Impact of visual inspection and radiographs for caries detection in children through a 2-year randomized clinical trial: The Caries Detection in Children–1 study

BackgroundVisual inspection (VIS) with radiographic examination (RAD) is the recommended diagnostic strategy for detecting caries in children; however, this recommendation is based on accuracy studies. The authors conducted a clinical trial to compare the detection and subsequent treatment of carious lesions in primary molars performed with VIS alone and with RAD.MethodsChildren (3-6 years old) were randomly assigned to 2 groups according to the diagnostic strategy used for caries detection on primary molars: VIS or RAD. Participants were diagnosed and treated according to the management plan related to the allocated group. The primary outcome was the number of new operative interventions during the 2-year follow-up period. Other secondary outcomes were also compared. Comparisons were performed with Mann-Whitney test using an intention-to-treat approach.ResultsOf the 252 children included and randomized, 216 were followed-up after 2 years (14.3% attrition rate). There was no difference between the groups for the primary outcome (P = .476). For the secondary outcomes, the RAD group had more restoration replacements (P = .038) and more restorations performed since the beginning of the study (P = .038) compared with the VIS group. In addition, the RAD group had a higher number of false-positive results than the VIS group (P < .001).ConclusionsSimultaneous use of VIS and RAD for caries diagnosis in primary molars of children who seek dental treatment does not provide additional benefits compared with VIS alone.Practical ImplicationsDentists should perform VIS only, not RAD, for detecting carious lesions in preschool-aged children.ClinicalTrials.gov: NCT02078453.     

磁敏感征和不对称静脉征对急性大脑中动脉闭塞患者诊断价值

目的探讨磁共振磁敏感加权成像(SWI)的动脉磁敏感征(SVS)和不对称脉静脉血管征(AVS)对急性大脑中动脉闭塞(AMCAO)引起急性缺血性卒中(AIS)体积程度的预测研究和临床价值。方法45例AMCAO患者,根据阿尔伯塔卒中计划早期CT评分为基础的改良SWI-ASPECTS评分梗死病灶侧显著组和稀疏组以及无SVS组、SVS≤20 mmm组、>21 mm组进行SWI-ASPECTS评分量化,比较患者脑梗死体积程度的差异。结果45例AMCAO患者,无SVS者11例(占24.4%),有SVS征者34例(SVS≤20 mm为19例,SVS>20 mm为15例)(占75.6%)。无SVS组、SVS≤20 mm组、SVS>20 mm组,其脑梗死体积分别为(5.11±5.913)mm^3、(22.71±33.568)mm^3和(111.51±87.352)mm^3,三组梗死体积差异有显著统计学意义(P<0.001),三组梗死SWI-ASPECTS评分差异有显著统计学意义(P<0.01)。随着SVS长度增加,SWI-ASPECTS评分呈减小趋势(经Spearman检验,r=-0.538,P<0.001);AVS稀疏组19例(占42.2%),AVS显著组26例(占57.8%),其体积分别为(103.555±80.684)mm^3和(7.413±8.224)mm^3,经Mann-Whitney U检验,稀疏组的梗死体积大于显著组,差异有显著统计学意义(Z=-5.102,P<0.001)。结论SVS是颅内动脉严重狭窄或闭塞的标志,代表了血栓的存在及血管内新鲜凝血块形成、预测栓子成分。AVS代表急性颅脑大血管闭塞的脑缺血区周围软脑膜侧支循环的形成,AVS越广泛,SVS长度越小,梗死面积越小,SWI-ASPECTS评分越高患者的侧支循环分级越高。这对于患者最终梗死体积及临床预后的评估都具有重要意义。     

Impact of school sealant programs on oral health among youth and identification of potential barriers to implementation

