Erosive Tooth Wear and Consumption of Beverages among Children in the United States

Background/Aim: Experimental studies have identified differences in the effect of physicochemical properties of beverages on the etiology of erosive tooth wear (ETW). Little is known from epidemiological studies about the relationship between ETW and consumption of juices, drinks and milk. This study examined the relationship between the consumption of juices, drinks, milk and ETW in children in the United States. Methods: The National Health and Nutrition Examinations Survey data for 2003–2004 was analyzed. Trained and calibrated examiners used the modified Smith and Knight Tooth Wear Index from a 1998 United Kingdom Adult Health Survey to measure ETW. Beverage consumption collected via a Food Frequency Questionnaire was processed with Diet*Calc software to obtain the average daily consumption frequency for all queried juice categories, milk and carbonated beverages. Survey-weighted descriptive and multivariable analyses were performed. Results: Prevalence of ETW was highest in children aged 18–19 years (56%), males (49%), and lowest in Blacks (31%). Milk and soft drinks (0.85 times a day) and fruit drinks (0.69) were the most consumed products by children. Children with ETW had significantly higher odds of being frequent consumers of apple juice after adjusting for age, gender, and race/ethnicity. Blacks had the highest mean daily apple juice consumption, but the mean difference between those with ETW and those without ETW was not significant. Conclusion: ETW was associated with frequent intake of apple juice, but the mean difference in consumption between groups with ETW versus those without ETW within racial/ethnic groups was not significant

Dental Service Utilization and Neighborhood Characteristics in Young Adults in The United States: A Multilevel Approach

Objective: To investigate the association between neighborhood level factors and dental visits in young adults in the United States after adjusting for individual level factors. Methods: The National Longitudinal Study of Adolescent Health Wave 1 (1994-1995) to Wave III (2001-2002) was analyzed. The primary outcome of having had at least one dental visit in the previous 12 months was analyzed via a multilevel random-effects logistic model accounting for geographic clustering in Wave III and survey design clustering from Wave I. Neighborhood level covariates were defined at the census tract level. Results: Overall rate of dental visits was 57 percent, highest among 18-20 year olds (65 percent) and lowest in 23-26 year olds (52 percent). Increased proportion of African-Americans (≤5 percent to ≥20 percent) and Hispanics (≤5 percent to ≥20 percent) in a neighborhood corresponded with a decrease in dental visits (60 percent versus 52 percent) and (58 percent versus 51 percent), respectively. Neighborhoods with a high proportion of college-educated residents had a higher percentage of dental visits. Similar differences were found when comparing the lowest and highest tertiles defined by poverty level and unemployment with dental visits. Neighborhood education was significantly associated with dental service utilization after adjustment for individual level factors and dental utilization in adolescence (Waves I and II) in the random effects model. Conclusions: This study demonstrates that the education level of residents within a neighborhood was associated with dental service utilization in young adults in the United States

Predictors of Dental Care Use: Findings From the National Longitudinal Study of Adolescent Health

Purpose To examine longitudinal trends and associated factors in dental service utilization by adolescents progressing to early adulthood in the United States. Methods The data source was the National Longitudinal Study of Adolescent Health from Waves I (1994–1995), II (1996), III (2001–2002), and IV (2007–2008). This was a retrospective, observational study of adolescents\u27 transition to early adulthood. We obtained descriptive statistics and performed logistic regression analyses to identify the effects of baseline and concurrent covariates on dental service utilization from adolescence to early adulthood over time. Results Dental service utilization within the prior 12 months peaked at age 16 (72%), gradually decreased until age 21 (57%), and remained flat thereafter. Whites and Asians had a 10–20 percentage points higher proportion of dental service utilization at most ages compared with Blacks and Hispanics. Dental service utilization at later follow-up visits was strongly associated with baseline utilization, with odds ratio = 10.7, 2.4, and 1.5 at the 1-, 7-, and 13-year follow-ups, respectively. These effects decreased when they were adjusted for current income, insurance, and education. Compared with Whites, Blacks were consistently less likely to report a dental examination. Conclusions Dental service utilization was highest in adolescence. Gender, education, health insurance, and income in young adulthood were significant predictors in reporting a dental examination. Blacks had lower odds of reporting a dental examination, either as adolescents or as young adults

A Methodology for Three-Dimensional Quantification of Anterior Tooth Width

The use of cone-beam computed tomography (CBCT) technology has been shown to be more accurate in measuring individual incisor tooth widths than the use of wax exemplars. There were fewer differences by investigators using CBCT than others using an F-test in a mixed model of the measurement differences of investigators, wax type, and which tooth was measured. In addition, the frequency of outliers was less in the CBCT method (a total of 5) as compared to the two-dimensional measurements in ether Aluwax (a total of 8) or Coprwax (a total of 12). Both results indicate that CBCT measurements accounted more precisely for tooth width and level of eruption

