Sugar Consumption and Changes in Dental Caries from Childhood to Adolescence.

There are no prospective studies investigating the effects of sugar-related feeding practices on changes in dental caries from early childhood to young adulthood. The aim of this study was to assess whether sugar-related feeding practices affect dental caries between the ages of 6 and 18 y. This birth cohort study was initiated in 1993 in Pelotas, Brazil. There were 3 dental clinical assessments; at ages 6 y (n = 359), 12 y (n = 339), and 18 y (n = 307). Sugar-related feeding practices were assessed at ages 4, 15, and 18 y. Covariates included sex and life course variables, such as family income, breast-feeding, mother's education, regularity of dental visit, and child's toothbrushing habits. Group-based trajectory analysis was performed to characterize trajectories of time-varying independent variables that had at least 3 time points. We fitted a generalized linear mixed model assuming negative binomial distribution with log link function on 3-time repeated dental caries assessments. One in 5 participants was classified as "high" sugar consumers, and nearly 40% were "upward consumers." "Low consumers" accounted for >40% of the sample. High and upward sugar consumers had higher dental caries prevalence and mean DMFT in all cohort waves when compared with low sugar consumers. Caries occurred at a relatively constant rate over the period of study, but in all sugar consumption groups, the increment of dental caries was slightly higher between ages 6 and 12 y than between 12 and 18 y. Adjusted analysis showed that dental caries increment ratio between ages 6 and 18 y was 20% and 66% higher in upward and high sugar consumer groups as compared with low consumers. The higher the sugar consumption along the life course, the higher the dental caries increment. Even the low level of sugar consumption was related to dental caries, despite the use of fluoride.

[The Common Risk Factor Approach - An Integrated Population- and Evidence-Based Approach for Reducing Social Inequalities in Oral Health]. / Common Risk Factor Approach ­ Ein integrierter bevölkerungsbezogener und evidenzbasierter Ansatz zum Ausgleich sozialer Ungleichheiten in der Mundgesundheit.

Worldwide, non-communicable diseases including dental caries and periodontal diseases, remain a major public health problem. Moreover, there is a social gradient in health across society that runs from the top to the bottom in a linear, stepwise fashion. Health promoting behaviours become more difficult to sustain further down the social ladder. Oral health inequalities also exist in Germany. Earlier explanations of social inequalities have mainly focused on individual lifestyle factors, ignoring the broader social determinants of health and disease. Until recently, the dominant approaches to general health promotion focused on actions to reduce specific diseases, separating oral health from general health. An alternative approach is the common risk factor approach (CRFA) where risk factors common to a number of major chronic diseases, including diseases of the mouth and teeth, are tackled. The CRFA focuses on the common underlying determinants of health to improve the overall health of populations, thereby reducing social inequalities. The main implication of the CRFA for oral health policies is to work in partnership with a range of other sectors and disciplines. Oral health issues need to be integrated with recommendations to promote general health. Improvements in oral health and a reduction in oral health inequalities are more likely by working in partnership across sectors and disciplines using strategies that focus upstream on the underlying determinants of oral diseases.

The Shape of the Dose-Response Relationship between Sugars and Caries in Adults.

Dental caries is considered a diet-mediated disease, as sugars are essential in the caries process. However, some gaps in knowledge about the sugars-caries relationship still need addressing. This longitudinal study aimed to explore 1) the shape of the dose-response association between sugars intake and caries in adults, 2) the relative contribution of frequency and amount of sugars intake to caries levels, and 3) whether the association between sugars intake and caries varies by exposure to fluoride toothpaste. We used data from 1,702 dentate adults who participated in at least 2 of 3 surveys in Finland (Health 2000, 2004/05 Follow-up Study of Adults' Oral Health, and Health 2011). Frequency and amount of sugars intake were measured with a validated food frequency questionnaire. The DMFT index was the repeated outcome measure. Data were analyzed with fractional polynomials and linear mixed effects models. None of the 43 fractional polynomials tested provided a better fit to the data than the simpler linear model. In a mutually adjusted linear mixed effects model, the amount of, but not the frequency of, sugars intake was significantly associated with DMFT throughout the follow-up period. Furthermore, the longitudinal association between amount of sugars intake and DMFT was weaker in adults who used fluoride toothpaste daily than in those using it less often than daily. The findings of this longitudinal study among Finnish adults suggest a linear dose-response relationship between sugars and caries, with amount of intake being more important than frequency of ingestion. Also, daily use of fluoride toothpaste reduced but did not eliminate the association between amount of sugars intake and dental caries.

