Effect of Receiving Dental Treatment on mortality among nursing facility residents.

AIM: To assess the association between receipt of different types of dental procedures and mortality among nursing home residents. METHODS AND RESULTS: Between June 2006 and March 2008, 535 nursing home residents received a health screening assessment and were offered comprehensive dental care. Death certificate data were obtained in September 2013 and multivariable regression models were generated to assess the effect of dental procedures delivered after the screening assessment on mortality, adjusting for demographic and health-related covariates. Residents had a mean age of 85.2 years at baseline and approximately 30% were edentulous. About two-thirds received at least one dental procedure, and about 88% had died, between the screening date and the end of follow-up. Among dentate residents, after adjustment for relevant covariates, for each one-unit increase in the number of intervals during which they received at least one preventive dental procedure there was a 13% decrease in mortality (HR = 0.87, 95% CI = 0.78-0.98) at any given time, while for prosthetic dental procedures there was a 16% decrease in mortality (HR = 0.84, 95% CI = 0.72-0.97). Among edentulous residents, only prosthetic procedures were analyzed, and they were not significantly associated with mortality. CONCLUSION: Among dentate institutionalized elderly, receipt of preventive or prosthetic dental procedures was associated with decreased mortality.

Models to Predict Future Permanent Tooth Caries Incidence in Children Using Primary Teeth Caries Experience.

Purpose: To assess permanent tooth caries incidence (ΔDMFS) among a cohort of African American children using the presence of any caries experience(decayed, missing, and filled surfaces-dmfs) in primary teeth and the presence of untreated primary tooth caries (ds) in two separate models. Methods: Data from a prospective study was used to apply two models with different clinical for predicting DMFS from ages six through 12 years. The first model used dmfs, and the second model used ds as predictors (both at age six years). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed. Results: The first model resulted in sensitivity from 81.8 percent to 100 percent, specificity from 35.6 percent to 42.6, PPV from 5.8 percent to 38.1 percent, and NPV from 90.0 percent to 100 percent. In the second model, the predictive values were from 33.3 percent to 55.6 percent, 62.7 percent to 72.7 percent, 3.4 percent to 45.5 percent, and 80 percent to 95.9 percent, respectively. Conclusions: The proposed models for permanent tooth caries incidence prediction are easy, not time consuming, and clinically applicable; if validated, they have the potential to change the current paradigm for caries risk assessment.

Streptococcus mutans serotypes and collagen-binding proteins Cnm/Cbm in children with caries analysed by PCR.

Streptococcus mutans, a primary bacterium associated with dental caries, has four known clinical serotypes (c, e, fand k). Certain serotypes, the presence of multiple serotypes and strains with collagen-binding proteins (CBP, Cnm and Cbm) have been linked with systemic disease. Evaluation of S mutans serotype distribution and caries association is needed in the United States. The purpose of this study was to evaluate the prevalence of S mutans serotypes from two cohorts of African-American children in rural Alabama using three sample types (saliva, plaque and individual S mutans isolates) by PCR detection for association with caries. Detection of CBP was also performed by PCR. In total, 129 children were evaluated and overall prevalence of serotypes were: serotype c(98%), e(26%), f(7%) and k(52%). Serotype c was statistically associated with higher caries scores in older children (P < 0.001) and serotype k was statistically more likely in females (P = 0.004). Fourteen per cent of children had CBP. Thirteen S mutans isolates from five children tested positive for both CBP. This study is the first to report on the prevalence of S mutans serotypes in a US population using the PCR-based approach. The frequency of serotype k in this study is the highest reported in any population, illustrating the need for further study to determine the prevalence of this clinically relevant serotype in the US. This is the first study to report S mutans isolates with both Cnm and Cbm in the same strain, and further analysis is needed to determine the clinical significance of these strains.

Survival analysis of caries incidence in African-American school-aged children.

OBJECTIVES: To conduct an assessment of time-dependent covariates related to dental caries of the permanent dentition among a low socioeconomic status, understudied cohort of children, incorporating time-dependent covariates through the application of extended Cox proportional hazards modeling. METHODS: This study modeled the time to first cavitated dental caries in permanent teeth among school-aged children and assessed factors associated with this event. A cohort of 98 low socioeconomic status African-American children with mean age of 5.85 years at baseline was recruited in Uniontown, Alabama and followed prospectively for 6 years. None of these children had dental caries on permanent teeth at baseline, and oral examinations were performed annually. Caries-free survival curves were generated to describe time to event (having first decayed, filled, or missing permanent surface). Bivariate and multivariable extended Cox hazards modeling was used to assess the relationships between time-dependent and time-independent covariates and time to event. RESULTS: Twenty-eight children (28.6 percent) had their first permanent tooth caries event during the 6-year follow-up. Multivariable results showed that greater consumption of water was associated with lower dental caries hazard, while previous primary tooth caries experience was associated with greater dental caries hazard after adjustment for frequency of consumptions of milk, added-sugar beverages, and 100 percent juice. CONCLUSIONS: There was a global/overall significant caries protective effect of water consumption during the school-age period of child development.

