The association between food insecurity,diet quality,and untreated caries among US children

BackgroundThe aim of this study was to examine the association between food insecurity and untreated caries among US children and the potential role of diet quality as a mediator in this relationship.MethodsThe authors analyzed data for 4,822 children aged 5 through 17 years from the National Health and Nutrition Examination Survey cycles from 2011 through 2014. The authors measured food security as household-level food security status (full, marginal, low, very low) and overall food security status (full food secure, food insecure). They measured diet quality using the Healthy Eating Index. The primary outcome measure was untreated caries (none, ≥ 1). The authors used multiple logistic regression analysis to evaluate the relationships among food insecurity, diet quality, and untreated caries. They conducted mediation analysis using the Baron and Kenny approach.ResultsFood-insecure children were more likely to have untreated caries compared with their fully food-secure counterparts, after controlling for confounding variables (odds ratio [OR], 1.38; 95% [CI, 1.11 to 1.72). Specifically, children from marginal and very low food-secure households had significantly higher odds of untreated caries (OR, 1.48; 95% CI, 1.10 to 2.01) compared with children from fully food-secure households (OR, 1.59; 95% CI, 1.12 to 2.26). Diet quality was not significantly associated with untreated caries.ConclusionsFood insecurity was negatively associated with untreated caries among US children. Diet quality was not associated with untreated caries.Practical ImplicationsSocial factors such as food insecurity should be taken into consideration when dental clinicians perform caries risk assessment because caries risk is shown to be associated with overall health and dental health.     

Association between vaping and untreated caries: A cross-sectional study of National Health and Nutrition Examination Survey 2017-2018 data

BackgroundWith the rise in the prevalence of electronic cigarette (e-cigarette) and vaping products and the emergence of evidence indicating their cariogenic potential, it is essential to examine the association between vaping and untreated caries at a population level.MethodsThe authors obtained data from the 2017-2018 National Health and Nutrition Examination Survey and investigated the outcome variable—untreated caries—using oral health examination data. The authors applied multiple logistic regression analyses to assess the association between untreated caries and smoking (cigarette smoking, vaping, and both) while controlling for education, race or ethnicity, income, age, sex, and time since previous dental visit.ResultsA total of 4,618 participants were included in the analyses for this cross-sectional study. Participants who currently smoked e-cigarettes were more likely to have untreated caries (odds ratio, 1.69; 95% CI, 1.24 to 2.29) than those who had never smoked, when adjusted for demographic variables. Similarly, dual smokers (e-cigarette and conventional smokers) were more likely to have untreated caries compared with nondual smokers (odds ratio, 2.43; 95% CI, 1.36 to 4.36).ConclusionBoth vaping and dual smoking are associated with an increased occurrence of untreated caries.Practical ImplicationsVaping status should be included as a part of health history questionnaires for patients. Dental professionals should be informed of the potential oral health implications of vaping and, in turn, impart this knowledge to patients.     

Caries risk and social determinants of health: A big data report

BackgroundOral health is influenced by social determinants of health (SDH), predisposing people and communities to greater risk of developing caries. This study evaluated the association between caries risk in adults and SDH such as ZIP Codes, systemic diseases, payment methods, and race or ethnicity.MethodsThe BigMouth Dental Data Repository (n = 57,211) was used to extract clinical and SDH data from patients’ dental electronic health records for 2019. Caries risk categories were used as ZIP Code data was merged with the Social Deprivation Index, a composite measure of area-level deprivation based on 7 demographic characteristics collected in the American Community Survey.ResultsThe results showed that the odds of being in the high caries risk group were higher for people in the 49- to 64-year age group (adjusted odds ratio [aOR], 2.24; 95% CI, 2.08 to 2.40; P ≤ .001), men (aOR, 1.19; 95% CI, 1.13 to 1.25; P ≤ .001), people who had comorbidities (diabetes: aOR, 1.16; 95% CI, 1.08 to 1.24; P ≤ .001; cardiovascular disease: aOR, 1.40; 95% CI, 1.32 to 1.50), and people with an Social Deprivation Index score above the 75th percentile (aOR, 2.39; 95% CI, 2.21 to 2.58; P ≤ .001). In addition, Hispanic and Black people had higher odds of being at high caries risk than other races or ethnicities (Hispanic: aOR, 3.05; 95% CI, 2.32 to 4.00; Black: aOR, 2.05; 95% CI, 1.02 to 4.01).ConclusionsThis study shows the association of caries risk with higher social deprivation, reinforcing the role of structural and upstream factors in oral health. This study is unique in using recorded ZIP Code information and assessing caries risk levels for those regions.Practical ImplicationsThe physical and structural environment should be considered contributors to caries risk in people.     

