Psychosocial Risk Exposure Limits Routine Pediatric Oral Health Care.

Introduction: This study aimed to identify social, psychological, and contextual factors that influenced attendance at routine oral health visits in a cohort of 189 preschool children who were followed over a 2-year period. Methods: Generalized estimating equation was used to examine the association between clinic attendance and the predictors. ORs and 95% CIs were reported in the multiple logistic regression models. The study was conducted in Rochester, New York, between February 2016 and February 2021. Results: Prior to the COVID-19 pandemic declaration, the rate of canceled and no-show appointments was greater for routine clinic visits (20% and 24%, respectively) than for research visits (14% and 9%, respectively) for the same participants; these rates increased during the pandemic. After adjusting for sociodemographic factors, the likelihood of a canceled or no-show appointment was associated with parental depression (OR=1.06, CI=1.03, 1.09), regardless of the type or occurrence of the visit. Conclusions: Findings from this study demonstrate that attendance to oral health care in young children is reliably reduced with parental depression and that this may provide one mechanism for early emerging health inequalities of oral health.

Interprofessional collaboration and smartphone use as promising strategies to improve prenatal oral health care utilization among US underserved women: results from a qualitative study.

BACKGROUND: Data on barriers and facilitators to prenatal oral health care among low-income US women are lacking. The objective of this study was to understand barriers/facilitators and patient-centered mitigation strategies related to the use of prenatal oral health care among underserved US women. METHODS: We used community-based participatory research to conduct two focus groups with eight pregnant/parenting women; ten individual in-depth interviews with medical providers, dental providers and community/social workers; and one community engagement studio with five representative community stakeholders in 2018-2019. Using an interpretive description research design, we conducted semi-structured interviews and focus groups which were audio-recorded, transcribed, and analyzed for thematic content. RESULTS: We identified individual and systemic barriers/facilitators to the utilization of prenatal oral health care by underserved US women. Strategies reported to improve utilization included healthcare system-wide changes to promote inter-professional collaborations, innovative educational programs to improve dissemination and implementation of prenatal oral health care guidelines, and specialized dental facilities providing prenatal oral health care to underserved women. Moreover, smartphones have the potential to be an innovative entry point to promote utilization of prenatal oral care at the individual level. CONCLUSIONS: Low-income women face multiple, addressable barriers to obtaining oral health care during pregnancy. Inter-professional collaboration holds strong promise for improving prenatal oral health care utilization.

Association of periodontal disease with depression and adverse birth outcomes: Results from the Perinatal database; Finger Lakes region, New York State.

Preterm and low birth weight infants are at greater risk for mortality and a variety of health and developmental problems. Data from the Finger Lakes Perinatal Data System database on 316,956 deliveries occurring between 2004-2014 and pregnancy outcomes were analyzed to assess the association of periodontal (gum) disease with depression, other maternal factors and adverse birth outcomes. Adjusted effects of periodontal disease and depression on adverse birth outcomes were estimated using multiple logistic regression models and path analysis. Having preterm delivery was associated significantly with depression (OR = 1.177; 95% CI: [1.146, 1.208]), having adequate health care (OR = 1.638; 95% CI: [1.589, 1.689]), smoking during pregnancy (OR = 1.259; 95% CI: [1.220, 1.300]), and being less educated (OR = 1.214; 95% CI: [1.174, 1.256]). Having low birth weight was significantly associated with depression (OR = 1.206; 95% CI: [1.170, 1.208]), smoking during pregnancy (OR = 1.855; 95% CI: [1.793, 1.919]), and being less educated (OR = 1.322; 95% CI: [1.275, 1.370]). Periodontal disease was significantly associated with alcohol use during pregnancy (OR = 1.314; 95% CI: [1.227, 1.407]) and white race (OR = 1.192; 95% CI: [1.167, 1.217]). Depression was significantly associated with periodontal disease (OR = 1.762; 95% CI: [1.727, 1.797]) and alcohol use during pregnancy (OR = 1.470; 95% CI: [1.377, 1.570]). We concluded that a positive association existed between depression during pregnancy and adverse birth outcomes, and that depression served as a mediator in the association of periodontal disease with adverse birth outcomes.

Prenatal Oral Health Care and Early Childhood Caries Prevention: A Systematic Review and Meta-Analysis.

