Oral diseases are a major global public health problem affecting over 3·5 billion people. However, dentistry has so far been unable to tackle this problem. A fundamentally different approach is now ...needed. In this second of two papers in a Series on oral health, we present a critique of dentistry, highlighting its key limitations and the urgent need for system reform. In high-income countries, the current treatment-dominated, increasingly high-technology, interventionist, and specialised approach is not tackling the underlying causes of disease and is not addressing inequalities in oral health. In low-income and middle-income countries (LMICs), the limitations of so-called westernised dentistry are at their most acute; dentistry is often unavailable, unaffordable, and inappropriate for the majority of these populations, but particularly the rural poor. Rather than being isolated and separated from the mainstream health-care system, dentistry needs to be more integrated, in particular with primary care services. The global drive for universal health coverage provides an ideal opportunity for this integration. Dental care systems should focus more on promoting and maintaining oral health and achieving greater oral health equity. Sugar, alcohol, and tobacco consumption, and their underlying social and commercial determinants, are common risk factors shared with a range of other non-communicable diseases (NCDs). Coherent and comprehensive regulation and legislation are needed to tackle these shared risk factors. In this Series paper, we focus on the need to reduce sugar consumption and describe how this can be achieved through the adoption of a range of upstream policies designed to combat the corporate strategies used by the global sugar industry to promote sugar consumption and profits. At present, the sugar industry is influencing dental research, oral health policy, and professional organisations through its well developed corporate strategies. The development of clearer and more transparent conflict of interest policies and procedures to limit and clarify the influence of the sugar industry on research, policy, and practice is needed. Combating the commercial determinants of oral diseases and other NCDs should be a major policy priority.
Phytohormones are natural chemical messengers that play critical roles in the regulation of plant growth and development as well as responses to biotic and abiotic stress factors, maintaining plant ...homeostasis, and allowing adaptation to environmental changes. The discovery of a new class of phytohormones, the brassinosteroids (BRs), almost 40 years ago opened a new era for the studies of plant growth and development and introduced new perspectives in the regulation of agronomic traits through their use in agriculture. BRs are a group of hormones with significant growth regulatory activity that act independently and in conjunction with other phytohormones to control different BR-regulated activities. Genetic and molecular research has increased our understanding of how BRs and their cross-talk with other phytohormones control several physiological and developmental processes. The present article provides an overview of BRs' discovery as well as recent findings on their interactions with other phytohormones at the transcriptional and post-transcriptional levels, in addition to clarifying how their network works to modulate plant growth, development, and responses to biotic and abiotic stresses.
Oral diseases: a global public health challenge Peres, Marco A; Macpherson, Lorna M D; Weyant, Robert J ...
The Lancet (British edition),
07/2019, Volume:
394, Issue:
10194
Journal Article
Peer reviewed
Open access
Oral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected. The most prevalent and consequential ...oral diseases globally are dental caries (tooth decay), periodontal disease, tooth loss, and cancers of the lips and oral cavity. In this first of two papers in a Series on oral health, we describe the scope of the global oral disease epidemic, its origins in terms of social and commercial determinants, and its costs in terms of population wellbeing and societal impact. Although oral diseases are largely preventable, they persist with high prevalence, reflecting widespread social and economic inequalities and inadequate funding for prevention and treatment, particularly in low-income and middle-income countries (LMICs). As with most non-communicable diseases (NCDs), oral conditions are chronic and strongly socially patterned. Children living in poverty, socially marginalised groups, and older people are the most affected by oral diseases, and have poor access to dental care. In many LMICs, oral diseases remain largely untreated because the treatment costs exceed available resources. The personal consequences of chronic untreated oral diseases are often severe and can include unremitting pain, sepsis, reduced quality of life, lost school days, disruption to family life, and decreased work productivity. The costs of treating oral diseases impose large economic burdens to families and health-care systems. Oral diseases are undoubtedly a global public health problem, with particular concern over their rising prevalence in many LMICs linked to wider social, economic, and commercial changes. By describing the extent and consequences of oral diseases, their social and commercial determinants, and their ongoing neglect in global health policy, we aim to highlight the urgent need to address oral diseases among other NCDs as a global health priority.