Oral disorders associated with the experience of verbal bullying among Brazilian school-aged children: A case-control study

BackgroundDental features have been considered a potential target of verbal bullying (VB) among school-aged children. The authors conducted a study to investigate the association between the presence of oral disorders and the occurrence of VB among 8- through 10-year-old school-aged children.MethodsThe study included 445 school-aged children 8 through 10 years old. VB was verified by a specific validated question from the Child Perceptions Questionnaire 8-10 index. Oral disorders such as untreated caries, fluorosis, clinical consequences of untreated caries, and malocclusion were evaluated. The Pearson χ² test and bivariate and multivariate conditional logistic regression analyses were used for statistical analysis.ResultsA total of 390 school-aged children completed the study. The results of the multivariate logistic regression model showed that a severe malocclusion (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.03 to 5.10), a greater maxillary misalignment (OR, 2.23; 95% CI, 1.05 to 4.73), and the presence of a tooth with pulp exposure (OR, 2.93; 95% CI, 1.58 to 5.45) were significantly associated with the occurrence of VB.ConclusionChildren aged 8 through 10 years with a severe malocclusion, larger maxillary misalignment, or the presence of pulp exposure had increased odds of experiencing VB compared with children without those oral health conditions.Practical ImplicationsOnce oral disorders involved in VB are identified, appropriate approaches should be used to address this issue. With this course of action, oral health care professionals may use the treatment and preventive care to eliminate potential factors for peer aggression.     

The effect of diet drinks on caries among US children: Cluster analysis

BackgroundThe effect of sugared beverages on dental caries has been widely studied in dental literature. A major limitation of these studies was examining the beverages as a single source. To overcome this limitation, a few studies used cluster analysis to group people into similar beverage consumption patterns. These studies did not differentiate between sugared beverages and diet drinks. Therefore the aim of this study is to examine the effect of consuming diet drinks on dental caries among US children by using cluster analysis.MethodsIn this cross-sectional study, the authors analyzed the dietary data of children aged 3 through 10 years, using 2 24-hour recall interviews in the 2011-2014 National Health and Nutrition Examination Survey data. Cluster analysis has been used to overcome the limitations of examining the beverages as a single source. Clusters were identified based on the R² statistic and the local peak of pseudo-F statistics. Survey procedure and sample weights were used to account for the complex National Health and Nutrition Examination Survey sampling design.ResultsSix beverage consumption clusters were identified: high soda, high 100% juice, high juice drinks, high diet drinks, high milk, and high water. Regression analysis showed that the high soda cluster had a tendency to increase caries risk (odds ratio [OR], 1.69, 95% confidence interval [CI], 0.9 to 3.1), while the high diet drinks cluster had neutral effect compared with the high water cluster (OR, 0.94, 95% CI, 0.5 to 1.8).ConclusionsThe results of this study suggest that diet drinks have no adverse effect on teeth among US children. Additional well-designed longitudinal studies should be conducted to establish the effect of diet drinks on caries when consumed during childhood.Practical ImplicationsAlthough this study did not show an association between caries and diet drinks, dental practitioners should be cautious about recommending these drinks, as they have been linked to systemic diseases. In addition, the American Academy of Pediatrics and National Academy of Medicine do not recommend that children consume these beverages.     

