Melbourne Dental School - Research Publications
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ItemNo Preview AvailableUtilising surface-level data to explore surface, tooth, individual and family influence on the aetiology of hypomineralised second primary molars(ELSEVIER SCI LTD, 2021-10)OBJECTIVES: Hypomineralised second primary molars (HSPM) are common developmental enamel defects. The aims of this study were to use surface-level data to explore the clustering of HSPM at four levels (family, child, tooth, surface). METHODS: This study of 172 twin pairs was nested within the Peri/postnatal Epigenetic Twin Study. HSPM was measured by standardised oral examinations at age 6 years. Multilevel logistic regression models were fitted to assess the correlation structure of surface level data and variation in HSPM. The associations between surface level risk factors and HSPM were then explored using the multilevel logistic regression model using the best fitting correlation structure. RESULTS: The prevalence of HSPM was 68 (19.8%) children, with a total of 141 (10.3%) teeth and 264 tooth surfaces (6.3%) affected. Multilevel models revealed that a hierarchical structure accounting for correlation at the family, child and tooth level best accounted for the variation in HSPM. The estimated variances from the best fitting model (Model 3) were largest at the family level (12.27, 95% CI 6.68, 22.51) compared with 5.23 at the child level and 1.93 at the tooth level. Application of regression analysis utilising this three-level correlation structure identified tooth/surface level factors in addition to the previously identified familial and individual risk factors for HSPM. CONCLUSION: In addition to familial (environmental and genetic) and unique child-level factors, the aetiology of HSPM is likely to be influenced by local tooth-level factors.
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ItemCaries experience and gingival health in children and adolescents with type 1 diabetes mellitus-A cross-sectional study(WILEY, 2022-06)AIM: To investigate the oral health of children and adolescents with type 1 diabetes (T1D) and its associations with diabetes-related and lifestyle factors. DESIGN: Cross-sectional study at a large tertiary hospital pediatric diabetes clinic. Oral examination determined dental caries experience and gingival health. Secondary outcome measures included salivary characteristics, oral hygiene and dietary practices, and diabetes-related factors. RESULTS: Eighty children and adolescents with T1D participated; mean (SD) age and HbA1c were 13.4(2.6) years and 7.7(0.9)%, respectively. Forty-seven (59%) participants had one or more decayed, missing or filled teeth; 75 (94%) participants had gingivitis. Half (50%) reported ≥3 hypoglycemic episodes necessitating rapid-acting carbohydrate in the previous week. Sixty-two participants (78%) had normal saliva flow, however, 42 (52%) had reduced salivary buffering capacity. Glycemic control (HbA1c ) was not associated with caries experience, gingival health or salivary characteristics. Increased frequency of tooth brushing (OR, 0.11; 95%CI 0.01-0.97, p = 0.05) and interdental flossing (OR, 0.31; 95%CI 0.12-0.81, p = 0.02) were associated with lower caries experience. Interdental flossing (OR, 0.31; 95% CI 0.12-0.80, p = 0.02) and good oral hygiene (OR, 0.06; 95% CI 0.01-0.22, p < 0.001) were associated with less gingivitis. CONCLUSION: Poor oral health is common in children with T1D, regardless of HbA1c. Given potential implications for short- and long-term systemic health, this study demonstrates the need for targeted strategies to improve oral health in children with T1D.
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ItemEtiology of molar incisor hypomineralization - A systematic review(WILEY, 2016-08)OBJECTIVES: Molar incisor hypomineralization (MIH) is a common developmental dental defect of permanent teeth, which can increase the risk of dental caries, infection and hospitalization. The etiology is currently unclear although prenatal or early childhood health factors are suspected. The aim of this systematic review was to assess the strength of evidence linking etiological factors with MIH. METHODS: A systematic search was conducted using the Medline and Embase electronic databases for studies investigating environmental etiological factors of MIH. Two reviewers assessed the eligibility of studies. The level of evidence and bias was determined for all eligible studies according to Australian National Health and Medical Research Council guidelines for systematic reviews of etiology and the Newcastle-Ottawa Scale. RESULTS: From a total of 2254 studies identified through electronic and hand searching, 28 were eligible for inclusion. Twenty-five of these investigated MIH and three investigated a related condition in primary teeth, hypomineralized second primary molars (HSPM), and these were analysed separately. A limited number of studies reported significant associations between MIH and pre- and perinatal factors such as maternal illness and medication use in pregnancy, prematurity and birth complications. Early childhood illness was implicated as an etiological factor in MIH in several studies, in particular fever, asthma and pneumonia. The studies investigating HSPM revealed an association with maternal alcohol consumption, infantile fever and ethnicity. However, the validity of these findings is impaired by study design, lack of adjustment for confounders, lack of detail and consistency of exposures investigated and poor reporting. CONCLUSIONS: Childhood illness is likely to be associated with MIH. Further prospective studies of the etiology of MIH/HSPM are needed.
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ItemPrevention of incipient carious lesions with various interventions during fixed and removable orthodontic treatment. A systematic review and meta-analysis(SCIENDO, 2021-07)Abstract Objective: To systematically review and quantify the effectiveness of interventions in reducing caries development during orthodontic treatment and evaluate the quality of evidence for the development of clinical guidelines. Materials and methods: A comprehensive literature search of the Cochrane, EMBASE and MEDLINE databases was conducted to identify eligible randomised controlled trials (RCTs). The risk of bias was assessed using the Cochrane risk of bias (RoB 2) tool. In order to facilitate the development of clinical guidelines, the quality of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results: A total of 18 RCTs were included in the qualitative synthesis, of which 10 had a high risk of bias, and eight had minor concerns. Three RCTs that investigated the efficacy of fluoride interventions during fixed orthodontic treatment were included in the quantitative synthesis. The pooled effect size resulted in a risk reduction of 0.23 (95% CI: -0.35, -0.11,p< 0.001) in the intervention group compared to controls. The GRADE evaluation identified the evidence as moderate due to the limited number of RCTs and moderate heterogeneity (I-squared statistic of 49.3%). Conclusions: Although fluoride is the most effective evidence-based preventive intervention during orthodontic treatment, large RCTs are required to provide high quality evidence. Further studies are needed to evaluate the caries preventive effects of oral hygiene programs, chlorhexidine, CPP-ACP and other interventions.
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ItemA twin study of body mass index and dental caries in childhood.(Nature Publishing Group, 2020-01-17)Sub-optimal nutrition and dental caries are both common with significant short and long-term implications for child health and development. We applied twin statistical methods to explore the relationship between body mass index (BMI) and dental caries. We measured BMI at 18 months and six years of age and cumulative dental caries experience at six years in 344 twin children. Dental caries in primary teeth was categorised into 'any' or 'advanced' and BMI was analysed as both a continuous and categorical variable. Statistical analyses included multiple logistic regression using generalized estimating equations and within/between-pair analyses. There was no association between BMI and 'any' dental caries experience at either time-point, neither overall nor in within/between pair analyses. However, 'advanced' dental caries at six years was associated with a within-pair difference in BMI of -0.55 kg/m2 (95% CI -1.00, -0.11, p = 0.015). A within-pair increase of 1 kg/m2 in BMI was associated with a lower within-pair risk of advanced dental caries (OR 0.68, 95% CI 0.52, 0.90, p = 0.007). These findings reveal a possible causal relationship between lower BMI and dental caries. As dental outcomes were only measured at one time point, the direction of this potentially causal relationship is unclear.