The Reliability of Parafoveal Cone Density Measurements

Background Adaptive optics scanning light ophthalmoscopy (AOSLO) enables direct visualisation of the cone mosaic, with metrics such as cone density and cell spacing used to assess the integrity or health of the mosaic. Here we examined the interobserver and inter-instrument reliability of cone density measurements. Methods For the interobserver reliability study, 30 subjects with no vision-limiting pathology were imaged. Three image sequences were acquired at a single parafoveal location and aligned to ensure that the three images were from the same retinal location. Ten observers used a semiautomated algorithm to identify the cones in each image, and this was repeated three times for each image. To assess inter-instrument reliability, 20 subjects were imaged at eight parafoveal locations on one AOSLO, followed by the same set of locations on the second AOSLO. A single observer manually aligned the pairs of images and used the semiautomated algorithm to identify the cones in each image. Results Based on a factorial study design model and a variance components model, the interobserver study\u27s largest contribution to variability was the subject (95.72%) while the observer\u27s contribution was only 1.03%. For the inter-instrument study, an average cone density intraclass correlation coefficient (ICC) of between 0.931 and 0.975 was calculated. Conclusions With the AOSLOs used here, reliable cone density measurements can be obtained between observers and between instruments. Additional work is needed to determine how these results vary with differences in image quality

Dental Sealants and Restorative Treatment for First Molars Among Medicaid Enrollees

Objectives To assess the association between dental sealant placement and subsequent restorative treatment of permanent first molars over time. Methods We analysed Wisconsin Medicaid claims data from 2001 to 2009 for children aged 6-16 years. Children entered the study cohort at age 6 and were censored if Medicaid eligibility was lost for \u3e31 days. A fixed effects analysis via a Cox proportional hazards model, stratified by individual, was used to estimate the time-averaged and time-dependent effects of sealant placement on dental treatment defined as any restorative, endodontic or surgical procedure. Results A total of 185,262 children with permanent first molars who turned 6 years enrolled in Medicaid were examined. Sealant placement was higher for teeth #16 and 26 (5.42 and 5.46 per 100 person-years (100PY), versus 5.29 and 5.31/100PY for #36 and 46, respectively. The average rate for restorative treatments had the opposite pattern, with lower rate for teeth #16 and 26 (1.78 and 1.72/100PY) versus teeth #36 and 46 (2.14 and 2.12/100PY), respectively. In the fixed effects regression model, the hazard of dental treatment was substantially lower after sealant placement on a tooth, with time-averaged hazard ratio HR = 0.23 (95% CI 0.21-0.25, P \u3c .001) versus before sealant. The largest effect was in the first year after sealant placement (HR = 0.13, 95% CI: 0.11-0.14), which decreased over time (HR = 0.50, 0.59 and 0.74 in years 2, 3 and 4, respectively), and was not statistically significant in later years. Conclusions This study demonstrates that permanent first molar sealant placement delayed subsequent dental treatments in children enrolled in Medicaid

A Retrospective Review of Clinical International Normalized Ratio Results and Their Implications

Background. Warfarin is a key element in therapy for atrial fibrillation, deep venous thrombosis (DVT), stroke (cerebrovascular accident) and cardiac valve replacement. Often, patients’ warfarin blood levels are not tightly controlled with regard to accepted therapeutic ranges, by virtue of the drug’s unpredictable nature. Methods. The authors searched 16,017 active clinical charts for active patients of record from the three campuses of the School of Dentistry, Marquette University (MU), Milwaukee, for the years 2009 and 2010. Dental records of 315 patients contained entries including “INR,” the abbreviation for the term “international normalized ratio.” Only 247 of those records contained an indication of whether the patient’s INR values were within therapeutic range. The authors found that 1.96 percent of the total MU dental clinic patient population had a history of warfarin use. Results. When the authors compared the INR values for patients with diagnoses of atrial fibrillation, DVT, stroke and cardiac valve replacement, they found that INR values for 107 of the 247 patients (43.3 percent) were not within therapeutic range for the respective diagnoses. For example, only 50 percent of the patients being treated for atrial fibrillation presented themselves for surgical dental treatment while their INR values were in tight control. Conclusion. The INR values for a significant number of dental patients are not within the therapeutic range for their medical conditions. These patients need to seek follow-up care from their medical care providers. Clinical Implications. Screening for INR in the dental office—especially before invasive dental treatment such as periodontal surgery, tooth extraction and dental implant placement—can help prevent postoperative complications. It also can aid the clinician in evaluating whether a patient’s INR is within therapeutic range and, subsequently, whether the patient’s physician needs to adjust the warfarin dosage