RESUMEN

INTRODUCTION: Dental caries is the most common non-communicable human disease, yet little is known about the role of environmental metals, despite teeth consisting of a hard matrix of trace elements. We conducted a cross-sectional study of associations between environmental metals and objective assessment of dental caries and subjective assessments of oral health among a representative sample of U.S. children and adolescents. METHODS: Data were from the 2017-March 2020 pre-pandemic data file of the National Health and Nutrition Examination Survey (NHANES). To account for metal mixtures, we used weighted quantile sum (WQS) regression to estimate the joint impact of multiple trace elements assessed in blood and urine with oral disease outcomes. RESULTS: The blood metal mixture index was associated with a 32% (95% CI: 1.11, 1.56) increased risk of decayed surfaces while the urine metal mixture index was associated with a 106%, RR (95% CI = 2.06 (1.58, 2.70) increased caries risk. For both blood and urine, Mercury (Hg) had the largest contribution to the mixture index followed by Lead (Pb). The WQS blood metal mixture index was also significantly associated with poorer self-rated oral health, although the magnitude of the association was not as strong as for the objective oral disease measures, RR (95% CI) = 1.04 (1.02, 1.07). DISCUSSION: Increased exposure to a metal mixture was significantly related to poorer objective and subjective oral health outcomes among U.S. children and adolescents. These are among the first findings showing that metal mixtures are a significant contributor to poor oral health.

Asunto(s)

RESUMEN

OBJECTIVE: The aims of this study were to investigate whether dental and dental hygiene students' career plans postgraduation were affected by the coronavirus disease 2019 (COVID-19) pandemic and to examine wellness and readiness for clinical practice among students who reported a change in career plans. METHODS: An anonymous online REDCap survey was developed and emailed to 436 dental and dental hygiene students at a US dental school. The survey consisted of 81 questions that covered demographics, career plans postgraduation, and readiness and wellness measures. An open-ended question assessing how students' career plans have changed during the pandemic was also included. RESULTS: A total of 252 students completed the survey, of whom 11.5% reported that their plans for future dental practice have changed since the COVID-19 outbreak. Students who reported a change to their career plans had significantly higher mean perceived stress (20.1 vs. 16.3; P = 0.003) and anxiety (9.2 vs. 6.2; P = 0.004) scores and lower mean resilience (18.9 vs. 20.9; P = 0.01) scores than those who reported no change to their career plans. Concerns were raised regarding the limited employment opportunities, long-term stability of the dental profession, and the interruptions to clinical education and licensure examinations consequent to the pandemic. CONCLUSIONS: A comprehensive effort inclusive of adeptly designed clinical and curriculum experiences paired with wellness interventions and support tailored to students is needed. These measures need to support trainees across varying years in training and resilience levels to be effective for dental and dental hygiene students as they approach their future career intentions in the dental profession. Additional longitudinal research is needed to assess if change in career intentions during the COVID-19 pandemic corresponds with actual change postpandemic and affects the dental profession. KNOWLEDGE TRANSFER STATEMENT: This study explores the potential short-term change in career intentions of dental hygiene and dental students during the COVID-19 pandemic. Findings can inform workforce planning as well as interventions developed and implemented by academic dental institutions to support student wellness during unexpected and prolonged emergency situations.

Asunto(s)

RESUMEN

OBJECTIVES: Access to routine dental services is important to maintaining good oral health. The aims of this study were to describe the dental care utilization patterns of a diverse group of Hispanic/Latino men and women and assess differences in dental care utilization by perceived need for dental care and proxy measures of acculturation. METHODS: Data from 13,792 participants of the Hispanic Community Health Study were analyzed with SAS 9.4. Time since last dental visit was dichotomized into <1 and ≥1 y. Acculturation measures included the language and social subscales of the Short Acculturation Scale for Hispanics, the Multiethnic Study of Atherosclerosis nativity subscore, and immigrant generation. Survey logistic regression adjusted for demographic (age and sex) and health-related variables, estimated associations among perceived need for dental care, acculturation measures, and dental care utilization. RESULTS: About a quarter (23%) of the participants were born in the 50 US states, excluding territories, while 77% were non-US born. Overall, 74% perceived a need for dental care. Upon covariate adjustment, perceiving a need for dental care was associated with reduced odds of reporting a past-year dental visit (odds ratio, 0.32; 95% CI, 0.28 to 0.37), while there appeared to be no meaningful association between proxy measures of acculturation and past-year dental visit. Having health insurance was significantly associated with a past-year dental visit (odds ratio, 2.23; 95% CI, 1.99 to 2.49) for all groups combined and among the different Hispanic/Latino background groups. CONCLUSIONS: Acculturation affects general health and contributes to general health disparities; however, its role in dental care utilization remains questionable. Given that acculturation is a process that occurs over several years, longitudinal studies that evaluate oral health trajectories along the acculturation continuum are needed. KNOWLEDGE TRANSFER STATEMENT: The results of this study are valuable for dental public health program planning and implementation for minority groups, as it describes the varying patterns of dental care utilization among US-born and non-US born Hispanics/Latinos and identifies factors that may partly explain dental care utilization patterns, such as acculturation.

