Browsing by Author "Martinez-Mier, E. Angeles"
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Item Aesthetical perception of dental fluorosis in a Colombian low income community(Universidad CES, 2020-12) Fragelli, Camila; Restrepo, Manuel; Bussaneli, Diego Girotto; Jeremias, Fabiano; de Cássia Loiola Cordeiro, Rita; Escobar-Rojas, Alfonso; Martinez-Mier, E. Angeles; dos Santos-Pinto, Lourdes; Cariology, Operative Dentistry and Dental Public Health, School of DentistryIntroduction and objective : Dental fluorosis (DF) is a defect in the development of enamel as a result of overexposure to fluoride and can aesthetically compromise the patient. This study aims to investigate the relationship between aesthetic perception and dental fluorosis in a low-income community with a high prevalence of DF. Materials and methods: A cross-sectional study was carried out with 171 schoolchildren aged 8 to 12 who live in a low socioeconomic community (El Cedro, Ayapel district, Córdoba, Colombia). The students were examined for dental caries (DMFT and dmft indexes (WHO criteria) and for dental fluorosis (TF index). Aesthetic perception was verified with the questionnaire on children's perceptions of the appearance of teeth (CQATA) Data analysis was performed using descriptive statistics and chi-square tests, Student's t, one-way ANOVA and linear regression (p ≤ 0.05). Results: The prevalence of DF was 84.8% (n = 145). Only the presence of caries (DMFT / deft ≠ 0) had a significant impact on aesthetic perceptions. A significantly lower rate was found in girls for the pleasant color report. The number of teeth affected by FD had a significant positive correlation with the general perception of dental health. Conclusion : The presence of mild DF in children with low socioeconomic status, in a population with a high prevalence of this enamel defect, did not seem to have an impact on accepting the appearance of tooth color.Item Associations between Urinary, Dietary, and Water Fluoride Concentrations among Children in Mexico and Canada(MDPI, 2020-11-08) Green, Rivka; Till, Christine; Cantoral, Alejandra; Lanphear, Bruce; Martinez-Mier, E. Angeles; Ayotte, Pierre; Wright, Robert O.; Tellez-Rojo, Martha M.; Malin, Ashley J.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryFluoride, which may be toxic to the developing brain, is added to salt in Mexico and drinking water in Canada to prevent dental caries. We compared childhood urinary fluoride (CUF) concentrations in Mexico City and Canada to characterize patterns of fluoride exposure in these two populations. We also examined associations of CUF with dietary and water fluoride levels in Mexico City and Canada respectively. We included 561 children (ages 4–6; mean age 4.8 years) from the Programming Research in Obesity, Growth, Environment, and Social Stress (PROGRESS) cohort in Mexico City, and 645 children (ages 2–6; mean age 3.7 years) from the Maternal–Infant Research on Environmental Chemicals (MIREC) cohort in Canada. We applied Spearman correlations, T-tests, ANOVA or covariate-adjusted linear regression to examine associations of CUF (mg/L; adjusted for specific gravity) with demographics and dietary or water fluoride concentrations. We used Welch equivalence testing to compare means across cohorts. Mean (SD) CUF was equivalent (t = 4.26, p < 0.001) in PROGRESS: 0.74 (0.42) and fluoridated Canadian communities: 0.66 (0.47), but lower in non-fluoridated Canadian communities: 0.42 (0.31) (t = −6.37, p < 0.001). Water fluoride concentrations were significantly associated with CUF after covariate adjustment for age and sex in MIREC (B = 0.44, 95% CI: 0.30, 0.59, p < 0.001). In contrast, daily food and beverage fluoride intake was not associated with CUF in PROGRESS (p = 0.82). We found that CUF levels are comparable among children in Mexico City and fluoridated Canadian communities, despite distinct sources of exposure. Community water fluoridation is a major source of fluoride exposure for Canadian children.Item Binational/Cross Cultural Health Enhancement Center (BiCCHEC) at IUPUI(Office of the Vice Chancellor for Research, 2012-04-13) Martinez-Mier, E. AngelesBiCCHEC fosters multidisciplinary research collaborations that address the biological, cultural, historical, legal, behavioral and demographic issues that impact the health status of communities where Latinos are born and where they live in Indiana. BiCCHEC has a commitment not only to research but also to teaching and service, and works always in partnership with communities. Current projects include: A microcredit project for residents of rural villages in Mexico, in partnership with the Indianapolis Rotary Club and ProMujer; a study on international service-learning outcomes of health professional