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Item Oral Health-Related Complications of Breast Cancer Treatment: Assessing Dental Hygienists’ Knowledge and Professional Practice(American Dental Hygienists' Association, 2014) Taichman, L. Susan; Gomez, Grace; Inglehart, Marita Rohr; Dental Public Health and Dental Informatics, School of DentistryPurpose: Approximately 200,000 women are diagnosed with breast cancer in the U.S. every year. These patients commonly suffer from oral complications of their cancer therapy. The purpose of this study was to assess dental hygienists' knowledge and professional practice related to providing care for breast cancer patients. Methods: A pre-tested 43-item survey was mailed to a random sample of 10% of all licensed dental hygienists in the state of Michigan (n=962). The survey assessed the respondents' knowledge of potential oral complications of breast cancer treatments as well as their professional practices when treating patients with breast cancer. After 2 mailings, the response rate was 37% (n=331). Descriptive and inferential analyses were conducted using SAS. Results: Many dental hygienists were unaware of the recommended clinical guidelines for treating breast cancer patients and lacked specific knowledge concerning the commonly prescribed anti-estrogen medications for pre-and postmenopausal breast cancer patients. Over 70% of the respondents indicated they were unfamiliar with the AI class of medications. Only 13% of dental hygienists correctly identified the mechanism of action of anti-estrogen therapy. Dental hygienists reported increased gingival inflammation, gingival bleeding, periodontal pocketing, xerostomia and burning tissues in patients receiving anti-estrogen therapies. Less than 10% believed that their knowledge of breast cancer treatments and the potential oral side effects is up to date. Conclusion: Results indicate a need for more education about the oral effects of breast cancer therapies and about providing the best possible care for patients undergoing breast cancer treatment.Item Early Lead Exposure Associated with Molar Hypomineralization(American Academy of Pediatric Dentistry, 2023-09) Tagelsir, Ahmed A.; Hector, Emily C.; Urena-Cirett, Jose Luis; Mercado-Garcia, Adriana; Cantoral, Alejandra; Hu, Howard; Peterson, Karen E.; Tellez-Rojo, Martha M.; Martinez-Mier, Esperanza A.; Dental Public Health and Dental Informatics, School of DentistryPurpose: The purpose of this study was to determine the association between prenatal and early life exposure to lead and the presence of molar hypomineralization (MH) in a group of Mexican children. Methods: A subset of participants of the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENTS) cohort study was examined for the presence of molar hypomineralization using European Academy of Pedi- atric Dentistry (EAPD) criteria. Prenatal lead exposure was assessed by K-ray fluorescence measurements of patella and tibia lead and by maternal blood lead levels by trimester and averaged over trimesters. Postnatal exposure was assessed by levels of maternal blood lead at delivery and child blood lead at 12 and 24 months. Results: A subset of 506 subjects from the ELEMENT cohorts (nine to 18 years old) were examined for MH; 87 subjects (17.2 percent) had MH. Maternal blood lead levels in the third trimester (odds ratio [OR] equals 1.08; 95 percent confidence interval [95% CI] equals 1.02 to 1.15) and averaged over three trimesters (OR equals 1.10; 95% CI equals 1.02 to 1.19) were significantly associated with MH status. None of the maternal bone lead or the child's blood lead parameters was significantly associated with the presence of MH (P>0.05). Conclusions: This study documents a significant association between prenatal lead exposure especially in late pregnancy and the odds of molar hypomineralization.Item Feasibility of Utilizing Electronic Dental Record Data and Periodontitis Case Definition to Automate Diagnosis(IOS, 2024) Patel, Jay; Shin, Daniel; Willis, Lisa; Zai, Ahad; Thyvalikakath, Thankam; Dental Public Health and Dental Informatics, School of DentistryPeriodontitis is an irreversible disease leading to tooth loss, and 42% U.S. population suffers from periodontitis. Hence, diagnosing, monitoring, and determining its prevalence is critical to develop preventive strategies. However, a nationwide epidemiological study