Masahiro Heima

Increased Enamel Hypoplasia and Very Low Birthweight Infants

Birth cohort studies of developmental defects of enamel (DDE) and early childhood caries (ECC) in very low birthweight (VLBW) and normal birthweight (NBW) infants are rare. In this birth cohort of 234 VLBW and 234 NBW infants, we report the incidence of ECC and DDE at 8 and 18-20 mos of corrected age. Infant medical and maternal socio-demographic data were abstracted from medical records at birth. Dental assessments for ECC and DDE (enamel hypoplasia, demarcated and diffuse opacities) were completed at 8 and 18-20 mos. The incidence of hypoplasia was significantly higher in VLBW compared with NBW infants (8 mos, 19% vs. 2%; 18 mos, 31% vs. 8%). The incidence of ECC (International Caries Detection and Assessment System: ICDAS ≥ 2) was 1.4% (8 mos) and 12% (18-20 mos) and was similar between the VLBW and NBW groups. At both ages, using a beta-binomial regression model to control for potential confounders (maternal and infant characteristics), we found increased risk for enamel hypoplasia among the VLBW infants compared with the NBW infants. African Americans had a lower risk for enamel hypoplasia at 18-20 mos. The VLBW infants should be monitored for ECC due to the presence of enamel hypoplasia.

Caregiver's education level and child's dental caries in African Americans: a path analytic study.

The objective of this study was to investigate the influence of caregiver education level on childrens dental caries mediated by both caregiver and child oral health behaviors. Participants were 423 low-income African American kindergarteners and their caregivers who were part of a school-based randomized clinical trial. Path analysis tested the hypothesis that caregiver education level affected untreated dental caries and cumulative overall caries experience (decayed or filled teeth) through the mediating influence of frequency of dental visits, use of routine care, and frequency of toothbrushing for both the caregiver and the child. The results supported the hypothesis: caregivers who completed high school were 1.76 times more likely to visit dentists compared with those who did not complete high school (e0.56 = 1.76, 95% CI: 1.03-2.99), which in turn was associated with 5.78 times greater odds of dental visits among their children (e1.76 = 5.78, 95% CI: 3.53-9.48). Childrens dental visits, subsequently, were associated with 26% fewer untreated decayed teeth compared with children without dental visits (e-0.31 = 0.74, 95% CI: 0.60-0.91). However, this path was not present in the model with overall caries experience. Additionally, caregiver education level was directly associated with 34% less untreated decayed teeth (e-0.42 = 0.66, 95% CI: 0.54-0.79) and 28% less decayed or filled teeth (e-0.32 = 0.72, 95% CI: 0.60-0.88) among the children. This study overcomes important conceptual and analytic limitations in the existing literature. The findings confirm the role of caregiver education in child dental caries and indicate that caregivers behavioral factors are important mediators of child oral health.

School screening and parental reminders in increasing dental care for children in need: a retrospective cohort study

OBJECTIVE The objective of this study is to assess follow-up dental care received by children given baseline screening and referrals as part of an ongoing clinical trial. METHODS A retrospective study with two cohorts of kindergarten children who had baseline and follow-up (9 months later) dental exams was used. The parents/caregivers of children with routine restorative or urgent needs at baseline received a referral letter and telephone reminders to seek care for their child. Children with referrals were evaluated at follow-up exam for the receipt of care. A baseline caregiver questionnaire provided information on the individual and family characteristics of the children. RESULTS A total of 303 children had dental exams at both time periods. At baseline, 42 percent (126/303) received referrals and among the referred group19 percent (24/126) received follow-up care. A greater proportion with urgent referrals (10/30, 33 percent) received care than those with routine referrals (14/96, 15 percent). Baseline dmft decayed, missing, filled primary teeth and DMFT decayed, missing, filled permanent teeth was similar between children who did/did not receive follow-up care (P = 0.178 and 0.491, respectively). Children receiving referrals had caregivers with less education, higher Medicaid participation, fewer routine care visits, poorer self-rating of teeth, and a higher proportion of children reporting tooth pain. Children without receipt of follow-up care had caregivers who were more likely to report not visiting a dentist within the last 5 years and a greater number of missed days from work because of tooth problems. CONCLUSION The rate of dental utilization was low even with school screening, referral and parental reminders among poor, largely minority inner-city kindergarten children.