Diet and Dental Caries: The Pivotal Role of Free Sugars Reemphasized.

The importance of sugars as a cause of caries is underemphasized and not prominent in preventive strategies. This is despite overwhelming evidence of its unique role in causing a worldwide caries epidemic. Why this neglect? One reason is that researchers mistakenly consider caries to be a multifactorial disease; they also concentrate mainly on mitigating factors, particularly fluoride. However, this is to misunderstand that the only cause of caries is dietary sugars. These provide a substrate for cariogenic oral bacteria to flourish and to generate enamel-demineralizing acids. Modifying factors such as fluoride and dental hygiene would not be needed if we tackled the single cause--sugars. In this article, we demonstrate the sensitivity of cariogenesis to even very low sugars intakes. Quantitative analyses show a log-linear dose-response relationship between the sucrose or its monosaccharide intakes and the progressive lifelong development of caries. This results in a substantial dental health burden throughout life. Processed starches have cariogenic potential when accompanying sucrose, but human studies do not provide unequivocal data of their cariogenicity. The long-standing failure to identify the need for drastic national reductions in sugars intakes reflects scientific confusion partly induced by pressure from major industrial sugar interests.

Reducing Inequalities in Oral Health in the Africa and Middle East Region.

Dentistry is facing many serious challenges and threats. Addressing them will require major changes in strategy. This work outlines the extent of dental disease in the Africa and Middle East Region (AMER) and suggests strategies to reduce inequalities in oral health. The main oral health challenges in the AMER relate to controlling the relentless increase in caries with age. A very conservative estimate of population caries levels suggests that a 5-fold increase in dental personnel would be required just to treat current levels of caries. Hence, we argue that current approaches to control caries in the AMER are both ineffective and unaffordable, and a new model to promote oral health is needed. Unless determinants of noncommunicable diseases are addressed and access to evidence-based minimal intervention dental care is improved, the burden of dental disease will persist. The new oral health promotion model calls for an integrated intersectoral common risk factor approach, namely, "oral health in all policies" (OHiAP). An OHiAP framework will initiate high-level policy initiatives and intersectoral partnerships. Oral health professionals have an important advocacy role in securing the fundamental changes in health strategy needed to control the growing, unjust, and unaffordable burden of oral disease.

An analysis of methods of toothbrushing recommended by dental associations, toothpaste and toothbrush companies and in dental texts.

OBJECTIVES: To assess the methods of toothbrushing recommended for both adults and children by dental associations, toothpaste and toothbrush companies and professional sources such as in dental textbooks and by experts. Secondly, to compare the advice by source and whether recommendations differed for adults and for children. METHODS: Examination of online material on methods of toothbrushing from dental associations, toothpaste and toothbrush companies and associated organisations providing professional advice; as well as from dental texts. RESULTS: There was a wide diversity between recommendations on toothbrushing techniques, how often people should brush their teeth and for how long. The most common method recommended was the Modified Bass technique, by 19. Eleven recommended the Bass technique, ten recommended the Fones technique and five recommended the Scrub technique. The methods recommended by companies, mainly toothpaste companies, differed from those of dental associations, as did advice in dental textbooks and research-based sources. There was a wide difference in the toothbrushing methods recommended for adults and for children. CONCLUSIONS: The unacceptably large diversity in recommendations on what toothbrushing method to use should concern the dental profession. Higher grades of evidence of effectiveness of toothbrushing techniques are required to inform professional bodies that develop guidelines on toothbrushing.

The role of the dental team in promoting health equity.

A recent important report endorsed by several prestigious and influential medical and dental organisations has outlined what health professions can do to reduce health inequalities. Despite overall improvements in oral health in recent decades, there are unacceptable inequalities in oral diseases. Urgent action is needed to reduce these unfair and unjust oral health inequalities that exist across society. Primary care dental teams are in an important position to become actively engaged in promoting oral health equity, both for their own patients and the wider community. This paper highlights practical ways that dental teams can become involved in action to reduce oral health inequalities.

