, and oral cancer are seen between those enrolled in Medicaid and commercial dental plans. Early childhood caries and oral cancer occur more frequently and at younger ages in Medicaid populations., Conclusions: This life span analysis of the US multipayer oral health care system shows the complexities of the current dental service environment and a lack of equitable access to oral health care., Practical Implications: Health policies should be focused on optimizing care delivery to provide effective preventive care at specific stages of the life span., (Copyright © 2022 American Dental Association. Published by Elsevier Inc. All rights reserved.)

This paper assesses the risk from sugar consumption in a population of schoolchildren with low caries experience. It relates eight different measures of sugar consumption to the occurrence of any DMFS increment, and, separately, to approximal and pit-and-fissure DMFS. The data are from a 3-yr longitudinal study of 429 children, initially aged 11-15, residing in non-fluoridated rural communities in Michigan, USA. All children completed at least three dietary interviews, were present for baseline and final dental examinations, and had a parent or guardian provide questionnaire information on residence history, use of fluoride and dental services, and family history. Results indicated that a higher proportion of total energy intake From sugars increased the probability of caries on all surfaces, and a higher total intake of sugars was also associated with total caries increment. No relationship, however, was found between DMFS increment and the frequency of eating high sugar Foods. Each additional 5 g of daily sugars intake was associated with a 1% increase in the probability of developing caries, and those whose energy intake from sugars was 1 SD above the mean had 2.0 times the risk of developing approximal caries than did children whose energy intake from sugars was 1 SD below the mean. [ABSTRACT FROM AUTHOR]

The article discusses presentations at a symposium of International Association for Dental Research by several persons focusing on the guidelines for fluoride intake in dental care. Topics discussed include the presentation by doctor Spencer on enamel fluorosis and whether fluoride intake should be a part of public policy; the presentation by doctor Buzalaf, focusing on the development of caries; and the presentation by doctor Mejàre, focusing on the risk of developing enamel fluorosis.

Background: The aim of this study is to use data representative of the U.S. population to determine if households (HHs) age, birth country, and marital status, are strong predictors as HHs education for dental sealants, restorations, and caries in children 5 to 19 years of age. Methods: A cross sectional analysis was performed with oral health data from three waves of the National Health and Nutrition Examination Survey (NHANES 2005 to 2010). The sample size consisted of children 5 to 19 years of age (n = 9151) and households > 18 years of age (n = 31,034). Dependent variables included the number of children with dental sealants, restorations, and caries. HHs independent variables consisted of gender, age, race, country of birth, HHs education level, marital status, and HHs spouse education. Multivariate regression analysis models were adjusted for HHs citizenship, health insurance, family size, and children age categories. Results: The prevalence of children 5–19 years of age with dental sealants, restorations, and caries was 31.3, 43, and 15.8% respectively. The odds of children having sealants were higher among HHs with a college education or above OR 2.05 [1.54.-2.73] vs. HHs with a < 9th grade, in HHs ages 39–49 (OR 1.78 [1.41–2.24) vs. 18–29 years of age, and in HHs spouses with a college education and above OR 1.71 [1.14–2.56] vs. HHs with a < 9th grade. The odds of having at least one restored tooth were higher in children from HHs born in Mexico 1.74 [1.44–2.10] vs. US born. The highest odds for caries were among children from HHs that were never married 1.91 [1.47–2.48] vs. married HHs. In HHs with a college education the odds for caries in children were 0.31 (0.22–0.43) for college and above, and 0.78 (0.60–1.01) for some college. Conclusions: The odds of children having dental sealants were higher in HHs with a college education, however, HHs ages 30–49 provided higher odds for sealants than spouses with college education. HHs birth place increased the odds of children with restorations more than HHs education. Children from HHs that never married had higher odds of experiencing dental caries. Recognizing the impact of these HHs characteristics could augment efforts in the prevention of adverse oral health outcomes in U.S. children. Households' age, country of birth, and marital status, stronger predictor variables than education in the prevalence of dental sealants, restorations, and caries among US children 5–19 years of age, NHANES 2005–2010. [ABSTRACT FROM AUTHOR]

