Study links lack of oral health care with complications during pregnancy

For pregnant women in the U.S., the use of oral health services during pregnancy remains low, with fewer than 40% seeking preventive oral health care. So reports a new study conducted by the Oral Health Workforce Research Center, part of the Center for Health Workforce Studies at the University at Albany’s College of Integrated Health Sciences, which was featured on the cover of this month’s issue of the Journal of the American Dental Association.

UAlbany researchers analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS), a longstanding data repository maintained by the Centers for Disease Control and Prevention, between 2016 and 2020. Disparities in gestational diabetes and hypertensive disorders were highlighted, with higher odds of these pregnancy complications among lower-income and minority women. 

Lack of regular preventive oral health care and delaying dental treatment during pregnancy increases the risk of developing dental diseases such as periodontal disease, which is potentially associated with gestational diabetes and hypertensive disorders.

The research team found that pregnant women who received preventive oral health care or visited a dentist or a dental clinic for oral health problems during pregnancy did in fact have a lower risk of developing gestational diabetes and hypertensive disorders.

“Our findings reinforce the connection between oral health and overall health,” said Dr. Simona Surdu, project director at the Center for Health Workforce Studies. “Integrating oral health education and services into maternal health care and expanding the oral health workforce through training, better distribution and interprofessional collaboration with prenatal care providers can improve access to oral health services for pregnant women — especially in underserved populations — and help reduce the risks of gestational diabetes and hypertensive disorders.” 

 

Pandemic dental office closures linked to increased burden on ERs from kids with dental issues

 

A lack of access to dentists during the COVID-19 pandemic coincided with a surge in hospital visits for dental conditions among Medicaid-insured children

Peer-Reviewed Publication

New York University

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Dental office closures early in the COVID-19 pandemic were associated with a 62-percent increase in the share of emergency department visits from toothaches, abscesses, and other painful dental issues among children covered by Medicaid, according to a new study led by researchers at NYU College of Dentistry.

The findings, published in the Journal of the American College of Emergency Physicians Open, suggest that families with young kids have difficulty accessing dental care during public health crises, which may further stress overburdened hospitals.

In March 2020, as COVID-19 cases grew exponentially in New York and around the country, public health measures to stop the virus’s spread prompted the closure of dental offices. While dentists could see patients for emergency appointments, all other routine dental care was postponed.

At the same time, hospitals were filling up with critically ill patients. NYU researchers wanted to understand whether patients with urgent dental issues were also ending up in emergency rooms.

“Emergency departments are not well equipped to treat dental conditions, as they are typically limited to relieving pain and referring patients to dentists to address the underlying issues,” said Shulamite Huang, a health economist and assistant professor of epidemiology and health promotion at NYU College of Dentistry. “As a result, visiting an emergency department for tooth pain can be a waste of health care system resources—resources that are in short supply during times of crisis, including the peak of the COVID-19 pandemic.”

Huang and her colleagues examined Medicaid claims data for children under the age of 19 across New York State to determine if there were any differences in emergency department visits for dental concerns before the pandemic (in 2018 and 2019) versus 2020. They focused on issues including cavities, infections, and abscesses, and excluded injuries such as cracked or knocked-out teeth.

The researchers found that denta practice closures from March through May 2020 led to a 62- percent increase in the share of children’s emergency room visits from non-traumatic dental issues over 2019 levels (from 3.7 percent of ER visits focusing on dental issues in 2019 to 6 percent in 2020). This surge in visits was the most pronounced among young children up to age 9, who were seen in emergency departments for dental issues twice as often during this period compared to the previous year.

Notably, the increase in emergency department visits was sustained even after many dentists reopened their offices in May 2020, although to a lesser degree.

“The sizable changes in the emergency department dental care of very young children suggests that this population was likely to fall through holes in the dental safety net,” said Huang. “Although dentists were allowed to treat dental emergencies, Medicaid-insured children may have had difficulty accessing care during the initial phase of the COVID-19 pandemic.”

The authors cite several possible reasons for this, including parents having difficulty determining whether kids in pain are experiencing a true emergency. In addition, very young children covered by Medicaid may not have established care with a dentist before the pandemic, as finding a dentist that accepts Medicaid and treats young children can be a challenge.

In preparation for future pandemics or other crises that stress US hospitals, the researchers encourage health systems to consider options for emergency dental care that can divert patients from the emergency department, including offering limited hospital-based dental services or incorporating urgent dental care clinics within hospitals. In addition, ensuring that children covered by Medicaid have access to a dentist in their community may both prevent painful dental issues and provide them with emergency dental care when needed.

Additional study authors include Scarlett Wang of the NYU Wagner Graduate School of Public Service and Heather Gold of NYU Grossman School of Medicine. This research was supported by the National Institute of Dental and Craniofacial Research (K25 DE028584 and K25 DE028584-02S1). 

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Journal

Journal of the American College of Emergency Physicians Open

DOI

10.1016/j.acepjo.2025.100094 

Hard evidence of soft teeth: the oral symptoms of hypophosphatasia

Researchers from Osaka University highlight the various dental symptoms of hypophosphatasia, a skeletal disease, in an attempt to improve its diagnosis and treatment

Peer-Reviewed Publication

Osaka University

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image: 

Intraoral photographs of the case of a boy aged 4 years with mild type HPP.