Despite the advancement of early childhood caries (ECC) prediction and treatment, ECC remains a significant public health burden in need of more effective preventive strategies. Pregnancy is an ideal period to promote ECC prevention given the profound influence of maternal oral health and behaviors on children's oral health. However, studies have shown debatable results with respect to the effectiveness of ECC prevention by means of prenatal intervention. Therefore, this study systematically reviewed the scientific evidence relating to the association between prenatal oral health care, ECC incidence, and Streptococcus mutans carriage in children. Five studies (3 randomized control trials, 1 prospective cohort study, and 1 nested case-control study) were included for qualitative assessment. Tested prenatal oral health care included providing fluoride supplements, oral examinations/cleanings, oral health education, dental treatment referrals, and xylitol gum chewing. Four studies that assessed ECC incidence reduction were included in meta-analysis using an unconditional generalized linear mixed effects model with random study effects and age as a covariate. The estimated odds ratio and 95% confidence intervals suggested a protective effect of prenatal oral health care against ECC onset before 4 years of age: 0.12 (0.02, 0.77) at 1 year of age, 0.18 (0.05, 0.63) at 2 years of age, 0.25 (0.09, 0.64) at 3 years of age, and 0.35 (0.12, 1.00) at 4 years of age. Children's S. mutans carriage was also significantly reduced in the intervention group. Future studies should consider testing strategies that restore an expectant mother's oral health to a disease-free state during pregnancy.

Advancement Of Teledentistry At The University Of Rochester's Eastman Institute For Oral Health.

Dental caries is the most prevalent infectious disease among US children. National surveys have shown that poor and minority-group children are not only disproportionately affected by dental caries but also have limited access to oral health care. Following successful exploratory applications of both synchronous and asynchronous models at the Eastman Institute for Oral Health, teledentistry has been demonstrated to be a practical and cost-effective way to improve oral health care for rural and disadvantaged children. These models support the role of teledentistry in reducing the costs of and barriers to accessing oral health care, improving oral health outcomes, increasing use of oral health care resources, and leading to the establishment of a dental home for underserved children. The advancement of teledentistry underscores the need for its integration with local, regional, and national telehealth programs and the role of policy makers in establishing a balanced framework for teledentistry within the overarching health care system.

Prenatal vitamin D and dental caries in infants.

OBJECTIVES: Inadequate maternal vitamin D (assessed by using 25-hydroxyvitamin D [25OHD]) levels during pregnancy may affect tooth calcification, predisposing enamel hypoplasia and early childhood caries (ECC). The purpose of this study was to determine the relationship between prenatal 25OHD concentrations and dental caries among offspring during the first year of life. METHODS: This prospective cohort study recruited expectant mothers from an economically disadvantaged urban area. A prenatal questionnaire was completed and serum sample drawn for 25OHD. Dental examinations were completed at 1 year of age while the parent/caregiver completed a questionnaire. The examiner was blinded to mothers' 25OHD levels. A P value ≤ .05 was considered significant. RESULTS: Overall, 207 women were enrolled (mean age: 19 ± 5 years). The mean 25OHD level was 48 ± 24 nmol/L, and 33% had deficient levels. Enamel hypoplasia was identified in 22% of infants; 23% had cavitated ECC, and 36% had ECC when white spot lesions were included in the assessment. Mothers of children with ECC had significantly lower 25OHD levels than those whose children were caries-free (41 ± 20 vs 52 ± 27 nmol/L; P = .05). Univariate Poisson regression analysis for the amount of untreated decay revealed an inverse relationship with maternal 25OHD. Logistic regression revealed that enamel hypoplasia (P < .001), infant age (P = .002), and lower prenatal 25OHD levels (P = .02) were significantly associated with ECC. CONCLUSIONS: This study found that maternal prenatal 25OHD levels may have an influence on the primary dentition and the development of ECC.

Comparative effectiveness study to assess two examination modalities used to detect dental caries in preschool urban children.

BACKGROUND: Dental caries affecting the primary dentition of U.S. children continues to be the most prevalent chronic childhood disease. Preventive screening for dental caries in toddlers by dental professionals is labor-intensive and costly. Studies are warranted to examine innovative screening modalities that reduce cost, are less labor-intensive, and have the potential to identify caries in high-risk children. SUBJECTS AND METHODS: Two hundred ninety-one children were randomized into two groups: Group 1 received a traditional, visual tactile examination initially and follow up-examinations at 6 and 12 months, and Group 2 received a teledentistry examination initially and follow-up examinations at 6 and 12 months. The mean primary tooth decayed and filled surfaces (dfs) scores were calculated for all children at baseline and 6 and 12 months. RESULTS: At baseline, the mean dfs score for children examined by means of teledentistry was 2.19, and for the children examined by means of the traditional method, the mean was 1.27; the means were not significantly different. At the 12-month examination, the mean dfs score for the children examined by means of teledentistry was 3.02, and for the children examined by means of the clinical method, the mean dfs was 1.70; the means were not significantly different. At 12 months the mean fillings score for the children examined by means of teledentistry was 1.43 and for the children examined by means of the clinical method was 0.51; the means were statistically significantly different (p<0.001). CONCLUSIONS: These results suggest that the teledentistry examinations were comparable to clinical examinations when screening for early childhood caries in preschool children. The data further showed that color printouts of teeth with cavities provided to parents of children who received teledentistry screenings promoted oral healthcare utilization, as children from the teledentistry study group received more dental care than children from the clinical study group.

