County-level correlates of dental service utilization for low income pregnant women. Ecologic study of the North Carolina Medicaid for Pregnant Women (MPW) program.

BACKGROUND: Dental care utilization for low income pregnant women is met with challenges in the traditional dentist-centered model of care. County-level measures provide insights for policy and roles for stakeholders that extend beyond the dentist-patient relationship. We examined county-level data to generate hypotheses about factors that influence utilization of dental services in North Carolina's Medicaid for Pregnant Women (MPW) program. METHODS: County-level Medicaid utilization data for dental services for 2014-2016 were pooled to get mean county estimates of dental utilization in the MPW program. Descriptive statistics and multivariate regression models of dental utilization and county-level measures are presented. Data used were collected by NC Child and the Robert Wood Johnson Foundation's County Health Rankings Reports. USDA Economic Research Service data were used to categorize counties in terms of Farming, Recreation, Persistent Poverty, and metro/non-metro status using Rural Urban Continuum Codes. RESULTS: Dental utilization ranged from 1-26% with a median of 8.5% across the 100 counties of North Carolina. Strong patterns linking utilization of dental services in the MPW program to contextual social measures of well-being emerged, specifically, increased reporting of child abuse and neglect, elevated infant mortality, poor quality of life, and worse ranking in years of potential life lost. Counties with persistent poverty had lower rates of dental utilization. CONCLUSIONS: Utilization of dental services in the MPW program is generally low. Patterns identify the potential for enhancing community-clinical linkages to improve birth outcomes and care coordination for pregnant women to enhance dental utilization in this population. Dental coverage in the Medicaid program in most states is administered separately from medical coverage. The separation of the funding mechanisms adds a further layer of complexity to care integration. Efforts to enhance dental care for pregnant women in the Medicaid program may benefit from policy that aligns incentives for care coordination within the community. Policy that extends the window of eligibility for dental benefits to 24 months after the birth of the child will help women complete the dental treatment that is needed. This also leverages the value of care coordination for community stakeholders from diverse child health sectors.

Association between periodontitis and spontaneous abortion: A case-control study.

BACKGROUND: Spontaneous abortion, or miscarriage, is a complication of pregnancy which can severely affect women both physically and psychologically. We investigated the associations of periodontitis and periodontopathic bacteria with spontaneous abortion. METHODS: We conducted a matched case-control study in two tertiary hospitals in Khon Kaen, Thailand. Cases were 85 women with spontaneous abortion at <20 weeks of gestation matched to 85 controls on age, gestational age, and hospital. Full-mouth periodontal examinations were performed. Periodontitis was defined as at least one site with probing depth ≥5 mm and clinical attachment level ≥2 mm at the same site. Subgingival plaque samples were collected to determine the levels of Porphyromonas gingivalis, Tannerella forsythia, and Fusobacterium nucleatum using real time polymerase chain reaction. RESULTS: The cases were significantly more likely to have periodontitis (50.6%) than the controls (21.2%; P = 0.007). Conditional logistic regression revealed a crude odds ratio (OR) of 4.1 for the association between periodontitis and spontaneous abortion (95% confidence interval [CI] = 1.9-8.9, P = 0.001). The OR decreased, but was still significant, after controlling for previous miscarriage (OR = 3.3, 95% CI = 1.4-7.8, P = 0.006). There was no significant association between the levels of periodontopathic bacteria and spontaneous abortion. Increased levels of P. gingivalis and F. nucleatum were associated with periodontitis in both case and control groups. Association between increased T. forsythia levels and periodontitis was observed only in the case women. CONCLUSIONS: Periodontitis was more common in women with spontaneous abortions as compared with matched controls. Levels of periodontopathic bacteria was not associated with spontaneous abortion in this population.

Microtensile Bond Strength Between Glass Ionomer Cement and Silver Diamine Fluoride-Treated Carious Primary Dentin.