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Credit: Osaka University Dental Hospital

Osaka, Japan – Hypophosphatasia is a relatively common skeletal disease that primarily affects bone and tooth strength. In the third national dental survey of hypophosphatasia in Japan, recently published in Scientific Reports, researchers analyzed the dental issues faced by Japanese patients in their largest survey to date. Their findings provide valuable information for dentists and medical doctors who treat this often misunderstood disease.

People with hypophosphatasia have variants in the gene responsible for making tissue-nonspecific alkaline phosphatase, which is important for bone mineralization. Although this generally leads to weakened bones, issues with teeth are also common. Less severe forms of hypophosphatasia are often diagnosed when the first teeth fall out earlier than expected, before 4 years of age. Dentists are therefore a major care provider for children with this disease—but they aren’t always familiar with its symptoms.

To explore the dental issues in patients with hypophosphatasia, researchers from Osaka University have conducted nationwide surveys of dental clinics every 5 years since 2013. In the most recent survey, they collected data from 103 cases from 30 clinics. This represents a big jump in numbers from the last two surveys (with 19 and 52 cases), allowing the researchers to conduct an in-depth analysis of the dental issues faced by Japanese patients.

“We had enough cases that we could break them down into two groups—those whose symptoms involved the teeth only, known as odonto-type disease, and those who had other symptoms, which we termed non-odonto-type disease,” explains Rena Okawa, lead author of the study. “We were surprised to see big differences in oral manifestations between the two groups.”

Specifically, the patients with odonto-type hypophosphatasia were more likely to lose their first teeth early, whereas those with non-odonto-type disease were more likely to have tooth misalignment and tooth hypomineralization (where the enamel on the outside of the teeth softens). Non-odonto-type disease was also linked to poor oral habits, such as finger sucking and tongue thrusting, and problems with swallowing.

“The trends that we observed in this study will be helpful for dentists who might come across patients with hypophosphatasia in their clinics,” says Kazuhiko Nakano, senior author. “Improved knowledge of the various ways this disease presents will lead to better diagnostic rates and earlier treatments for affected patients.”

Given that there is now an enzyme replacement therapy available to treat hypophosphatasia, its early diagnosis is particularly important for preventing problems with adult teeth later in life. The researchers hope that their findings will allow dentists to identify suspected cases of hypophosphatasia early and recommend appropriate multidisciplinary treatments.

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The article, “Japanese nationwide dental survey of hypophosphatasia reveals novel oral manifestations,” was published in Scientific Reports at DOI: https://doi.org/10.1038/s41598-025-91043-7

Dental implants still functional after forty years

 

Peer-Reviewed Publication

University of Gothenburg

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image: 

Sargon Barkarmo and Jan Kowar, Sahlgrenska Academy at the University of Gothenburg.

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Credit: Photo by Elin Lindström

Dental implants used to replace single teeth continue to function well after several decades, according to a study from the University of Gothenburg, Sweden. After nearly forty years, all examined implants were still in place and fully functional. 

The study is the longest follow-up study of single dental implants in the world and is based on a follow-up of a small group of patients who received single implants to replace missing teeth between 1982 and 1985.

The implants are a result of research conducted by Professor Per-Ingvar Brånemark at the University of Gothenburg. His discovery of how bone integrates with titanium implants has enabled millions of patients to replace lost teeth with a reliable and long-lasting solution. 

Stable implants 

Of the 16 patients who received implants during the study period, 13 participated in the follow-up, conducted at the Brånemark Clinic, Public Dental Service Västra Götaland. These 13 patients had a total of 18 implants. 

"It is impressive that the single implants function so well after such a long time. Even though the study included a small number of patients, the results show that the implants remain in place and that the bone loss around them is virtually unchanged after forty years. This confirms that the foundation Brånemark established still holds," says Sargon Barkarmo, prosthodontist and senior lecturer at the University of Gothenburg. 

A dental implant is an artificial tooth root made of titanium that is surgically placed into the jawbone, where it integrates and becomes stable. A crown is then attached to the implant, providing both functionality and aesthetics. 

The crowns placed on the implants had a shorter lifespan than the implants themselves. At the forty-year follow-up, only about 60 percent of the original crowns remained, with many having been replaced one or more times. 

"The study shows that the crowns were mostly replaced for aesthetic reasons rather than technical failures. In the future, implant treatments could be further improved with the development of new crown materials," says Jan Kowar,  prosthodontist and senior lecturer at the University of Gothenburg, and co-author of the study. 

Implants and healing 

The researchers point out that older implant systems, which have been shown to be highly effective, are unfortunately no longer available on the market. This is due to the continuous introduction of new systems that quickly replace older ones, despite their proven long-term success. 

The study concludes that implants placed using well-planned surgical techniques and given sufficient healing time have an excellent long-term prognosis. Sargon Barkarmo again: 

"Today, methods that accelerate treatment and healing are commonly used. These approaches also need long-term follow-ups and careful evaluation to ensure equally good results over time," he says. 

The study results have been published in the scientific journal Clinical Implant Dentistry and Related Research.

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Journal

Clinical Implant Dentistry and Related Research

DOI

10.1111/cid.13443