Fluoride supplements and fluorosis: a meta-analysis

This paper presents a systematic review of the dental literature that was carried out to investigate whether the regular use of fluoride supplements in non-fluoridated communities during the period of tooth development increases the risk of dental fluorosis. A MEDLINE search was organized for all documents published, in English, between January 1966 and September 1997 using the following key words: fluorosis, dental, fluoride, fluoride supplement or supplements, drop or drops, and tablet or tablets. Twenty-four studies that assessed the development of dental fluorosis in children who had used fluoride supplements earlier in their life were included in this review. Of the 24 studies, 10 were crosssectional/case control studies and four were follow-up studies. These studies had data that allowed a quantitative estimation of the risk of developing dental fluorosis in users of fluoride supplements. The other 10 studies were excluded because they either did not present enough data or had other methodological problems. A qualitative review of the studies found a consistent and strong association between the use of fluoride supplements and dental fluorosis. The meta-analyses of the cross-sectional/case-control studies estimated that the odds ratio of dental fluorosis in users of fluoride supplements compared with non-users ranged between 2.4 and 2.6. The meta-analyses of the follow-up studies estimated that the relative risk in long-term users was between 5.5 and 12.2. This review confirmed that in non-fluoridated communities the use of fluoride supplements during the first 6 years of life is associated with a significant increase in the risk of developing dental fluorosis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75253/1/j.1600-0528.1999.tb01991.x.pd

Time of Development of Occlusal and Proximal Lesions: Implications for Fissure Sealants

Analysis of surface and tooth-specific data from NHANES I and HHANES shows that the pattern of dental caries differs greatly from tooth to tooth and surface to surface. Occlusal caries precedes all other types, and increases most rapidly and to the highest levels in the molars. Caries on the proximal surfaces comes later. For sealants to be of value, they must reduce the need for restorations. Therefore, the value of sealants will be determined by the balance between high enough levels of potential caries on occlusal surfaces to give them something to prevent, and low levels of, or sufficiently delayed, proximal lesions to prevent the loss of the otherwise saved occlusal surface. The data presented demonstrate that as of the time of NHANES I, the number of permanent molars that could have had surfaces saved from restoration, at least for a number of years, appears to be sufficient to warrant widespread use of sealants on those teeth. More recent data (HHANES) suggest that the current decline in caries prevalence is likely to reduce the value of sealants in the short run because there are fewer occlusal lesions in young children, but may increase the value of sealants in the long run because proximal caries in older children and adults is also declining.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65756/1/j.1752-7325.1986.tb03119.x.pd

Efficacy of Educational Interventions Targeting Primary Care Providers' Practice Behaviors: an Overview of Published Systematic Reviews

Objectives : Primary care providers (e.g., family physicians, pediatricians, registered nurses, physician assistants, and nurse practitioners) could play a pivotal role in the provision of preventive services, especially for very young children (younger than 3 years old) and population groups with limited access to dental care. Given the current problems with access to dental care among low-income Americans, we contend there is a need to involve nondental primary health care providers in screening for and preventing oral health problems. The objective of this overview is to present findings from systematic reviews on the efficacy of continuing medical education, printed educational material, academic outreach, reminders, and local opinion leaders on the adoption of new knowledge and practices by primary care providers. Methods : A search was conducted using the Cochrane Library and MEDLINE. The search aimed to locate systematic reviews published between January 1988 and March 2003. Two researchers independently extracted data and assessed study quality using a modified version of the QUOROM statement. Results : Eleven systematic reviews were included in this overview. The evidence from the included systematic reviews showed that formal continuing medical education (CME) and distributing educational materials did not effectively change primary care providers' behaviors. There are effective interventions available to increase knowledge and change behaviors of primary care providers, such as small group discussion, interactive workshops, educational outreach visits, and reminders. Conclusion : There is a limited knowledge base on the efficacy of the selected interventions on oral health screening by primary care providers. Considering the potential role of primary care providers in improving oral health of underserved populations, this research area should receive more attention.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65255/1/j.1752-7325.2004.tb02747.x.pd

Letters to the Editor

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153764/1/jdd065011002.pd

Periodontal disease, tooth loss, and oral hygiene among older Americans

– Recent research has suggested that susceptibility to destructive periodontal disease may not be as universal as was previously thought. This report analyzes data from a representative national sample of 11 338 American adults aged 25–74, examined in a national survey in 1971–74. Results showed that 46.1% of those aged 65–74 were edentulous, but half of the dentate persons in that age group were diagnosed as free of destructive periodontal disease. Periodontal (PI) and oral hygiene (OHI-S) index scores in this group were significantly better in those persons who had lost fewest teeth. When persons aged 65–74 who retained 25 or more teeth were compared with younger adults who also had 25 or more teeth, OHI-S and CI scores were similar. H is hypothesized that maintenance of oral hygiene levels corresponding to OHI-S scores of 0.3–0.6, and calculus levels corresponding to CI scores of 0.1–0.2, is sufficient to maintain a dentition free of periodontal disease throughout life. Slightly higher OHI-S levels (0.7–1.3) and CI levels (0.3–0.6) might be compatible with acceptably low levels of periodontal disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72103/1/j.1600-0528.1985.tb01684.x.pd

