Nadia Laniado

Aims: The aims of this study were to examine the association of social network size with severe tooth loss and the number of missing teeth among Hispanic adults with diabetes in the United States and to assess whether the association varied by glycemic control. Methods: Data obtained from 1,007 adults who participated in the Hispanic Community Health Study were analyzed. Structural social support was measured with the Social Network Index (SNI), which assessed network size and frequency of social contacts. Tooth loss was measured by a count of the number of missing teeth and categorically as severe tooth loss (Results: The prevalence of severe tooth loss was 5.91%. For each one-unit increase in SNI, the expected log count of the number of missing teeth was reduced by 3.3% ( p -value: 0.037). Conclusions: In this study, a larger social network size was associated with fewer missing teeth among Hispanic persons living with diabetes. Further examination of social support and oral health is warranted.

Objectives: The aim of this study was to assess the knowledge of state dental directors regarding their state's professional practice act, specifically scope of practice laws regarding point‐of‐care chairside screening for diabetes.Methods: A cross‐sectional study design was used to examine the 50 state dental directors' knowledge of policy around point‐of‐care diabetes testing in their state. A five‐item survey instrument was designed in a web‐based platform and electronically distributed in 2022.Results: Thirty‐seven states (74%) responded to the survey. Regarding whether it was within the scope of practice for dentists to provide chairside point‐of‐care HbA1c screening, 17 states (46.0%) responded “yes,” 5 states (13.5%) responded “no,” and 15 states (40.5%) responded “don't know.” Of the 17 states who provide diabetes testing, four states (23.5%) reported that dentists were reimbursed, nine states (53.0%) reported they were not reimbursed, and four states (23.5%) reported they did not know regarding reimbursement.Conclusions: There is significant state heterogeneity with regard to laws, regulations, and reimbursement for chairside diabetes testing in the United States. This is accompanied by vagueness and lack of specificity in the state education laws. For more widespread promotion and adoption of this evidence‐based screening, the entire dental community including clinicians, educators, policymakers, payers, and professional organizations at all levels are encouraged to work together to advocate for clarification and specificity in the language of state education laws as well as reimbursement for this vital service.

Objectives: The purpose of this study was to examine the association of social support with untreated dental caries and severe tooth loss in adults in the United States.Methods: This cross‐sectional study was conducted by analyzing data obtained from 5,447 individuals, 40 years of age and older, in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008 who had both a complete dental examination and social support index measures. Sample characteristics, overall and by social support level, were examined through descriptive statistical analyses. Logistic regression analyses were performed to estimate the association of social support with untreated dental caries and severe tooth loss.Results: In this nationally representative sample (mean age 56.5 years) the prevalence of low social support was 27.5%. The prevalence of individuals with moderate‐to‐high social support increased with higher levels of educational attainment and income level. In fully adjusted models, relative to those who had moderate‐high social support levels, individuals with low social support had 1.49 higher odds of untreated dental caries (95% CI, 1.17‐1.90, p=0.002) and 1.23 higher odds of severe tooth loss (95% CI, 1.05‐1.44, p=0.011).Conclusions: Higher odds of untreated dental caries and severe tooth loss were found among U.S. adults with low levels of social support compared to those with moderate‐to‐high levels of social support. Additional studies are warranted to provide a more current perspective on the impact of social support on oral health so that programs may be developed and tailored to reach these populations.

Aims To examine whether baseline periodontal disease is independently associated with incident prediabetes and incident diabetes in Hispanics/Latinos in the United States. Materials and Methods This study examined 7,827 individuals, 18-74 years of age without diabetes, from the Hispanic Community Health Study/Study of Latinos. Participants received a full mouth periodontal examination at baseline (2008-2011) and disease was classified using the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) case definitions. At Visit 2 (2014-2017) incident prediabetes and diabetes were assessed using multiple standard procedures including blood tests. Multivariable survey Poisson regressions estimated the rate ratio and 95% confidence intervals of incident prediabetes and incident diabetes associated with periodontal disease severity. Results Among the individuals without prediabetes or diabetes at baseline, 38.8% (n = 1,553) had developed prediabetes and 2.2% (n = 87) had developed diabetes after six years. Nineteen percent (n = 727) of individuals with prediabetes at baseline developed diabetes after six years. Adjusting for all potential confounders, no significant association was found between periodontal disease severity and either incident prediabetes (Rate Ratio 0.93, 95% confidence interval [CI]: 0.82,1.06) or incident diabetes (Rate Ratio 0.99, 95% CI: 0.80,1.22). Conclusions Our findings suggest that among a diverse cohort of Hispanic/Latino individuals living in the U.S., there was no association between periodontal disease severity and the development of either prediabetes or diabetes during a six-year follow-up period.

Unaccompanied migrant minors are increasingly seeking asylum status in the United States (U.S.) where guidelines for age assessment call for the use of multiple forms of evidence. A commonly used approach in the U.S. is dental radiographs to assess the root development of third molars. Not only has research shown this methodology to be unreliable and imprecise, but the evidence has shown significant variability in dental development by chronologic age, race/ethnicity, sex, socioeconomic status, systemic disease, nutritional health, and other environmental factors. Misclassification of minors as adults based upon the imprecise tool of dental age assessment can have serious and harmful consequences. In the U.S., this misclassification has resulted in the housing of minors with adults in Immigrant and Custom Enforcement (ICE) operated jails. In addition, there are significant ethical concerns with regard to the use of radiographs for purposes that are neither diagnostic nor therapeutic and the lack of informed consent. In this commentary we review the (1) inadequacy of dental radiographs as a means of chronologic age assessment for minors, and (2) the ethical implications of implementing this flawed and inappropriate assessment on a highly vulnerable population.