Amid I. Ismail

Risk indicators for dental caries using the International Caries Detection and Assessment System (ICDAS)

BACKGROUND While national surveys have found that African-Americans have a higher prevalence and severity of dental caries than white-Americans, there are only a few descriptive studies of the prevalence and severity of dental caries in low-income urban African-Americans. OBJECTIVES This study assessed the prevalence, severity and determinants of dental caries, using the International Caries Detection and Assessment System (ICDAS). METHODS A representative sample of low-income families (a caregiver and a child aged 0-5 years) was selected from low-income census tracts in the city of Detroit, Michigan. Of the 12,655 randomly selected housing units, 10,695 were occupied and 9781 were successfully contacted (91.5%). There were 1386 families with eligible children in the contacted households; and of those, 1021 were interviewed and examined at a permanent examination center organized for this study. This represents an overall response rate of 73.7%. At the center, trained staff interviewed the main caregivers of the selected children, and trained and calibrated dentists examined the caregiver and her/his child. Data used in this study included information gathered from the social, behavioral and parenting questionnaires, the Block Food Frequency Questionnaire (total sugar intake), and data collected from community and census databases. RESULTS Over 90% of the adults (ages 14-70 years, average 29.3) had at least one noncavitated carious lesion and 82.2% had at least one primary cavitated lesion. Negative binomial regression models found that the age of caregivers and the number of churches in neighborhoods were negatively associated with the number of noncavitated tooth surfaces. Cavitated tooth surfaces were positively associated with age, oral hygiene status, being worried about teeth, a recent visit to a dentist, and the number of grocery stores in the neighborhoods. However, the number of cavitated tooth surfaces was negatively associated with preventive dental visits, positive rating of oral health status and the number of dentists in a community. CONCLUSIONS Dental caries, especially at the noncavitated stage, is highly prevalent in low-income African-American adults in Detroit. A significant increase in the mean number of missing teeth was observed after the age of 34 years. This study found that different individual, social, and community risk indicators were associated with noncavitated versus cavitated tooth surfaces.

Root caries in an optimally fluoridated and a high-fluoride community.

The purpose of this study was to measure the prevalence and distribution of root caries in two New Mexico communities. One community, Deming, had a natural fluoride concentration of 0.7 mglL in its drinking water, optimum for its climate. The other, Lordsburg, was naturally fluoridated at 3.5 mg/L, five times the optimum. Dental examinations were carried out on 151 adults in Deming (mean age, 39.8 years) and 164 in Lordsburg (mean age, 43.2 years); only persons born in the communities were included. Prevalence of root caries was 23.8% in Deming and 7.3% in Lordsburg; mean number of lesions was 0.69 in Deming and 0.08 in Lordsburg (p < 0.0001). Although there was more gingival recession in Lordsburg, Root Caries Index scores were five times greater in Deming. Root caries was more prevalent in older age groups, and was correlated with coronal caries experience in both communities. Root caries was correlated with plaque and calculus scores in Deming only. Logistic regression showed that city of residence was the major predictor of root caries, with other significant predictors being age, education, gingival recession, and loss of periodontal attachment. When combined with previous research, these results confirm that root caries experience is directly related to the fluoride concentration in the drinking water.

Predictors of Dental Caries Progression in Primary Teeth

The current evidence on the role of the social, behavioral, and community determinants of dental caries is based on cross-sectional analyses. The available evidence has not been based on analysis of multiple determinants within the same population. This longitudinal study addresses both of these limitations. The study included data from 788 dyads of children and their caregivers (77% follow-up), who were examined in 2002–03 and 2004–05. The families were assessed by calibrated dentists for severity of caries at both time periods. Additionally, the caregivers answered questionnaires administered by trained interviewers. The caries increment was adjusted for reversals. Significant predictors of higher caries increment were higher consumption of soda drinks, older age of child, greater weight-for-age, fewer dental treatment visits, higher baseline caries levels of children and their caregivers, dental fatalism, and neighborhood disadvantage status. The selected risk factors in the final model explained about 20% of the variation in the increment.

