Children living in deprived areas 3 times more likely to need dental extractions

Researchers at Queen Mary University of London have found that children living in areas with high levels of deprivation are three times more likely to have severe tooth decay that requires a dental extraction in hospital, compared with children living in more affluent areas. The findings highlight an urgent need for equitable access to preventive dentistry.

In the study, published today (16 July 2024) in BMJ Public Health, researchers analysed de-identified GP and hospital records for 600,000 children between the ages of five and 16 living in North East London. During the five-year study period, one in 200 children had at least one tooth removed under a general anaesthetic, which must be done in a hospital setting. Most of those children had multiple teeth extracted.

The study findings demonstrate major socioeconomic and ethnic inequalities in severe tooth decay in children, which is preventable through access to NHS dentists, and policies such as toothbrushing in schools and control of sugar in food and drinks.

• Children living in areas with the highest proportion of low-income households were three times more likely to require a dental extraction, compared with those living in areas with the lowest proportion of low-income households.
• Children from some ethnic groups were more likely to need a dental extraction, compared with children from White British ethnic groups:
  • White Irish: twice as likely;
  • Bangladeshi: 1.5 times more likely;
  • Pakistani: 1.4 times more likely.
• Children living with obesity were less likely to require a dental extraction than children with healthy weight. More research is needed to replicate and understand this finding.

The researchers also examined the data by North East London borough, comparing rates of children’s dental extractions with access to NHS general dental practitioners. After adjusting for deprivation and ethnic group, the highest risk of hospital dental extraction was for children in Tower Hamlets, which also has the lowest general dental practitioner attendance in North East London. Conversely, children living in Redbridge, Havering, and Barking & Dagenham had the lowest risk of hospital dental extraction - these areas have the highest proportion of five-year-olds accessing general dental practitioner services. Additionally, the 2022 National Dental Epidemiology Programme (NDEP) oral health survey found that only 13% of decayed teeth in five-year-old children in London had been filled.

This study is the first to analyse inequalities in children’s tooth extractions under general anaesthesia by ethnic group in such granular detail, revealing a difference in outcomes between White Irish and White British groups, and between Bangladeshi, Pakistani and Indian groups. By linking hospital data to GP records, which include 16 categories for ethnic group, researchers were able to reveal ethnic inequalities that are less apparent when using the broader ethnicity categories used in previous research.   

This research was funded by a grant from Barts Charity (ref: MGU0419).

Vanessa Muirhead, Co-author and Reader and Honorary Consultant in Dental Public Health at Queen Mary, said:

“Sadly, our findings demonstrate wide socioeconomic and ethnic inequalities related to access to dental care and outcomes.

“Tooth extraction is a last resort, but when families have difficulty accessing timely preventive and treatment services, dental problems can progress until children need more serious and costly interventions such as multiple tooth extractions under general anaesthesia.”

Nicola Firman, lead author and Health Data Scientist at Queen Mary, said:

“Linking health data from different settings has allowed us to see inequalities in the dental care system more clearly.

“Our findings point to an urgent need for equitable access to preventive general dental services, and interventions that are targeted at the wider determinants of dental health.”

Christopher Tredwin, Dean and Director of the Institute of Dentistry at Queen Mar, said:

“This research highlights clear oral health inequalities, which we are also acutely aware of through our longstanding service of the local community.

“In partnership with Barts Health NHS Trust, the Queen Mary Institute of Dentistry opened a new dental outreach clinic in Kenworthy Road, Homerton, earlier this year. It is now providing quicker and easier access to dental care in the local area, while our dental and therapy students learn to treat children in these primary care settings. Through the outstanding work of our students at these clinics, we hope to mitigate the effects of unequal access to general dentistry in North East London and help to provide care for those who need it most.”

Victoria King, Director of Funding and Impact at Barts Charity, said:

“This important work, supported by Barts Charity, has demonstrated that there are major inequalities linked to severe tooth decay for children in East London, which could be preventable. Supporting research to understand these health inequalities is key to making better healthcare possible for our diverse East London population."

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JOURNAL

BMJ Public Health

DOI

10.1136/bmjph-2023-000622 

Kidney function is associated with tooth loss in postmenopausal women

Kidneys play a critical role in overall health by removing waste products from the blood. When they fail to sufficiently filter out foreign elements, several serious, lifethreatening, medical conditions can result. A new study suggests that chronic kidney disease may also be linked with tooth loss. Results of the survey are published online today in Menopause, the journal of The Menopause Society.

