Association between clinical manifestations of sickle cell anaemia in children and the occurrence of dental caries: A cross-sectional study

Objective: The aim of this study was to determine the association between clinical manifestations of sickle cell anemia (including hospitalization and pain crisis) and dental caries in children in Bahia. Material and Methods: The study design was crosssectional, and the population included children aged from 6 to 96 months from August 2007 to July 2008 (N = 686). Interviews were performed to identify the sociodemographic profiles of the participants, and oral examinations were conducted by three examiners who were previously trained and calibrated to identify the presence of dental caries according to World Health Organization (WHO) criteria. Logistic regression analysis was performed for confirmatory analysis and estimation of confidence intervals (CIs). Results: The results showed that pain crises and hospitalizations were positively associated with caries (crude odds ratio (OR) = 2.11 and adjusted OR = 1.24; crude OR = 2.50 and adjusted OR = 1.46, respectively), but these associations were not statistically significant. Conclusion: The severity of the sickle cell condition alone was not sufficient to aggravate the prevalence of caries; thus, there are no major differences in caries prevalence between children with and without sickle cell disease.KEYWORDSSickle cell anemia; Dental caries; Epidemiology; Paediatrics.

A debreceni Stomatologiai Klinika története Adler Péter professzor vezetése alatt (1946–1979)

History of the Stomatology Clinic in Debrecen under the Leadership of Professor Péter Adler (1946–1979). With the approaching front of the 2nd World War in October 9, 1944, Professor András Csilléry head of the Stomatology Clinic left Debrecen because of his political views, so the institution remained without a leader until 17th November. Thereafter as a substitute, trainees then Stefánia Morvay Assistant Lecturer under the supervision of Professor Gyula Verzár was the head. From June 20, 1946, Péter Adler was assigned to the lead, which was one of the longest leading positions of the Faculty of Medicine since he was director of the clinic until July 1, 1979. Péter Adler graduated from the University of Vienna, where he specialized in the field of Dentistry and worked at the Department of Orthodontics at the Polyclinic of Vienna, while in spring 1939 he had to return home for political reasons. During the war he worked as a translator and then assigned to forced labor, and after the war, he was placed to the Stomatology Clinic in Debrecen. From 1948 he worked as a chief clinician, in 1952 he became candidate of sciences (CSc), and in 1953 he was appointed as a university professor. He received Doctor of Science (DSc) degree in 1957. He was a member of the editorial board of several foreign professional journals, he was accepted by several international editorial boards, wrote several textbooks. He translated two books written by others into German. He was chairman of the Association of Hungarian Dentists and Editor-in-Chief of the Stomatologica Hungarica. The main topics of the research at the Stomatology Clinic are: examination of hypersensitivity to dental anesthetics, clarification of many details of caries epidemiology, proof of the protective effect of fluoride against caries. Under his leadership there was a dynamic scientific work on the Stomatology Clinic, proven by the fact that between 1945–1980 12 books, 487 publications, book chapters and monographs appeared, which was unique among similar national institutions. He lay down the fundaments of the dental education in 1976 and contributed the architectural and professional requirements of the new Stomatology Clinic in 1981.

Early Childhood Caries: Epidemiology, Aetiology, and Prevention

Early childhood caries (ECC) is one of the most prevalent diseases in children worldwide. ECC is driven by a dysbiotic state of oral microorganisms mainly caused by a sugar-rich diet. Additionally, poor oral hygiene or insufficient dental plaque removal leads to the rapid progression of ECC. ECC leads not only to dental destruction and pain with children, but also affects the quality of life of the caregivers. Children with extensive ECC are at high risk to develop caries with the permanent dentition or will have other problems with speaking and/or eating. To prevent ECC, several strategies should be taken into account. Children should brush their teeth with toothpastes containing gentle ingredients, such as mild surfactants and agents showing antiadherent properties regarding oral microorganisms. Parents/caregivers have to help their children with brushing the teeth. Furthermore, remineralizing and nontoxic agents should be included into the toothpaste formulation. Two promising biomimetic agents for children’s oral care are amorphous calcium phosphate [Cax(PO4)ynH2O] and hydroxyapatite [Ca5(PO4)3(OH)].

Interpreting Poisson Regression Models in Dental Caries Studies

Oral epidemiology involves studying and investigating the distribution and determinants of dental-related diseases in a specified population group to inform decisions in the management of health problems. In oral epidemiology studies, the hypothesis is typically followed by a cogent study design and data collection. Appropriate statistical analysis is essential to demonstrate the scientific association between the independent factors and the target variable. Analysis also helps to develop and build a statistical model. Poisson regression and its extensions have gained more attention in caries epidemiology than other working models such as logistic regression. This review discusses the fundamental principles and basic knowledge of Poisson regression models. It also introduces the use of a robust variance estimator with a focus on the “robust” interpretation of the model. In addition, extensions of regression models, including the zero-inflated model, hurdle model, and negative binomial model, and their interpretation in caries studies are reviewed. Principles of model fitting, including goodness-of-fit measures, are also discussed. Clinicians and researchers should pay attention to the statistical context of the models used and interpret the models to improve the oral and general health of the communities in which they live.

Caries Epidemiology and Community Dentistry: Chances for Future Improvements in Caries Risk Groups. Outcomes of the ORCA Saturday Afternoon Symposium, Greifswald, 2014. Part 1

This paper reviews the first part of the outcomes of the ORCA Saturday Afternoon Symposium 2014 dealing with ‘caries epidemiology and community dentistry: chances for future improvements in caries risk groups'. After the caries decline in many countries, there are remaining pockets of higher caries levels, mostly in the primary dentition and/or linked to a low socio-economic status (SES). The review into the evidence of caries-preventive measures clearly points to the use of fluorides, especially toothbrushing with fluoridated toothpaste and collective measures such as water fluoridation. In contrast to several unsuccessful high-risk approaches, community and public health programmes seem to be able to ensure a population-wide access and compliance in risk groups. Their simple and evidence-based measures mostly combine regular plaque removal and fluoride applications via toothbrushing, at least for children and adolescents. For the future, the common risk factor approach which addresses associations between oral health, social deprivation, diet, hygiene, smoking, alcohol use and stress should lead to combined efforts with other community health and education specialists. Further engagement with public policy, community leaders and administration is needed in order to strengthen healthy choices and behaviour, e.g. in ‘healthy' schools and kindergartens. It seems advisable that these population programmes also aim at improving upstream factors.