Oral Health Risk Research Articles

Promoting Oral Health in Childhood: A Quality Improvement Project.

The American Academy of Pediatrics recommends periodic oral health risk assessments (OHRAs) for young children to prevent early childhood caries and promote oral health. The objective of this quality improvement project was to incorporate OHRAs, including documentation of the oral screening examination, into well-child visits for patients aged 12 to 47 months to drive (1) improved rates of preventive fluoride varnish (FV) application and (2) improved dental referrals for children at high risk for caries. We identified a quality gap in our OHRAs, oral examination completion, FV application rates, and dental referral rates via retrospective data collection. Plan-Do-Study-Act cycles targeted modification of electronic medical record templates, oral health education, and standardization of work processes. Process and outcome measures were analyzed with statistical process control charts. At baseline, OHRAs and oral screening examinations were documented in <2% of patients. Of eligible children, 42% had FV applied. Routine dental referrals before age 3 years were uncommon. After multiple Plan-Do-Study-Act cycles, documentation of OHRAs and oral screening examinations (process measures) improved to 45% and 73%, respectively. The primary outcome measure, FV rates, improved to 86%. Referral of high-risk patients to a dentist improved to 54%. A systematic, evidence-based approach to improving oral health, including electronic medical record-based interventions, resulted in improved documentation of oral health risks and oral screening, improved rates of FV application in young children, and increased identification and referral of high-risk patients.

Reducing pediatric caries and obesity risk in South Asian immigrants: randomized controlled trial of common health/risk factor approach

BackgroundThis paper describes the design and methods of a multi-phase study to reduce early childhood caries and obesity in vulnerable South Asian (SA) immigrants in the United States. Early childhood caries and obesity are the most common diseases of early childhood. Risk factors for both diseases are rooted in early childhood feeding practices such as bottle feeding and intake of sweets and sweetened beverages. The Common Health/Risk Factor Approach to addressing oral health is widely promoted by the WHO and other policy makers. This approach recognizes links between oral health and other diseases of modernity. Our CHALO! (“Child Health Action to Lower Obesity and Oral health risk”--from a Hindi word meaning "Let's go!") study targets SA families at high risk for early childhood caries and obesity. CHALO! addresses common risk factors associated with these two common diseases of childhood.MethodsThis two part project includes a randomized controlled trial, and a Knowledge Translation campaign. A randomized controlled trial will enroll n = 360 families from pediatric practices serving South Asians in the New York metro area. The intervention group will receive home visits by SA community health workers at 6, 8, 10, 12, 14, and 16 months of age. Controls will receive culturally tailored educational material. Primary outcomes-- cariogenic and obesogenic feeding practices at 6, 12, and 18 months-- will be assessed with the MySmileBuddy iPad based tool. Secondary outcomes include: oral hygiene practices, anthropometrics, and caries incidence at 18 months. A public education campaign will focus on both families and health care providers.DiscussionThere are few Common Health/Risk Factor Approach published studies on obesity and oral health risk in children, despite health morbidity and costs associated with both conditions. CHALO! comprises a multi-level interventions designed to promote culturally competent, sustainable change.Trial registrationClinicalTrials.govNCT03077425.

Oral health and oral health risk behaviour in children with and without externalising behaviour problems

AimThis was to study children with early detected externalising behaviour problems compared to matched controls regarding oral health, oral health risk behaviour and the parental evaluation of the child’s oral health and dental care.MethodsChildren aged 10–13 years and with externalising behaviour problems, were compared to matched controls. Behavioural characteristics were based on the Strength and Difficulties Questionnaire. The children and their parents completed questionnaires regarding dental fear, tooth brushing, dietary habits and evaluation of oral health and dental care. Data on dental caries risk assessments, caries, behaviour management problems and dental trauma were obtained from dental files.ResultsThere were no differences in caries prevalence in children with early detected externalising behaviour problems, compared to controls. However, the former group consumed more sweet drinks when thirsty and brushed their teeth fewer than twice daily; they also had more dental trauma in both dentitions and a higher risk range for dental fear, compared to controls.ConclusionsThis study points out potential oral health risk factors in children with early-detected externalising behaviour problems. Although no difference in caries prevalence was observed, externalising behaviour may affect oral health. Therefore, dental professionals should support the families and the children to preserve dental health by offering increased prophylactic measures. There were no differences between children with externalising behaviour problems, compared with controls, regarding the parent evaluation of their child’s dental health. However, more parents in the study group evaluated the dental care as poor or not functioning.