Anterior restoration longevity among nursing facility residents: a 30-year retrospective study.

AIM: To assess factors influencing anterior dental restoration longevity among the institutionalized elderly. METHODS: Among a sample of Eastern Iowa nursing facility dental patients, one anterior restoration placed from 1985 to 2014 was selected at random from each subject. Kaplan-Meier survival curves were generated, with restoration failures defined as subsequent restorative codes involving the same surface; endodontic procedures; or extractions. Bivariate and multivariable Cox proportional hazards modeling were performed. RESULTS: In multivariable analyses, the 1985 to 1999 cohort (n = 496) had longer restoration survival in in females < 75 years old versus males < 75 years old (P = 0.016), males ≥75 years old (P = 0.026) and females ≥75 years old (P = 0.030); one- versus three-surface restorations (P < 0.001); and restorations placed by faculty/residents versus pre-doctoral students (P = 0.009). The 2000 to 2014 cohort (n = 521) had longer restoration survival in females < 75 years old versus males ≥75 years old (P = 0.012) and females ≥75 years old (P = 0.019); residents who paid out-of-pocket versus those on Medicaid (P = 0.019); and composite resin versus glass ionomer cement restorations (P < 0.001). CONCLUSIONS: Knowing how long restorations last, and what factors affect their longevity, could improve treatment planning, informed consent, and communication with residents and caregivers, and also help inform practice guidelines for restorative care among the institutionalized elderly.

Mutans Streptococci and Dental Caries: A New Statistical Modeling Approach.

Survival analyses have been used to overcome some of the limitations encountered with other statistical analyses. Although extended Cox hazard modeling with time-dependent variables has been utilized in several medical studies, it has never been utilized in assessing the complex relationship between mutans streptococci (MS) acquisition (time-dependent covariate) and time to having dental caries (outcome). This study involved secondary analyses of data from a prospective study conducted at the University of Alabama at Birmingham. Low socioeconomic status, African-American preschool children from Perry County, AL, USA (n = 95) had dental examinations at age 1 year and annually thereafter until age 6 years by three calibrated dentists. Salivary MS tests were done at ages 1, 1.5, 2, 2.5, 3, and 4 years. The patterns of and relationship between initial MS detection (time-dependent covariate) and dental caries experience occurrence were assessed, using extended Cox hazard modeling. The median time without MS acquisition (50% of the children not having positive MS test) was 2 years. Approximately 79% of the children had positive salivary MS tests by the age of 4 years. The median caries experience survival (50% of the children not having dental caries) was 4 years. During the follow-up period, 65 of the children (68.4%) had their initial primary caries experience. Results of the extended Cox hazard modeling showed a significant overall/global relationship between initial caries experience event at any given time during the follow-up period and having a positive salivary MS test at any time during the follow-up period (hazard ratio = 2.25, 95% CI 1.06-4.75). In conclusion, the extended Cox modeling was used for the first time and its results showed a significant global/overall relationship between MS acquisition and dental caries. Further research using causal mediation analysis with survival data is necessary, where the mediator "presence of MS" is treated as a time-dependent variable.

Association Between Early Childhood Caries and Colonization with Streptococcus mutans Genotypes From Mothers.

PURPOSE: The purpose of this study was to evaluate Streptococcus mutans genotypes (GT) between mother and child (M-C) in a high caries risk cohort to explore the association with early childhood caries (ECC). METHODS: Sixty-nine infants (each approximately one year old) had periodic oral examinations (dmfs) and microbial samples collected from dental plaque, saliva, and other oral surfaces. Their mothers had an examination and plaque collected. S mutans isolates were genotyped using repetitive extragenic palindromic-PCR (rep-PCR). Statistical analyses were conducted for associations of S mutans in M-C dyads with caries outcomes. RESULTS: Twenty-seven S mutans genotypes (GT) from 3,414 isolates were identified. M-C were categorized as GT match (n equals 40) or no-match (n equals 29). When modeling the severity of ECC at 36 months (approximately four years old), the estimated dmfs in the match group was 2.61 times that of the no-match group (P=.014). CONCLUSIONS: Colonization of children with Streptococcus mutans genotypes that matched with mothers was shown to be highly associated with early childhood caries. Although the data suggest vertical transmission of S mutans in 40 of 69 children that shared GT with their mother, it is possible that other individuals transmitted the S mutans. Nonetheless, these findings support the importance of the mother's oral microbial status as a contributing influence to their children's oral health.