BackgroundSchool sealant programs (SSPs) increase sealant prevalence among children lacking access to oral health care. SSPs, however, are substantially underused. From 2013 through 2018, the Centers for Disease Control and Prevention funded 18 states for SSP activities in high-need schools (≥ 50% free and reduced-price meal program participation). From 2019 through 2020, the authors assessed SSPs' impact in reducing caries and how states expanded SSPs. The authors also discuss potential barriers to expansion.MethodsFor Aim 1, the authors used a published methodology and SSP baseline screening and 1-year retention data to estimate averted caries over 9 years attributable to SSPs. For Aim 2, the authors used state responses to an online survey, phone interviews, and annual administrative reports.ResultsUsing data for 62,750 children attending 18.6% of high-need schools in 16 states, the authors estimated that 7.5% of sound, unsealed molars would develop caries annually without sealants and placing 4 sealants would prevent caries in 1 molar. Fourteen states reported SSP expansion in high-need schools. The 2 most frequently reported barriers to SSP expansion were levels of funding and policies requiring dentists to be present at assessment or sealant placement.ConclusionsThe authors found that SSPs typically served children at elevated caries risk and reduced caries. In addition, the authors identified funding levels and policies governing supervision of dental hygienists as possible barriers to SSP expansion.Practical ImplicationsIncreasing SSP prevalence could reduce caries. Further research on potential barriers to SSP implementation identified in this study could provide critical information for long-term SSP sustainability.     

Oral colonisation by aerobic and facultatively anaerobic Gram-negative rods and yeast in Tibetans living in Lhasa

Sample groups of children (n=50) and adults (n=38) were selected from pools of 207 children, (11-13-year olds from two primary schools) and 94 adults (25-44-year olds from four governmental agencies) who were the subjects of an oral health survey among Tibetans living in Lhasa, Tibet Autonomous Region. Mean ages of the study groups of children (38% females) and adults (61% females) were 11.6+/-0.9 and 37.1+/-6.1 years, respectively. All had lived in Tibet since birth. Oral rinse samples were selective cultured to isolate, quantify and speciate aerobic and facultatively anaerobic Gram-negative rods (using the API 20E kit) and yeasts (using API 20C AUX and API ZYM kits). For children, the isolation rates for oral coliform bacteria and yeasts were 84 and 14%, respectively, for adults, the respective rates were 26 and 40%. The corresponding quantities of coliforms/yeasts for children and adults were 0.4+/-1.6 x 10(3)c.f.u./15.8+/-72.3 and 0.2+/-0.6 x 10(3)c.f.u./57.2+/-137.5c.f.u. per millilitre oral rinse, respectively. Aerobic and facultatively anaerobic Gram-negative rods and Stenotrophomonas maltophilia, a free-living saprophytic and ubiquitous bacterial species of wide geographic distribution, were significantly more frequently recovered from the children's oral rinses. The isolation rates of facultatively anaerobic Gram-negative rods in adults and yeasts in both groups were similar to those found in similar cohorts from southern China in earlier studies. Randomly amplified polymeric DNA analysis showed that the S. maltophilia spp. isolated from children were of several different clonal types and were school specific. This study shows that the colonisation rate of facultatively anaerobic Gram-negative rods in adults and yeasts in both groups are similar to those in populations living at lower altitudes, the native young, urban Tibetans appear to exhibit a high oral carriage rate of S. maltophilia spp.     

A cluster analysis model for caries risk assessment

Cluster analysis was applied to determine, the natural grouping of individuals, among sixty 8-10-year-old children, and to identify the most significant set of markers for risk assessment. The risk clusters were obtained with initial clinical and bacteriological measurements including dmf + DMFS, active caries, mutans streptococci and lactobacilli counts in plaque or saliva on two media, and Snyder's test results. The morbidity clusters were constructed with the final clinical indexes and incidence after 18 months (dependent variables). A risk cluster was identified that included the following significant initial variables; dmf + DMFS, active caries, counts of mutans streptococci from plaque on TSY20B and lactobacilli in saliva, and Snyder's test results. This set of markers identified 86% of the children at high risk who developed high morbidity, as well as 94% of children in the low-risk cluster who developed low or no caries. The results of this investigation provide the basis to develop a system for caries risk assessment.     

The Association Between Enamel Fluorosis and Dental Caries in U.S. Schoolchildren

BackgroundThe authors assessed the association between enamel fluorosis and dental caries to determine if there is any beneficial effect of enamel fluorosis in U.S. schoolchildren.

