R J Billings

University of Rochester, Rochester, New York, United States

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Publications (45)58.06 Total impact

  • Dorota T Kopycka-Kedzierawski, Ronald J Billings
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    ABSTRACT: Abstract Background: Dental caries affecting the primary dentition of U.S. children continues to be the most prevalent chronic childhood disease. Preventive screening for dental caries in toddlers by dental professionals is labor-intensive and costly. Studies are warranted to examine innovative screening modalities that reduce cost, are less labor-intensive, and have the potential to identify caries in high-risk children. Subjects and Methods: Two hundred ninety-one children were randomized into two groups: Group 1 received a traditional, visual tactile examination initially and follow up-examinations at 6 and 12 months, and Group 2 received a teledentistry examination initially and follow-up examinations at 6 and 12 months. The mean primary tooth decayed and filled surfaces (dfs) scores were calculated for all children at baseline and 6 and 12 months. Results: At baseline, the mean dfs score for children examined by means of teledentistry was 2.19, and for the children examined by means of the traditional method, the mean was 1.27; the means were not significantly different. At the 12-month examination, the mean dfs score for the children examined by means of teledentistry was 3.02, and for the children examined by means of the clinical method, the mean dfs was 1.70; the means were not significantly different. At 12 months the mean fillings score for the children examined by means of teledentistry was 1.43 and for the children examined by means of the clinical method was 0.51; the means were statistically significantly different (p<0.001). Conclusions: These results suggest that the teledentistry examinations were comparable to clinical examinations when screening for early childhood caries in preschool children. The data further showed that color printouts of teeth with cavities provided to parents of children who received teledentistry screenings promoted oral healthcare utilization, as children from the teledentistry study group received more dental care than children from the clinical study group.
    Telemedicine and e-Health 09/2013; · 1.40 Impact Factor
  • D.T. KOPYCKA-KEDZIERAWSKI, R.J. BILLINGS
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    ABSTRACT: Objectives : To assess the incidence of Early Childhood Caries (ECC) in 1-5 year old initially caries free children attending selected urban childcare centers. Methods: Children enrolled in the study were randomized into two groups: Group I received a visual/tactile examination and Group II received a teledentistry examination. Baseline, six month and twelve month follow-up examinations were conducted. Results: Two hundred eighty six children were enrolled in the study; 208 (approximately 73%) of the children were caries free at baseline. Of the 208 children who were caries free at the initial exam, 170 children were examined at 6 months. One hundred thirty three children remained caries free and 37 initially caries free children became caries active at the 6 six month follow-up exam. Ninety children were examined at 12 months. Sixty four children remained caries free and 26 initially caries free children became caries active at the 12 month follow-up exam. The mean dfs score for the 170 children at the 6 month follow-exam was 1.68 (SD=4.30). The mean dfs score for the 90 children at the 12 month follow-up exam was 1.77 (SD=4.28). At the 12 month follow-up examination, ECC incidence for the initially caries free children enrolled in this study was not significantly different when considering examination modality, i.e. teledentistry or visual-tactile, gender, age or ethnicity. Referrals for preventive or restorative care were provided for all children participating in the study. Conclusions: Almost twenty two percent of the initially caries free children became caries active at the six month examination and almost twenty nine percent at the twelve month examination. A total of 50% of the children became caries active over the course of the study. These data suggest that continuing efforts are needed to improve the oral health of urban preschool children. Supported by NIH/NIDCR K23 DE 017230
    03/2012