students in the U.S., Latin America (Mexico), Africa (Kenya), and Asia (China), a partnership among IUSD, IUSM and IUSON faculty; a study on oral health disparities using community-based participatory research methodology, in partnership with La Plaza, and the Institute for Mexicans Abroad; and, a study on the dissemination of the Helping Babies Breath program in small rural communities, in partnership with the UAEH.Item CariesCare International adapted for the pandemic in children: Caries OUT multicentre single-group interventional study protocol(BMC, 2021-12) Martignon, Stefania; Cortes, Andrea; Douglas, Gail V. A.; Newton, J. Timothy; Pitts, Nigel B.; Avila, Viviana; Usuga-Vacca, Margarita; Gamboa, Luis F.; Deery, Christopher; Abreu-Placeres, Ninoska; Bonifacio, Clarisa; Braga, Mariana M.; Carletto-Körber, Fabiana; Castro, Patricia; Cerezo, María P.; Chavarría, Nathaly; Cifuentes, Olga L.; Echeverri, Beatriz; Jácome-Liévano, Sofía; Kuzmina, Irina; Lara, J. Sebastián; Manton, David; Martinez-Mier, E. Angeles; Melo, Paulo; Muller-Bolla, Michèle; Ochoa, Emilia; Osorio, Jesús R.; Ramos, Ketty; Sanabria, Angie F.; Sanjuán, Johanna; San-Martín, Magdalena; Squassi, Aldo; Velasco, A. Karina; Villena, Rita; Ferreira Zandona, Andrea; Beltrán, Edgar O.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryBackground Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this “Caries OUT” study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time. Methods In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children’s oral-health behaviour change, parents’ and dentists’ process acceptability, and costs exploration. A sample size of 258 3–5 and 6–8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments’ time. A trained examiner per centre will conduct examinations at baseline, at 5–5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child’s CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents’ and dentists’ process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate. Discussion The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time.Item A Comparison of Simple Analytical Methods for Determination of Fluoride in Microlitre-Volume Plasma Samples(Karger, 2019-04) Zohoori, F. Vida; Maguire, Anne; Martinez-Mier, E. Angeles; Buzalaf, Marília Afonso Rabelo; Sanderson, Roy; Eckert, George J.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryThe aim was to compare potential methods for fluoride analysis in microlitre-volume plasma samples containing nano-gram amounts of fluoride. Methods: A group of 4 laboratories analysed a set of standardised biological samples as well as plasma to determine fluoride concentration using 3 methods. In Phase-1, fluoride analysis was carried out using the established hexamethyldisiloxane (HMDS)-diffusion method (1 mL-aliquot/analysis) to obtain preliminary measurement of agreement between the laboratories. In Phase-2, the laboratories analysed the same samples using a micro-diffusion method and known-addition technique with 200 µL-aliquot/analysis. Coefficients of Variation (CVs) and intra-class correlation coefficients (ICCs) were estimated using analysis of variance to evaluate the amount of variation within- and between-laboratories. Based on the results of the Phase-2 analysis, 20 human plasma samples were analysed and compared using the HMDS-diffusion method and known-addition technique in Phase-3. Results: Comparison of Phase-1 results showed no statistically significant difference among the laboratories for the overall data set. The mean between- and within-laboratory CVs and ICCs were < 0.13 and ≥0.99, respectively, indicating very low variability and excellent reliability. In Phase-2, the overall results for between-laboratory variability showed a poor CV (1.16) and ICC (0.44) for the micro-diffusion method, whereas with the known-addition technique the corresponding values were 0.49 and 0.83. Phase-3 results showed no statistically significant difference in fluoride concentrations of the plasma samples measured with HMDS-diffusion method and known- addition technique, with a mean (SE) difference of 0.002 (0.003) µg/mL. In conclusion, the known-addition technique could be a suitable alternative for the measurement of fluoride in plasma with microlitre-volume samples.Item Fluoride concentration in saliva and biofilm fluid following the application of three fluoride varnishes(Elsevier, 2017-05) Al Dehailan, Laila; Lippert, Frank; González-Cabezas, C.; Eckert, George J.; Martinez-Mier, E. Angeles; Department of Cariology, Operative Dentistry and Dental Public Health, School of DentistryObjective Most of the commercially available fluoride varnishes (FV) have not been evaluated for their cariostatic properties. Consequently, the aim of this in vivo study was