Asunto(s)

RESUMEN

INTRODUCTION: Adverse childhood experiences (ACEs) are negative life events occurring before the age of 18 y. ACEs are risk factors for heart disease and diabetes in adult life. Furthermore, individuals who experience ACEs are more likely to smoke and become obese-factors associated with poor oral health. OBJECTIVE: This study investigated likely associations between ACEs and the oral health measures of the 2010 Behavioral Risk Factor Surveillance System (BRFSS). METHODS: Data from 16,354 participants of the 2010 BRFSS were analyzed with SAS 9.4. ACE scores were calculated in 2 domains: abuse (emotional, physical, or sexual) and household challenges (parental separation or divorce, intimate partner violence, household substance abuse, household mental illness, and incarceration). ACE scores, ranging from 0 to 8, were categorized into 0, 1, 2, 3, and ≥4. The 2010 BRFSS oral health measures included >1 y since last dental visit, ≥6 teeth extracted, and ≥2 y since last dental cleaning. Survey logistic regression estimated prevalence odds ratios and 95% CIs, adjusted for age, sex, race/ethnicity, and educational attainment. RESULTS: The weighted mean ACE score was 1.74 (95% CI = 1.68 to 1.81), and the weighted and age-standardized percentages of study participants with ACE scores of 0, 1, 2, 3, and ≥4 were 33.1%, 24.3%, 14.9%, 9.69%, and 18.1%, respectively. There appeared to be a dose-response association between categories of ACE scores and the oral health measures. Specifically, when compared with participants with an ACE score of 0, participants with ACE scores of 1, 2, 3, and ≥4 had adjusted prevalence odds ratios (95% CIs) of 1.10 (0.82 to 1.47), 1.20 (0.90 to 1.60), 1.35 (0.98 to 1.85), and 1.72 (1.31 to 2.26), respectively, for reporting ≥2 y since last dental cleaning. CONCLUSIONS: Findings suggest that ACEs may be associated with poor oral health measures in adulthood, even after adjusting for important oral diseases risk factors. Longitudinal follow-up studies are needed to delineate pathways by which this relationship occurs. KNOWLEDGE TRANSFER STATEMENT: Our findings indicate that exposure to childhood trauma may have negative impacts on oral health in adulthood. Oral health practitioners need to be aware of the potential impacts of childhood trauma on health behaviors that ultimately affect oral health outcomes.

Asunto(s)

RESUMEN

INTRODUCTION: Adolescents are a population group that actively uses tobacco products; however, limited reports are available on the effects of tobacco products on adolescents' oral health. OBJECTIVES: This study investigated associations between self-reported use of cigarettes and e-cigarettes on the oral health status of a representative sample of US adolescents. METHODS: Data came from 13,650 adolescents aged 12 to 17 y who participated in the 2013-2014 wave of the Population Assessment of Tobacco and Health study. Participants self-reported current use (i.e., past 30 d) and ever use of cigarettes and e-cigarettes, as well as past-year diagnoses with dental problems by a doctor, dentist, or other health professional (self-reported by parent or emancipated youth). Survey-adjusted logistic regression was used to estimate prevalence odds ratios (PORs) and 95% CIs. RESULTS: The proportion of adolescents who self-reported current use of only cigarettes was 3.2%, while 1.7% reported current use of only e-cigarettes. Similarly, 1.4% reported current use of both cigarettes and e-cigarettes, while 7.1% reported ever use of both. About 22% self-reported a provider diagnosis with dental problems in the past year. The covariate-adjusted associations between current cigarette and e-cigarette use on self-reported provider-diagnosed dental problems in the past year were, respectively, POR = 1.50 (95% CI, 1.18 to 1.90) and POR = 1.11 (95% CI, 0.79 to 1.55), while self-reported current use of both was associated with POR = 1.72 (95% CI, 1.24 to 2.38). Ever use of cigarettes and e-cigarettes was likewise associated with increased prevalence odds of self-reported past-year diagnosis with dental problems, although to a lesser magnitude. CONCLUSION: Findings suggest that dual use of e-cigarettes and conventional cigarettes is associated with poor oral health outcomes among adolescents. However, studies of a longitudinal nature are needed to confirm these findings. KNOWLEDGE TRANSFER STATEMENT: The results of this study are relevant to public health and oral health practitioners seeking to intervene during developmental periods in which adolescents may have access to tobacco products in the home and in social settings.

