National Institute of Dental and Craniofacial Research Submission for the NIH Comprehensive Strategic Plan and Budget To Reduce and Ultimately Eliminate Health Disparities

The NIDCR health disparities plan recognizes that eliminating oral health disparities requires a comprehensive and systematic approach to understand and address the multiple and often complex factors that may determine oral health. While the research challenges relate to understanding the causes of health disparities, elucidating risk factors, facilitating means of risk reduction, and enhancing care delivery and health promotion, attention also must be paid to addressing the lack of diversity in the scientific workforce and to improving educational and outreach activities to transfer health information to the communities of interest. Thus, the plan emphasizes three major areas: research, research training, and health communication. The plan builds on the investments of NIDCR since the early 1990’s to enhance research opportunities for underrepresented minorities and on more than 50 years of research to understand, treat and prevent oral diseases. Recognizing the complexity and wealth of factors that may contribute to disparities in oral health, and the considerable diversity between and within the affected communities, the NIDCR strategy to eliminate health disparities is viewed as an incremental long-term approach that involves collaborations with many organizations and institutions that constitute the oral health community – researchers, educators, clinicians, academic institutions, patient advocates, and professional and voluntary groups

Prevalence of Total Tooth Loss, Dental Caries, and Periodontal Disease in Mexican-American Adults: Results from the Southwestern HHANES

The Southwestern portion of the Hispanic Health and Nutrition Examination Survey (HHANES) was conducted by the National Center for Health Statistics (NCHS) in 1982 and 1983. The survey population was Mexican-Americans residing in five Southwestern states. This report presents data on the prevalence of total tooth loss, dental caries, and periodontal diseases in 3860 Mexican-American adults aged from 18 to 74. Results show that 4.3% of this group was edentulous. Among the dentate, Mexican-Americans had lower overall DMF scores but higher numbers of untreated decayed teeth than did residents of the same region seen in the NHANES I survey in 1971-1974. Caries of the smooth surfaces in both posterior and anterior teeth was more pronounced in the older than in the younger age groups. Mexican-Americans had more gingivitis but fewer periodontal pockets than did the general population in the Western states during NHANES 1. The caries pattern in the Mexican-Americans suggests that caries among adults may remain a problem in the future, with the possibility of increased involvement with the aging, although modest, of smooth tooth surfaces.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68143/2/10.1177_00220345870660061801.pd

Public knowledge of the prevention of dental decay and gum diseases

The document attached has been archived with permission from the Australian Dental Association (23rd Jan 2008). An external link to the publisher’s copy is included.In 1992, a mail survey was conducted among South Australians aged 10 years and older to assess the knowledge of prevention of dental caries and gum diseases and to explore its variation by sociodemographic factors. The survey provided 838 completed questionnaires. Questions were asked on perceptions of importance of a number of preventive measures, the main purpose of water fluoridation and sources of information. Respondents rated four myths for preventing dental caries as the most important: 97 per cent rated regular tooth brushing; 87 per cent rated regular dental visits; 85 per cent rated calcium in the diet; and 78 per cent rated eating fibrous foods as definitely or probably important. Only 56 per cent of respondents rated drinking water with fluoride as definitely or probably important for preventing dental caries, and only half (50.2 per cent) identified the main purpose of water fluoridation as the prevention of decay. Respondents rated regular tooth brushing (96 per cent) and regular dental visits (87 per cent) as important for the prevention of gum diseases. However, the myth of massaging the gums was rated as important by 67 per cent. Higher percentages of females, older adults and those with lower educational attainment rated the myths for preventing caries as important. Younger people were less able to specify the main purpose for fluoridation of water supplies. The persistence of myths and the low rating of the importance of scientifically efficacious measures are major challenges for oral health promotion.Kaye F. Roberts Thomson, and A. John Spence

Distribution of coronal and root caries experience among persons aged 60+ in South Australia