MethodsThe authors used data from a National Institute of Dental Research survey of the oral health of U.S. children conducted in 1986 and 1987 to determine the prevalence of caries and mean decayed, missing or filled surfaces on permanent maxillary right first molars in children 7 to 17 years of age who had a history of a single residence. (To date, this is the only national oral health data set in the United States with detailed information on fluoride exposures.) They examined the association between enamel fluorosis and caries using logistic regression analysis, controlling for potential confounders in communities with water at or above optimal fluoridation levels and in communities with nonfluoridated or suboptimally fluoridated water.ResultsPermanent maxillary right first molars with fluorosis consistently had lower levels of caries experience than did normal molars. Adjusted odds ratios for caries prevalence in molars with fluorosis were 0.71 (95 percent confidence interval [CI], 0.56–0.89) in communities with nonfluoridated or suboptimally fluoridated water and 0.89 (95 percent CI, 0.74–1.06) in communities with water at or above optimal fluoridation levels.ConclusionThis study's findings suggest that molars with fluorosis are more resistant to caries than are molars without fluorosis.Clinical ImplicationsThe results highlight the need for those considering policies regarding reduction in fluoride exposure to take into consideration the caries-preventive benefits associated with milder forms of enamel fluorosis.     

The association between vitamin D levels and caries experience in children and youth participating in National Health and Nutrition Examination Survey 2011-2016: A cross-sectional study

BackgroundGiven equivocal findings from existing nationally representative studies, the authors sought to determine associations between vitamin D levels and caries experience in US children using updated National Health and Nutrition Examination Survey data.MethodsThe authors used data from 2011-2016 National Health and Nutrition Examination Survey. Vitamin D status was assessed on the basis of the sufficiency thresholds of 50 and 75 nmol/L for serum 25-hydroxyvitamin D (25[OH]D) recommended by the Institute of Medicine (now National Academy of Medicine) and Endocrine Society, respectively. Caries experience was defined as the total number of decayed or filled tooth surfaces (dfs) and decayed, missing, or filled tooth surfaces (DMFS) and a binary measure of any dfs and DMFS. Associations between 25(OH)D and any or total dfs and DMFS were examined in children aged 2 through 5, 6 through 8, 9 through 11, and 12 through 18 years, using multivariable logistic and linear regression models after adjustment for covariates.ResultsChildren aged 2 through 5 years with 25(OH)D above 75 nmol/L experienced fewer total dfs (β = –1.94; 95% CI, –3.60 to –0.28) than those with 25(OH)D below 75 nmol/L. Children 6 through 8 years with 25(OH)D above 75 nmol/L had lower presence of any dfs (odds ratio, 0.59; 95% CI, 0.36 to 0.95) than those with 25(OH)D below 75 nmol/L, and those with 25(OH)D above 50 nmol/L had lower presence of any DMFS (odds ratio, 0.38; 95% CI, 0.19 to 0.79) than those with 25(OH)D below 50 nmol/L. There were no associations of 25(OH)D status with either any or total DMFS in children 12 through 18 yearsConclusionsThere were no consistent associations of 25(OH)D status with caries experience across age groups.Practical ImplicationsVitamin D status was not associated consistently with reduced caries experience.     

Noxious family environments in relation to adult and childhood caries

BackgroundThe authors tested hypotheses that more noxious family environments are associated with poorer adult and child oral health.MethodsA 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.ResultsThe 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.ConclusionsNoxious 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 ImplicationsNoxious 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.     

Focus on Fluorides: Update on the Use of Fluoride for the Prevention of Dental Caries

Improving the efficacy of fluoride therapies reduces dental caries and lowers fluoride exposure.BackgroundFluoride is delivered to the teeth systemically or topically to aid in the prevention of dental caries. Systemic fluoride from ingested sources is in blood serum and can be deposited only in teeth that are forming in children. Topical fluoride is from sources such as community water, processed foods, beverages, toothpastes, mouthrinses, gels, foams, and varnishes. The United States Centers for Disease Control and Prevention (CDC) and the American Dental Association (ADA) have proposed changes in their long standing recommendations for the amount of fluoride in community drinking water in response to concerns about an increasing incidence of dental fluorosis in children. Current research is focused on the development of strategies to improve fluoride efficacy. The purpose of this update is to inform the reader about new research and policies related to the use of fluoride for the prevention of dental caries.MethodsReviews of the current research and recent evidence based systematic reviews on the topics of fluoride are presented. Topics discussed include: updates on community water fluoridation research and policies; available fluoride in dentifrices; fluoride varnish compositions, use, and recommendations; and other fluoride containing dental products. This update provides insights into current research and discusses proposed policy changes for the use of fluoride for the prevention of dental caries.ConclusionsThe dental profession is adjusting their recommendations for fluoride use based on current observations of the halo effect and subsequent outcomes. The research community is focused on improving the efficacy of fluoride therapies thus reducing dental caries and lowering the amount of fluoride required for efficacy.