The relation between oral impacts on daily performances and perceived clinical oral conditions in primary school children in the Ugu District, Kwazulu Natal, South Africa.

UNLABELLED: Few studies have related the common oral health related quality of life (OHRQoL) impacts in children to perceived causes. OBJECTIVE: To assess the prevalence, extent and intensity of oral impacts in relation to perceived clinical conditions in primary school children in South Africa. METHODS: Cross-sectional study of a random sample of children attending 26 schools. The Child Oral Impacts on Daily Performance (Child-OIDP) index, administered through individual face-to-face interviews, was used. RESULTS: Sixty four per cent of the sample of 2610 children aged 11-13 years participated. 36.2% reported having one or more oral impacts on daily performances, 61.1% having one affected and 63.1% reporting impacts were of "very little" or "little" intensity. Eating was most commonly affected (22.8%) mainly related to decay (40%), followed by cleaning the teeth (17.2%). Toothache impacted on speaking (32.5%), whereas toothache (35.7%) and tooth decay (28.6%) influenced studying. Position of teeth impacted on smiling (19.2%), social (8.5%) and speaking (7.5%). Bleeding gums" and "tooth colour" affected cleaning teeth and smiling respectively. CONCLUSIONS: The prevalence of oral impacts on the quality of life in this South African population of schoolchildren was relatively modest, as was the extent and intensity of the impacts, affecting mainly eating, cleaning of teeth and smiling.

Sociodemographic differences in oral health-related quality of life related to dental caries in thai school children.

OBJECTIVE: This study aimed to assess associations between sociodemographic and oral health behavioural factors with dental caries and oral health-related quality of life (OHRQoL) attributed to dental caries in a national representative sample of 12- and 15-year-old Thai children. METHOD: A representative subsample from the sixth Thailand National Oral Health Survey, 1,063 12-year-olds and 811 15-year-olds, completed a questionnaire on sociodemographic and behavioural information and were orally examined and interviewed about OHRQoL using the Child-OIDP or OIDP indexes. Associations of sociodemographic and behavioural factors with DMFT and Condition-Specific impacts (CS-impacts) attributed to dental caries were investigated using Chi-square tests and regressions. RESULTS: For both groups, DMFT scores were associated with gender, geographic area and recently receiving dental treatment. Geographic area was the only sociobehavioural factor independently associated with CS-impacts. Dental caries accounted for the significant associations of sugary snacks and drinks consumption with CS-impacts. Significant associations of CS-impacts with consuming crispy snacks in 12-year-olds and fizzy drinks in 15-year-olds became non-significant when DT was entered into models. CONCLUSIONS: There were considerable geographic differences in DMFT and CS-impacts attributed to dental caries among Thai children.

Impacts on quality of life related to dental caries in a national representative sample of Thai 12- and 15-year-olds.

Dental caries is generally given the highest priority in national oral health services for school-aged populations. Yet, there is no study exploring the impacts on quality of life specifically related to dental caries in national samples of school-aged children. This study assessed prevalence and characteristics of oral impacts attributed to dental caries on quality of life and compared them with overall oral health impacts. In addition, associations of oral impacts attributed to dental caries and dental caries status were investigated. A national representative sample of 1,063 12- and 811 15-year-olds completed a sociodemographic and behavioural questionnaire, and were orally examined and interviewed about oral health-related quality of life using the Child-OIDP or OIDP indexes, respectively. Associations of condition-specific impacts (CS impacts) attributed to dental caries with components of DMF were investigated using χ(2) tests and multivariate logistic regressions. CS impacts attributed to dental caries were reported by nearly half the children and such impacts accounted for half of overall oral impacts from all oral conditions. The majority of impacts were of little intensity and affected only 1-2 daily performances, particularly performances on Eating, Emotional stability and Cleaning teeth. CS impacts were significantly positively associated with number of decayed teeth, and strongly associated with severe decay.

Relationship between periodontal status and levels of glycated hemoglobin.