The document attached has been archived with permission from the Australian Dental Association. An external link to the publisher’s copy is included.This report provides epidemiological data describing caries experience among the population of non-institutionalized older adults in Adelaide and Mt Gambier. Subjects were selected in a stratified random sample of persons aged 60+ who were listed on the South Australian Electoral Database. Oral examinations were conducted by four calibrated dentists among 853 dentate persons aged 60 years and over. There was an average of 14.7 missing teeth, 8.3 filled teeth and 0.3 decayed teeth, and a further 0.2 teeth were present as retained roots. The mean number of missing teeth was higher (p < 0.05) in older compared with younger age groups, and in Mt Gambier compared with Adelaide. The mean DFS of 22.1 was significantly higher (p < 0.05) among younger persons, females and in Adelaide. Root surface caries affected an average of 3.1 surfaces, and was greater (p < 0.05) among persons aged 70-79 years, males and Adelaide residents. However, when root caries was expressed as an attack rate per 100 exposed surfaces, differences were statistically significant only among age groups. Analysis of specific teeth revealed that no more than 40 per cent of molars were retained, and between 30 and 58 per cent of retained molars had coronal fillings.Gary D. Slade, A. John Spence

Health information quality of websites on periodontology

Aim: This study aimed to assess the quality of the information available on the Web on gum disease. Methods: The term ‘gum disease’ was searched in Google and in MedlinePlus. The first 200 websites were analysed by the Journal of the American Medical Association (JAMA) criteria and the Health On the Net Foundation (HONCode) certification, instruments for assessing quality of health information. Data was analysed through the Mann-Whitney test or KruskalWallis test, followed by the Dunn’s test, using the GraphPad Prism Software version 6. Results: MedlinePlus presented a significantly higher JAMA score than Google. Google’s first ten results had a higher JAMA score than the remaining websites. Journalism and health portals are the most reliable affiliations, while commercial and dental practices had low JAMA scores. JAMA score was significantly higher in websites with the HONCode certification compared to the ones without it. Conclusion: There are current concerns regarding patients’ use of the Internet for accessing health information. However, the conclusion we can make is that Google seems to favour websites with high quality information, at least in terms of JAMA score or HONCode accreditation. The JAMA score of dental practices’ websites could be improved by providing basic information such as authorship and date

Dental Caries, Fluorosis, and Fluoride Exposure in Michigan Schoolchildren

This study relates the prevalence of caries and fluorosis among Michigan children, residing in four different areas, to the various concentrations of F in the communities' water supplies. Demographic information, details of F history, and dental attendance data were collected by a questionnaire form filled out by parents. Children ages six to 12 were screened for caries by means of the NIDR criteria and for fluorosis by means of the TSIF index. Results pertain only to continuous residents and the permanent dentition. The prevalence of both caries and fluorosis was significantly associated with the F concentration in the community water supply. Approximately 65% of all children were caries-free, ranging from 55.1 % in fluoride-deficient Cadillac to 73.7% in Redford (1. 0 ppm F). About 36% of all children had dental fluorosis, ranging from 12.2 in Cadillac to 51.2 in Richmond (1.2 ppm). All of the fluorosis was very mild. From logistic regression, the prevalence of caries was significantly associated with age, dental attendance, and the use of a water supply fluoridated at 1.0 ppm. The odds of experiencing fluorosis increased at every F level above the baseline (Cadillac), with the use of topical F rinses, and with age. Results suggest that children in the four communities may be ingesting a similar level of F from sources such as dentifrices, dietary supplements, and professional applications, but the factor that differentiates them with respect to the prevalence of caries and fluorosis is the F concentration in the community water supply.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66926/2/10.1177_00220345880670050101.pd

The Effects of Sugars Intake and Frequency of Ingestion on Dental Caries Increment in a Three-year Longitudinal Study