Dental status as a predictor of mortality among nursing facility residents in eastern Iowa.

OBJECTIVE: This study aimed to evaluate dental status (ie, number of teeth and presence of removable dental prostheses) as a predictor of all-cause mortality among nursing facility residents. BACKGROUND: Edentulism has been associated with poorer health outcomes in geriatric populations. MATERIALS AND METHODS: Between March 2006 and June 2008, oral health screening examinations were completed for 584 residents of 10 nursing facilities in four eastern Iowa counties. In September 2013, demographic, general and oral health information was obtained from the screening forms and linked with Iowa state death certificate data. The study outcome (time to death) was defined as the number of days between the screening examination and death. Univariate and bivariate distributions were assessed, and multivariable Cox proportional hazards regression models were generated to arrive at factors associated with time to death. RESULTS: A total of 535 residents were eligible for data analysis. Age at screening ranged from 60-103 years (mean=85.2), 70% were female, and 33% were edentulous. By September 2013, 468 (87.5%) had died, with a median time to death among these individuals of 2.0 years. The final multivariable Cox model included data from 393 (73.4%) of the residents; statistically significant relationships were observed between time to death and dental status, age, sex, cooperativeness with care providers and renal disease. CONCLUSIONS: Dental status remained strongly associated with time to death even after controlling for other important demographic and health-related factors.

Genetic Diversity and Evidence for Transmission of Streptococcus mutans by DiversiLab rep-PCR.

This two-part study investigated the genetic diversity and transmission of Streptococcus mutans using the DiversiLab repetitive extragenic palindromic PCR (rep-PCR) approach. For children with S. mutans and participating household members, analysis for evidence of unrelated child-to-child as well as intra-familial transmission was evaluated based on commonality of genotypes. A total of 169 index children and 425 household family members from Uniontown, Alabama were evaluated for genetic diversity using rep-PCR. Thirty-four unique rep-PCR genotypes were observed for 13,906 S. mutans isolates. For transmission, 117 child and household isolates were evaluated for shared genotype (by child and by genotype cases, multiple matches possible for each child). Overall, children had 1-9 genotypes and those with multiple genotypes were 2.3 times more likely to have caries experience (decayed, missing and filled teeth/surfaces>0). Only 28% of children shared all genotypes within the household, while 72% had at least 1 genotype not shared with anyone in the household. Children had genotype(s) not shared with any household members in 157 cases. In 158 cases children and household members shared a genotype in which 55% (87/158 cases) were shared with more than one family member. Children most frequently shared genotypes with their mothers (54%; 85/158), siblings (46%; 72/158) and cousins (23%; 37/158). A reference library for S. mutans for epidemiological surveillance using the DiversiLab rep-PCR approach is detailed. The genetic diversity of S. mutans in this population demonstrated frequent commonality of genotypes. Evidence for both child-to-child and intra-familial transmission of S. mutans was observed by rep-PCR.

Dental Caries in High-risk, School-age African American Children in Alabama: A Six-year Prospective.

PURPOSE: The purpose of this study was to assess the prevalence and incidence of dental caries in school-age African American children who received semi-annual fluoride varnish applications. METHODS: A cohort of six-year-old high caries-risk African American children (n equals 98) was recruited in Uniontown, Ala., USA, and followed for six years. Oral examinations were done annually by three trained/calibrated dentists. Tooth surfaces with cavitated caries, teeth missing due to caries, and teeth with filled surfaces were recorded using World Health Organization criteria. Also, as part of the study, children received periodic oral health instruction, fluoride varnish applications, and referrals to dentists starting at baseline. RESULTS: The person-level prevalence of decayed, missing, and filled surfaces of primary and permanent teeth (dmfs/DMFS) was: 61.2 percent at mean age of 5.9 years old (n equals 98, mean dmfs/DMFS equals 11.6); 63.8 percent at 6.7 years old (n equals 80, mean dmfs/ DMFS equals 13.2); 70.6 percent at 7.8 years old (n equals 68, mean dmfs/DMFS equals 14.2); 65.7 percent at 8.8 years old (n equals 68, mean dmfs/DMFS equals 11.8); 55.6 percent at 9.7 years old (n equals 63, mean dmfs/DMFS equals 8.8); 40.3 percent at 10.7 years old (n equals 62, mean dmfs/DMFS equals 3.4); and 37.1 percent at 11.7 years old (n equals 62, mean dmfs/DMFS equals 2.3). The six-year person-level incidence of dmfs/DMFS was 32.3 percent (mean dmfs/DMFS equals 1.6) from 5.9 to 11.7 years old (N equals 62). CONCLUSIONS: In spite of the oral health education and fluoride varnish applications, there was substantial new dental caries in this high-risk sample. Additional studies evaluating risk factors for caries development are ongoing.