estimating the prevalence reported a concern about the discontinuation of such studies due to cost and ethical reasons. Therefore, this study determined the feasibility of utilizing electronic dental record (EDR) data and periodontitis case definition to automate periodontitis diagnosis. We utilized EDR data from the Indiana University School of Dentistry of 28,908 unique patients. We developed and tested a computer algorithm to diagnose periodontitis using the case definition. We found 44%, 22%, and 1% of patients with moderate, severe, and mild periodontitis, respectively. The algorithm worked with 100% sensitivity, specificity, and accuracy because of the excellent quality of the EDR data. We concluded the feasibility of providing automated periodontitis diagnosis from EDR data to conduct epidemiological studies across the US.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 ADDENDUM: Critical windows of fluoride neurotoxicity in Canadian Children(Elsevier, 2022) Farmus, Linda; Till, Christine; Green, Rivka; Hornung, Richard; Martinez Mier, E. Angeles; Ayotte, Pierre; Muckle, Gina; Lanphear, Bruce P.; Flora, David B.; Dental Public Health and Dental Informatics, School of DentistryItem Critical windows of fluoride neurotoxicity in Canadian children(Elsevier, 2021) Farmus, Linda; Till, Christine; Green, Rivka; Hornung, Richard; Martinez Mier, E. Angeles; Ayotte, Pierre; Muckle, Gina; Lanphear, Bruce P.; Flora, David B.; Dental Public Health and Dental Informatics, School of DentistryBackground: Fluoride has been associated with IQ deficits during early brain development, but the period in which children are most sensitive is unknown. Objective: We assessed effects of fluoride on IQ scores across prenatal and postnatal exposure windows. Methods: We used repeated exposures from 596 mother-child pairs in the Maternal-Infant Research on Environmental Chemicals pregnancy and birth cohort. Fluoride was measured in urine (mg/L) collected from women during pregnancy and in their children between 1.9 and 4.4 years; urinary fluoride was adjusted for specific gravity. We estimated infant fluoride exposure (mg/day) using water fluoride concentration and duration of formula-feeding over the first year of life. Intelligence was assessed at 3-4 years using the Wechsler Preschool and Primary Scale of Intelligence-III. We used generalized estimating equations to examine the associations between fluoride exposures and IQ, adjusting for covariates. We report results based on standardized exposures given their varying units of measurement. Results: The association between fluoride and performance IQ (PIQ) significantly differed across prenatal, infancy, and childhood exposure windows collapsing across child sex (p = .001). The strongest association between fluoride and PIQ was during the prenatal window, B = -2.36, 95% CI: -3.63, -1.08; the association was also significant during infancy, B = -2.11, 95% CI: -3.45, -0.76, but weaker in childhood, B = -1.51, 95% CI: -2.90, -0.12. Within sex, the association between fluoride and PIQ significantly differed across the three exposure windows (boys: p = .01; girls: p = .01); among boys, the strongest association was during the prenatal window, B = -3.01, 95% CI: -4.60, -1.42, whereas among girls, the strongest association was during infancy, B = -2.71, 95% CI: -4.59, -0.83. Full-scale IQ estimates were weaker than PIQ estimates for every window. Fluoride was not significantly associated with Verbal IQ across any exposure window. Conclusion: Associations between fluoride exposure and PIQ differed based on timing of exposure. The prenatal window may be critical for boys, whereas infancy may be a critical window for girls.Item Maternal fluoride exposure, fertility and birth outcomes: The MIREC cohort(Elsevier, 2022-04) Goodman , Carly; Hall , Meaghan; Green , Rivka; Hornung , Richard; Martinez-Mier , Esperanza Angeles; Lanphear , Bruce; Till, Christine; Dental Public Health and Dental Informatics, School of DentistryObjective Fluoride exposure >1.5 mg/L from water has been associated with adverse pregnancy and birth outcomes. Little is known, however, about the effect of fluoride at levels consistent with water fluoridation (i.e., 0.7 mg/L) on pregnancy and birth outcomes. We examined the relationship between maternal fluoride exposure, fertility, and birth outcomes in a Canadian pregnancy cohort living