Dental caries remains one of the most pervasive infectious disease around the world. Protection against dental caries can be achieved experimentally by eliciting salivary IgA targeting surficial antigens of S. mutans, however, no such a vaccine has been launched for human use yet. Live vectored vaccines hold the greatest feasibility to induce potent and long-lasting immunity in the host. The FDA approved intranasal cold-adapted influenza vaccine has been used in clinical settings for many years. The vaccine can not only induce broad adaptive immune responses especially mucosal immunity, but the member strains can also circumvent existing immunity, presenting promising candidates for live vectored anti-caries vaccine. Moreover, the genetic techniques for modification of cold-adapted influenza viruses are well developed and widely applicable. Thus, we hypothesize that effective anti-caries vaccine can be developed with the backbone of cold-adapted influenza viruses by inserting specific antigenic identifier sequences of S. mutans into the viral genome, which is anticipated to protect against dental caries in humans with easy inoculation. The immune efficacies of recombinant cold-adapted influenza viruses expressing exogenous antigens have been verified by in vivo experiments for multiple infectious diseases, giving us great confidence to validate the safety properties and protection effect with this chimeric vaccine in animals or even humans. Existing data suggests that the live anti-caries vaccine may help improve public oral health by controlling the caries disease itself., (Copyright © 2019. Published by Elsevier Ltd.)

Study Objectives: Perfluoroalkyl acids (PFAAs) are a class of anthropogenic and persistent compounds that may impact some biological pathways related to oral health. The objective of our study was to estimate the relationship between dental caries prevalence and exposure to four PFAA: perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorohexane sulfonic acid (PFHxS) and perfluorooctane sulfonic acid (PFOS) in a nationally representative sample of US adolescents., Setting/design: We analysed cross-sectional data from the National Health and Nutrition Examination Survey from 1999 to 2012 for 12-19-year-old US adolescents., Participants: Of 10 856 adolescents aged 12 to 19 years who had a dental examination, we included 2869 with laboratory measurements for serum PFAA concentrations and complete covariate data in our study., Primary and Secondary Outcome Measures: Dental caries prevalence was defined as the presence of decay or a restoration on any tooth surface, or the loss of a tooth due to tooth decay. We used multivariable logistic regression to estimate the covariate-adjusted association between serum PFAA concentrations and dental caries prevalence, accounting for the complex National Health and Nutrition Examination Survey design., Results: Of 2869 adolescents, 59% had one or more dental caries. We observed no associations between the prevalence of dental caries and serum concentrations of PFOA, PFOS or PFHxS. The adjusted odds of caries were 21% (OR 0.79; 95% CI 0.63 to 1.01), 15% (OR 0.85; 95% CI 0.67 to 1.08) and 30% (OR 0.7; 95% CI 0.55 to 0.90) lower among adolescents in the 2nd, 3rd and 4th serum PFNA concentration quartiles compared to adolescents in the first quartile, respectively. The linear trend for this association was not statistically significant., Conclusion: PFOA, PFOS and PFHxS were not associated with prevalence of dental caries. The prevalence of caries was reduced with increasing serum PFNA concentrations; however, these results should be interpreted cautiously given that we were unable to adjust for several factors related to oral health., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: This paper describes the design and methods of a multi-phase study to reduce early childhood caries and obesity in vulnerable South Asian (SA) immigrants in the United States. Early childhood caries and obesity are the most common diseases of early childhood. Risk factors for both diseases are rooted in early childhood feeding practices such as bottle feeding and intake of sweets and sweetened beverages. The Common Health/Risk Factor Approach to addressing oral health is widely promoted by the WHO and other policy makers. This approach recognizes links between oral health and other diseases of modernity. Our CHALO! ("Child Health Action to Lower Obesity and Oral health risk"--from a Hindi word meaning "Let's go!") study targets SA families at high risk for early childhood caries and obesity. CHALO! addresses common risk factors associated with these two common diseases of childhood.Methods: This two part project includes a randomized controlled trial, and a Knowledge Translation campaign. A randomized controlled trial will enroll n =  360 families from pediatric practices serving South Asians in the New York metro area. The intervention group will receive home visits by SA community health workers at 6, 8, 10, 12, 14, and 16 months of age. Controls will receive culturally tailored educational material. Primary outcomes-- cariogenic and obesogenic feeding practices at 6, 12, and 18 months-- will be assessed with the MySmileBuddy iPad based tool. Secondary outcomes include: oral hygiene practices, anthropometrics, and caries incidence at 18 months. A public education campaign will focus on both families and health care providers.Discussion: There are few Common Health/Risk Factor Approach published studies on obesity and oral health risk in children, despite health morbidity and costs associated with both conditions. CHALO! comprises a multi-level interventions designed to promote culturally competent, sustainable change.Trial Registration: ClinicalTrials.gov NCT03077425 . [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the associations between interdental cleaning behavior and the prevalence of caries and periodontal disease and numbers of missing teeth, with data from the National Health and Nutrition Examination Survey (2011 to 2012 and 2013 to 2014). Analysis included the following parameters: interproximal clinical attachment level (iCAL) ≥3 mm, interproximal probing depth (iPD) ≥4 mm, number of coronal and interproximal caries, number of missing teeth, ≥1 surfaces with coronal caries, and periodontal profile classes (PPCs). Chi-square was used for bivariate associations. Associations of interdental cleaning with outcomes were assessed with multiple linear regression and generalized logit regression, adjusting for age, race, sex, diabetes, smoking, education, dental visits, and sugar consumption. Nonusers had a significantly higher percentage of sites with iCAL ≥3 mm and iPD ≥4 mm as compared with individuals who used interdental cleaning devices ( P < 0.0001). Individuals with a higher frequency of cleaning (4 to 7×/wk) had a significantly lower extent of sites with iCAL ≥3 mm as compared with lower-frequency cleaning (1 to 3×/wk; P ≤ 0.05). Interdental cleaning users showed lower numbers of coronal caries, interproximal coronal caries, and missing teeth as compared with nonusers ( P < 0.0001). Nonusers had 1.73-times (95% confidence interval, 1.53 to 1.94) higher odds for having ≥1 surfaces of coronal caries as compared with interdental cleaning users, regardless of the weekly frequency. Individuals were less likely to be in diseased PPCs if they were interdental cleaning users. Low-frequency cleaners (1 to 3×/wk) had significantly greater odds (1.43; 95% confidence interval, 1.08 to 1.88) to have severe disease (PPC-G) versus health (PPC-A) than were high-frequency cleaners (4 to 7×/wk). Interdental cleaning users showed lower levels of periodontal disease and caries and lower numbers of missing teeth. Higher frequency of interdental cleaning was correlated with increased periodontal health. Individuals with severe periodontal disease could show additional oral health benefits by increasing cleaning frequency. The data support the use of interdental cleaning devices as an oral hygiene behavior for promoting health.