Geographic and health system correlates of interprofessional oral health practice

Objective This study explores geographic, system, and organizational constructs that predict medical care teams’ willingness to administer fluoride varnish and conduct oral health risk assessments. Methods A cross-sectional survey of voluntary health professionals attending trainings on interprofessional oral health practice was completed at ten meetings across the United States from April through September, 2016. Bivariate and multivariate analyses were used to examine unknown correlates of oral health prevention and intervention at geographic, organizational, and system levels relating to the impact of referral mechanisms and systems as well as health information technology on fluoride varnish administration and risk-based oral evaluations. Results A convenience cohort (n = 560) from 44 states was examined. Most (68.7%, n = 385) agreed with the dependent variable “medical providers at our site, or part of our network, are administering fluoride varnish and identifying oral health risk factors in the majority of patients seen.” In bivariate analysis, organization type (P = 0.0067), having successful referral systems (P Conclusion The dependability of medical-to-dental referral systems and processes impacts the administration of fluoride varnish and identification of oral health risk factors by motivated primary care teams. Additionally, the ease of EHR use and the availability of electronic information exchange were found to impact primary care oral health practice. Significance statement Caries activity is one of the most common diseases of childhood, and prevention/intervention by primary care teams can positively impact patient results. This analysis examined unknown correlates of oral health prevention and intervention at geographic, organizational, and system levels relating to the impact of referral mechanisms and systems as well as health information technology on fluoride varnish administration and risk-based oral evaluations.

Elevating Oral Health Interprofessional Practice Among Pediatricians Through a Statewide Quality Improvement Learning Collaborative.

Because of persistent effects of early childhood caries and impacts of dental health professional shortages areas, the integration of oral health in primary care settings is a public health priority. In this study, we explored oral health interprofessional practice (OHIP) as an integrative pathway to reduce oral health disparities. OHIP can include performing oral health risk assessments, describing the importance of fluoride in the drinking water, implementing fluoride varnish application, and referring patients to a dental home. To conduct a formative evaluation of how 15 pediatric primary care practices implemented the adoption of OHIP in their clinical settings. Using an ecological framework, we conducted a qualitative process evaluation to measure the factors that inhibited and facilitated OHIP adoption into pediatric settings. Document review analysis and qualitative interviews were conducted with pediatric practices to contextualize challenges and facilitators to OHIP adoption. A total of 15 Children's Health Insurance Program Reauthorization Act pediatric practices located in 13 South Carolina counties participated in this study. Outcomes of interest were the facilitators and challenges of OHIP adoption into pediatric primary care practices. Thematic analysis revealed challenges for OHIP adoption including limited resources and capacity, role delineation for clinical and administrative staff, communication, and family receptiveness. OHIP training for clinical practitioners and staff and responsiveness from clinical staff and local dentists were facilitators of OHIP adoption. Twelve key recommendations emerged on the basis of participant experiences within OHIP, with developing an active dental referral network and encouraging buy-in from clinical staff for OHIP adoption as primary recommendations. We demonstrated the effectiveness of a learning collaborative meeting among pediatric primary care providers to adopt OHIPs. This work reveals an actionable pathway to support oral health equity advancement for children through an additional access point of preventive oral care, reinforcement of positive oral health behaviors, and interaction between parent and child for overall health and wellness of the family.

Adhesives for fixed orthodontic brackets.