Emotional distress and risk of dental caries: Evaluating effect modification by chronic conditions among low-income African American caregivers in Detroit, Michigan

Background/aimLimited research has been conducted regarding the association between mental illness and dental caries. We studied the impact of emotional distress on current and new dental caries among low-income African-American caregivers in Detroit, Michigan and if this association was mediated by poor oral hygiene and sugar consumption and modified by a chronic health condition.MethodsData came from Detroit Dental Health Project, a prospective cohort study of low-income African American caregivers and their children. We focused on baseline (n = 1,021) and 4-year follow-up participants (n = 614). Dental caries were assessed using the International Caries Detection and Assessment System. The study outcomes included two baseline caries outcomes (counts of non-cavitated lesions, baseline counts of cavitated lesions) and two outcomes of new caries over 4 years (new cavitated lesions and new non-cavitated lesions). The exposure was emotional distress. We performed multivariable quasi-Poisson regression analysis to test the association between emotional distress and caries. We tested effect modification by stratifying data by chronic health conditions and performed causal mediation analysis to test an indirect effect of oral hygiene and sugar consumption.ResultsNinety six percent of the caregivers were female, and their average age was 28 years old. Thirteen percent reported emotional distress at baseline. After accounting for potential confounding, emotional distress was positively associated with cavitated lesions at baseline (IRR = 1.36, 95% CI = 1.08, 1.70). Among those with a chronic health condition, stronger association was observed (IRR = 1.73, 95% CI = 1.27, 2.35). After 4 years, those with emotional distress and chronic health conditions had an increased risk of developing non-cavitated carious lesions (IRR = 1.41, 95% CI = 1.06, 1.88). Poor oral hygiene explained 51% of the association between emotional distress and baseline cavitated lesions (natural indirect effect = 1.16, 95% CI = 1.02, 1.33), but there was no evidence for an indirect effect of sugar consumption.ConclusionIn this group of young, African-American caregivers with low socioeconomic status, dental caries was associated with emotional distress. This association was explained by poor oral hygiene and strengthened among those who reported a chronic health condition

Prevalence of Deep Periodontal Pockets in New Mexico Adults Aged 27 to 74 Years *

The purpose of this study was to describe the distribution of advanced periodontal destruction (pocket depth equal to or deeper than six mm) in continuous residents, aged 27 to 74 years, of Lordsburg and Deming, New Mexico. The distance from the free gingival margin to the base of the gingival crevice or pocket was measured on the facial and mesiofacial sides of six index teeth. The presence of supragingival calculus, subgingival calculus, and plaque, as well as gingival bleeding around the index teeth, also were evaluated. Of the 372 examinees, only 46 individuals (12.4 percent) had at least one deep pocket equal to or deeper than six mm on at least one site on the six index teeth. Age was significantly associated with prevalence of deep pockets, although about 80 percent of those aged 47 to 74 years did not have deep pockets. Of those with deep pockets, 89.1 percent had fewer than four tooth sites (out of 12) affected. The only significant risk factor of the presence of deep pockets, other than age, was the number of teeth with plaque accumulations. Age and the number of teeth with plaque explained only 10.5 percent of the variability in the prevalence of deep pocketing, suggesting that risk factors other than those included in this study may be important. The results of this study indicate that destructive periodontal disease occurs at selected sites within the mouth, and that about 87 percent of the adults over age 27, in this population, do not have deep pockets in the si. index teeth examined.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66049/1/j.1752-7325.1986.tb03142.x.pd

Risk indicators for dental caries using the International Caries Detection and Assessment System (ICDAS)

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73802/1/j.1600-0528.2006.00369.x.pd

Evaluation of a brief tailored motivational intervention to prevent early childhood caries

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87108/1/j.1600-0528.2011.00613.x.pd

Cigarette Smoking Among Low-Income African Americans: A Serious Public Health Problem

Background This study examines the current prevalence of cigarette smoking and the number of cigarettes smoked in a community-based sample of 1021 low-income African-American men and women. Methods Participants were selected using a two-stage, area probability sample design. Data were collected in 2002–2003 in face-to-face interviews and analyzed in 2005. All data and analyses were weighted to account for the complex sampling design. Results Fifty-nine percent of men and 41% of women were current smokers, with younger individuals apparently initiating smoking at an earlier age than older individuals. Conclusions The high prevalence of cigarette use provides further evidence that the excess burden of tobacco-related disease among low-income African-American families may be on the rise. This is of great concern, and if confirmed by further research, indicates an urgent need for preventive intervention