to investigate intra-oral fluoride retention and clearance patterns from three different FV. Methods Eighteen subjects (7–11 years) participated in a laboratory analyst-blinded, randomized, crossover study comparing the ability of 5% sodium fluoride varnishes (CavityShield-CS, Enamel Pro-EP, Vanish-V) to enhance fluoride concentrations in biofilm fluid, centrifuged and whole saliva over a period of 48 h after a single FV application. Results Similar fluoride concentration × time patterns were noted for all investigated FV and studied variables, with the highest fluoride concentrations observed for the first biological sample collected after FV application (30 min). Mean ± SE (area under fluoride clearance curve) values were (μg F/g or ml × min): biofilm fluid − CS (472 ± 191), EP (423 ± 75), V (1264 ± 279); centrifuged saliva − CS (42 ± 7), EP (19 ± 3), V (41 ± 8); whole saliva − CS (68 ± 11), EP (64 ± 10), V (60 ± 7). V delivered more fluoride to biofilm fluid than CS (p = 0.0116) and EP (p = 0.0065), which did not differ (p = 0.27). For centrifuged saliva, CS and V were not significantly different (p = 0.86), but resulted in higher fluoride retention than EP (p < 0.0008). No significant differences among FV were observed for whole saliva (p = 0.79). Conclusion The present study has shown that FV vary in their ability to deliver fluoride intra-orally potentially related to formulation differences. To what extent the present findings relate to clinical efficacy remains, however, to be determined. Clinical significance Clinical research that investigates fluoride release patterns into saliva and biofilm fluid from different FV products is insufficient. More research is needed to investigate different FV formulations for their efficacy in order to help clinicians make better evidence based treatment choices.Item Fluoride in the diet of 2-years-old children(Wiley, 2017-06) Martinez-Mier, E. Angeles; Spencer, Kathryn L.; Sanders, Brian J.; Jones, James E.; Soto-Rojas, Armando E.; Tomlin, Angela M.; Vinson, LaQuia A.; Weddell, James A.; Eckert, George J.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryObjectives This study aimed to calculate the fluoride concentrations of commonly consumed foods and beverages for 2-years-old children utilizing market basket information for the US Midwest region. Methods Total Diet Study food lists were cross-referenced with National Health and Nutrition Examination Survey—What We Eat in America data to determine the foods and beverages to be included. Fluoride concentrations were determined using a modification of the hexamethyldisiloxane microdiffusion technique. Fluoride concentrations were summarized for each of the food categories. Daily dietary fluoride intake was estimated using a simulation analysis. Results Food and beverage fluoride concentrations varied widely, ranging from nondetectable for some oils and dairy products to more than 3.0 μgF/g food for some processed meats, fish and fruits. The estimated mean (±SD) daily dietary fluoride intake, excluding dentifrice and supplements, was 412±114 μgF/d. The estimated average ingestion for a 2-years-old weighing 12.24 kg was 0.034±0.009 mg/kg/d. A diet based on foods and beverages in the fifth percentile of fluoride intake distribution for an average child would result in 247 μgF/d or 0.020 mg/kg/d, while a diet with foods and beverages in the 95th percentile would result in a total intake of 622 μgF/d or 0.051 mg/kg/d. Conclusions The fluoride concentrations of foods and beverages vary widely, and, if items in the 95th percentile of fluoride intake distribution are ingested, children could consume more fluoride than the recommended 0.05 mg/kg/d. Fluoride intake calculated in this study was higher than historically reported dietary levels.Item Fluoride Metabolism in Pregnant Women: A Narrative Review of the Literature(MDPI, 2022) Castiblanco-Rubio, Gina A.; Martinez-Mier, E. Angeles; Cariology, Operative Dentistry and Dental Public Health, School of DentistryEpidemiological studies use biomarkers of fluoride exposure in pregnant women as surrogate measures of fetal fluoride exposure; however, there is little understanding of how pregnancy affects fluoride metabolism and its biomarkers. This narrative review summarizes the changes of pregnancy that have the potential to impact fluoride’s absorption, distribution and excretion, and highlights the limited body of evidence on the topic. The physiologic systems that experience pregnancy-associated changes relevant to fluoride’s metabolism are the cardiovascular, renal, metabolic and gastrointestinal, as well bone and calcium metabolism and the body’s acid-base balance. The available evidence indicates that fluoride is found in the maternal plasma and urine, placenta, amniotic