Purpose: The study objectives were to investigate the effect of silver diamine fluoride (SDF) on the microtensile bond strength between glass ionomer cement and carious primary dentin and evaluate the mode of restoration failure. Methods: Forty carious primary molars were sectioned in half through the middle of the carious lesion and randomly allocated to test and control groups. The test specimens were treated with 38 percent SDF, and the control, deionized water. The samples were stored in artificial saliva for 14 days at 37 degrees Celsius, and the dentin surfaces were conditioned and restored with Fuji IX GP Extra. After 24 hours in artificial saliva, the specimens were prepared for microtensile bond strength testing and stressed in tension at one mm per minute until failure. Mean bond strengths were compared using the paired t test. The failure mode was assessed with a stereomicroscope under 40X magnification. Results: The mean microtensile strength for the test group was 7.4 MPa (SD=±5.1) and 6.3 (±4.6) for the control group (P>0.05). Most common failure mode was the mixed failure mode in both groups. Conclusion: Silver diamine fluoride does not adversely affect the bond strength between glass ionomer cement and carious primary dentin in vitro.

Nationwide 2.5-Year School-Based Public Health Intervention Program Designed to Reduce the Incidence of Caries in Children of Grenada.

UNLABELLED: This paper describes an innovative public health intervention, called 'Smile Grenada', targeting the oral health of children in Grenada utilizing the resources of a US dental school, several oral health care companies, local governmental and public health authorities, and Grenadian school personnel. METHODS: Preintervention visual/tactile caries examinations were collected from 1,092 schoolchildren (mean age 9.9 years, standard deviation, SD = 3.7) in 2010. The intervention included: (1) classroom-based toothbrushing with fluoridated toothpaste, (2) fluoride varnish applied by trained dental students, teachers and local providers 3 times a year and (3) glass ionomer sealants placed on first permanent molars in children aged 6-8 years. Postintervention data were collected in May, 2013 (n = 2,301, mean age 9.8 years, SD = 3.7). Decayed and demineralized surfaces were examined for the whole sample and decay/demineralization and sealant retention on 6-year molars were examined separately (ages 6-8 in 2013 cohort). RESULTS: The number of decayed/demineralized surfaces declined across all age groups. The average number of decayed surfaces dropped from 9 at baseline to just over 6 (F1, 3,393 = 69.8, p < 0.0001) and the average number of demineralized surfaces dropped from 6 to less than 2 (1.8 surfaces; F1, 3,393 = 819.0, p < 0.0001). For children aged 6-8 years, there were statistically significantly fewer decayed surfaces (t1, 2,086 = 12.40, p < 0.0001; mean baseline 0.93, SD = 1.75; mean follow-up 0.23, SD = 0.83) and demineralized surfaces (t1, 2,086 = 19.7, p < 0.0001; mean baseline 2.11, SD = 2.74; mean follow-up 0.50, SD = 0.97) on 6-year molars. The Smile Grenada program successfully demonstrated a locally sustainable model for improving oral health in children in a developing country.

Noxious family environments in relation to adult and childhood caries.

BACKGROUND: The authors tested hypotheses that more noxious family environments are associated with poorer adult and child oral health. METHODS: A community sample of married or cohabiting couples (N = 135) and their elementary school-aged children participated. Dental hygienists determined the number of decayed, missing and filled surfaces via oral examination. Subjective oral health impacts were measured by means of questionnaires completed by the parents and children. The parents completed questionnaires about interparental and parent-to-child physical aggression (for example, pushing) and emotional aggression (for example, derision), as well as harsh discipline. Observers rated the couples' hostile behavior in laboratory interactions. RESULTS: The extent of women's and men's caries experience was associated positively with their partners' levels of overall noxious behavior toward them. The extent of children's caries experience was associated positively with the level of their mothers' emotional aggression toward their partners. CONCLUSIONS: Noxious family environments may be implicated in compromised oral health. Future research that replicates and extends these findings can provide the foundation to translate them into preventive interventions. PRACTICAL IMPLICATIONS: Noxious family environments may help explain the limitations of routine oral health preventive strategies. Interprofessional strategies that also address the family environment ultimately may prove to be more effective than are single modality approaches.

Periodontal inflammatory conditions among gutka chewers and non-chewers with and without prediabetes.