The Dental Neglect Scale in adolescents

BackgroundDental neglect has been found to be related to poor oral health, a tendency not to have had routine check-ups, and a longer period of time since the last dental appointment in samples of children and adults. The Dental Neglect Scale (DNS) has been found to be a valid measure of dental neglect in samples of children and adults, and may be valid for adolescents as well. We administered the DNS to a sample of adolescents and report on the relationships between the DNS and oral health status, whether or not the adolescent has been to the dentist recently for routine check-ups, and whether or not the adolescent currently goes to a dentist. We also report the internal and test-retest reliabilities of the DNS in this sample, as well as the results of an exploratory factor analysis.MethodsOne hundred seventeen adolescents from seven youth groups in the Seattle-Tacoma metropolitan area (Washington State, U.S.) completed the DNS and indicated whether they currently go to a dentist, while parents indicated whether the adolescent had a check-up in the previous three years. Adolescents also received a dental screening. Sixty six adolescents completed the questionnaire twice. T-tests were used to compare DNS scores of adolescents who have visible caries or not, adolescents who have had a check-up in the past three years or not, and adolescents who currently go to a dentist or not. Internal reliability was measured by Cronbachs alpha, and test-rest reliability was measured by intra-class correlation. Factor analysis (Varimax rotation) was used to examine the factor structure.ResultsIn each comparison, significantly higher DNS scores were observed in adolescents with visible caries, who have not had a check-up in the past three years, or who do not go to a dentist (all p values < 0.05). The test-retest reliability of the DNS was high (ICC = 0.81), and its internal reliability was acceptable (Cronbachs alpha = 0.60). Factor analysis yielded two factors, characterized by home care and visiting a dentist.ConclusionThe DNS appears to operate similarly in this sample of adolescents as it has in other samples of children and adults.

The effectiveness of xylitol in a school-based cluster-randomized clinical trial

Objective: The purpose of this double-blind, cluster-randomized clinical trial was to examine the effects of xylitol gummy bear snacks on dental caries progression in primary and permanent teeth of inner-city school children. Methods: A total of 562 children aged 5-6 years were recruited from five elementary schools in East Cleveland, Ohio. Children were randomized by classroom to receive xylitol (7.8 g/day) or placebo (inulin fiber 20 g/day) gummy bears. Gummy bears were given three times per day for the 9-month kindergarten year within a supervised school environment. Children in both groups also received oral health education, toothbrush and fluoridated toothpaste, topical fluoride varnish treatment and dental sealants. The numbers of new decayed, missing, and filled surfaces for primary teeth (dmfs) and permanent teeth (DMFS) from baseline to the middle of 2nd grade (exit exam) were compared between the treatment (xylitol/placebo) groups using an optimally-weighted permutation test for cluster-randomized data. Results: The mean new d3-6mfs at the exit exam was 5.0 ± 7.6 and 4.0 ± 6.5 for the xylitol and placebo group, respectively. Similarly, the mean new D3-6MFS was 0.38 ± 0.88 and 0.48 ± 1.39 for the xylitol and placebo group, respectively. The adjusted mean difference between the two groups was not statistically significant: new d3-6mfs: mean 0.4, 95% CI -0.25, 0.8), and new D3-6MFS: mean 0.16, 95% CI -0.16, 0.43. Conclusion: Xylitol consumption did not have additional benefit beyond other preventive measures. Caries progression in the permanent teeth of both groups was minimal, suggesting that other simultaneous prevention modalities may have masked the possible beneficial effects of xylitol in this trial.

Expanded studies of the pharmacokinetics and clinical effects of multidose sublingual triazolam in healthy volunteers.

Abstract Previous work described the pharmacokinetics and clinical effects of multidose sublingual triazolam (Halcion; Pharmacia & Upjohn Co, Kalamazoo, Mich). This laboratory study evaluated the hypothesis that incremental dosing of triazolam produces dose-dependent central nervous system depression that is profound and long lasting. Forty-nine healthy adults between the ages of 21 and 39 years, not receiving dental treatment, were randomly assigned to placebo (n = 12) or 1 of 3 triazolam groups (0.25-mg single dose, n = 12; 0.5 mg divided between 2 equal doses for 60 minutes, n = 12; or 0.75 mg divided among 3 doses for 90 minutes, n = 13). Plasma triazolam concentrations were determined. Bispectral index (BIS) and the Observer Assessment of Alertness/Sedation scale were used to assess sedation. Plasma triazolam concentrations increased with time in all subjects, with Tmax and Cmax both increasing dose dependently. Compared with placebo, all dosing paradigms produced dose-dependent BIS suppression and sedation. The single dose of 0.25 mg reached its peak BIS suppression at 90 (81 ± 7) minutes and sedation at 120 (3.6 ± 0.5) minutes and returned to baseline before 360 minutes. In contrast, incremental dosing of 0.5 and 0.75 mg produced profound and long-lasting BIS suppression and sedation that did not plateau until either 180 or 210 minutes as measured by the BIS index (67 ± 14 and 60 ± 16 at 0.5 and 0.75 mg, respectively) and 150 minutes as measured by the Observer Assessment of Alertness/Sedation scale (3.2 ± 1.0 and 2.7 ± 0.4 at 0.5 and 0.75 mg, respectively). These data more fully characterize the effects of incremental dosing with sublingual triazolam and provide additional insight for discharge safety recommendations.

Image quality evaluation of eight complementary metal‐oxide semiconductor intraoral digital X‐ray sensors

PURPOSE To evaluate the image quality generated by eight commercially available intraoral sensors. METHODS Eighteen clinicians ranked the quality of a bitewing acquired from one subject using eight different intraoral sensors. Analytical methods used to evaluate clinical image quality included the Visual Grading Characteristics method, which helps to quantify subjective opinions to make them suitable for analysis. RESULTS The Dexis sensor was ranked significantly better than Sirona and Carestream-Kodak sensors; and the image captured using the Carestream-Kodak sensor was ranked significantly worse than those captured using Dexis, Schick and Cyber Medical Imaging sensors. The Image Works sensor image was rated the lowest by all clinicians. Other comparisons resulted in non-significant results. CONCLUSIONS None of the sensors was considered to generate images of significantly better quality than the other sensors tested. Further research should be directed towards determining the clinical significance of the differences in image quality reported in this study.