Bonding of orthodontic brackets to teeth is important to enable effective and efficient treatment with fixed appliances. The problem is bracket failure during treatment which increases operator chairside time and lengthens treatment time. A prolonged treatment is likely to increase the oral health risks of orthodontic treatment with fixed appliances one of which is irreversible enamel decalcification. This is an update of the Cochrane Review first published in 2003. A new full search was conducted on 26 September 2017 but no new studies were identified. We have only updated the search methods section in this new version. The conclusions of this Cochrane Review remain the same. To evaluate the effects of different orthodontic adhesives for bonding. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 26 September 2017), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 8) in the Cochrane Library (searched 26 September 2017), MEDLINE Ovid (1946 to 26 September 2017), and Embase Ovid (1980 to 26 September 2017). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. Trials were selected if they met the following criteria: randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing two different adhesive groups. Participants were patients with fixed orthodontic appliances. The interventions were adhesives that bonded stainless steel brackets to all teeth except the molars. The primary outcome was debond or bracket failure. Data were recorded on decalcification as a secondary outcome, if present. Information regarding methods, participants, interventions, outcome measures and results were extracted in duplicate by pairs of review authors. Since the data were not presented in a form that was amenable to meta-analysis, the results of the review are presented in narrative form only. Three trials satisfied the inclusion criteria. A chemical cured composite was compared with a light cured composite (one trial), a conventional glass ionomer cement (one trial) and a polyacid-modified resin composite (compomer) (one trial). The quality of the trial reports was generally poor. There is no clear evidence on which to make a clinical decision of the type of orthodontic adhesive to use.

Integrative and collaborative care models between pediatric oral health and primary care providers: a scoping review of the literature.

Collaborative and/or integrative care between oral health and primary care providers can increase access to care to a more expansive population, helping to mitigate oral health related disease. The objective of this review was to present and evaluate different types of care models that exist between oral health and primary care providers in pediatric settings. A literature search was conducted using five databases: MEDLINE/PubMed, ISI Web of Science, Dentistry and Oral Sciences Source, Cochrane Database, and EMBASE, to identify literature from January 1990 to January 2016. Combinations of controlled terms were utilized. Eligible sources targeted pediatric populations ages 1-17 and provided descriptions of existing collaborative and/or integrative models. Data related to the practice model, oral care provided, level of integration/collaboration and workflow were extracted. Sixteen articles were included that discussed 24 models of collaboration. These models provided ranges of services, but each offered a minimum of oral health risk assessment, oral health instruction, topical fluoride application and assessment for further treatment. These models included different levels of collaboration based off a ranking system created by the authors with 16.6 percent (4) classified as low, 54.2 percent (13) as medium and 29.2 percent (7) as high. Existing care models offered varying services and levels of integration and/or collaboration, but each offered a baseline of oral care. Most of these collaborations were based within Federally Qualified Health Centers and aimed to ease access to care issues.

Nutrition and the community-dwelling older person: a pilot study in general practice.

Nutrition is vital for health, and undernutrition can compromise physical and mental wellbeing. The prevalence of undernutrition among older community-dwelling adults attending general practice in Australia is not readily known. The aims of the study were to determine the prevalence of malnutrition of the elderly in Australian general practice, to assess malnutrition-related factors and to describe the older people's perception about nutrition. The study sample comprised 60 older people aged 75 years and above attending one general practice in South Australia. The combination of qualitative and quantitative data provided a more complete account of nutrition and its meaning for the older person. Three commonly used, validated nutritional screening tools were useful in determining undernutrition between 15 and 20% in a community population. One screening tool determined a 62% incidence of nutritional risk. Health characteristics determined almost 75% of participants identified at oral health risk. Frailty, medications and chronic disease were identified as factors associated with nutritional risk. Examination of older persons' perceptions about nutrition and wellbeing identified two major themes: older people have nutritional awareness but lack details, especially in relation to the benefits of protein intake, and there is limited awareness on the health benefits of good nutrition. This study confirms that nutritional risk is common in general practice. Understanding older person's perceptions of good nutrition is vital to be able to effectively change their nutritional status and plan amenable interventions. Screening practices with valid and reliable screening tools are imperative to ensure appropriate identification and management of older people at risk. WHAT THIS ARTICLE ADDS.