BACKGROUND: It is known that gutka chewing jeopardizes periodontal health; however, severity of periodontal inflammation in gutka chewers with and without prediabetes remains unknown. The aim of this study is to investigate the association of periodontal inflammatory conditions with gutka chewing and prediabetes. METHODS: In this cross-sectional study, the effect of gutka use on periodontal health is investigated among 44 individuals with prediabetes and 44 without prediabetes. Demographic information regarding age, sex, duration of prediabetes, and gutka-chewing habits was collected using a questionnaire. Periodontal inflammatory conditions (plaque index [PI], bleeding on probing [BOP], probing depth [PD], marginal bone loss [MBL]) and fasting blood glucose levels (FBGLs) were recorded. Group differences in periodontal inflammatory parameters were tested using univariate and multivariable analyses (α ≤5%). RESULTS: Periodontal inflammatory parameters (PI, BOP, and PD) were significantly higher in individuals with prediabetes irrespective of gutka-chewing habit (P <0.05). Odds of periodontal inflammation in individuals with prediabetes were nine times higher than in healthy controls (95% confidence interval [CI] = 3.4 to 23.6). Gutka chewing alone, chewing among individuals with prediabetes, and chewing among healthy controls did not significantly increase the odds of periodontal inflammatory conditions. Individuals with prediabetes were significantly more likely to have periodontal inflammation than individuals without prediabetes even after controlling for sex and gutka chewing (odds ratio = 13.2; 95% CI = 4.3 to 40.7). CONCLUSION: In medically healthy individuals, periodontal inflammatory conditions are worse in gutka chewers compared to non-chewers; in patients with prediabetes, the severity of periodontal inflammation is governed by hyperglycemia when compared to habitual gutka usage.

Periodontitis and gestational diabetes mellitus in non-smoking females.

BACKGROUND: Chronic inflammation has been implicated in the pathogenesis of gestational diabetes mellitus (GDM). Periodontal disease is associated with increased levels of inflammatory mediators and may be a risk factor for GDM. The authors aimed to examine the association between periodontitis and GDM among non-smoking pregnant females. METHODS: This case-control study included 50 females who were diagnosed with GDM and 50 age- and hospital-matched females without diabetes in Khon Kaen, Thailand. Full-mouth periodontal examinations were performed during pregnancy by two calibrated dentists who were unaware of the case-control status. Periodontitis was defined as ≥1 site with probing depth (PD) ≥5 mm and clinical attachment level (CAL) ≥2 mm at the same site. Serum samples were collected to measure C-reactive protein (CRP), tumor necrosis factor-α, and interleukin-6 levels. Analyses were performed using conditional logistic regression. RESULTS: Fifty percent of the case females had periodontitis compared to 26% of the controls. Females with GDM had significantly higher mean PD and CAL, more sites with bleeding on probing, and increased levels of CRP compared to the controls. Periodontitis was significantly associated with GDM (odds ratio = 3.00, 95% confidence interval = 1.19 to 7.56). The association remained significant with additional adjustment for family history of diabetes, prepregnancy body mass index, and weight gain during pregnancy. CONCLUSIONS: The results suggest that periodontitis is associated with GDM. Therefore, clinicians should assess periodontal conditions of pregnant females.

Involvement of Ayurvedic practitioners in oral health care in the United States.

BACKGROUND: Ayurveda, an ancient medical science originating in India, also is practiced in the United States. The authors conducted a study primarily to explore the involvement of Ayurvedic practitioners in treating oral diseases. METHODS: Eighty-five practitioners participated in this cross-sectional survey. The authors obtained self-reported data on demographics of the practitioners, the general and oral health conditions they treated, and the treatment modalities used. They performed descriptive statistical and logistic regression analyses by using statistical software. RESULTS: Participants predominantly were female and white or non-Hispanic, as well as part-time practitioners. Their educational backgrounds ranged from a 5½-year bachelor's degree in Ayurveda to short-term training. Of the 60 respondents who answered the question about treating oral diseases, 25 (42 percent) reported that they did so. Conditions treated were related to oral malodor, gingival or periodontal disease and toothache. Ayurvedic treatments administered for these conditions primarily were preventive in nature. CONCLUSIONS: Ayurvedic practitioners in the United States treat a variety of oral diseases by using predominantly preventive traditional care. Ayurvedic practitioners of Asian origin and those who practiced for a longer duration were more likely to report that they treated oral diseases. Larger, population-based studies are needed to understand more fully the current role of Ayurvedic practitioners in oral health care. Ayurvedic treatment modalities aimed at oral diseases need to be evaluated through rigorous randomized controlled trials for safety and effectiveness. PRACTICE IMPLICATIONS: Patients with limited or no access to oral health care might seek Ayurvedic treatment, and those who have access to conventional oral health care might wish to complement it with Ayurvedic treatment. Practitioners can incorporate preventive Ayurvedic treatments, which are based mainly on natural products, into overall preventive care regimens, if proven safe and effective.