Global oral health inequalities: dental caries task group--research agenda.

The IADR Global Oral Health Inequalities Task Group on Dental Caries has synthesized current evidence and opinion to identify a five-year implementation and research agenda which should lead to improvements in global oral health, with particular reference to the implementation of current best evidence as well as integrated action to reduce caries and health inequalities between and within countries. The Group determined that research should: integrate health and oral health wherever possible, using common risk factors; be able to respond to and influence international developments in health, healthcare, and health payment systems as well as dental prevention and materials; and exploit the potential for novel funding partnerships with industry and foundations. More effective communication between and among the basic science, clinical science, and health promotion/public health research communities is needed. Translation of research into policy and practice should be a priority for all. Both community and individual interventions need tailoring to achieve a more equal and person-centered preventive focus and reduce any social gradient in health. Recommendations are made for both clinical and public health implementation of existing research and for caries-related research agendas in clinical science, health promotion/public health, and basic science.

Obesity and Sugar‐sweetened Beverages in African‐American Preschool Children: A Longitudinal Study

A representative sample of 365 low‐income African‐American preschool children aged 3–5 years was studied to determine the association between sugar‐sweetened beverage consumption (soda, fruit drinks, and both combined) and overweight and obesity. Children were examined at a dental clinic in 2002–2003 and again after 2 years. Dietary information was collected using the Block Kids Food Frequency Questionnaire. A BMI score was computed from recorded height and weight. Overweight and obesity were defined by national reference age‐sex specific BMI: those with an age‐sex specific BMI ≥85th, but <95th percentile as overweight and those with BMI ≥95th age‐sex specific percentile as obese. The prevalence of overweight was 12.9% in baseline, and increased to 18.7% after 2 years. The prevalence of obesity increased from 10.3 to 20.4% during the same period. Baseline intake of soda and all sugar‐sweetened beverages were positively associated with baseline BMI z‐scores. After adjusting for covariates, additional intake of fruit drinks and all sugar‐sweetened beverages at baseline showed significantly higher odds of incidence of overweight over 2 years. Among a longitudinal cohort of African‐American preschool children, high consumption of sugar‐sweetened beverages was significantly associated with an increased risk for obesity.

Modifiable Risk and Protective Factors for Depressive Symptoms in Low-Income African American Mothers

Low-income African American mothers of young children experience high rates of depression, but many of the risk factors that have been identified provide little direction for intervention. The authors examined modifiable risk and protective factors for probable depression (Center for Epidemiological Studies Depression Scale >or= 23) in 824 African American mothers living in the 39 poorest census tracts in Detroit. Household food insufficiency and deteriorated housing significantly increased the odds of likely depression, whereas availability of a loan in a crisis, help with childcare, and transportation were protective. However, more frequent experiences of everyday discrimination greatly increased the odds of elevated depressive symptoms. These findings support the need for interventions that operate across individual and societal levels to address the fundamental causes of poor mental health.

Evidence on existing caries risk assessment systems: are they predictive of future caries?

AIM To critically appraise evidence for the prediction of caries using four caries risk assessment (CRA) systems/guidelines (Cariogram, Caries Management by Risk Assessment (CAMBRA), American Dental Association (ADA), and American Academy of Pediatric Dentistry (AAPD)). This review focused on prospective cohort studies or randomized controlled trials. METHODS A systematic search strategy was developed to locate papers published in Medline Ovid and Cochrane databases. The search identified 539 scientific reports, and after title and abstract review, 137 were selected for full review and 14 met the following inclusion criteria: (i) used as validating criterion caries incidence/increment, (ii) involved human subjects and natural carious lesions, and (iii) published in peer-reviewed journals. In addition, papers were excluded if they met one or more of the following criteria: (i) incomplete description of sample selection, outcomes, or small sample size and (ii) not meeting the criteria for best evidence under the prognosis category of the Oxford Centre for Evidence-Based Medicine. RESULTS There are wide variations among the systems in terms of definitions of caries risk categories, type and number of risk factors/markers, and disease indicators. The Cariogram combined sensitivity and specificity for predicting caries in permanent dentition ranges from 110 to 139 and is the only system for which prospective studies have been conducted to assess its validity. The Cariogram had limited prediction utility in preschool children, and a moderate to good performance for sorting out elderly individuals into caries risk groups. One retrospective analysis on CAMBRAs CRA reported higher incidence of cavitated lesions among those assessed as extreme-risk patients when compared with those at low risk. CONCLUSION The evidence on the validity for existing systems for CRA is limited. It is unknown if the identification of high-risk individuals can lead to more effective long-term patient management that prevents caries initiation and arrests or reverses the progression of lesions. There is an urgent need to develop valid and reliable methods for caries risk assessment that are based on best evidence for prediction and disease management rather than opinions of experts.