Asunto(s)

RESUMEN

An association between periodontitis and nonalcoholic fatty liver disease (NAFLD) has been reported by experimental animal and epidemiologic studies. This study investigated whether circulating levels of serum C-reactive protein (CRP) and a weighted genetic CRP score representing markers of inflammatory burden modify the association between periodontitis and NAFLD. Data came from 2,481 participants of the Study of Health in Pomerania who attended baseline examination that occurred between 1997 and 2001. Periodontitis was defined as the percentage of sites (0%, <30%, ≥30%) with probing pocket depth (PD) ≥4 mm, and NAFLD status was determined using liver ultrasound assessment. Serum CRP levels were assayed at a central laboratory, and single-nucleotide polymorphisms previously identified through genome-wide association studies as robustly associated with serum CRP were combined into a weighted genetic CRP score (wGSCRP). Logistic regression models estimated the association between periodontitis and NAFLD within strata of serum CRP and separately within strata of the wGSCRP. The prevalence of NAFLD was 26.4% (95% confidence interval [CI], 24.6, 28.1) while 17.8% (95% CI, 16.0-19.6) had ≥30% of sites with PD ≥4 mm. Whereas the wGSCRP was not a modifier ( Pinteraction = 0.8) on the multiplicative scale, serum CRP modified the relationship between periodontitis and NAFLD ( Pinteraction = 0.01). The covariate-adjusted prevalence odds ratio of NAFLD comparing participants with ≥30% of sites with PD ≥4 mm to those with no site affected was 2.39 (95% CI, 1.32-4.31) among participants with serum CRP <1 mg/L. The corresponding estimate was 0.97 (95% CI, 0.57-1.66) for participants with serum CRP levels of 1 to 3 mg/L and 1.12 (95% CI, 0.65-1.93) for participants with serum CRP >3 mg/L. Periodontitis was positively associated with higher prevalence odds of NAFLD, and this relationship was modified by serum CRP levels.

Asunto(s)

Asunto(s)

RESUMEN

Directed acyclic graphs (DAGs) are nonparametric graphical tools used to depict causal relations in the epidemiologic assessment of exposure-outcome associations. Although their use in dental research was first advocated in 2002, DAGs have yet to be widely adopted in this field. DAGs help identify threats to causal inference such as confounders, bias due to subject selection, and inappropriate handling of missing data. DAGs can also inform the data analysis strategy based on relations among variables depicted on it. This article uses the example of a study of temporomandibular disorders (TMDs), investigating causal effects of facial injury on subsequent risk of TMD. We illustrate how DAGs can be used to identify 1) potential confounders, 2) mediators and the consequences of attempt to estimate direct causal effects, 3) colliders and the consequences of conditioning on colliders, and 4) variables that are simultaneously mediators and confounders and the consequences of adjustment for such variables. For example, one DAG shows that statistical adjustment for the pressure pain threshold would necessarily bias the causal relation between facial injury and TMD. Finally, we discuss the usefulness of DAGs during study design, subject selection, and choosing variables to be measured in a study.

Asunto(s)

RESUMEN

After decades of decline in prevalence of complete tooth loss (edentulism), the trend continues to be misinterpreted, producing flawed projections and misdirected health goals. We investigated population trends in edentulism among U.S. adults aged ≥ 15 yr by creating time-series data from 5 national cross-sectional health surveys: 1957-1958 (n ≈ 100,000 adults), 1971-1975 (n = 14,655 adults), 1988-1998 (n = 18,011 adults), 1999-2002 (n = 12,336 adults), and 2009-2012 (n = 10,522 adults). Birth cohort analysis was used to isolate age and cohort effects. Geographic and sociodemographic variation in prevalence was investigated with a sixth U.S. survey of 432,519 adults conducted in 2010. Prevalence through 2050 was projected with age-cohort regression models using Monte-Carlo simulation of prediction intervals. Across the 5-decade observation period, edentulism prevalence declined from 18.9% in 1957-1958 (95% confidence limits: 18.4%, 19.4%) to 4.9% in 2009-2012 (95% confidence limits: 4.0%, 5.8%). The most influential determinant of the decline was the passing of generations born before the 1940s, whose rate of edentulism incidence (5%-6% per decade of age) far exceeded later cohorts (1%-3% per decade of age). High-income households experienced a greater relative decline, although a smaller absolute decline, than low-income households. By 2010, edentulism was a rare condition in high-income households, and it had contracted geographically to states with disproportionately high poverty. With the passing of generations born in the mid-20th century, the rate of decline in edentulism is projected to slow, reaching 2.6% (95% prediction limits: 2.1%, 3.1%) by 2050. The continuing decline will be offset only partially by population growth and population aging such that the predicted number of edentulous people in 2050 (8.6 million; 95% prediction limits: 6.8 million, 10.3 million) will be 30% lower than the 12.2 million edentulous people in 2010.

Asunto(s)