Evaluation of in-office dental unit waterline testing.

In-office dental unit waterline (DUWL) testing systems are commercially available for monitoring DUWL bacteria. The current study compared Aquasafe, Petrifilm, and Heterotrophic Plate Count Sampler (HPCS) with R2A plating methodology, considered the gold standard for enumerating heterotrophic bacteria in potable water. Samples were collected from 20 dental units. Heterotrophic bacterial counts of ≤500 CFUs/mL were used as the cut-off for assessing in-office testing compared to R2A laboratory plating. Validity was assessed using sensitivity and specificity, along with positive and negative predictive values. Results were also compared using concordance and kappa statistics. All in-office tests demonstrated 100% specificity and positive predictive values, while sensitivity and negative predictive values were low (Petrifilm, 57%/50%; HPCS, 50%/46%; Aquasafe, 21%/35%). Concordance and kappa values for agreement with R2A plating were as follows: Petrifilm 70% (κ = 0.44), HPCS 65% (κ = 0.38), and Aquasafe 45% (κ = 0.14). In-office DUWL testing with Aquasafe, Petrifilm, and HPCS agreed poorly with R2A plating methodology and is not valid or reliable as a means of accurately monitoring bacterial density in DUWL. These in-office test systems should not be used for assessing compliance with the ADA and CDC standard for acceptable heterotrophic bacterial counts in DUWLs (≤500 CFUs/mL).

Periodontal disease is related to local and systemic mediators of inflammation.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Local and systemic biomarkers in gingival crevicular fluid increase odds of periodontitis. Fitzsimmons TR, Sanders AE, Bartold PM, Slade GD. J Clin Periodontol 2010;37(1):30-6. REVIEWER: Ananda P. Dasanayake, BDS, MPH, PhD, FACE. PURPOSE/QUESTION: The authors attempted to study the independent and combined effects of local (IL-1ß) and systemic (CRP) inflammatory biomarkers in gingival crevicular fluid (GCF) on the risk of periodontitis. SOURCE OF FUNDING: Government: National Health and Medical Research Council (NHMRC) of Australia and NHMRC Sidney Sax Public Health Fellowship. TYPE OF STUDY/DESIGN: Case-control study. LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence. STRENGTH OF RECOMMENDATION GRADE: Not applicable.

Tooth decay in alcohol abusers compared to alcohol and drug abusers.

Alcohol and drug abuse are detrimental to general and oral health. Though we know the effects of these harmful habits on oral mucosa, their independent and combined effect on the dental caries experience is unknown and worthy of investigation. We compared 363 "alcohol only" abusers to 300 "alcohol and drug" abusers to test the hypothesis that various components of their dental caries experience are significantly different due to plausible sociobiological explanations. After controlling for the potential confounders, we observe that the "alcohol and drug" group had a 38% higher risk of having decayed teeth compared to the "alcohol only" group (P < .05). As expected, those who belonged to a higher social class (OR = 1.98; 95% CI = 1.43-2.75) and drank wine (OR = 1.85; 95% CI = 1.16-2.96) had a higher risk of having more filled teeth. We conclude that the risk of tooth decay among "alcohol only" abusers is significantly lower compared to "alcohol and drug" abusers.

"Does periodontal therapy reduce the risk for systemic diseases?".

Periodontal disease is treated by various approaches, including simple oral hygiene practices, professional mechanical debridement, antimicrobial therapy and periodontal surgery. There is evidence to associate periodontal disease with several systemic diseases and conditions, including myocardial infarction, adverse pregnancy outcomes, diabetes mellitus, and respiratory disease. This article reviews the published literature that describes the effects of periodontal treatment on cardiovascular diseases, adverse pregnancy outcomes, diabetes mellitus, and respiratory disease. While some progress has been made, further research is required to understand the value of periodontal interventions in the prevention of systemic diseases.

Maté drinking and oral and oro-pharyngeal cancer: a systematic review and meta-analysis.