Examining the association of medical-dental integration with closure of medical care gaps among the elderly population

BackgroundThe integration of medical and dental care in the dental setting offers a unique opportunity to close medical care gaps, such as providing immunizations and laboratory-based tests, compared with traditional nonintegrated settings.MethodsWe used a matched cohort study design among patients 65 years or older (n = 2,578) with an index dental visit to the Kaiser Permanente Northwest medical-dental integration (MDI) program from June 1, 2018, through December 31, 2019. MDI patients were matched 1:1 to non-MDI controls (n = 2,578) on 14 characteristics. The Kaiser Permanente Northwest MDI program focuses on closing 23 preventive (for example, flu vaccines) and disease management care gaps (for example, glycated hemoglobin testing) within the dental setting. The closure of all care gaps (yes versus no) was the outcome for the analysis. Multivariable logistic regression was used to evaluate the association between exposure to the MDI program and level of office integration (least, moderate, and most integration) with closure of care gaps. All data were obtained through Kaiser Permanente Northwest’s electronic health record.ResultsMDI patients had significantly higher odds (odds ratio [OR], 1.46, 95% confidence interval [CI], 1.29 to 1.65) of closing all medical care gaps than non-MDI patients. Greater MDI integration was associated with significantly higher odds of gap closure compared with non-MDI (least integration: OR, 1.18, 95% CI, 1.02 to 1.37; moderate integration: OR, 1.70, 95% CI, 1.36 to 2.12; most integration: OR, 2.08, 95% CI, 1.73 to 2.50).ConclusionsPatients receiving dental care in an MDI program had higher odds of closing medical care gaps compared with similar patients receiving dental care in a non-MDI program.Practical ImplicationsMDI is effective at facilitating delivery of preventive and disease management medical services.     

Impact of disability diagnosis on dental care use for adults in the United States: Status matters

BackgroundApproximately 25% of adults in the United States have a disability that limits function and independence. Oral health care represents the most unmet health care need. This population has been found to have decreased oral health outcomes compared with the general population.MethodsThe authors used the 2018 adult National Health Interview Survey to assess the association between disability status and dental care use (dental visit within or > 2 years). Disability status was categorized as adults with an intellectual, acquired, or developmental disability (IADD) that limits function, other disability that limits function, or no disability, on the basis of diagnoses of birth defect, developmental diagnosis, intellectual disability, stroke, senility, depression, anxiety, or emotional problem, all causing problems with function.ResultsAdults with an IADD with functional and independence-limiting disabilities experienced higher crude odds of going 2 years or more without a dental visit than adults without disabilities (odds ratio [OR], 2.29; 95% CI, 1.96 to 2.67). This association was part of a significant interaction and was stronger among those with IADDs who could afford oral health care (OR, 1.73; 95% CI, 1.47 to 2.14) than among those who could not afford oral health care (OR, 1.21; 95% CI, 0.88 to 1.67; P value of interaction <.01).ConclusionsAdults with IADDs have decreased access to oral health care compared with adults with other disabilities or without disabilities. The inability to afford oral health care lessens the impact of disability status.Practical ImplicationsDentists can use this study to understand the implications of IADD diagnoses on dental care use and make efforts to facilitate care for these patients.     

Patient-reported receipt of oral cancer screenings and smoking cessation counseling from US oral health care providers: National Health and Nutrition Examination Survey, 2015-2016

