The relationship between dental status, food selection, nutrient intake, nutritional status, and body mass index in older people

This paper reviewed the findings from a national survey in Great Britain which assessed whether dental status affected older people's food selection, nutrient intake, and nutritional status. The survey analyzed national random samples of free-living and institution subjects for dental examination, interview, and four-day food diary as well as blood and urine tests In the free-living sample, intakes of non-starch polysaccharides, protein, calcium, non-heme iron, niacin, and vitamin C were significantly lower in edentulous as compared to dentate subjects. People with 21 or more teeth consumed more of most nutrients, particularly non-starch polysaccharides. This relationship in intake was not apparent in the hematological analysis. Plasma ascorbate and retinol were the only analytes significantly associated with dental status. Having 21 or more teeth increased the likelihood of having an acceptable body mass index (BMI). Thus, maintaining a natural and functional dentition defined as having more than twenty teeth into old age plays an important role in having a healthy diet rich in fruits and vegetables, a satisfactory nutritional status, and an acceptable BMI

Can Tobacco consumption explain the association between SEP and chronic periodontitis in adults living in a deprived area of the UK? A secondary analysis of the ELOHI study data.

Aim: To assess whether there are social inequalities on periodontitis at the population level in a deprived area of the United Kingdom (UK) and further elucidate the relationship between socio-economic position, plaque accumulation, tobacco smoking, and chronic periodontitis in a representative sample of adults living in a multicultural and socially deprived area. Methods: The present sub study used the cross-sectional data previously collected in the East London Oral Health Inequality (ELOHI) study, conducted in the outer northeast boroughs of London, UK. A stratified two-staged sampling was performed which consisted of a sample of 2149 adults (16-65 years of age). Participants underwent an oral examination and answered a supervised questionnaire in their own homes. Data regarding information on the explanatory variables: socio-economic position (SEP), oral health behaviour and indicators were obtained from the ELOHI study. The main outcome variable for the present sub study was chronic periodontitis (presence of at least one site of a tooth with a pocket depth (PD) ≥4mm). Statistical analysis included conceptual hierarchical modelling and mediation analysis. The level of statistical significance was set at 0.05. Results: The prevalence of periodontitis in this area of East London was very high, 80.5% among males and 82% among females although these differences were not statistically significant. Hierarchical conceptual modelling analysis demonstrated that those in the manual/routine occupations category were 2.21 (95% CI 1.64-2.989) more likely to have chronic periodontitis than those in the professional category. The difference between those in the intermediate and the professional and managerial occupations category were not statistically significant after adjusting for demographic and behavioural variables. The results of mediation analysis, using the four steps proposed by Baron and Kenny demonstrated that the association between socio-economic position and periodontitis was partially mediated through smoking. Conclusion: A social gradient in periodontal diseases in part mediated by tobacco consumption may exist even in areas where there are highly socially deprived communities was identified. SEP as measured by NS-SEC was found to be associated with the chronic periodontitis experience (PD ≥ 4mm) with individuals placed higher in the NS-SEC ranking demonstrating a lesser risk of disease as compared to a lower NS-SEC ranking

Determinants of traumatic dental injuries in different genders

Objectives: This study aimed to identify the role of aetiological factors of traumatic dental injuries (TDI) in different genders. Material and Methods: A random sample of 3,180 female and 3,324 male fifteen-to-eighteen-year-olds from all senior high schools in Kaohsiung City, Taiwan, was selected. Each completed a supervised questionnaire and was examined using standard clinical procedures. Results: The participation rate was 90.4%. Those female adolescents that lived with at least a non-birth parent (p=0.026, OR=1.468, 95% CI=1.047, 2.058), that had a higher Adolescent Risk Taking Scale score (p=0.001, OR=1.072, 95% CI=1.030, 1.116), that had an overjet larger than five millimetres (p<0.001, OR=1.625, 95% CI=1.273, 2.074), or that showed inadequate lip coverage (p<0.001, OR=1.462, 95% CI=1.199, 1.784), were at greater risk of TDI. Contrarily, those male participants that had a family head with a secondary level of education (p=0.001, OR=1.372, 95% CI=1.130, 1.666), that had a higher Adolescent Risk Taking Scale score (p<0.001, OR=1.063, 95% CI=1.031, 1.097), that took more weekly hours of physical exercise (p=0.004, OR=1.020, 95% CI=1.006, 1.034), that had an overjet larger than five millimetres (p<0.001, OR=1.783, 95% CI=1.449, 2.194), or that showed inadequate lip coverage (p=0.016, OR=1.231, 95% CI=1.039, 1.457) had a higher risk of TDI. Conclusions: Males and females had different determinants of TDI. Family structure played a more relevant role in the occurrence of female adolescents' TDI, while family head's level of education and weekly hours of physical exercise were more important for the counterpart. In both genders, risk taking behaviour, overjet and lip coverage were associated with the occurrence of TDI