Dietary patterns related to caries in a low-income adult population.

The aim of this study was toexamine the relationship between dietary patterns and caries experience in a representative group of low-income African-American adults. Participants were residents of Detroit, Michigan, with household incomes below 250% of the federally-established poverty level (n = 1,021). Dietary histories were obtained by trained interviewers in face-to-face interviews with the adult participants, using the Block 98.2® food frequency questionnaire. Caries was measured by the ICDAS criteria (International Caries Detection and Assessment System). There were 200 dietary records whose data were judged to be invalid; these participants were omitted from the dietary analyses to leave n = 821. Factor analysis identified patterns of liquid and solid food consumption, and the resulting factor scores were used as covariates in multivariable linear regression. Caries was extensive, with 82.3% of the 1,021 participants (n = 839) having at least one cavitated lesion. Nearly three quarters of the adult participants were overweight or obese. This population had severe caries, poor oral hygiene, and diets that are high in sugars and fats and low in fruits and vegetables. Apart from tap water, the most frequently consumed food item by adults of all ages was soft drinks; 19% of all energy from sugar came from soft drinks alone. In both the bivariate analyses and in the regression model, frequency of soft drink consumption and the presence of gingival plaque deposits were significantly associated with caries. Interventions to promote oral health are unlikely to be successful without improvements in the social and physical environment.

Perceived everyday discrimination and psychological distress: does social support matter?

Objectives. We investigate the association between perceived everyday discrimination and psychological distress among urban African-American women with young children (under 6 years) living in low-income neighborhoods. Specifically, we examine whether instrumental and emotional social support moderates the association between perceived everyday discrimination and psychological distress. Design. The data come from the Detroit Dental Health Project, a two-stage area probability sample representative of low-income African-American children in the city of Detroit. The analysis focuses on 969 female caregivers of young children. A series of hierarchical regression analyses were performed to examine the role of social support in the link between perceived everyday discrimination and psychological distress, with appropriate adjustments for the complex sample design. Results. Both moderate and high frequency levels of discrimination were associated with higher levels of psychological distress after controlling for age, education, income, and self-rated health. There was a main effect of emotional support so that availability of emotional support was associated with less psychological distress. Instrumental support exerted a buffering effect to mitigate the negative influence of moderate levels of perceived discrimination on psychological distress. Conclusion. Findings suggest that instrumental social support provides some protection from everyday stress. Social support, however, does not offset the impact of acute stress caused by frequent perceptions of everyday discrimination.

Patient Preferences and the Measurement of Utilities in the Evaluation of Dental Technologies

Advances in life sciences that are predicted in the 21st century will present many challenges for health professionals and policy-makers. The major questions will be how to allocate resources to pay for costs of new technologies and who will best benefit from advances in new diagnostic and treatment methods. We review in this paper the concept of utility and how it can be applied and expanded to provide data to help health professionals make decisions that are preferred by patients and the public at large. Utility is a measure of peoples well-being or preferences for outcomes. The measurement of utilities of a new diagnostic technology, for example, can be carried out with the use of simple methods that do not incorporate all of the uncertainties and potential outcomes associated with providing the test, or with more complex methods that can incorporate most uncertainties. This review describes and critiques the different measurement methods of utilities.