BackgroundOral health care providers are encouraged to screen for oral cancer (OC) and oropharyngeal cancer (OP) and promote smoking cessation to their patients. In this study, the authors investigated the prevalence and correlates of receiving OC and OP screening and tobacco and OC and OP counseling from oral health care providers.MethodsThe authors analyzed self-reported survey data from the National Health and Nutrition Examination Survey 2015-2016 for participants who reported a dental visit. They created different samples for each subanalysis and categorized them according to smoking status. The authors calculated weighted proportions and adjusted odds for receiving tobacco counseling and screening for OC and OP in a dental office.ResultsOverall, 25.85% of US adults 30 years or older who had ever visited an oral health care professional received OC and OP screening. Odds of receiving an OC and OP screening were lower among current cigarette smokers than among never cigarette smokers (adjusted odds ratio [AOR], 0.47; 95% confidence interval [CI], 0.30 to 0.74) and among non-Hispanic blacks (AOR, 0.36; 95% CI, 0.22 to 0.59), Mexican Americans (AOR, 0.23; 95% CI, 0.10 to 0.53), non-Hispanic Asians (AOR, 0.21; 95% CI, 0.13 to 0.35), and those of other races (AOR, 0.39; 95% CI, 0.24 to 0.65), than among non-Hispanic whites. Participants with a high school education or more had higher odds of receiving an OC and OP screening (AOR, 1.88; 95% CI, 1.04 to 3.43) and counseling for screening (AOR, 1.64; 95% CI, 1.07 to 2.51) than did those with less than a high school education. Participants with family incomes of 400% or more of the federal poverty guideline had higher odds of receiving OC and OP screening (AOR, 5.17; 95% CI, 2.06 to 12.94) but lower odds of receiving tobacco counseling (AOR, 0.45; 95% CI, 0.24 to 0.82) than did participants with family incomes of less than 100% of the federal poverty guideline.ConclusionsOral health care providers underscreen for OC and OP among high-risk groups, including current cigarette smokers, minorities, and people of low socioeconomic status. The authors charge oral health care educators to include OC and OP screening and smoking cessation counseling in training and continuing education programs to increase the confidence of oral health care providers.Practical ImplicationsPotential to influence change on current pre-doctoral clinical training programs and to increase opportunities for continuing education courses that review the importance of, as well as, how to successfully complete smoking cessation counseling.     

Emergency department visits for infectious oral conditions in Massachusetts, 2014 through 2018

BackgroundThe authors aimed to measure population-based preventable emergency department (ED) visits related to infectious oral conditions (IOCs) in Massachusetts and to examine the associated sociodemographic factors to support prevention efforts.MethodsA statewide retrospective analysis of ED visits related to IOCs in Massachusetts from 2014 through 2018 was conducted using a Center for Health Information and Analysis database. The authors described patients' characteristics, dental diagnoses frequencies, emergency severity, lengths of stay, associated treatment, and costs. Multilevel logistic regression was used to assess factors associated with IOC visits.ResultsIOC visits in 2014 through 2018 were 1.2% (149,777) of the total ED visits, with an estimated cost of $159.7 million. There was an annual decline in the prevalence of IOC visits from 2014 through 2018. After adjusting for sociodemographic factors, odds of IOC were higher among males (adjusted odd ratio [AOR], 1.26; 95% CI, 1.24 to 1.27), non-Hispanic Blacks compared with non-Hispanic Whites (AOR, 1.03; 95% CI, 1.02 to 1.06), people residing in dental health care professional shortage areas (AOR, 1.06; 95% CI, 1.04 to 1.07), public insurance beneficiaries (AOR, 1.90; 95% CI, 1.87 to 1.93), or uninsured (AOR, 2.60; 95% CI, 2.54 to 2.66) compared with privately insured.ConclusionsThere was an annual decline in the prevalence of IOC visits from 2014 through 2018. Higher odds of IOC visits were associated with young adults, Black patients, uninsured people, public insurance beneficiaries, and people who reside in dental health care professional shortage areas.Practical ImplicationsThe authors provided statewide data to support proposed policies to improve oral health care in Massachusetts. IOCs are mostly preventable, but well-coordinated care between medicine and dentistry is integral for prevention.     