Outcomes in Trials for Management of Caries Lesions (OuTMaC):protocol

Background Clinical trials on caries lesion management use an abundance of outcomes, hampering comparison or combination of different study results and their efficient translation into clinical practice. Core outcome sets are an agreed standardized collection of outcomes which should be measured and reported in all trials for a specific clinical area. We aim to develop a core outcome set for trials investigating management of caries lesions in primary or permanent teeth conducted in primary or secondary care encompassing all stages of disease. Methods To identify existing outcomes, trials on prevention and trials on management of caries lesions will be screened systematically in four databases. Screening, extraction and deduplication will be performed by two researchers until consensus is reached. The definition of the core outcome set will by based on an e-Delhi consensus process involving key stakeholders namely patients, dentists, clinical researchers, health economists, statisticians, policy-makers and industry representatives. For the first stage of the Delphi process, a patient panel and a separate panel consisting of researchers, clinicians, teachers, industry affiliated researchers, policy-makers, and other interested parties will be held. An inclusive approach will be taken to involve panelists from a wide variety of socio-economic and geographic backgrounds. Results from the first round will be summarized and fed back to individuals for the second round, where panels will be combined and allowed to modify their scoring in light of the full panel’s opinion. Necessity for a third round will be dependent on the outcome of the first two. Agreement will be measured via defined consensus rules; up to a maximum of seven outcomes. If resources allow, we will investigate features that influence decision making for different groups. Discussion By using an explicit, transparent and inclusive multi-step consensus process, the planned core outcome set should be justifiable, relevant and comprehensive. The dissemination and application of this core outcome set should improve clinical trials on managing caries lesions and allow comparison, synthesis and implementation of scientific data. Trial registration Registered 12 April 2015 at COMET (http://www.comet-initiative.org

Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study

Government and nongovernmental organizations need national and global estimates on the descriptive epidemiology of common oral conditions for policy planning and evaluation. The aim of this component of the Global Burden of Disease study was to produce estimates on prevalence, incidence, and years lived with disability for oral conditions from 1990 to 2017 by sex, age, and countries. In addition, this study reports the global socioeconomic pattern in burden of oral conditions by the standard World Bank classification of economies as well as the Global Burden of Disease Socio-demographic Index. The findings show that oral conditions remain a substantial population health challenge. Globally, there were 3.5 billion cases (95% uncertainty interval [95% UI], 3.2 to 3.7 billion) of oral conditions, of which 2.3 billion (95% UI, 2.1 to 2.5 billion) had untreated caries in permanent teeth, 796 million (95% UI, 671 to 930 million) had severe periodontitis, 532 million (95% UI, 443 to 622 million) had untreated caries in deciduous teeth, 267 million (95% UI, 235 to 300 million) had total tooth loss, and 139 million (95% UI, 133 to 146 million) had other oral conditions in 2017. Several patterns emerged when the World Bank's classification of economies and the Socio-demographic Index were used as indicators of economic development. In general, more economically developed countries have the lowest burden of untreated dental caries and severe periodontitis and the highest burden of total tooth loss. The findings offer an opportunity for policy makers to identify successful oral health strategies and strengthen them; introduce and monitor different approaches where oral diseases are increasing; plan integration of oral health in the agenda for prevention of noncommunicable diseases; and estimate the cost of providing universal coverage for dental care

The efficacy of silver diamine fluoride in arresting caries in children

Data sourcesPubMed, Scopus, Web of Science, the Latin American and Caribbean Health Sciences Literature database (LILACS), the Brazilian Library in Dentistry (BBO), Cochrane Library and grey literature.Study selectionTwo reviewers selected randomised clinical trials (RCTs) that compared the efficacy of SDF application with other active treatments or placebo in arresting carious lesions.Data extraction and synthesisThree authors extracted data using customised extraction forms, and risk of bias was assessed by two independent reviewers. Meta-analyses were performed on studies classified at 'low' or 'unclear' risk of bias, where similar outcomes were recorded in primary teeth, and that compared SDF to active treatments.ResultsEleven studies were included; five studies were at 'low', two at 'unclear' and four studies at 'high' risk of bias. Eight were conducted with primary teeth, two with permanent first molars and one conducted on both. Six studies used 38% SDF, two 30% SDF, one 12% SDF, one compared 38% SDF to 12% SDF and one used Nano Silver Fluoride (NSF).ConclusionsSDF is more effective than active treatments or placebo for carious lesion arrest in primary teeth. The body of evidence was of high quality for primary teeth. However, there was not enough high quality evidence to draw conclusions about carious lesion arrest in first permanent molars

Core outcomes in periodontal trials:study protocol for core outcome set development

Abstract Background There are a large number of clinical outcome measures used to assess the effectiveness of prevention and management strategies of periodontal diseases. This heterogeneity causes difficulties when trying to synthesise data for systematic reviews or clinical guidelines, reducing their impact. Core outcome sets are an agreed, standardised list of outcomes that should be measured and reported in all trials in specific clinical areas. We aim to develop a core outcome set for effectiveness trials investigating the prevention and management of periodontal disease in primary or secondary care. Methods To identify existing outcomes we screened the Cochrane systematic reviews and their included studies on the prevention and management of periodontal diseases. The core outcome set will be defined by consensus of key stakeholders using an online e-Delphi process and face-to-face meeting. Key stakeholders involved in the development will include: patients, dentists, hygienists/therapists, specialists, clinical researchers and policy-makers. Stakeholders will be asked to prioritise outcomes and feedback will be provided in the next round(s). Stakeholders will have an opportunity to add outcomes found in the Cochrane review screening process at the end of the first round. If consensus is not reached after the second round we will provide feedback prior to a third round. Remaining outcomes will be discussed at a face-to-face meeting and agreement will be measured via defined consensus rules of outcome inclusion. Discussion The inclusive consensus process should provide a core outcome set that is relevant to all key stakeholders. We will actively disseminate our findings to help improve clinical trials, systematic reviews and clinical guidelines with the ultimate aim of improving the prevention and management of periodontal diseases. Trial registration COMET ( http://www.comet-initiative.org/studies/details/265?result=true ). Registered on August 2012