Factors associated with early childhood caries incidence among high caries-risk children.

OBJECTIVES: To assess the relationships between different behavioral factors and Early Childhood Caries (ECC) in African-American pre-school children. METHODS: Ninety-six African-American children aged 3-22 months old at baseline were recruited from a high caries risk, non-fluoridated African-American community in Uniontown, Alabama. The children had dental examinations annually following World Health Organization (WHO) criteria at mean ages 1.1, 2.0, 3.1 and 4.0 years. All children received fluoride varnish application at each study visit. Parents provided oral hygiene and dietary information semiannually by completing questionnaires. Area-under-the-curve (AUC) with the trapezoidal rule was used to summarize longitudinal exposure data. Bivariate and multivariable relationships between ECC incidence and behavioral risk factors were assessed using logistic regression and negative binomial modeling for dichotomous and count dependent variables, respectively, with the independent variables defined at age 1, age 3 and as the AUC. RESULTS: Greater frequency of toothbrushing and greater AUC composite of daily frequency of consumption of 100% juices were associated with lower incidence of dental caries (P-values = 0.01 and 0.049, ORs = 0.34 and 0.37, respectively). Greater AUC of daily frequency of consumption of sweetened foods and history of a previous visit to a dentist by age 3 were associated with greater incidence of ECC (ORs = 9.22 and 4.57, P-values = 0.002 and 0.03, respectively). CONCLUSION: For these children living in a non-fluoridated community, more frequent consumption of sweetened food, less frequent consumption of 100% juice, less frequent toothbrushing, and reporting a previous visit to a dentist were significantly associated with greater ECC incidence.

Factors related to receipt of dental care in Eastern Iowa nursing facilities.

OBJECTIVE: To assess factors related to nursing facility residents' receipt of dental treatment when it was offered on site. METHODS: Screening forms that included demographic, general, and dental health information were obtained from residents of 10 nursing facilities in Eastern Iowa, and their dental procedure history for up to 7 years after screening was recorded. Residents were grouped as having received either no procedures; diagnostic procedures only; or nondiagnostic procedures. RESULTS: Of the 586 residents, the mean age was 83.8 years at screening and 31.3% were edentulous. The odds of receiving nondiagnostic procedures were lower among residents who were older (OR = 0.98, 95%CI 0.96-0.99) or edentulous (OR = 0.31, 95%CI 0.20-0.46), compared to those who received no dental procedures. CONCLUSIONS: Those who were older or edentulous had lower odds of receiving nondiagnostic dental procedures. Well-designed prospective cohort studies are needed to better evaluate barriers to receipt of dental treatment among the institutionalized elderly.

Prevalence and incidence of early childhood caries among African-American children in Alabama.

OBJECTIVES: This study aims to assess the prevalence and incidence of early childhood caries (ECC) in African-American children. METHODS: A cohort of 96 African-American children approximately 1 year of age at baseline were recruited in Uniontown, Alabama, and followed for 3 years. Oral examinations were conducted annually by one of three trained/calibrated dentists using portable equipment, without radiographs, following WHO criteria. RESULTS: The prevalence of decayed/missing/filled surfaces (dmfs) was: 1.1 percent (all d) at approximately age 1 (n = 90, six children were excluded for having no erupted teeth); 12.8 percent (d = 10.5 percent & f = 4.7 percent) at age 2 (n = 86); 39.3 percent (d = 21.4 percent, m = 2.4 percent & f = 22.6 percent) at age 3 (n = 84); and 65.8 percent (d = 28.8 percent, m = 5.5 & f = 46.6 percent) at age 4 (n = 73). The percentages of incisors, canines, first molars, and second molars with dmfs were: 0.1 percent, 0.0 percent, 0.0 percent, and 0.0 percent, at age 1; 2.4 percent, 0.1 percent, 0.8 percent, and 0.6 percent at age 2; 8.2 percent, 0.8 percent, 7.6 percent, and 6.3 percent at age 3; and 10.2 percent, 2.2 percent, 12.6 percent and 16.7 percent at age 4, respectively. The three, 1-year, person-level incidence rates were 12.8 percent (age 1 to age 2), 38.6 percent (age 2 to age 3), and 56.2 percent (age 3 to age 4). From baseline, the 2-year incidence was 39.3 percent and 3-year incidence was 65.8 percent, whereas the 2-year caries incidence from age 1 to age 3 was 66.7 percent (n = 72). CONCLUSION: The majority of children developed caries during the 3-year follow-up, which is much higher than the 32 percent prevalence of caries among African-American children under age 6 years in National Health and Nutrition Examination Survey from 1999 to 2002.