Update on the prevalence of untreated caries in the US adult population, 2017-2020

BackgroundUntreated caries is a prevalent disease that is associated with a substantial health and economic burden. Many past efforts have assessed the epidemiology of untreated caries, and this study provides the most up-to-date figures on the distribution and determinants of the disease in the adult US population for the period 2017 through 2020.MethodsUsing data from the 2017-2020 National Health and Nutrition Examination Survey, the author derived estimates for untreated caries prevalence in the adult US population. The author conducted subgroup analyses to assess how the epidemiology differed between coronal and root caries and how the disease was distributed among population subgroups.ResultsOn the basis of a weighted sample representative of 193.5 million adults, the prevalence of untreated caries was found to be 21.3%. Specific prevalence of coronal and root caries were 17.9% and 10.1%, respectively. Caries was most prevalent in those aged 30 through 39 years (25.2%) and 40 through 49 years (22.3%), men (23.5%), those of other (36.5%) or non-Hispanic Black (35.6%) race or ethnicity, those with family income to poverty ratio of 0.5 through 1.0 (46.2%) or less than 0.5 (37.3%), those with educational attainment less than high school graduation (39.6%), those who did not have health insurance (42.1%), and those who were underweight (25.1%) or obese (23.5%).ConclusionsUntreated caries is present in more than 1 in 5 adults within the US population and is disproportionately distributed among those of lower socioeconomic status.Practical ImplicationsThere is a substantial unmet health care need in the US adult population for the prevention and management of untreated caries, and public health efforts should aim particularly to address disease within those subgroups who are at a disproportionately high risk.     

Factors associated with cost conversations in oral health care settings

BackgroundPatient–provider cost conversations can minimize cost-related barriers to health, while improving treatment adherence and patient satisfaction. The authors sought to identify factors associated with the occurrence of cost conversations in dentistry.MethodsThis was a cross-sectional study using data from an online, self-administered survey of US adults who had seen a dentist within the past 24 months at the time of the survey. Multivariable hierarchical logistic regression analysis was used to identify patient and provider characteristics associated with the occurrence of cost conversations.ResultsOf the 370 respondents, approximately two-thirds (68%) reported having a cost conversation with their dental provider during their last dental visit. Cost conversations were more likely for patients aged 25 through 34 years (odds ratio [OR], 2.84; 95% CI, 1.54 to 5.24), 35 through 44 years (OR, 3.35; 95% CI, 1.50 to 7.51), and 55 through 64 years (OR, 3.39; 95% CI, 1.38 to 8.28) than patients aged 18 through 24 years. Cost conversations were less likely to occur during visits with dental hygienists than during visits with general or family dentists (OR, 0.25; 95% CI, 0.11 to 0.58). In addition, respondents from the South (OR, 1.90; 95% CI, 1.04 to 3.48) and those screened for financial hardship were more likely to report having cost conversations with their dental providers (OR, 6.70; 95% CI, 2.69 to 16.71).ConclusionsWithin the study sample, cost conversations were common and were facilitated via financial hardship screening.Practical ImplicationsModifying oral health care delivery processes to incorporate financial hardship screening may be an effective way to facilitate cost conversations and provision of patient-centered care.     

Tooth loss and uncontrolled diabetes among US adults

BackgroundThe objective of this study was to analyze the association between tooth loss and uncontrolled diabetes among US adults.MethodsThe authors used National Health and Nutrition Examination Survey data from 2011 through 2018. The sample included 16,635 participants 20 years and older who represent 187,596,215 people in the United States in a probability weighted sample. The authors used bivariate analysis and multiple regressions to analyze factors associated with edentulism and number of missing teeth.ResultsThe multiple logistic regression model significantly predicted edentulism using diabetes status (adjusted odds ratio controlled diabetes, 1.44 [95% CI, 1.12 to 1.86]; adjusted odds ratio uncontrolled diabetes, 2.26 [95% CI, 1.33 to 3.85]), missing annual dental visits, seeing a dentist only for treatment, family income below 200% of the federal poverty guideline, being female, being 65 years or older, tobacco smoking, and no college education. After controlling for the same covariates, multiple Poisson regression analysis showed that dentate adults with controlled and uncontrolled diabetes had higher relative risk of tooth loss than those without diabetes (adjusted risk ratio controlled diabetes, 1.52 [95% CI, 1.35 to 1.71]; adjusted risk ratio uncontrolled diabetes, 1.57 [95% CI, 1.35 to 1.83]).ConclusionsUS adults with uncontrolled (glycated hemoglobin ≥ 9%) and controlled diabetes (glycated hemoglobin < 9%) were more likely to be edentulous and experience tooth loss than adults without diabetes.Practical ImplicationsUS health policy officials should adopt benefits policies to provide regular dental examinations to people who have diabetes, have low income (< 200% of the federal poverty guideline), or are 65 years or older to reduce tooth loss and improve their quality of life. Dentists should work with physicians to help patients control glycemic levels.     