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    ABSTRACT: Bacterial urease enzymes hydrolyze salivary urea and generate alkali in the oral cavity. A recent longitudinal study showed that urease activity in plaque was associated with reduced caries risk in children over a three-year study period; however, increased urease activity in saliva was significantly associated with increased caries risk. Objective: The objective of this study was to evaluate the relationship of ureolytic oral bacteria with dental caries in children over a three-year period. Methods: 140 plaque samples collected from 20 children over a three-year period were selected from a larger longitudinal study on the basis of the variability in urease activity levels observed during the study period. The samples were analyzed by qPCR using gene specific primers for two ureolytic species (Actinomyces naeslundii and Streptococcus salivarius), two arginolytic species (Streptococcus sanguis and Streptococcus gordonii), and Streptococcus mutans. Generalized latent linear and mixed models were used to study the relationship of these bacteria with three caries outcomes: enamel caries, dentin caries, and dmfs, adjusted for age, gender, and baseline caries. Results: A. naeslundii was negatively associated with enamel caries (adj.β=-0.03, P=0.001). S. salivarius , which is a predominant ureolytic species in saliva and which is found only in very small numbers in plaque was positively associated with dentin caries (adj.β=3.44, P=0.012) and with the dmfs (adj.b=2.69, P=0.024). S. sanguis (adj.β=0.05, P=0.015) and S. gordonii (adj.β=0.04, P=0.015) were positively associated with enamel caries, while S. mutans was positively associated with the advanced lesions (adj.β=2.54, P=0.031). Conclusion: The results from the microbiological analysis are in agreement with the biochemical findings of this prospective study with respect to the relationship of urease with caries development in children. A more thorough microbiological analysis using novel and more powerful technologies will help further dissect this complex relationship. Grant Support: K23 DE015285, G12 RR 0305, U54RR026139-01A1
    AADR Annual Meeting 2012; 03/2012
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    Puerto Rico health sciences journal 12/2011; 30(4):165-6. · 0.71 Impact Factor
  • D.T. KOPYCKA-KEDZIERAWSKI, R.J. BILLINGS
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    ABSTRACT: Objectives: To assess the feasibility of Teledentistry as a screening method for dental caries in preschool children. Methods: Caries prevalence was determined in a cohort of urban preschool children 12-60 months of age. Children were randomized into two panels: panel I received a visual/tactile oral examination and panel II received a teledentistry examination. Results: Of 286 children examined, approximately 27% had caries experience. The mean dfs score for all children was 1.58 (SD=4.11) with a range of 0-34 carious surfaces. The mean dfs score for the children examined by means of Teledentistry was 1.95 (SD=4.48) and for the children examined by means of the visual/tactile method, the mean dfs was 1.26 (SD=3.78); the means between the two panels were not significantly different (Wilcoxon Mann-Whitney test, p>.05). Referrals for preventive or restorative care were provided for all children participating in the study. Conclusion: The results of this field study suggest that dental screening by means of Teledentistry maybe an acceptable substitute for caries exams performed by a trained and calibrated dentist, as well as a highly cost-effective method for oral health surveys of preschool children. Teledentistry also has potential utility as a screening tool for older children and adults, as well as a method of consultation with specialists for rural dwelling individuals with poor access to oral health care. Supported by NIH/NIDCR K23 DE 017230
    4th AADR Fall Focused Symposium: Oral Health Disparities Research and the Future Face of America 2011; 11/2011
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    ABSTRACT: Recent cross-sectional studies suggest that reduced ability to generate alkali via the urease pathway in dental plaque may be an important caries risk factor, but it has not been assessed prospectively. To evaluate the effect of plaque and saliva urease activity on the risk for developing new caries over a three-year period in children. A panel of 80 children, three to six years of age at recruitment, was followed prospectively for three years. Plaque urease activity, saliva urease activity and dental caries were measured every six months. Survival analysis methodology was used to evaluate the effect of urease on caries development during the study period adjusted for gender, age, baseline caries levels, sugar consumption, amount of plaque, and mutans streptococci levels. The risk for developing new caries increased in a dose-responsive manner with increasing levels of urease activity in saliva (adjusted HR(Q4 vs. Q1): 4.98; 95% CI: 1.33, 18.69) and with decreasing urease activity in plaque (adjusted HR(Q4 vs. Q1): 0.29; 95% CI: 0.11, 0.76). Multiple measurements of urease activity were conducted to overcome the variability of urease activity in this study. Baseline caries and mutans streptococci in saliva were also important predictors of caries risk. Increased urease activity in saliva can be an indicator of increased caries risk in children, whilst increased urease activity in plaque may be associated with reduced caries risk. The reproducibility of urease measurements must be improved before these findings can be further tested and clinically applied.