A woman’s glomerular filtration rate shows how well her kidneys are functioning. Kidney function decreases with time after menopause and is associated with declining reproductive hormone levels. These hormone changes during menopause also often lead to abdominal obesity, which is an independent risk factor for the development of chronic kidney disease and also linked with a higher risk of tooth loss.

The consequences of kidney disease are numerous, including an increased probability of experiencing problems with bone and cardiovascular health. Tooth loss, which reflects oral health status, is also associated with systemic diseases, such as diabetes, thyroid disease, and osteoporosis, and is independently associated with an increased risk of stroke. Excessive tooth loss can also impair chewing and speech.

Previous studies have identified an association between kidney function and tooth count. This newest study involving nearly 65,000 participants, however, is the first known to evaluate the association between chronic kidney disease and tooth loss in postmenopausal women across the ages. It concluded that the glomerular filtration rate, a measure of kidney function, is significantly associated with having at least 20 (of a total of 28) adult teeth, suggesting that chronic kidney disease and tooth loss are significantly associated, especially in postmenopausal women aged 66 to 79 years.

These findings suggest that preventing and managing mineral and bone metabolism disorders in postmenopausal women with chronic kidney disease are crucial to prevent tooth loss. It is also important to address kidney disease progression, as the consequences affect multiple body systems beyond just oral health.

Survey results are published in the article “Chronic kidney disease in postmenopausal women is associated with tooth loss.”

“This study highlights the known link between chronic kidney disease and bone metabolism. Increased attention to oral and bone health is warranted in postmenopausal women with chronic kidney disease, in addition to meticulous efforts aimed at preserving kidney function. Conversely, oral health is a window to overall health, and good oral hygiene is important for women of all ages,” says Dr. Stephanie Faubion, medical director for The Menopause Society. 

Hidden challenges of tooth loss and dentures revealed in new study

 

The hidden challenges faced by people with tooth loss and dentures has been identified by new research from the University of Sheffield

Peer-Reviewed Publication

UNIVERSITY OF SHEFFIELD

 

IMAGE: 

IMAGE COPYRIGHT GINA ALLEN 2024

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CREDIT: IMAGE COPYRIGHT GINA ALLEN 2024

The hidden challenges faced by people with tooth loss and dentures has been identified by new research from the University of Sheffield.

 

Improvements in dental care, more people living longer and the social value placed on having a healthy smile has led to people keeping their own teeth longer, but it has also led to an increasing number of people needing some kind of restoration work including crowns, bridges and implants. 

 

Many of these treatments remain unobtainable for most people due to the availability of NHS dentists and the high cost of private dental work. Removable dentures are often the only viable option for anyone experiencing tooth loss with an estimated 10 to 15 percent of the population wearing them.

 

A new study by researchers at the University of Sheffield’s Healthy Life Span Institute and the School of Clinical Dentistry has highlighted the emotional struggles and hidden challenges patients experience when having dentures fitted. This is the first study to map out the patient journey and how this experience can affect the overall success of the treatment.

 

The study found that patients think about their denture journey in four stages:

 

• Tooth Loss: This is the initial stage where patients experience the physical loss of teeth.

 

• The Emotional Tunnel: This stage focuses on the emotional rollercoaster of tooth loss. Patients experience self-consciousness, depression, and struggle with dentures. They may feel shame, anger, or fear, but also hope.

 

• Prosthetic Hope: This stage represents the hope and optimism patients feel when getting dentures. They might anticipate regaining their smile and ability to eat normally.

 

• Prosthetic Compromise leading to managing disclosure: This final stage acknowledges that dentures take some getting used to. Patients might need to adjust their expectations and learn how to manage talking and eating with dentures. They might also develop strategies to feel comfortable disclosing their denture use to others.

 

These feelings and how dentists understand and manage them can influence the patient outcomes. A dentist's empathy during this adjustment period is crucial for successful denture use and better patient outcomes.

 

The study also identified that wearing removable dentures can be a hidden disability for many. People with dentures feel they have to hide them due to feeling embarrassed or worrying they will fall out. Some patients also avoided social situations 

 

Lead researcher Barry Gibson, Professor in Medical Sociology at the University of Sheffield said “Tooth loss can be hugely traumatic and this study has uncovered just how challenging it is for people needing partial dentures. Feelings such as embarrassment or shame can significantly affect the process of having dentures made and fitted. On top of this if they don’t fit properly this can make everyday activities such as speaking, eating and drinking very difficult which affects a person’s quality of life. The impact can be so dramatic that it can impact their confidence to leave the house. This can have a devastating and lasting impact.