Background: No evidence-based guidelines exist for preventive dental care before radiation therapy (RT) in patients with head and neck cancer (HNC). An ongoing multicenter, prospective cohort study, Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients (OraRad), is addressing this knowledge gap. The authors evaluated the level of dental disease before RT in the OraRad cohort, factors associated with dental disease, and dental treatment recommendations made before RT., Methods: As part of OraRad, the authors assessed caries, periodontal disease, dental recommendations, and dental interventions performed before RT., Results: Baseline measures were reported for 356 participants (77% men) with mean (standard deviation) age of 59.9 (11.0) years. Measures included mean number of teeth (22.9), participants with at least 1 tooth with caries (37.2%), and participants with at least 1 tooth with probing depth 5 millimeters or greater (47.4%). Factors associated with less extensive dental disease before RT included having at least a high school diploma, having dental insurance, history of routine dental care, and a smaller tumor size (T1 or T2). Based on the dental examination before RT, 163 (49.5%) participants had dental treatment recommended before RT, with extractions recommended most frequently., Conclusion: Many patients with HCN require dental treatment before RT; more than one-third require extractions., Practical Implications: Most patients have some level of dental disease at the start of RT, indicating the importance of dental evaluation before RT. By observing dental outcomes after RT, OraRad has the potential to determine the best dental treatment recommendations for patients with HCN., (Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.)