The performance of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification of periodontitis for epidemiology surveillance purposes remains to be ...investigated. This study assessed the surveillance use of the 2018 EFP/AAP classification and its agreement with the unsupervised clustering method compared with the 2012 Centers for Disease Control and Prevention(CDC)/AAP case definition.
Participants (n = 9424) in the National Health and Nutrition Examination Survey (NHANES) were staged by the 2018 EFP/AAP classification and classified into subgroups via k-medoids clustering. Concordance levels between periodontitis definitions and the clustering method were evaluated through the multiclass area under the receiver operating characteristic curve (multiclass AUC) among "periodontitis cases" and the general population, respectively. The multiclass AUC of the 2012 CDC/AAP definition versus clustering was used as a reference. The associations of periodontitis with chronic diseases were estimated using multivariable logistic regression.
All the participants were identified as "periodontitis cases" by the 2018 EFP/AAP classification, and the prevalence of stage III-IV was 30%. The optimal numbers of clusters were three and four. The 2012 CDC/AAP definition versus clustering yielded a multiclass AUC of 0.82 and 0.85 among the general population and "periodontitis cases," respectively. The multiclass AUC of the 2018 EFP/AAP classification versus clustering was 0.77 and 0.78 for different target populations. Similar patterns prevailed in associations with chronic diseases between the 2018 EFP/AAP classification and clustering.
The validity of the 2018 EFP/AAP classification was verified by the unsupervised clustering method, which performed better in distinguishing "periodontitis cases" than classifying the general population. For surveillance purposes, the 2012 CDC/AAP definition showed a higher agreement level with the clustering method than the 2018 EFP/AAP classification.
Socioeconomic position (SEP) is a well‐known risk indicator for chronic periodontitis. However, it is still unclear how SEP during the life course influences periodontal outcomes in adulthood. This ...study aimed to systematically review longitudinal studies investigating the influence of individual‐level SEP during the life course on subsequent periodontitis in adulthood. Inclusion criteria were epidemiological longitudinal observational studies, in which indicators of relative SEP were assessed prior to clinical assessment of periodontitis. Six electronic databases (PubMed, EMBASE, Web of Science, Scopus, Latin American and Caribbean Health Sciences Literature (LILACS) and ScieLO) were searched. The methodological quality of the studies was assessed using the Newcastle‐Ottawa Quality Assessment Scale (NOS). The search identified 1720 papers. After removal of duplicates (n=697), title and screening (n=996), and full‐text review (n=19), eight original manuscripts from seven studies were finally included. Sample sizes ranged from 167 to 2806, and the follow‐up time from exposure to outcome ranged from 2 to 28 years. Studies evaluated education, occupation or income as SEP indicators. Prevalence, extent and severity of periodontal attachment loss, probing pocket depth and alveolar bone loss were the studied outcomes. Based on NOS, studies presented low risk of bias. Six of eight papers reported that relatively low SEP earlier in life was associated with poorer periodontal health in adulthood. The available scientific evidence demonstrates potential longitudinal impact of earlier lower SEP on later periodontal health. The findings were consistent despite differences in study methods.
Aim
To assess the effect of cognition on the loss of functional dentition.
Materials and Methods
We used data from the three waves of the Panel on Health and Ageing of Singaporean Elderly study ...(n = 4990 at baseline, 774 complete cases analysed) over 6 years (2009–2015). The outcome was the loss of functional dentition (<21 teeth). The exposure was cognitive impairment, while baseline confounders included age, sex, education, and ethnicity. Time‐varying confounders included income, living arrangements, smoking, diabetes, depressive symptoms, cardiovascular disease, and body mass index. We used marginal structural mean models with inverse probability treatment weighted.