fluid and fetus. Although plasma and urinary fluoride vary across gestation, there is insufficient quality evidence to determine the direction or extent of such variation. Furthermore, there is no doubt that fluoride from maternal blood crosses the placenta and is absorbed and excreted by the fetus; however, the biological mechanisms behind this placental passage are unknown. Research on maternal and prenatal biomarkers of fluoride exposure would benefit from studies on how pregnancy-associated changes affect the metabolism of fluoride across gestation, the mechanisms for the intestinal absorption of fluoride in pregnant women, and the placental passage of fluoride.Item Impact of lack of transportation on access to dental care(Elsevier, 2024-11-22) Kim, Jaewhan; Roy, Indrakshi; Martinez-Mier, E. Angeles; Shukla, Anubhuti; Weir, Peter; Dental Public Health and Dental Informatics, School of DentistryObjectives: Access to healthcare may be influenced by the availability of transportation. Nevertheless, the impact of transportation challenges on access to dental care has not been thoroughly examined. This study investigates the influence of transportation availability on dental care visits, dental cleanings, and exams. Methods: This is a retrospective observational study. The 2021 Medical Expenditure Panel Survey (MEPS), a national survey in the United States, was used for this study. Adults (≥18 years old) from the 2021 survey were included. The 2021 Full Year Consolidated File and the Dental Visits file were linked to identify the main independent variable and the outcomes.Weighted zero-inflated negative binomial regression and weighted logistic regression were employed to analyze the outcomes of dental care visits, and dental cleanings, and exams. Results: The study included a total of 204,704,044 adults, with an average age of 49 (SD: 18) years, and a 51 % female representation. Approximately 5.5 % (n=11,285,968) of the population reported facing transportation challenges. Subjects encountering transportation challenges exhibited a 26 % decrease in dental care visits compared to those without such challenges (Incidence Rate Ratio (IRR)=0.74, p < 0.01, 95 % CI: 0.64-0.87). Individuals lacking transportation had 39 % lower odds of receiving a dental cleaning (odds ratio (OR)=0.61, p < 0.01, 95 % CI: 0.48-0.77) and 29 % lower odds of undergoing a checkup or exam (OR=0.71, p < 0.01, 95 % CI: 0.56-0.90). Conclusions: The study's findings underscore the significant impact of transportation challenges on access to dental care. Limited access to dental care due to transportation issues could exacerbate disparities in oral health outcomes. Implementing targeted interventions to address transportation challenges could contribute to improved oral health outcomes.Item In vitro Validation of Quantitative Light-Induced Fluorescence for the Diagnosis of Enamel Fluorosis in Permanent Teeth(Karger, 2017-11) Cuevas-Espinosa, D. M.; Martinez-Mier, E. Angeles; Ando, Masatoshi; Castiblanco, G. A.; Cortes, F.; Rincon-Bermudez, C. M.; Martignon, Stefania; Cariology, Operative Dentistry and Dental Public Health, School of DentistryThis study aimed to validate quantitative light-induced fluorescence (QLF) as a diagnostic tool for mild and moderate enamel fluorosis in permanent teeth, comparing it to visual diagnosis and histological assessment completed using polarized light microscopy (PLM). The buccal surfaces of 139 teeth were visually classified using the Thylstrup and Fejerskov Index (TFI) into sound (TFI 0; n = 17), mild (TFI 1-2; n = 69), and moderate (TFI 3-4; n = 43) fluorosis. Fluorosis was then assessed with QLF (variables ΔF, A, and ΔQ at 5-, 15-, and 30-radiance thresholds) using as reference areas the entire surface and a region of interest (ROI), identified as the most representative region of a fluorosis lesion. PLM images of longitudinal thin sections including the ROI were assessed for histological changes. Correlations among TFI, PLM, and QLF were determined. A receiver-operating characteristic curve was conducted to determine QLF's diagnostic accuracy when compared to the TFI and PLM assessments. This was used to assess the probability that the images were correctly ranked according to severity as determined by PLM and TFI. A positive correlation was found between QLF and PLM, and between QLF and TFI. QLF showed the highest sensitivity and specificity for the diagnosis of mild fluorosis. There was also a strong agreement between TFI and PLM. The selection of a ROI resulted in a stronger correlation with TFI and PLM than when the entire surface was used. The study results indicate that defining an ROI for QLF assessments is a valid method for the diagnosis of mild and moderate enamel fluorosis.