Incorporation of Dental Health Screening in Paediatric Office Practice

Introduction: Dental health problems in children are often overlooked. Poor oral health negatively affects growth, learning, communication, self-esteem and rarely can also lead to serious fatal infection. Paediatrician can play key role in screening dental health problems. The objectives of this study were to screen children for dental caries in paediatric office and correlate with socio-demographic, dietary and oral hygiene risk factors.Material and Methods: After basic oral health training, paediatrician assessed oral health risk factors with pre-validated questionnaire and carried out dental examination at paediatric OPD.Results: Dental health problems were found in 364(42.8%) out of 850 subjects. Age was significantly associated (p&lt;0.0001) with type of teeth involved. Incisors were most affected in infants and involvement of posterior teeth increased with age. Statistically significant (p&lt;0.05) oral health risk factors were increasing age, lower socio-economic status, malnutrition, lower parents’ education, positive family history, bottle feeding, increased consumption of biscuits, fizzy drinks and chewing gum; delayed start and less time spent on brushing, infrequent change of toothbrush, incorrect brushing technique, inadequate parental knowledge and supervision.Conclusion: Dental screening can easily be incorporated in busy paediatric practice. An identification and record of individual risk factor is useful in selecting counselling strategies and monitoring.

Older Adult Oral Health Risk in Arkansas

Older Adult Oral Health Risk in Arkansas

Oral health and later coronary heart disease: Cohort study of one million people.

AimsSystematic reviews report an association between poorer oral health and an increased risk of coronary heart disease. This contentious relationship may not be causal but existing studies have been insufficiently well powered comprehensively to examine the role of confounding, particularly by cigarette smoking. Accordingly, we sought to examine the role of smoking in generating the relationship between oral health and coronary heart disease in life-long non-smokers.Methods and resultsIn the Korean Cancer Prevention Study, 975,685 individuals (349,579 women) aged 30–95 years had an oral examination when tooth loss, a widely used indicator of oral health, was ascertained. Linkage to national mortality and hospital registers over 21 years of follow-up gave rise to 64,784 coronary heart disease events (19,502 in women). In the whole cohort, after statistical adjustment for age, there was a moderate, positive association between tooth loss and coronary heart disease in both men (hazard ratio for seven or more missing teeth vs. none; 95% confidence interval 1.08; 1.02, 1.14; Ptrend across tooth loss groups <0.0001) and women (1.09; 1.01, 1.18; Ptrend 0.0016). Restricting analyses to a subgroup of 464,145 never smokers (25,765 coronary heart disease events), however, resulted in an elimination of this association in men (1.01; 0.85, 1.19); Ptrend 0.7506) but not women (1.08; 0.99, 1.18; Ptrend 0.0086).ConclusionIn men in the present study, the relationship between poor oral health and coronary heart disease risk appeared to be explained by confounding by cigarette smoking so raising questions about a causal link.

The oral health behaviours and fluid consumption practices of young urban Aboriginal preschool children in south-western Sydney, New South Wales, Australia.

Australian Aboriginal children have a higher risk of dental caries yet there is limited focus on oral health risk factors for urban Aboriginal preschool children. This study examined the oral health behaviours and fluid consumption practices of young children from an urban Aboriginal community in south-western Sydney, Australia. In total, 157 Aboriginal children who were recruited to the "Gudaga" longitudinal birth cohort participated in this study. A survey design was employed and parents responded to the oral health questions when their child was between 18 and 60 months. Few parents (20%) were concerned about their child's oral health across the time period. By 60 months, only 20% of children had seen a dentist while 80% were brushing their teeth at least once daily. High levels of bottle use were seen up to 30 months. Consumption of sugary drinks was also very high in the early years, although this was replaced by water by 36 months. While there are some encouraging findings, such as the rates of tooth brushing and increasing rates of water consumption, the findings do highlight the poor uptake of dental services and high levels of bottle usage among urban aboriginal children during their early years. SO WHAT?: Targeted oral health promotional programs are needed in the urban Aboriginal community to better support parents understanding of good oral health practices in the early years and engagement with dental health services.