In Latin America, maté is consumed as a beverage regularly. Among the cancers that are associated with maté drinking is oral and oro-pharyngeal cancer, incidence of which is high in the region. In order to further understand this association between maté drinking and the risk of oral and oro-pharyngeal cancer, we performed a systematic review and meta-analysis of related studies. All relevant studies published in English as original articles up to June 2009 were identified through a literature search using PubMed and Medline and by reviewing the references from the retrieved articles. Four case-control studies done in Latin America were identified. There were 879 maté users and 1128 non- or low-maté users in those studies with a total of 566 oral and oro-pharyngeal cancers. The adjusted association between maté drinking and oral and oro-pharyngeal cancer was significant within 3 of those studies. Meta-analysis yielded a significant summary odds ratio (OR) of 2.11 (95% confidence interval=1.39-3.19). Population Attributable Risk for maté drinking was 16%. While the epidemiological data indicate that maté users have an increased risk of oral and oro-pharyngeal cancer, little is known about whether this increased risk is due to the high temperature of the beverage when it is consumed or due to certain carcinogenic constituents that are present in maté. More human and animal studies are needed before a conclusion can be made on the oral and oro-pharyngeal carcinogenic risk of maté to humans.

TNF-alpha and antibodies to periodontal bacteria discriminate between Alzheimer's disease patients and normal subjects.

The associations of inflammation/immune responses with clinical presentations of Alzheimer's disease (AD) remain unclear. We hypothesized that TNF-alpha and elevated antibodies to periodontal bacteria would be greater in AD compared to normal controls (NL) and their combination would aid clinical diagnosis of AD. Plasma TNF-alpha and antibodies against periodontal bacteria were elevated in AD patients compared with NL and independently associated with AD. The number of positive IgG to periodontal bacteria incremented the TNF-alpha classification of clinical AD and NL. This study shows that TNF-alpha and elevated numbers of antibodies against periodontal bacteria associate with AD and contribute to the AD diagnosis.

Promoting better oral health practices among aboriginal Taiwanese adolescents: a school based oral health education intervention program.

The purpose of this study was to test the efficacy of an educational program aimed at improving oral health knowledge and behaviors in junior high school students in indigenous communities in Taiwan. Two junior high schools were randomly selected. Students in the intervention school received an oral health education program. Both groups received structured questionnaires to assess their oral health practices and risk behaviors at baseline and after the intervention. The intervention group had statistically significant positive changes in their oral health knowledge (p<.001), an increase in tooth-brushing frequency (p<.001), and a decrease in tobacco use (p=.01). Most (87%) students considered the educational program excellent or good. Carefully designed health education programs delivered within schools in areas with limited access to health care can improve the students' knowledge and reduce their risk behaviors which may prove to be a mechanism that ultimately reduces health disparities.

Inflammation and Alzheimer's disease: possible role of periodontal diseases.

The molecular and cellular mechanisms responsible for the etiology and pathogenesis of Alzheimer's disease (AD) have not been defined; however, inflammation within the brain is thought to play a pivotal role. Studies suggest that peripheral infection/inflammation might affect the inflammatory state of the central nervous system. Chronic periodontitis is a prevalent peripheral infection that is associated with gram-negative anaerobic bacteria and the elevation of serum inflammatory markers including C-reactive protein. Recently, chronic periodontitis has been associated with several systemic diseases including AD. In this article we review the pathogenesis of chronic periodontitis and the role of inflammation in AD. In addition, we propose several potential mechanisms through which chronic periodontitis can possibly contribute to the clinical onset and progression of AD. Because chronic periodontitis is a treatable infection, it might be a readily modifiable risk factor for AD.

Alzheimer's disease and peripheral infections: the possible contribution from periodontal infections, model and hypothesis.

Alzheimer's disease (AD) affects approximately 4.5 million people in the U.S. and this number will increase as the population ages and the life-span increases. Therefore, of paramount importance is identifying mechanisms and factors that affect the risk of developing AD. The etiology and pathogenic mechanisms for AD have not been defined, although inflammation within the brain is thought to play a role. Consistent with this hypothesis, studies suggest that peripheral infections contribute to the inflammatory state of the central nervous system. Periodontitis is a prevalent, persistent peripheral infection associated with gram negative, anaerobic bacteria that are capable of exhibiting localized and systemic infections in the host. This review offers a hypothetical link between periodontitis and AD and will present possible mechanistic links between periodontitis related inflammation and AD. It will review the pathogenesis of periodontitis and the mechanisms by which periodontal infections may affect the onset and progression of AD. Since periodontitis is a treatable condition, it may be a readily modifiable risk factor for AD.