 

“Understanding the emotional difficulties identified in the study will help dentists to improve the care given to denture patients and lead to a more successful and better experience for everyone”

 

The research team partnered with local Sheffield artist Gina Allen to create an art piece reflecting the diverse emotional journeys of denture wearers. 

 

The picture is a collage that illustrates the type of journeys patients go through from tooth loss to life with a denture. It uses colour to depict the emotional nature of the journey and demonstrates that all patients have a unique journey and outcome from the experience.  One patient, a young woman, has a successful outcome; a middle-aged man is OK but a bit 'Meh!' An older woman continues to struggle to cope with some aspects of adapting to her denture.

 

Artist Gina Allen said  “I’m a visual artist with a science background and a particular interest in how art can help to explore and interpret data, often around social and environmental themes. It seemed to me that there was such a depth and variety of individual experiences captured by the research team on this project, so it was a really interesting challenge to be involved in, trying to use the visual parameters of an artwork to convey some of that in an engaging and meaningful way.”

 

This collaboration has influenced the development of a new patient questionnaire designed to:

• Identify Individual Needs: Tailor care based on specific patient experiences.
• Improve Communication: Enable dentists and patients to have open conversations about dentures.
• Trigger Follow-Up: Identify patients who may need additional support.

 

In addition to identifying the emotional challenges faced by patients, the study also highlights the need for a clinical care pathway to improve patient support, focus on improving denture fit, educate patients about denture care, and combat the shame and stigma associated with wearing dentures.

 

Mr Bilal El-Dhuwaib, Clinical Teacher in Restorative Dentistry at the University of Sheffield, said: “This study is important because it goes beyond the typical numbers-driven approach to dentistry by looking at crucial aspects of patients' emotions and lived experiences. By understanding the psychological and social impact of tooth loss and replacement, the research provides a valuable toolkit for myself and fellow dentists to better understand and address the emotional rollercoaster patients navigate during this process. By equipping dentists with the tools to understand these challenges, we can create a more compassionate and effective approach to tooth replacement."

 

Alcohol-based mouthwash brand disrupts the balance of your oral microbiome

Peer-Reviewed Publication

MICROBIOLOGY SOCIETY

SUMMARY

• Researchers have identified a significant change in composition and abundance of bacteria in study participants’ oral microbiomes after using a popular brand of alcohol-based mouthwash.
• The oral microbiome is the community of bacteria that live in the mouth, they help us digest our food and keep our mouth healthy.
• Researchers found that two species of opportunistic bacteria were significantly more abundant in the mouth after daily use of the alcohol-based mouthwash, Fusobacterium nucleatum and Streptococcus anginosus.
• These two bacteria have been previously linked to several diseases including gum disease and oesophageal and colorectal cancers.
• Although results show potentially damaging alterations to the microbiome, researchers urge that the study results do not mean that the general public should no longer use mouthwash.

The oral microbiome is the community of bacteria that live in the mouth, they help us digest our food and keep our mouth healthy. Changes to the composition of the oral microbiome have been linked to periodontal diseases and some cancers.

The research, published in Journal of Medical Microbiology found that two species of opportunistic bacteria were significantly more abundant in the mouth after three months of daily use of the alcohol-based mouthwash, Fusobacterium nucleatum and Streptococcus anginosus. These two bacteria have been previously linked to gum disease, esophageal and colorectal cancers. Researchers also saw a decrease in a group of bacteria called Actinobacteria which are crucial contributors to the regulation of blood pressure.

Dr Jolein Laumen, first author of the study and researcher at ITM’s Unit of Sexually Transmitted Infections said:

“Alcohol-based mouthwashes are widely available. The public may use them daily to tackle bad breath or prevent periodontitis, but they should be aware of the potential implications. Ideally, long-term usage should be guided by healthcare professionals”.

Treating gum disease after heart rhythm ablation reduced risk of AFib recurrence

Research Highlights:

• Treating gum disease within three months after a heart procedure to correct an irregular heart rhythm, known as atrial fibrillation (AFib), may lower the chances of it reoccurring.
• Inflamed gums may predict AFib recurrence after heart ablation, a procedure to fix the irregular heartbeat.
• AFib patients should be examined for gum disease and encouraged to seek dental treatment, researchers said.