Mortality rate and oral health – a cohort study over 44 years in the county of Stockholm

Objective: To study the association between oral health and all-cause mortality rate over 44 years. In addition, the specific relations between oral health and death caused by cardiovascular disease (CVD), cancer or other reasons were investigated.Materials and Methods: An epidemiological investigation studying the oral health of the population consisting of 1393 randomly selected subjects was performed in the County of Stockholm. The individuals were invited to a clinical examination, an interview and a radiographic examination. The incidence of mortality during the years 1970–2014 as well as the causes of death according to the death certificate were registered in 2015. Cox regression survival analysis was used for investigating the effect of several variables upon the time to the outcome of death.Results: Forty-six percent of the subjects were still alive at the end of the year 2014. Cancers caused 27% of the deaths, while 22% died due to CVD. The mortality risk was positively and significantly correlated to oral health when compensated for age, sex, smoking and social status. In addition, the mortality risk caused by CVD, cancer or other reasons was significantly increased for those with poor oral health.Conclusions: Oral health was found to be a risk indicator of death caused by CVD and cancer as well as for all-cause mortality. Thus, the associations are unspecific. Harmful lifestyle factors impact dental health behavior as well as mortality risk. This might contribute to the association between oral health and mortality risk.

Knowledge, attitudes, and practices among gynecologists regarding oral health of expectant mothers and infants in Bhubaneswar City, Odisha.

Early intervention is aimed at preventing or mitigating common pediatric oral diseases and conditions while initiating a relationship between the mother, the child, and the dental caregiver. Every expectant mother should receive oral health education and risk assessment. There are a number of reports that showed the association between oral diseases and preterm, low birth weight, and gestational diabetes. The purpose of this study is to understand the attitude and knowledge regarding prenatal as well as infant oral health care among gynecologists in the medical colleges in Bhubaneswar, Odisha, India. The study involved a survey involving gynecologists in medical colleges in Bhubaneswar, Odisha. A pretested questionnaire was provided to all the gynecologists (21) working in the medical colleges in Bhubaneswar regarding prenatal and perinatal oral health care. The study gave an idea that most gynecologists working in a medical college in Bhubaneswar, Odisha, India, had adequate knowledge regarding oral health of expectant mothers, but lack in knowledge when it comes to imparting knowledge on infants' health care. There is an adequate knowledge among the gynecologists about oral health of expectant mothers and infants, but still, there is a need of a multidisciplinary collaboration among gynecologists, pediatricians, and pediatric dentists to prevent the dental diseases rather than treating them.

Simultaneous oral health risk behaviors among adolescents: evidence from the National School-based Student Health Survey.

To investigate the prevalence of simultaneous oral health risk behaviors and associated factors among Brazilian adolescents. The study comprised data of 109,104 adolescents participating in the Brazilian National School-based Student Health Survey. The simultaneous presence of less frequent toothbrushing (E), current smoking (C), no visits to the dentist (D), low fruit intake (F), and high sugar intake (A) was assessed by comparison of observed/expected prevalence (OP/EP). Logistic regression was used to assess sociodemographic and family factors associated with the clustering patterns of oral health risk behaviors. The simultaneous occurrence of two or more oral health risk behaviors was of 60.40%. The highest prevalence values were found for the following patterns with OP/EP over 1.20: EDF, CFA, and EDFA. The odds for two or more combined oral health risk behaviors were higher for adolescents whose parents did not participate in homework, from public schools, males, and of Asian or Indigenous ethnicity (OR > 1.00; p < 0.05). Low family affluence level (FAL) acted as a risk factor for the pattern ECDFA (OR = 2.58; p = 0.009), while low and mean FAL functioned as protection factors for the pattern CFA (OR = 0.71; p < 0.001, and OR = 0.76; p = 0.011). The prevalence of simultaneous oral health risk behaviors was low and negatively associated with sociodemographic and family factors. Interventions aiming at reducing these behavior patterns should prioritize the groups that have been identified as being at most risk.

Knowledge, attitude and practice among Health Visitors in the United Kingdom toward children's oral health.

The purpose of this study was to determine knowledge, attitude, and practical behavior of health visitors regarding children's oral health in the United Kingdom (UK). A web-based self-administered survey with 18 closed and 2 open ended questions was distributed to a convenience sample of approximately 9,000 health visitors who were currently employed in the United Kingdom and a member of the Institute of Health Visiting. A total of 1,088 health visitors completed the survey, resulting in a response rate of 12%. One-third of the health visitors reported that they had not received oral health training previously. Almost all agreed that oral health advice/promotion should be included in their routine health visiting contacts. Previous oral health training/education was associated with an increase in oral health knowledge; confidence in entering a discussion with parents/caregivers and willingness to be involved in dental referral process. The results of our study support the need for health visitors to receive oral health training in oral health promotion including oral health risk assessment, guidance on evidence based up-to-date prevention measures, increasing the dental attendance prevalence at early stages and awareness of including specific oral health guidelines/fact sheets into their regular practice.

