Raul I. Garcia

Objective: We examined whether taste or smell dysfunction was associated with untreated caries and if sugar intake modified the association. Methods: We used cross-sectional National Health and Nutrition Examination Survey (NHANES) data from 5,882 adults aged 40+ who completed the dental examination and Taste and Smell protocols in 2011–2014. Self-reported dysfunction was defined as reporting at least 1 problem with taste and smell. Objectively measured dysfunctions (2013–2014 only) included inability to identify bitter and salty solutions on whole-mouth taste tests and ≤5 odorants correctly identified on the 8-item Pocket Smell Test (PST). Caries was assessed by calibrated dental examiners. Logistic regression estimated the odds and 95% confidence intervals (CIs) for untreated caries among persons with dysfunction compared with those without dysfunction. Covariates included age, sex, race/ethnicity, smoking, flossing frequency, alcohol use, dry mouth, and diabetes. Effect modification by added sugar level (<10% vs. ≥10% of calories) was examined. Results were weighted to account for the NHANES survey design. Results: Fourteen percent of participants self-reported problems with smell, 9% with taste, and 9% with both. Measured taste dysfunction prevalence was 11% to 17%, and 12% had significant smell loss on the PST. Adjusted odds of untreated caries were higher in participants who self-reported both taste and smell problems compared to neither (odds ratio [OR] = 1.38; 95% CI, 1.03–1.84). Added sugar level modified the association between measured ability to taste bitterness and caries: nontasters with high added sugar intake had twice the odds of caries as tasters with low added sugar intake (OR = 2.03; 95% CI, 1.35–3.05). Smell dysfunction alone, self-reported or measured, was not significantly associated with caries. Conclusion: Perceived dysfunction of taste and smell and inability to taste bitterness at high added sugar intakes were associated with increased odds of untreated caries. Screening for chemosensory dysfunction may identify persons with greater risk of dental caries and facilitate referral to a dentist. Knowledge Transfer Statement: Screening for taste dysfunction in primary care and community-based settings may identify persons with greater risk of dental caries and facilitate referral to a dentist.

ObjectivesPeriodontal disease is multifactorial in its aetiology, which encompasses biopsychosocial contributors, including psychological stress. Gastrointestinal distress and dysbiosis have been associated with several chronic inflammatory diseases yet have rarely been investigated with respect to oral inflammation. Given the implications of gastrointestinal distress on extraintestinal inflammation, this study aimed to evaluate the potential role of such distress as a mediator between psychological stress and periodontal disease. MethodsUtilizing a cross-sectional, nationwide sample of 828 adults in the USA generated via Amazon Mechanical Turk, we evaluated data collected from a series of validated self-report psychosocial questionnaires on stress, gut-specific anxiety around current gastrointestinal distress and periodontal disease, including periodontal disease subscales targeted at physiological and functional factors. Structural equation modelling was used to determine total, direct and indirect effects, while controlling for covariates. ResultsPsychological stress was associated with gastrointestinal distress (ss = .34) and self-reported periodontal disease (ss = .43). Gastrointestinal distress also was associated with self-reported periodontal disease (ss = .10). Gastrointestinal distress likewise mediated the relation between psychological stress and periodontal disease (ss = .03, p = .015). Given the multifactorial nature of periodontal disease(s), similar results were demonstrated using the subscales of the periodontal self-report measure. ConclusionsAssociations exist between psychological stress and overall reports of periodontal disease as well as more specific physiological and functional components. Additionally, this study provided preliminary data supporting the potential mechanistic role that gastrointestinal distress plays in connecting the gut-brain and the gut-gum pathways.

Few studies have evaluated the association between periodontitis and spontaneous abortion (SAB), and all had limitations. We used data from the Pregnancy Study Online (PRESTO), a prospective preconception cohort study of 3,444 pregnancy planners in the United States and Canada (2019–2022), to address this question. Participants provided self-reported data on periodontitis diagnosis, treatment, and symptoms of severity (i.e., loose teeth) via the enrollment questionnaire. SAB (pregnancy loss at <20 weeks’ gestation) was assessed via bimonthly follow-up questionnaires. Participants contributed person-time from the date of a positive pregnancy test to the gestational week of SAB, loss to follow-up, or 20 weeks’ gestation, whichever came first. We fitted Cox regression models with weeks of gestation as the time scale to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs), and we used inverse probability of treatment weighting to account for differential loss to follow-up. We used probabilistic quantitative bias analysis to estimate the magnitude and direction of the effect of exposure misclassification bias on results. In weighted multivariable models, we saw no appreciable association between preconception periodontitis diagnosis (HR = 0.97, 95% CI: 0.76, 1.23) or treatment (HR = 1.01, 95% CI: 0.79, 1.27) and SAB. A history of loose teeth was positively associated with SAB (HR = 1.38, 95% CI: 0.88, 2.14). Quantitative bias analysis indicated that our findings were biased towards the null but with considerable uncertainty in the bias-adjusted results.