The objective of this study was to assess whether there is a bi-directional relationship between periodontal status and diabetes. Study 1 included 5,856 people without periodontal pockets of ≥ 4 mm at baseline. Relative risk was estimated for the 5-year incidence of periodontal pockets of ≥ 4 mm (CPI scores 3 and 4, with the CPI probe), in individuals with glycated hemoglobin (HbA1c) levels of ≥ 6.5% at baseline. Study 2 included 6,125 people with HbA1c < 6.5% at baseline. The relative risk was assessed for elevation of HbA1c levels in 5 years, with baseline periodontal status, assessed by CPI. Relative risk of developing a periodontal pocket was 1.17 (p = 0.038) times greater in those with HbA1c of ≥ 6.5% at baseline, adjusted for body mass index (BMI), smoking status, sex, and age. Relative risks for having HbA1c ≥ 6.5% at 5-year follow-up in groups with periodontal pockets of 4 to 5 mm and ≥ 6 mm at baseline were 2.47 (p = 0.122) and 3.45 (p = 0.037), respectively, adjusted for BMI, alcohol consumption, smoking status, sex, and age. The risk of developing periodontal disease was associated with levels of HbA1c, and the risk of elevations of HbA1c was associated with developing periodontal pockets of more than 4 mm.

Oral health and cancer, cardiovascular, and respiratory mortality of Japanese.

Cardiovascular diseases, cancer, and respiratory disease are major causes of death in developed countries. No study has simultaneously compared the contribution of oral health with these major causes of death. This study examined the association between oral health and cardiovascular diseases, cancer, and respiratory mortality among older Japanese. Self-administered questionnaires were mailed to participants in the Aichi Gerontological Evaluation Study (AGES) Project in 2003. Mortality data were analyzed for 4425 respondents. Three categories of oral health were used: 20 or more teeth, 19 or fewer teeth and eat everything, 19 or fewer teeth and eating difficulty. Sex, age, body mass index (BMI), self-rated health, present illness, exercise, smoking, alcohol, education, and income were used as covariates. During 4.28 years' follow-up, 410 people died, 159 from cancer, 108 of cardiovascular diseases, and 58 of respiratory disease. Multivariate adjusted Cox proportional hazard models showed that, compared with the respondents with 20 or more teeth, respondents with 19 or fewer teeth and with eating difficulty had a 1.83 and 1.85 times higher hazard ratio for cardiovascular disease mortality and respiratory disease mortality, respectively. There was no significant association with cancer mortality. Oral health predicted cardiovascular and respiratory disease mortality but not cancer mortality in older Japanese.

Global oral health inequalities: task group--implementation and delivery of oral health strategies.

This paper reviews the shortcomings of present approaches to reduce oral diseases and inequalities, details the importance of social determinants, and links that to research needs and policies on implementation of strategies to reduce oral health inequalities. Inequalities in health are not narrowing. Attention is therefore being directed at determinants of major health conditions and the extent to which those common determinants vary within, between, and among groups, because if inequalities in health vary across groups, then so must underlying causes. Tackling inequalities in health requires strategies tailored to determinants and needs of each group along the social gradient. Approaches focusing mainly on downstream lifestyle and behavioral factors have limited success in reducing health inequalities. They fail to address social determinants, for changing people's behaviors requires changing their environment. There is a dearth of oral health research on social determinants that cause health-compromising behaviors and on risk factors common to some chronic diseases. The gap between what is known and implemented by other health disciplines and the dental fraternity needs addressing. To re-orient oral health research, practice, and policy toward a 'social determinants' model, a closer collaboration between and integration of dental and general health research is needed. Here, we suggest a research agenda that should lead to reductions in global inequalities in oral health.

Assessment of time taken to treat dental trauma in Nigerian children.

AIM: To assess the clinical time (diagnosis and treatment times) to manage traumatic dental injuries (TDIs) in children attending paediatric dental clinics in Nigeria. STUDY DESIGN: Cross sectional observational pilot study on children presenting at four government hospitals in South West Nigeria over a 3-month period. METHODS: Dental injury was classified using the method recommended by Andreasen et al. [2003]. A standardized protocol was followed and the details of the diagnosis time, treatment time and total clinical time for management of different traumatic injuries to the primary and permanent dentition were recorded and calculated on a data collection form. RESULTS: There were 73 dental injuries in 39 children. For the primary dentition, complicated crown fracture had the highest average total treatment time namely 76.0±48.1 minutes as well as the highest average number of visits (2.6 visits). More time was spent manageing the same level of injury in the permanent dentition than in the primary dentition. For the permanent dentition, extrusive luxation injury had the highest average total treatment time (103.3±11.5 minutes). CONCLUSION: The clinical time for management of dental injuries in children was relatively high and varied by type of injury.