Results
The mean age of the participants was 70.2 years at baseline. The proportion of participants with loss of functional dentition increased from 74.6% to 89.9% over 6 years. Women, ethnic Chinese, less educated, smokers, people with diabetes, and individuals with depression had a higher proportion of loss of functional dentition than their counterparts. Loss of functional dentition was 1.8 times higher (odds ratio 1.80; 95% confidence interval 0.88–3.69) among those with cognitive impairment after taking well‐known confounders into account.
Conclusions
After accounting for the time‐varying exposure and confounding evidence, the association between cognition and functional dentition among the elderly in Singapore remains uncertain.
Aims
To comprehensively review, identify and critically assess the performance of models predicting the incidence and progression of periodontitis.
Methods
Electronic searches of the MEDLINE via ...PubMed, EMBASE, DOSS, Web of Science, Scopus and ProQuest databases, and hand searching of reference lists and citations were conducted. No date or language restrictions were used. The Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist was followed when extracting data and appraising the selected studies.
Results
Of the 2,560 records, five studies with 12 prediction models and three risk assessment studies were included. The prediction models showed great heterogeneity precluding meta‐analysis. Eight criteria were identified for periodontitis incidence and progression. Four models from one study examined the incidence, while others assessed progression. Age, smoking and diabetes status were common predictors used in modelling. Only two studies reported external validation. Predictive performance of the models (discrimination and calibration) was unable to be fully assessed or compared quantitatively. Nevertheless, most models had “good” ability to discriminate between people at risk for periodontitis.
Conclusions
Existing predictive modelling approaches were identified. However, no studies followed the recommended methodology, and almost all models were characterized by a generally poor level of reporting.
Background
We aimed to describe the prevalence of different tooth loss outcomes along with the use of dentures and implants among Australians aged 15+ years across socioeconomic and demographic ...groups. In addition, we performed time trend analyses of tooth loss.
Methods
Data from the National Study of Adult Oral Health 2017–18 included gender, age, residential location, household income, Socio‐Economic Indexes for Areas, possession of dental insurance and pattern of dental visiting. Outcomes were complete tooth loss, inadequate dentition, average number of missing teeth, denture wearing and implants. We compared our findings with data from previous surveys carried out in 1987–88 and 2004–06.
Results
Tooth loss decreased from 14.4% in 1987–88 to 6.4% in 2004–06, and to 4.0% in 2017–18. The proportion of people with lack of functional dentition halved from 20.6% 1987–88 to 10.2% in 2017–18; the average number of teeth lost due for any reason slightly reduced from 2004–06 (6.1) to 2017–18 (5.7). Tooth loss increased with age and was higher among socioeconomically disadvantaged, uninsured and those with unfavourable pattern of dental visiting groups than in their counterparts.
Conclusions
An overall improvement in tooth retention was identified over the last decades. However, socioeconomic inequalities persist.
Chewing disability is associated with impaired quality of life, potentially leading to depression, and cognitive impairment. Although the chewing-ability-cognition relationship has been explored, ...examining whether depression mediates this relationship remains unclear. We investigated the association between chewing disability and cognitive impairment development and a potential mediation via depression among older persons.
Older persons without cognitive impairment at baseline (n = 973) from the 3 waves of the Panel on Health and Ageing of Singaporean Elderly were investigated. The outcome was incident cognitive impairment by the end of the study, while the exposure was chewing disability over the study period. Time-varying depression was the mediator. Time-fixed confounders included sex, ethnicity, education, marital status, living arrangement, and housing type, and time-varying confounders included age, smoking, cardiovascular diseases, diabetes, number of teeth, and denture wearing. We used marginal structural modeling to evaluate the effect of chewing disability on cognitive impairment development.
After 6 years, 11% developed cognitive impairment, and chewing disability was reported by 33%. Chewing disability was associated with higher odds of developing cognitive impairment (OR 1.43, 95% CI: 1.09, 1.87), of which 85.3% was explained by the controlled direct effect of chewing disability, whereas the remaining 14.7% could be eliminated if there was no depression.
Our findings indicate an association between chewing disability and cognitive impairment, while the role of depression could not be fully elucidated. Oral health should be incorporated as part of older persons' care for its potential to assess the risk for other systemic conditions.
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