Nonfluoride caries-preventive agents: executive summary of evidence-based clinical recommendations.

BACKGROUND: In this article, the authors present evidence-based clinical recommendations regarding the use of nonfluoride caries preventive agents. The recommendations were developed by an expert panel convened by the American Dental Association (ADA)Council on Scientific Affairs. The panel addressed several questions regarding the efficacy of nonfluoride agents in reducing the incidence of caries and arresting or reversing the progression of caries. TYPES OF STUDIES REVIEWED: A panel of experts convened by the ADA Council on Scientific Affairs, in collaboration with ADA Division of Science staff, conducted a MEDLINE search to identify all randomized and nonrandomized clinical studies regarding the use of non fluoride caries-preventive agents. RESULTS: The panel reviewed evidence from 50 randomized controlled trials and 15 nonrandomized studies to assess the efficacy of various nonfluoride caries-preventive agents. CLINICAL IMPLICATIONS: The panel concluded that certain nonfluoride agents may provide some benefit as adjunctive therapies in children and adults at higher risk of developing caries. These recommendations are presented as a resource for dentists to consider in the clinical decision-making process. As part of the evidence based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences.

Dental caries recurrence following clinical treatment for severe early childhood caries.

PURPOSE: To determine the relapse rate within one year for a cohort of children treated for severe early childhood caries (S-ECC). METHODS: In an earlier report, we assessed the suppressive effect of 10 percent povidone-iodine and the elimination of active caries on salivary mutans streptococci (MS) populations in 77 children with S-ECC; 49 children returned for a 6-month recall exam that occurred 5 to 12 months post dental surgery. Relapse declaration required at least one caries lesion needing a restoration. Contrasts of relapse (R) and non-relapse (NR) to the covariates of gender, race, ethnicity, age, surfaces available for relapse (SAR), time to appointment, and baseline salivary mutans streptococci (MS) counts were statistically evaluated. RESULTS: 19 children (39%) were declared R and 30 (61%) were NR. The 2 groups did not statistically differ on: gender, race, ethnicity, age, SAR, baseline salivary MS counts and time to recall appointment. Statistical analyses also showed the covariates had no significant effect on probability of relapse or time to relapse (P>0.05). CONCLUSIONS: None of the covariates were related to R. The R rate (39%) observed is consistent with earlier reports. Novel approaches are needed to improve relapse prevention.

Assessment of caries experience in 12-year-old adolescents in Piracicaba, Sao Paulo, Brazil.

PURPOSE: The aim of the present study was to analyse the association between socioeconomic and behavioural factors and the presence of active non-cavitated caries lesions in 12-year-old adolescents in Piracicaba, São Paulo, Brazil. MATERIALS AND METHODS: A cross-sectional study was carried out in 1001, 12-year-old adolescents who were selected by the cluster sampling method. A modified version of the World Health Organization criteria for identifying lesions including white lesions (WL) in enamel was used. Information on behavioural and socioeconomic factors was obtained using a semi-structured questionnaire. The outcome variables were DMFS, DMFS+WL and WL. The data obtained were analysed using the chi-square test and a logistic regression model. RESULTS: The mean DMFS was 1.87 (SD = 3.05) and DMFS+WL was 2.27 (SD = 3.66). The logistic regression model showed that income was statistically significantly associated with DMFS, DMFS+WL and WL, whereas educational level of the father, number of residents in the house and number of dental visits were associated with DMFS and DMFS+WL. The onset of toothbrushing was associated with WL. CONCLUSIONS: The present study showed that economic factors are associated with all stages of caries development. In addition to these factors, family size, number of dental visits, educational level of the father and onset of toothbrushing could be considered markers of dental health risk.

The integration of social work into a postgraduate dental training program: a fifteen-year perspective.