Oral health and medical conditions among Amish children.

Background: The Amish are a growing population who live a traditional, rural way of life, which makes them less accepting of modernism. Most Amish live in poverty and are detached from modern health care. In addition, the recent change of their lifestyle has been reported, such as consuming a nontraditional diet and the usage of electronic devices. As a result, their lifestyle change may have impacted their oral health. However, since only a single report about oral health among Amish children has been published approximately three decades ago it has not yet been updated. This study describes oral health among Amish children and their medical conditions during visits to a mobile dental unit (MDU). Material and Methods: The dental records of all patients (N=216) who visited a mobile dental unit were reviewed, which covers 1 year from May 20, 2011, the first date of service. The following factors were taken into consideration during the review process: parental perceptions of their children’s oral health care, dental care experiences, and general health information. Results: Fifty-four (27.8%) children, ages 3 to 17, have never received dental treatment before visiting the MDU; the average number of untreated decayed teeth was 6.8. In spite of this, most parents rated their children’s oral health as good or very good (87.7%). The high cost and long distance travel associated with routine, professional dental care makes it difficult for children to maintain good oral hygiene. Our analysis revealed that bleeding disorders were more prevalent among this gene pool compared to the nation at large; however, asthma was less common. Conclusions: There are oral and general health disparities among Amish children. There is a lack of awareness among Amish parents with regard to their children’s oral health. Key words:Amish, child, dental caries, mobile health units.

The effect of social geographic factors on the untreated tooth decay among head start children

Background Disparities among untreated dental caries exist for children from low-income families in the United States. Understanding of the mechanism of the disparities is required to reduce it and social geographic factors are one of the important influences. Although the effect of fluoridated water has been well reported, studies of other sociogeograpic factors, such as the density of available dentists, are still very limited. The objective of this study is to explore the effect of sociogeographic factors on the number of primary teeth with untreated dental caries among children from low-income families who are enrolled in Head Start programs throughout Northeast Ohio of the United States. Material and Methods This was a cross-sectional chart review study. Three hundred-eighty-eight charts were reviewed, and the number of primary teeth with untreated dental caries (dt) and the children’s addresses were retrieved. The sociogeographic variables, including fluoridated water availability and the density of available dentists who accept a government-supported insurance (Medicaid dentists), were collected. Results The mean (standard deviation) of children’s age was 3.51 (1.14) years with a range of 7 months to 5 years. A negative binomial regression model analysis, which used dt as a dependent variable and children’s characteristic factors (i.e. age, gender, insurance type, and total number of primary teeth) and sociogeographic factors (i.e. Population, total number of Medicaid dentists, density of Medicaid dentist, and Fluoride water availability) of cities, as independent variables, demonstrated that only the density of Medicaid dentist in the sociogeographic factors indicated a significant effect (Estimated ß-Coefficients (Standard Errors)=-0.003 (0.002), p=0.030). Conclusions This study demonstrated a significant negative association between the density of available dentists and untreated dental caries among children from low-income families in Head Start programs in Northeast Ohio. Increasing available dentists may be a strategy to reduce the number of early childhood caries. Key words:Child, poverty, dental caries, Health Services Accessibility.

“Dentists’ and dietitians’ recommendations of snacks and dental caries experience among kindergarteners”

Background Parents receive diet recommendations for their children from dentists and dietitians, but a conflict of diet suggestions has been reported. This research was conducted to investigate dental caries experiences in children consuming snacks that were recommended by dentists and/or dietitians. Material and Methods A total of 442 kindergarteners under went dental examinations, and their caregivers filled out questionnaires. Snacks were sorted by name. Three dentists and three dietitians determined whether they would recommend these snacks. The snacks were divided into four categories: snacks recommended by both groups, snacks recommended by neither, snacks recommended only by dentists, and snacks recommend only by dieticians. Children were assigned to particular groups based on their primary snack consumption. The children’s caries experiences (dft) were compared among the four groups. Results The agreement level on the recommended snacks between dietitians and dentists was moderate (Kappa=0.43). Thirty-nine snacks were identified; 13 recommended by neither, 4 recommended by dietitians, 7 were recommended only by dentists, and 15 were recommended by both. The mean (standard deviation) of dft amongthe children was 4.66 (3.81), 2.66 (3.17), 3.21 (3.37), and 4.02 (4.02), and respectively. The ANOVA and Tukey post-hoc tests indicated that children who consumed snacks recommended only by one professional, dietitian or dentist, have significantly fewer dental caries than children who consumed snacks recommended by neither professional. (ANOVA: F=4.494, p=0.004, Tukey post-hoc test: p=0.007 and p=0.046, respectively). Conclusions Dentists can recommend snacks that are nutrient dense, even though it contains sucrose. Key words:Child, dental caries, snacks, dentist, nutritionists.