Five-year incidence of periodontal disease is related to body mass index.

Numerous cross-sectional epidemiological studies suggest that obesity is associated with periodontal disease. This longitudinal study tested whether body mass index (BMI) was related to the development of periodontal disease in a sample of employed Japanese participants. Data are from the statutory medical checkups routinely collected for employees in and around Nagoya, Japan. The authors tested the relationship between BMI at baseline and the 5-year incidence of periodontal disease in a sample of 2787 males and 803 females. The hazard ratios for developing periodontal disease after 5 years were 1.30 (P < .001) and 1.44 (P = .072) in men and 1.70 (P < .01) and 3.24 (P < .05) in women for those with BMIs of 25-30 and ≥ 30, respectively, compared to those with BMI < 22, after adjusting for age, smoking status, and clinical history of diabetes mellitus. These findings demonstrate a dose-response relationship between BMI and the development of periodontal disease in a population of Japanese individuals.

Using universal patterns of caries for planning and evaluating dental care.

There are universal patterns of caries, in terms of prevalence, incidence, frequency distribution and rates of progression, in permanent teeth that can be considered working rules that can be applied when planning dental care. The universal patterns are: (1) caries levels follow trend lines; therefore, knowing the caries level at one age can be used to predict the levels at later ages in that cohort by looking at the trend line for that cohort; (2) the distribution of dental caries of a population exhibits the following characteristics: as the mean DMFT increases, the percentage of caries-free individuals falls and the caries distribution widens; this changing relationship between the mean DMFT and prevalence is not limited to a subgroup of the population who already have had some caries experience; (3) there is a specific mathematical relationship between the mean DMFT and mean DMFS; (4) there is a hierarchy of caries susceptibility by tooth type and sites on teeth; for a given DMFT or DMFS, there is a specific intra-oral pattern of caries by tooth type; (5) changes in mean DMFT scores for individuals and groups are not linear, but 'stepped'; there are groupings of teeth and tooth sites that may have similar 'resistance' to caries; (6) as the mean DMFT declines, the posteruptive time for initiation of caries increases and the progression rate of caries through enamel decreases. This is true regardless of the presence of fluoride. Any improvement in dental health will cause this effect.

Edentulism and fruit and vegetable intake in low-income adults.

Poor dental status negatively relates to dietary intakes. However, this issue has not been researched among the most vulnerable groups in society. We aimed to investigate, in a national low-income sample, the association between dental status and fruit and vegetable consumption. We analyzed data on adults aged 50 years and older from the Low Income Diet and Nutrition Survey, a representative sample of deprived UK households. Considerable numbers reported difficulty eating specific foods, with significantly worse experience among edentate than dentate people. The mean daily fruits and vegetables consumption was low (256.5 g for dentate, 207.1 g for edentate). After adjustment for socio-demographic and behavioral variables, edentate individuals consumed 50.7 g (27.0, 74.3) fewer fruits/vegetables per day than the dentate. Over and above the effects of material deprivation on nutrient intake, edentulism negatively relates to eating fruits and vegetables and achieving a healthy diet in materially deprived older adults.

The role of cognitive ability in socio-economic inequalities in oral health.

Studies have postulated a role for cognitive ability in socio-economic inequalities in general health. This role has not been examined for oral health inequalities. We examined whether cognitive ability was associated with oral health, and whether it influenced the relationship between oral health and socio-economic position. Data were from the Third National Health and Nutrition Examination Survey (1988-1994), for participants aged 20-59 years. Oral health was indicated by extent of gingival bleeding, extent of loss of periodontal attachment, and tooth loss. Simple reaction time test, symbol digit substitution test, and serial digit learning test indicated cognitive ability. Education and poverty-income ratio were used as markers of socio-economic position. Participants with poorer cognitive ability had poorer oral health for all indicators. The association between oral health and socio-economic position attenuated after adjustment for cognitive ability. Cognitive ability explained part, but not all, of the socio-economic inequalities in oral health.