In 1993, Eastman Dental Center partnered with the Social Work Division of the University of Rochester Medical Center to develop a social work model of care with the goal of addressing the biopsychosocial needs of the dental population. This article will describe the gradual integration of social work within dentistry and its subsequent impact on resident education, clinical care, research, and program development. Examples of social work's contributions in the dental setting include resident/faculty education on critical psychosocial issues such as child maltreatment and intimate partner violence; the development and implementation of grant-funded projects that utilize trained paraprofessionals to address oral health disparities; interdisciplinary collaboration with dental residents and faculty members on research activities; patient advocacy; oral health promotion within the community; and the creation of a patient assistance fund to meet uncovered care-related expenses. This fifteen-year model demonstrates the viability and sustainability of a social work presence within the academic dental setting.

Effect of tobacco smoke on the oral health of U.S. women of childbearing age.

OBJECTIVES: To determine the oral health status of US women of childbearing age and to analyze the effect of tobacco smoke on their oral health. METHODS: Data from the 1999-2004 National Health and Nutrition Examination Survey were evaluated for women 15-44 years of age. The association of exposure to tobacco smoke with untreated caries, mean DMFS, gingivitis, and periodontitis were examined in bivariate and regression analyses controlling for potential confounders. RESULTS: The prevalence of untreated caries was 25%, for gingivitis 49%, and for periodontitis 6%. After adjusting for potential confounders, self-reported current smoking was a strong independent risk indicator for untreated caries, periodontitis, and to a lesser extent for greater DMFS count. Women with detectable cotinine levels below 15 ng/mL presented with an increased risk for gingivitis. Independent factors associated with increased risk for untreated caries were being Black, having less than a high school education, Medicaid or no health insurance, previous live births, and infrequent and episodic dental visits. Characteristics associated with gingivitis were being Mexican-American, obese, pregnant, and having infrequent dental visits. Older age, no insurance, and the last dental visit for treatment were independently associated with periodontitis. CONCLUSIONS: Dental caries and periodontitis were prevalent among certain subgroups of women of reproductive age. Smoking was found to be a significant risk indicator for various negative oral health outcomes. Barriers to accessing to dental care that were manifested by untreated caries among Black women, mothers, and Medicaid beneficiaries must be better understood.

Prevalence of dental caries in Early Head Start children as diagnosed using teledentistry.

PURPOSE: This study's purpose was to assess caries prevalence by means of teledentistry in 12- to 60-month old children enrolled in Early Head Start inner-city child core centers. METHODS: Images of the primary dentition were obtained by trained telehealth assistants using on intraoral camera. Images were entered into a Web-based storage and retrieval program. They were transmitted to a secure, remote-site computer and evaluated by a calibrated pediatric dentist. RESULTS: Of 162 children screened, 93 were caries free and 69 had early childhood caries (ECC). Of these, 28 had severe early childhood caries (S-ECC). The mean dfs score for all 162 children was 1.88. The mean dfs score for the 69 ECC children was 4.42. The mean dfs for the subgroup of 28 S-ECC children was 7.61. Caries scores of S-ECC children were statistically significantly different from caries scores of the entire cohort and from caries scores of the ECC children. CONCLUSIONS: This study's results show that: (1) almost half of the preschoolers enrolled in the study were affected by dental caries; (2) only a few children had ever had a dental visit; and (3) teledentistry offers a potentially efficient means of screening high-risk preschool children for signs of early childhood caries.

Association between infant breastfeeding and early childhood caries in the United States.

OBJECTIVE: Despite limited epidemiologic evidence, concern has been raised that breastfeeding and its duration may increase the risk of early childhood caries. The objective of this study was to assess the potential association of breastfeeding and other factors with the risk for early childhood caries among young children in the United States. METHODS: Data about oral health, infant feeding, and other child and family characteristics among children 2 to 5 years of age (N = 1576) were extracted from the 1999-2002 National Health and Nutrition Examination Survey. The association of breastfeeding and its duration, as well as other factors that previous research has found associated with early childhood caries, was examined in bivariate analyses and by multivariable logistic and Poisson regression analyses. RESULTS: After adjusting for potential confounders significant in bivariate analyses, breastfeeding and its duration were not associated with the risk for early childhood caries. Independent associations with increased risk for early childhood caries were older child age, poverty, being Mexican American, a dental visit within the last year, and maternal prenatal smoking. Poverty and being Mexican American also were independently associated with severe early childhood caries, whereas characteristics that were independently associated with greater decayed and filled surfaces on primary teeth surfaces were poverty, a dental visit within the last year, 5 years of age, and maternal smoking. CONCLUSIONS: These data provide no evidence to suggest that breastfeeding or its duration are independent risk factors for early childhood caries, severe early childhood caries, or decayed and filled surfaces on primary teeth. In contrast, they identify poverty, Mexican American ethnic status, and maternal smoking as independent risk factors for early childhood caries, which highlights the need to target poor and Mexican American children and those whose mothers smoke for early preventive dental visits.