Disparities in dental health issues and oral health care visits in US children with tobacco smoke exposure

BackgroundThe objective of the authors was to assess the relationships between tobacco smoke exposure (TSE) and dental health and dental care visits among US children.MethodsThe authors examined 2018-2019 National Survey of Children’s Health data on TSE, dental health, and oral health care visits. Children aged 1 through 11 years (N = 32,214) were categorized into TSE groups: no home TSE (did not live with a smoker), thirdhand smoke (THS) exposure (lived with a smoker who did not smoke inside the home), or secondhand smoke (SHS) and THS exposure (lived with a smoker who smoked inside the home). The authors conducted multivariable logistic regression analyses, adjusting for child age, sex, race or ethnicity, prematurity, caregiver education level, family structure, and federal poverty threshold.ResultsChildren with home SHS and THS exposure were at increased odds of having frequent or chronic difficulty with 1 or more oral health problem (adjusted odds ratio [AOR], 1.59; 95% CI, 1.07 to 2.35; P = .022) and carious teeth or caries (AOR, 1.74; 95% CI 1.14 to 2.65; P = .010) than those with no TSE. Compared with children aged 1 through 11 years with no TSE, children with SHS and THS exposure were 2.22 times (95% CI, 1.01 to 4.87; P = .048) more likely to have not received needed oral health care but at decreased odds of having had any kind of oral health care visit (AOR, 0.55; 95% CI, 0.32 to 0.95; P = .032), including a preventive oral health care visit (AOR, 0.60; 95% CI, 0.36 to 0.99; P = .047).ConclusionsTSE in children is associated with caries and inadequate oral health care visits.Practical ImplicationsThe pediatric dental visit is an opportune time to educate caregivers who smoke about dental health to improve their children’s teeth condition and increase oral health care visits.     

Association between rs11362 polymorphism in the beta-defensin 1 (DEFB1) gene and dental caries: A meta-analysis

ObjectivesBeta-defensin 1, encoded by the DEFB1 gene, is an important molecule that confers protection from dental caries. Numerous studies have been conducted on the rs11362 polymorphism in the DEFB1 gene. We evaluated the results from studies that have investigated the association between rs11362 polymorphism and dental caries, through a meta-analysis.MethodsThis meta-analysis was designed according to the PRISMA statement guideline. Electronic databases (PubMed, Web of Science, Scopus, and Cochrane Library) were scanned by two independent researchers. The publication bias was determined by statistical analyses using funnel plot, Egger regression test, and Begg and Mazumdar rank correlation test. Heterogeneity was evaluated using the chi-square test, tau-square, and Higgins I² test. Odds ratio (OR) was used to measure the effect size.ResultsRank correlation and regression procedures showed the absence of publication bias in the meta-analysis (p > 0.05). The DEFB1 rs11362 polymorphism in the heterozygous (CC vs. CT: OR = 2.20, 95% confidence interval (CI): 1.17, 4.10; p = 0.014) and dominant (CC vs. CT + TT: OR = 3.11, 95% CI: 1.18, 8.21; p = 0.022) models in the permanent dentition subgroup showed significant differences. However, there was no significant difference between any model in either the deciduous dentition (p > 0.05) or the mixed dentition subgroups (p > 0.05).ConclusionsThis meta-analysis suggests that the DEFB1 rs11362 polymorphism is associated with dental caries in permanent dentition. Moreover, individuals with the TT genotype were found to have seven times higher risk of dental caries than individuals with the CC genotype. There was no such association or statistical difference observed for deciduous and mixed dentitions.     