in areas where municipal drinking water fluoride concentrations ranged from 0.04 to 0.87 mg/L. Methods Using data from the Maternal-Infant Research on Environmental Chemicals (MIREC) study, we estimated fluoride exposure during pregnancy using three different metrics: (1) maternal urinary fluoride concentrations standardized for specific gravity (MUFSG) and averaged across all three trimesters (N = 1566), (2) water fluoride concentration (N = 1370), and (3) fluoride intake based on self-reported consumption of water, coffee, and tea, adjusted for body weight (N = 1192). Data on fertility, birth weight, gestational age, preterm birth, and small-for-gestational age (SGA) were assessed. We used multiple linear regression to examine associations between fluoride exposure, birth weight and gestational age, and logistic regression to examine associations with fertility, preterm birth, and SGA, adjusted for relevant covariates. Results Median (IQR) MUFSG was 0.50 (0.33–0.76) mg/L, median water fluoride was 0.52 (0.17–0.64) mg/L, and median fluoride intake was 0.008 (0.003–0.013) mg/kg/day. MUFSG, water fluoride concentrations, and fluoride intake were not significantly associated with fertility, birth weight, gestational age, preterm birth, or SGA. Fetal sex did not modify any of the associations. Conclusion Fluoride exposure during pregnancy was not associated with fertility or birth outcomes in this Canadian cohort.Item Longevity of dental restorations in Sjogren's disease patients using electronic dental and health record data(Springer Nature, 2024-02-07) Gomez, Grace Gomez Felix; Wang, Mei; Siddiqui, Zasim A.; Gonzalez, Theresa; Capin, Oriana R.; Willis, Lisa; Boyd, LaKeisha; Eckert, George J.; Zero, Domenick T.; Thyvalikakath, Thankam Paul; Dental Public Health and Dental Informatics, School of DentistryBackground: Decreased salivary secretion is not only a risk factor for carious lesions in Sjögren's disease (SD) but also an indicator of deterioration of teeth with every restorative replacement. This study determined the longevity of direct dental restorations placed in patients with SD using matched electronic dental record (EDR) and electronic health record (EHR) data. Methods: We conducted a retrospective cohort study using EDR and EHR data of Indiana University School of Dentistry patients who have a SD diagnosis in their EHR. Treatment history of patients during 15 years with SD (cases) and their matched controls with at least one direct dental restoration were retrieved from the EDR. Descriptive statistics summarized the study population characteristics. Cox regression models with random effects analyzed differences between cases and controls for time to direct restoration failure. Further the model explored the effect of covariates such as age, sex, race, dental insurance, medical insurance, medical diagnosis, medication use, preventive dental visits per year, and the number of tooth surfaces on time to restoration failure. Results: At least one completed direct restoration was present for 102 cases and 42 controls resulting in a cohort of 144 patients' EDR and EHR data. The cases were distributed as 21 positives, 57 negatives, and 24 uncertain cases based on clinical findings. The average age was 56, about 93% were females, 54% were White, 74% had no dental insurance, 61% had public medical insurance, < 1 preventive dental visit per year, 94% used medications and 93% had a medical diagnosis that potentially causes dry mouth within the overall study cohort. About 529 direct dental restorations were present in cases with SD and 140 restorations in corresponding controls. Hazard ratios of 2.99 (1.48-6.03; p = 0.002) and 3.30 (1.49-7.31, p-value: 0.003) showed significantly decreased time to restoration failure among cases and positive for SD cases compared to controls, respectively. Except for the number of tooth surfaces, no other covariates had a significant influence on the survival time. Conclusion: Considering the rapid failure of dental restorations, appropriate post-treatment assessment, management, and evaluation should be implemented while planning restorative dental procedures among cases with SD. Since survival time is decreased with an increase in the number of surfaces, guidelines for restorative procedures should be formulated specifically for patients with SD.Item Findings and Future Directions from a Smoking