Dental screening of preschool children using teledentistry: a feasibility study.

PURPOSE: The purpose of this study was to assess the feasibility and reliability of using intraoral cameras and telehealth communication technology to screen preschool children for oral disease, in particular early childhood caries (ECC). METHODS: The authors used the existing infrastructure of the Health-e-Access telehealth Network to: (1) assess the diagnostic quality of dental images using the Dr. Camscope intraoral camera; and (2) compare the resulting images to a traditional oral examination. A calibrated dental examiner observed 50 preschool children 4 to 6 years old who were enrolled in an inner-city childcare center. Following the oral examination, images of the children's teeth were obtained by a trained telehealth assistant and transmitted to the remote site computer; identifiers were removed and the images were randomized. After a 2-week washout period, the images were read by the same examiner. RESULTS: A complete set of dental images was obtained from all 50 children in the study. A greater proportion of children examined using the intraoral camera were observed to have caries (42%) compared to children examined visually (28%). Furthermore, a greater number of carious teeth were detected from the images than from the visual examinations. The mean teledentistry dfs score was 2.10, and the oral examination 1.50 (P > .05). The kappa agreement was 61 (kappa = 0.61; 95% CI = 039-0.89). CONCLUSIONS: There was no statistically significant difference between a visual examination and an examination using an intraoral camera, thus suggesting that the intraoral camera is a feasible and potentially cost-effective alternative to a visual oral examination for caries screening, especially early childhood caries, in preschool children attending childcare centers.

Teledentistry in inner-city child-care centres.

In Rochester, NY, telehealth centres were established in six inner-city elementary schools and seven child-care centres. The teledentistry project complemented the existing telehealth model. Using an intraoral camera, telehealth assistants record digital images of children's teeth (768 x 494 pixels) and send the images to a computer at the expert dental site (the Eastman Department of Dentistry at the University of Rochester). The paediatric dentist at the expert site reviews the images, and provides referral and treatment recommendations. Subsequently, the telehealth assistant contacts the child's parents or guardians and assists them to obtain appropriate dental care for their child. In the pilot study, we screened 50 children. In the first nine months of 2005, we screened 123 children. The results of our initial teledental screenings of children aged 12-48 months attending inner-city child-care centres revealed that almost 40% had active dental caries, mainly early childhood caries (ECC). For the first time, many children attending inner-city child-care centres have had their teeth examined at an early age and been given prompt feedback on the need for dental care.

A longitudinal study of caries onset in initially caries-free children and baseline salivary mutans streptococci levels: a Kaplan-Meier survival analysis.

OBJECTIVES: To apply survival analysis to a longitudinal study of the relationship between salivary mutans streptococci (MS) levels at baseline in initially caries-free children and caries onset in deciduous, mixed, and permanent dentition. METHODS: The Kaplan-Meier survival analysis method was used to compare survival times to caries onset for initially caries-free children with low levels of MS at baseline with survival times to caries onset for initially caries-free children with high levels of MS at baseline. RESULTS: Data from a 6-year longitudinal study of caries risk in initially caries-free children in Rochester and the Finger Lakes Region of western New York were utilized for this study. Of 464 children analyzed, 327 had a low level of MS and 137 had a high level of MS at baseline. Survival analyses showed that children with a low level of MS at baseline remained caries-free for a longer period than children with a high level of MS at baseline. Statistically significant relationships [hazard ratios (HR)] with onset of caries in deciduous, mixed and permanent teeth were found with high and low levels of salivary MS. CONCLUSIONS: Based on our analysis, we concluded that children who were caries-free at baseline and who had high salivary MS levels at baseline would be at greater risk, i.e. more susceptible to caries onset, at any given time than caries-free children who had low salivary MS levels at baseline. Survival functions for deciduous, mixed and permanent dentitions with their 95% confidence limits have been calculated. Survival analysis for the exploration of longitudinal caries studies has an advantage over traditional statistical methods, as it takes into account censored observations and incorporates the concept of risk over time. Hence, survival analysis is well suited for studying transitions from one health state to another, in this case, from a caries-free state to a caries-active state.