    Archives of oral biology 07/2011; 56(12):1560-8. · 1.65 Impact Factor
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    D T Kopycka-Kedzierawski, R J Billings
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    ABSTRACT: To assess dental caries prevalence and dental care utilisation in pre-school children enrolled in urban childcare centres that participated in a comparative effectiveness study. Cross-sectional study. Caries prevalence was determined in a cohort of children 12-60 months of age. Eligible children were randomised into two groups: group one received a traditional visual/tactile oral examination and group two received a teledentistry examination. Questionnaires were administered to the children's parents/guardians to gather demographics and information about using dental and medical services. Of 234 children examined, approximately 28% had caries experience. The mean dfs score was 1.56 with a range of 0-34 carious surfaces. The mean dfs score for the children examined by means of teledentistry was 1.75 and for the children examined by means of the traditional visual/tactile method mean dfs was 1.40; the means between the two groups were not significantly different. Twenty-six children showed evidence of being treated for dental caries. According to the parents, 31.5% of the children had never had a dental check-up before, only 3% of the children were lacking dental insurance and majority of the parents (92%) did not perceive accessing dental care for the children as a problem. The Wilcoxon Mann-Whitney test and the Kruskal-Wallis test were used to assess statistical differences among groups of children. The data showed that 28% of the children had caries and, of these, 61% had never been treated for caries, thus indicating that continued efforts are needed to improve oral health care utilisation by inner-city preschool children.
    European Archives of Paediatric Dentistry. Official Journal of the European Academy of Paediatric Dentistry. 06/2011; 12(3):133-8.
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    ABSTRACT: Bacterial urease activity in dental plaque and in saliva generates ammonia, which can increase the plaque pH and can protect acid-sensitive oral bacteria. Recent cross-sectional studies suggest that reduced ability to generate ammonia from urea in dental plaque can be an important caries risk factor. In spite of this proposed important clinical role, there is currently no information available regarding important clinical aspects of oral ureolysis in children. The objective of this study was to evaluate the distribution and pattern of urease activity in the dental plaque and in the saliva of children during a three-year period, and to examine the relationship of urease with some important caries risk factors. A longitudinal study was conducted with repeated measures over a three-year period on a panel of 80 children, aged 3-6 years at recruitment. The dynamics of change in urease activity were described and associated with clinical, biological, and behavioural caries risk factors. Urease activity in plaque showed a trend to remain stable during the study period and was negatively associated with sugar consumption (P<0.05). Urease activity in unstimulated saliva increased with age, and it was positively associated with the levels of mutans streptococci in saliva and with the educational level of the parents (P<0.05). The results of this study reveal interesting and complex interactions between oral urease activity and some important caries risk factors. Urease activity in saliva could be an indicator of mutans infection in children.
    Archives of oral biology 05/2011; 56(11):1282-9. · 1.65 Impact Factor
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    ABSTRACT: To determine the relapse rate within one year for a cohort of children treated for severe early childhood caries (S-ECC). In an earlier report, we assessed the suppressive effect of 10 percent povidone-iodine and the elimination of active caries on salivary mutans streptococci (MS) populations in 77 children with S-ECC; 49 children returned for a 6-month recall exam that occurred 5 to 12 months post dental surgery. Relapse declaration required at least one caries lesion needing a restoration. Contrasts of relapse (R) and non-relapse (NR) to the covariates of gender, race, ethnicity, age, surfaces available for relapse (SAR), time to appointment, and baseline salivary mutans streptococci (MS) counts were statistically evaluated. 19 children (39%) were declared R and 30 (61%) were NR. The 2 groups did not statistically differ on: gender, race, ethnicity, age, SAR, baseline salivary MS counts and time to recall appointment. Statistical analyses also showed the covariates had no significant effect on probability of relapse or time to relapse (P>0.05). None of the covariates were related to R. The R rate (39%) observed is consistent with earlier reports. Novel approaches are needed to improve relapse prevention.