Oral health risks associated with recreational and professional scuba diving: A pilot study

Oral health risks associated with recreational and professional scuba diving: A pilot study

Oral health risks associated with recreational and professional scuba diving – a pilot study

The pressure experienced during diving can cause a variety of pressureinduced injuries to the head, face and oral regions. The most common oral complications are odontocrexis (dislodgement of dental restorations), barometric-related dental pain caused by air bubbles and increased pressure at the restoration–tooth interface or by flaring of periapical infections, temporomandibular joint disorders caused by heavy or poorly designed mouthpieces, and cross-contamination of pathogens caused by improper disinfection of shared equipment. This study aims to identify the most common effects of frequent pressure variation on the oral health of divers from Ras Al Khaimah (RAK) Police and assess the in vitro survival of composite and amalgam restorations. A questionnaire eliciting demographic, occupational and barotrauma-related information was completed by members of RAK Police and the data analysed. High-quality composite and amalgam restoration was performed on extracted teeth before exposure to 0.5–0.6MPa at 37°C, simulating deep-diving conditions, and repeated seven times for a duration of 10 minutes. Survival of the restorations was monitored. Questionnaire data revealed that deep divers experience periodontal damage, enamel fissures and odontocrexis of metal and composite restorations, which could be associated with diving depth and frequency. These observations were supported by the in vitro assessment. Odontocrexis was observed earlier and more severely in amalgam restorations than in composite restorations. Increased pressure during diving can therefore affect the integrity of both amalgam and composite restorations, but composite restorations can withstand increased pressure for a longer duration than amalgam restorations before eventually showing damage, as observed both in vitro and in vivo. Divers with more experience and who dive deeper are affected to a greater extent by barotrauma than those with less experience or who do not dive as deep.

Bioaccessibilities and health implications of heavy metals in exposed-lawn soils from 28 urban parks in the megacity Guangzhou inferred from an in vitro physiologically-based extraction test

This study focused on characterizing the oral bioaccessibilities and human health risks of eight heavy metals (Cd, Pb, Cr, Ni, Cu, Zn, Fe, and Mn) in surface-exposed lawn soils from 28 urban parks in Guangzhou. The physiologically-based extraction test (PBET) method was used to assess bioavailability (in gastric and intestinal phases) and human health risk was assessed via statistical modelling (carcinogenic risk assessment, hazard quotients and hazard indices). Mean bioaccessibilities of Cd, Pb, Cr, Ni, Cu, Zn, Fe, and Mn from all soil samples were 50.90 ± 17.67%, 5.81 ± 1.67%, 7.12 ± 3.24%, 17.91 ± 18.34%, 11.93 ± 2.88%, 34.33 ± 10.02%, 1.68 ± 0.48%, 26.71 ± 5.06%, respectively. The concentrations of most heavy metals were higher in the gastric phase, except for Cr and Ni which remained higher in the intestinal phase. Principal component analysis revealed that the bioaccessibilities of the heavy metals could be split into three groupings, based on the urban park of soil origin. The carcinogenic risk probabilities for Pb and Cr were under the acceptable level (< 1 × 10−4) for both adults and children. The hazard quotient and hazard index values indicated no significant risk of non-carcinogenic effects to children or adults exposed to Guangzhou urban park soils. This research will help inform further risk assessment and management of heavy metal contaminants in urban environments.

Factors Influencing the Phenotypic Characterization of the Oral Marker, PROP.

In the last several decades, the genetic ability to taste the bitter compound, 6-n-propyltiouracil (PROP) has attracted considerable attention as a model for understanding individual differences in taste perception, and as an oral marker for food preferences and eating behavior that ultimately impacts nutritional status and health. However, some studies do not support this role. This review describes common factors that can influence the characterization of this phenotype including: (1) changes in taste sensitivity with increasing age; (2) gender differences in taste perception; and (3) effects of smoking and obesity. We suggest that attention to these factors during PROP screening could strengthen the associations between this phenotype and a variety of health outcomes ranging from variation in body composition to oral health and cancer risk.