Objective: To describe the patterns of specific dental service utilization among the various sociodemographic groups in North Carolina served by the East Carolina University School of Dental Medicine (ECU SoDM). Design: This was a descriptive study utilizing self-reported patients' sociodemographic information, payment method history, and CDT codes of procedures performed. Deidentified clinical data recorded for 26 710 patients and 534 983 procedures from 2011 to 2020 were extracted from a centralized axiUm database. Data were analyzed using IBM SPSS Statistics, version 25.0. Cross-tabulations between dental service utilizations, patients' demographics, and payment method were performed using chi-square analysis. Setting: Nine dental clinic sites across the state of North Carolina. Participants: In total, 26 710 adults 23 years to older than 65 years were included in the sample for this study. Main Outcome Measures: In total, 534 983 procedure codes completed for the eligible patients were cross-tabulated with payment method. Results: Payment method was significantly related to individual characteristics including location of service, age, race, ethnicity, and untreated decay (P < .001). Payment method is associated with the dental service type utilized by an individual (P < .001). Patients who received Medicaid benefits were more likely to receive restorative procedures, removable prosthetics, or oral surgery. Despite NC Medicaid covering preventive procedures, patients who received Medicaid benefits showed lower utilization of preventive procedures than expected. Privately insured or self-paying individuals demonstrated a greater variety of service option utilization, as well as more frequent usage of more specialized procedure options such as endodontics, periodontics, fixed prosthodontics, and implants. Conclusions: Payment method was found to be related to patients' demographics and type of dental service utilized. Adults older than 65 years demonstrated a higher proportion of self-payment for dental care, indicating a lack of payment options for this population. In the interest of providing care for underserved populations in North Carolina, policy makers should consider expanding dental coverage for adults older than 65 years.

Objectives: To evaluate a storytelling intervention targeting the oral health beliefs, knowledge, and behaviors of AIAN pregnant women and mothers.Methods: Fifty‐three adult AIAN women from three tribal communities in Northern California participated. The intervention story delivered oral health messaging using a traditional storytelling format. The effect of the intervention on self‐reported oral health behaviors, dental knowledge, and beliefs was assessed using a pretest‐posttest design, with an additional six‐month follow‐up. Tests of repeated measures using Generalized Linear Models were conducted to assess changes in oral health knowledge, beliefs, and behaviors.Results: Knowledge and beliefs significantly increased as a result of the intervention and persisted after six months. A consistent, significant increase in positive oral health behaviors from baseline to six‐months was also observed.Conclusions: The results of this intervention study suggest promise for traditional storytelling to increase oral health‐related knowledge, beliefs, and behaviors among self‐identified AIAN pregnant women and mothers.

Based on a theoretical framework describing culturally sensitive (CS) health communication, this experiment tested the relative contributions of surface structure and deep structure in the recall of oral health information from pamphlets varied in written message and images. Using a 2 × 2 factorial design, Spanish-speaking Mexican heritage mothers of children under six (n = 160) were randomly assigned to read one of four 12-page pamphlets containing the same oral health information in Spanish: (1) standard written message/standard images; (2) standard written message/CS images; (3) CS written message/standard images; and (4) CS written message/CS images. Participants completed a 22-item oral health knowledge questionnaire before and after reading the pamphlet. Controlling for the effects of pretest scores, acculturation, and educational level on information recall, findings showed significant positive main effects for CS images (F(1, 152) = 5.03, p = .026, partial ŋ² = .032) and CS written message (F(1, 152) = 5.21, p = .024, partial ŋ² = .033). There was no interaction. These results support the two dimensions of CS and their independent effects. They should be applicable to a variety of health communication channels. Further research is needed to investigate the causal mechanism behind the observed effects.