Pediatric dental care use and parent- or caregiver-rated oral health among Alabama children enrolled in Medicaid

BackgroundReducing caries and improving access to dental care is a public health challenge. Understanding low use of dental care is of critical importance. This study estimated parent- or caregiver-reported prevalence and identified factors associated with children’s dental care use, including the association with children’s oral health.MethodsA cross-sectional analysis of children enrolled in Medicaid in Alabama, using data from the 2017 statewide Consumer Assessment of Healthcare Providers and Systems Health Plan Survey, was conducted. Associations were measured using adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) from logit regression and generalized linear model postestimation of least-squares means.ResultsThe 6-month prevalence of children receiving dental care was 70.4%. Children aged 0 through 3 years (aPR, 0.72; 95% CI, 0.53 to 0.91) had lower prevalence of care than other age groups. The prevalence of low-rated oral health was 9.2%. Low-rated oral health was associated with not receiving dental care (aPR, 1.50; 95% CI, 1.12 to 1.87) and parental education of 8th grade or less (aPR, 2.59; 95% CI, 1.20 to 3.98). Falsification tests determined that dental care use was not associated with ratings for overall health (aPR, 1.18; 95% CI, 0.83 to 1.52) or emotional health (aPR, 1.06; 95% CI, 0.79 to 1.33).ConclusionsIt was observed that children not receiving dental care had low-rated oral health; however, as a cross-sectional study, it was not possible to assess the temporality of this relationship.Practical ImplicationsOral health care providers should continue to recognize their role in educating parents and providing anticipatory guidance on children’s oral health.     

Association between first oral examination characteristics and dental treatment needs in privately insured children: A claims data analysis

BackgroundEarly childhood caries (ECC) remains the most common, preventable infectious disease among children in the United States. Screening is recommended after the eruption of the first tooth, but it is unclear how the age at first dental examination is associated with eventual restorative treatment needs. The authors of this study sought to determine how provider type and age at first dental examination are associated longitudinally with caries experience among children in the United States.MethodsDeidentified claims data were included for 706,636 privately insured children aged 0 through 6 years as part of the nationwide IBM Watson Health Market Scan (2012-2017). The authors used Kaplan-Meier survival analysis to describe the association between the age of first visit and restorative treatment needs.ResultsA total of 21% of this population required restorative treatment, and the average age at first dental examination was 3.6 years. A multivariable Cox proportional hazards model showed increased hazard for restorative treatment with age at first dental visit at 3 years (hazard ratio, 2.05; 95% CI, 1.97 to 2.13) and 4 years (hazard ratio, 3.99; 95% CI, 3.84 to 4.16).ConclusionThe high proportion of children requiring restorative treatment and late age at first dental screening show needed investments in educating general dentists, medical students, and pediatricians about oral health guidelines for pediatric patients.Practical ImplicationsCommunicating the importance of children establishing a dental home by age 1 year to parents and health care professionals may help reduce disease burden in children younger than 6 years.     

Trends in use of dental care provider types and services in the United States in 2000-2016: Rural-urban comparisons

BackgroundThe authors conducted a study to assess recent trends in dental care provider mix (type of dental professionals visited) and service mix (types of dental procedures) use in the United States and to assess rural-urban disparities.MethodsData were from the 2000 through 2016 Medical Expenditure Panel Survey. The sample was limited to respondents who reported at least 1 dental visit to a dental professional in the survey year (N = 138,734 adults ≥ 18 years). The authors estimated rates of visiting 3 dental professionals and undergoing 5 dental procedures and assessed the time trends by rural-urban residence and variation within rural areas. Multiple logistic regression was used to assess the association between rural and urban residence and service and provider mix.ResultsA decreasing trend was observed in visiting a general dentist, and an increasing trend was observed in visiting a dental hygienist for both urban and rural residents (trend P values < .001). An increasing trend in having preventive procedures and a decreasing trend in having restorative and oral surgery procedures were observed only for urban residents (trend P values < .001). The combined data for 2000 through 2016 showed that rural residents were less likely to receive diagnostic services (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.72 to 0.93) and preventive services (AOR, 0.87; 95% CI, 0.78 to 0.96), and more likely to receive restorative (AOR, 1.11; 95% CI, 1.02 to 1.21) and oral surgery services (AOR, 1.23; 95% CI, 1.11 to 1.37).ConclusionsAlthough preventive dental services increased while surgical procedures decreased from 2000 through 2016 in the United States, significant oral health care disparities were found between rural and urban residents.Practical ImplicationsThese results of this study may help inform future initiatives to improve oral health in underserved communities. By understanding the types of providers visited and dental services received, US dentists will be better positioned to meet their patients’ oral health needs.     