A three-year longitudinal study was carried out with a group of children, initially aged 11-15, residing in non-fluoridated rural communities in south-central Michigan. This report analyzes the relation between caries increment and consumption of sugars from all sources to see if accepted relationships have changed with the caries decline in the United States. There were 499 children who provided three or more 24-hour dietary recall interviews, and who received dental examinations at baseline and after three years. Caries increment averaged 2.91 DMFS over the three years, with 81 % of new lesions on pit-and-fissure surfaces. Consumption of sugars from all sources averaged 156 g per day for males and 127 g per day for females, an average of 52 kg per person per year. Sugars constituted one-quarter of total caloric intake for both boys and girls, and the average number of eating occasions per day was 4.3. Children who consumed a higher proportion of their total energy intake as sugars had a higher increment of approximal caries, though there was little relation to pit-and-fissure caries. The average number of daily eating occasions was not related to caries increment, nor was the average number of sugary snacks (defined as foods with 15% or more of sugars) consumed between meals, but the average consumption of between-meal sugars was related to the approximal caries increment. When children were categorized by high caries increment compared with no caries increment, a tendency toward more frequent snacks was seen in the high-caries children. In an age of generally declining caries, it was concluded that higher average daily consumption of sugars, and higher between-meal consumption of sugars, was still a risk factor for children susceptible to approximal caries. Overall frequency of eating and frequency of ingestion of sugary foods between meals, however, were both poorly related to approximal caries increment. Pit-and-fissure caries could not be related to any aspect of sugars consumption.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67206/2/10.1177_00220345880670111201.pd

Dental caries experience in children of a remote Australian Indigenous community following passive and active preventive interventions

OBJECTIVES:To report on changes in dental caries experience in children of a remote Indigenous community following 6 years of passive preventive intervention (PPI) and 2 years of active preventive intervention (API). METHODS:Five consecutive cross-sectional surveys were conducted on 4- to 15-year-old school going children between 2004 and 2017 following phases of Community Water Fluoridation (CWF), post-cessation of CWF and API. Following treatment of any cavities present, API included selective placement of fissure sealants (FS) and an annual application of povidone-iodine (PI) and fluoride varnish (FV). The World Health Organization's (WHO) "Oral Health Surveys - Basic Methods (4th Edition)" methodology was used in the first two and the International Caries Detection and Assessment System (ICDAS-II) in the latter three surveys. ICDAS-II codes of 3-6, representing advanced caries, were combined to allow comparison to the decayed component of the DMF caries index. RESULTS:Age-weighted mean dmft decreased by 37.7% in the deciduous (DD) and DMFT by 35% in the permanent (PD) dentitions between the pre- and post-CWF surveys, followed by increases of 25% and 7.7%, respectively, between the 1-year and 4-year post-CWF surveys. After 2 years of API, mean dmft decreased by 14.3% and DMFT by 7.1%. Untreated dental caries however remained a concern in the DD and PD during both phases of PPI and of API. The decline in caries experience for both dentitions following 2 years of API exceeded that for the 6-year period of PPI. CONCLUSIONS:The annual reductions in caries experience of 7.2% (DD) and 8% (PD) during the phase of API exceeded annual decreases of 4.7% (DD) and 4.6% (PD) during the phase of PPI. Due to remoteness, cost and logistics in ensuring long-term viability of API programmes, CWF remains necessary in this type of community.Jeroen Kroon, Ratilal Lalloo, Santhosh K. Tadakamadla, Newell W. Johnso

A content analysis of oral health messages in Australian mass media

Accepted manuscript online: 27 JAN 2015Background: Social analysis regarding oral health and oral health promotion are almost non-existent in the Australian context. The usefulness of such exploration lies in framing and informing research methodologies and health promotion initiatives and can improve our understanding of oral health behaviours and their social contexts. Methods: We conducted a systematic content analysis of a random sample of popular Australian magazines, newspapers and television shows from May to September 2012. Our sample included the top three best-selling magazines, six weekly newspapers, one from each available Australian state; and the four highest-ranked Australian prime-time television shows and their associated commercials. Results: Data comprised of 72 hours of prime-time television and 14,628 pages of hardcopy media. 71 oral health related media ‘incidents’ were counted during a five month period. Only 1.5% of incidents referenced fluoride and only two made dietary references. Women were represented almost six times more than men and the majority of oral health related incidents conveyed no social context (63%). Conclusions: Oral health messages conveyed in Australian media fail to provide a social context for preventative or health-promoting behaviours. In light of increased levels of oral disease and retention of natural teeth, more community-based oral health promotion and support for oral health literacy would be prudent in the Australian context.Kelly Jones, Jessica Merrick and Christine Beasle