Treating gum disease in the 3-months after a procedure to correct an irregular heartbeat known as atrial fibrillation (AFib) may lower oral inflammation and may reduce AFib recurrence, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

According to the U.S. Centers for Disease Control and Prevention (CDC), about half of American adults ages 30 or older have some form of periodontal or gum disease, with the incidence increasing with age.

This study is among the first to investigate the potential impact of gum disease treatment on AFib. AFib is a condition in which the heart beats irregularly, increasing the risk of stroke by five-fold. More than 12 million people in the U.S. are expected to have AFib by 2030, according to the American Heart Association’s 2024 Heart Disease and Stroke Statistics.

“Gum disease can be modified by dental intervention. Proper management of gum disease appears to improve the prognosis of AFib, and many people around the world could benefit from it,” said lead study author Shunsuke Miyauchi, M.D., Ph.D., an assistant professor at the Health Service Center at Hiroshima University in Japan who engages in general cardiology, arrhythmia practice and research.

Researchers followed 97 patients who had undergone the non-surgical procedure to correct AFib (radiofrequency catheter ablation) and received treatment for gum inflammation along with 191 ablation patients who did not receive treatment for gum disease. Catheter ablation is a procedure that uses radiofrequency energy to destroy a small area of heart tissue causing rapid and irregular heartbeats. This study found that an index measuring the severity of gum inflammation was associated with the return of AFib.

After the ablation procedure, during the average follow-up period of between 8.5 months to 2 years, researchers found:

• AFib recurred among 24% of all participants  throughout the follow-up period.
• Patients with severe gum inflammation who had it treated after heart catheter ablation were 61% less likely to have a recurrence of AFib, compared to ablation patients who did not have treatment for severe gum inflammation.
• Patients who had recurrences of AFib had more severe gum disease than those who did not have recurrences.
• Having gum disease, being female, experiencing irregular heartbeat for more than two years and left atrial volume were predictors for AFib recurrences. Left atrial volume often leads to AFib recurrence as it includes thickening and scarring of connective tissues, Miyauchi explained.

Miyauchi noted that, “While the main findings were consistent with their expectations, we were surprised how useful a quantitative index of gum disease, known as periodontal inflamed surface area or PISA, could be in cardiovascular clinical practice.”

While the American Heart Association does not recognize oral health as a risk factor for heart disease, it recognizes that oral health can be an indicator of overall health and well-being. Bacteria from inflamed teeth and gums may travel through the bloodstream to the rest of the body, including the heart and brain. Chronic gum inflammation may be associated with other systemic health conditions, including coronary artery disease, stroke and Type 2 diabetes.

Study details and background:

• A total of 288 adults (66% men; 34% women) being treated for AFib were enrolled in this study.
• The single center study was conducted from April 1, 2020 to July 31, 2022, at Hiroshima University Hospital in Hiroshima, Japan, and all participants were Asian.
• Enrollees were examined by a dentist before undergoing catheter ablation for AFib.

“We are now working on further research to reveal the mechanism underlying the relationship between gum disease and AFib,” Miyauchi said.

The study’s limitations include: a small number of patients enrolled from a single center; patients were not randomized to receive dental treatment; periodontal status was not followed up after the initial examination among the participants who did not receive gum disease treatment; and inflammatory markers were not reassessed after the ablation procedure.

• 
  
• AHA news release: New initiative focuses on oral health clinicians in prevention and early detection of heart disease (Jan. 2024)
• AHA news release: Poor oral health may contribute to declines in brain health (Feb 2022)
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ChatGPT to help dental students retain knowledge and enhance performance

 I

A study aiming to utilize current dental course materials, syllabi, and textbooks to investigate ChatGPT's potential benefits for dental students. was presented at the 102nd General Session of the IADR, which was held in conjunction with the 53rd Annual Meeting of the American Association for Dental, Oral, and Craniofacial Research and the 48th Annual Meeting of the Canadian Association for Dental Research, on March 13-16, 2024, in New Orleans, LA, USA.

The abstract, “ChatGPT to Help Dental Students Retain Knowledge and Enhance Performance” was presented during the “SCADA: Clinical Science/Public Health Research” Poster Session that took place on Thursday, March 14, 2024 at 11 a.m. Central Standard Time (UTC-6).