Cessation Trial Utilizing a Clinical Decision Support Tool(Elsevier, 2022-09) Rindal, Donald Brad; Kottke, Thomas E.; Jurkovich, Mark W.; Asche, Stephen E.; Enstad , Chris J.; Truitt, Anjali R.; Ziegenfuss, Jeanette Y.; Romito, Laura M.; Thyvalikakath, Thankam P.; O'Donnell, Jean; Spallek, Heiko; Dental Public Health and Dental Informatics, School of DentistryBackground Tobacco smoking is the leading cause of disease, death, and disability in the United States. Dental practitioners are advised to provide evidence-based smoking cessation interventions to their patients, yet dental practitioners frequently fail to deliver brief smoking cessation advice. Objectives To test whether giving dental practitioners a clinical decisions support (CDS) system embedded in their electronic dental record would increase the rate at which patients who smoke (1) report receiving a brief intervention or referral to treatment during a recent dental visit, (2) taking action related to smoking cessation within 7 days of visit, and (3) stop smoking for 1 day or more or reduce the amount smoked by 50% within 6 months. Methods Two-group, parallel arm, cluster-randomized trial. From March through December 2019, 15 nonacademic primary care dental clinics were randomized via covariate adaptive randomization to either a usual care arm or the CDS arm. Adult smokers completed an initial telephone survey within 7 days of their visit and another survey after 6 months. Results Forty-three patients from 5 CDS and 13 patients from 2 usual care clinics completed the 7-day survey. While the proportion of patients who reported receipt of a brief intervention or referral to treatment was significantly greater in the CDS arm than the usual care arm (84.3% vs 58.6%; P = .005), the differences in percentage of patients who took any action related to smoking cessation within 7 days (44.4% vs 22.3%; P = .077), or stopped smoking for one day or more and/or reduced amount smoked by 50% within 6 months (63.1% vs 46.2%; P = .405) were large but not statistically significant. Conclusions Despite interruption by COVID-19, these results demonstrate a promising approach to assist dental practitioners in providing their patients with smoking cessation screening, brief intervention and referral to treatment.Item Demarcated Primary Second Molar Hypomineralization: Prevalence Data and Associated Sociodemographic Determinants from Indiana(American Academy of Pediatric Dentistry, 2021) Ahmed, Azza Tagelsir; Soto-Rojas, Armando; Dean, Jeffrey; Eckert, George J.; Martinez-Mier, Esperanza Angeles; Dental Public Health and Dental Informatics, School of DentistryPurpose: Demarcated primary second molar hypomineralization (DMH-Es) is a common developmental defect of enamel, with prevalence estimates between five percent and 20 percent. From the Americas, studies exploring the problem of DMH-Es and explicitly using the European Academy of Pediatric Dentistry diagnostic criteria were limited to some South American countries, but no similar studies were available from any of the North American countries including the United States. The purpose of this study was to investigate the prevalence and sociodemographic determinants of DMH-Es among schoolchildren in Indiana, USA. Methods: Four hundred twenty-three schoolchildren (average age equals 7.6 [±2.2 standard deviation] years) were examined by a calibrated pediatric dentist. Sociodemographic data were collected from patients' questionnaires and electronic dental records. Results: DMH-Es had a prevalence estimate of six percent versus 40 percent overall of any enamel defect (AED) of the primary second molars (PSMs) and/or the permanent first molars (PFMs). Race/ethnicity was significantly associated with a higher overall prevalence of AED of PSMs but not with the prevalence estimate of DMH-Es. Older age group (10 years or older), living in central Indiana, and water fluoridation were significantly associated with a higher overall prevalence of AEDs (P<0.01) but not with the prevalence of DMH-Es. Caries experience was significantly higher in children with demarcated molar hypomineralization (DMH) of PFMs and/or PSMs than in the group without. Conclusions: DMH-Es prevalence estimate was similar to the global figures. Certain demographic characteristics were significantly associated with the overall prevalence of the enamel defects of the examined teeth.