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.     

Dental health status,use, and insurance coverage among adults with chronic conditions: Implications for medical-dental integration in the United States

BackgroundThe authors examined potential benefits and difficulties in integrating oral health care and medical care for adults with chronic conditions (CCs).MethodsThe authors used National Health and Nutrition Examination Survey 2009-2016 data to estimate crude (age- and sex-standardized) and model-adjusted estimates to examine the association between dental disease (severe tooth loss, untreated caries) and chronic disease (≥ 3 CCs, fair or poor health) and Medical Expenditure Panel Survey 2014-2016 data to estimate crude estimates of past-year medical and dental use and financial access according to CC status. Reported differences are significant at P < .05.ResultsNational prevalences of reporting fair or poor health and 3 or more CCs were both approximately 15%. Standardized prevalence of dental disease was notably higher among adults reporting CCs than those not reporting. After controlling for covariates, the magnitude of the association was substantially lower, although the association remained significant. Adults with CCs were approximately 50% more likely to report having a past-year medical visit and no dental visit than those not reporting CCs. Among adults reporting CCs, prevalence of having no private dental insurance and low income was approximately 20% and 60% higher, respectively, than that among adults not reporting CCs.ConclusionsAdults with CCs had higher prevalence of dental disease, past-year medical visit and no dental visit, and limited financial access.Practical ImplicationsMedical visits may be the only opportunity to provide dental education and referrals to adults with CCs. Improved medical-dental integration could improve oral health care access and oral health among these adults who are at higher risk of dental disease.     

Association between primary headaches and temporomandibular disorders: A systematic review and meta-analysis

BackgroundThe primary objective of this systematic review was to answer the following question systematically: Is there any association between primary headaches (PHs) and temporomandibular disorders (TMDs) in adults?Types of Studies ReviewedThe protocol was registered with the International Prospective Register of Systematic Reviews. The authors performed the search in 6 main databases and 3 gray literature sources. The included articles had to have adult samples. PHs must have been diagnosed using the International Classification of Headache Disorders, and TMDs must have been diagnosed using Research Diagnostic Criteria for Temporomandibular Disorders, Diagnostic Criteria for Temporomandibular Disorders, or International Classification of Orofacial Pain. Risk of bias was evaluated using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tools. The meta-analysis was performed using Review Manager software, Version 5.4. Certainty of evidence was screened according to Grading of Recommendations Assessment, Development and Evaluation.ResultsNine of 2,574 articles reviewed met the inclusion criteria for qualitative analysis and, of these, 7 met the inclusion criteria for quantitative analysis. Odds ratios (ORs) for painful TMD and tension-type headache (OR, 1.94 [95% CI, 0.56 to 6.76] to OR, 7.61 [95% CI, 1.84 to 31.48]), migraines (OR, 4.14 [95% CI, 1.38 to 12.43] to OR, 5.44 [95% CI, 3.61 to 8.21]), and chronic headaches (OR, 40.40 [95% CI, 8.67 to 188.15] to OR, 95.93 [95% CI, 12.53 to 734.27]) were calculated. Articular TMDs without pain were evaluated in 2 articles, and both did not show positive association with tension-type headache nor migraine. Three studies were classified as moderate risk of bias and 6 as low risk of bias. The certainty of evidence varied between very low and low.Conclusions and Practical ImplicationsRecognizing the positive association between painful TMD and PHs can help dentists and physicians treat the pain and avoid it, or recommend the patient to a specialist.