The study, by Ihunna Amugo of Meharry Medical College, Nashville, TN, USA, conducted an extensive literature review, analyzing previous studies in different educational contexts to evaluate ChatGPT's efficacy in dental education. Questions aligned with dental course materials and objectives were formulated to ensure ChatGPT's relevance to the specific needs of dental students. The research encompassed various dental courses, including operative dentistry, nutrition, periodontics, oral radiology, and biology of disease.

By applying ChatGPT in these courses, its capabilities were harnessed to generate step-by-step instructions, summaries, and questions to supplement traditional learning methods. Data on students' interactions with ChatGPT were collected and analyzed, assessing usage patterns, engagement levels, and perceived benefits. 

The study's results indicated that ChatGPT has the potential to enhance students' understanding and knowledge retention. In addition, ChatGPT can effectively provide instructional support and generate relevant content for dental students. 

Low-cost liquid tames tooth decay

An inexpensive, cavity-fighting liquid called silver diamine fluoride (SDF) works as well as dental sealants to keep tooth decay at bay in a school cavity prevention and treatment program, according to a new study by researchers at NYU College of Dentistry. 

 

The study, which followed more than 4,000 elementary school students for four years and is published in JAMA Pediatrics, shows that SDF is an effective alternative to sealants, and can increase access to dental care while reducing costs.

 

Dental cavities are the most prevalent chronic disease in children and can lead to pain, school absences, and lower academic performance. To prevent cavities, especially among children less likely to see a dentist, the Centers for Disease Control and Prevention (CDC) supports the use of school sealant programs. In sealant programs, dental professionals visit schools to apply a thin, protective coating to the surface of teeth that hardens and safeguards against decay.

 

SDF has emerged as another promising treatment for fighting cavities. Originally approved by the FDA for treating tooth sensitivity, the solution is brushed onto the surface of teeth, killing decay-causing bacteria and remineralizing teeth to prevent further decay.

 

“A growing body of research shows that SDF—which is quicker to apply and less expensive than sealants—can prevent and arrest cavities, reducing the need for drilling and filling,” said Richard Niederman, DMD, professor of epidemiology & health promotion at NYU College of Dentistry and the study’s senior author.

 

SDF in schools

Researchers at NYU College of Dentistry led CariedAway, the nation’s largest school-based cavity prevention study, to compare the use of SDF and traditional sealants. The study included approximately 4,100 children in New York City elementary schools; more than a quarter of kids had untreated cavities at the start of the study.

 

At each school visit, a team of health professionals examined children’s teeth and applied either sealants or SDF followed by fluoride varnish, depending on which treatment the school was randomly assigned to receive. Sealants were administered by dental hygienists, while SDF was applied by either dental hygienists or registered nurses, all under the supervision of a dentist. Starting in 2018, the team visited each school twice a year, although the COVID-19 pandemic and school closures led to missed visits.

 

The researchers reported last year in the journal JAMA Network Open that a single treatment of either SDF or sealants prevented 80% of cavities and kept 50% of existing cavities from worsening two years later. The team continued their study for another two years, and in their study published in JAMA Pediatrics, found that SDF and sealants prevented roughly the same number of cavities after children were followed for a total of four years. Moreover, both sealants and SDF reduced the risk of decay at each follow-up visit.

 

“Our longitudinal study reaffirms that both sealants and SDF are effective against cavities. SDF is a promising alternative that can support school-based cavity prevention—not to replace the dental sealant model, but as another option that also prevents and arrests decay,” said Ryan Richard Ruff, PhD, MPH, associate professor of epidemiology & health promotion at NYU College of Dentistry and the study’s first author.

 

“Most research shows that SDF can stop a cavity from progressing further. Our study demonstrated that SDF can prevent cavities from happening in the first place,” said Tamarinda Barry Godín, DDS, MPH, associate program director and supervising dentist for CariedAway, research scientist at NYU College of Dentistry, and the study’s coauthor. 

 

An “untapped” oral health workforce

Embracing SDF for cavity prevention and treatment in schools could keep kids from needing fillings, saving families and the healthcare system money. Yet these programs can only succeed if there are enough health professionals to provide care.

 

The NYU researchers found that children who had SDF applied by dental hygienists and registered nurses had similar outcomes, suggesting that nurses—including school nurses—could play a crucial role in cavity prevention programs. 

 

“Nurses may be an untapped resource for addressing oral health inequities,” added Ruff. “Our results suggest that nurses can effectively provide this preventive care, which could dramatically improve access, given the role of school nurses and the size of the nursing workforce.”