    Pediatric dentistry 01/2011; 33(7):510-4. · 0.56 Impact Factor
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    ABSTRACT: OBJECTIVE: Reports indicate that treatment of S-ECC is characterized by poor clinical outcomes. This report determined the relapse (R) rate within one year post dental surgery for a cohort of children treated for S-ECC. METHOD: 77 children with S-ECC had dental surgery completed in one session; all children had 10% povidone iodine and 1.23% APF foam applications at the completion of dental surgery [JPHD 69(3):163-167;2009]; 49 of these 77 children returned within 12 months (m) post dental surgery for caries examination; these 49 children comprised the study population of this report. R was defined as the presence of new caries lesion(s) requiring a restoration(s). The relationship of R to the covariates of patient gender (24F, 25M); race (4Asian, 25Black,15white, 5other); ethnicity (Hisp7, Non Hisp 42); age (3.72y+/-0.86); enamel surfaces available for relapse (SAR) post dental surgery (63.5+/-11.8) and baseline (pre-dental surgery) log10 MS/ml saliva (6.17+/-0.90)was determined by both logistic regression (effects on probability of R within 12m) and by Weibull regression (effects on the time of R within 12m). RESULTS: No relapse (NR) occurred during the first 90 days (d) post dental surgery; 19 children (38.8%) met the criterion for R and 30 (61.2%) for NR. There was no significant difference in R v. NR groups (p>0.05) for: gender, race, ethnicity (Fisher's exact test) and age, SAR, baseline log10 MS/ml saliva (two sample t-test). Logistic regression and Weibull regression analyses showed the covariates had no significant effect on probability or time to R (p>0.05). CONCLUSIONS: 1. none of the covariates were related to R suggesting the need for further studies on risk factors; 2. the R rate for S-ECC observed in this report (38.8%) is consistent with earlier reports; and 3. novel interventions are needed to improve clinical outcomes for S-ECC. (Funded by NIDCR grant DE016280)
    IADR General Session 2010; 07/2010
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    ABSTRACT: Objectives: To assess caries prevalence in pre-school children enrolled in inner-city childcare centers. Methods: Baseline caries prevalence was determined in a cohort of children 12-60 months of age participating in a comparative effectiveness study. Eligible children were randomized into two groups: group one received a traditional visual/tactile oral examination and group two received a Teledentistry examination. Each child was examined for the presence or absence of dental caries in the primary dentition, as measured by the dfs index. Children in both groups will be reexamined at 6 months and 12 months after baseline. Results: Of 211 children examined, 60 (approximately 29%) were caries active. The mean dfs score was 1.41 (SD=3.74) with a range of 0 to 34 carious surfaces. The mean dfs score for the children examined by means of Teledentistry was 1.38 (SD=3.17) and for the children examined by means of the traditional visual/tactile method, mean dfs was 1.44 (SD=4.12); the means between the two groups were not significantly different (t-test, p>.05). Overall, Hispanic children (n=41) had the highest mean dfs score of 1.68, followed by African-American children (n=138, dfs=1.59), children of mixed ethnicity (n=17, dfs= 0.29) and Caucasian children (n=15, dfs=0.27). Females had a higher mean dfs score (dfs=1.75, SD=4.68) than males (dfs=1.06, SD=2.37). Only eleven percent of the children with caries showed evidence of having been treated for caries. Referrals for preventive or restorative care were provided for all children participating in the study. Conclusion: The data, thus far, show that only a small number of the children with dental caries had been treated for caries, thus indicating that continued efforts to reduce or eliminate barriers and to improve oral health care utilization by inner-city preschool children are needed. Supported by NIH/NIDCR K23 DE 017230
    IADR General Session 2010; 07/2010
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    ABSTRACT: Urease activity generates ammonia in the dental plaque and in the saliva, and it is, therefore, believed to inhibit the development of dental caries. Recent cross-sectional studies have demonstrated an inverse association between plaque urease activity and caries experience in adults and in children. OBJECTIVE: The objective of this study was to evaluate the relationship of urease activity with caries development in children, in a prospective manner. METHODS: A prospective study was undertaken in a group of 80 children, aged 3 to 6 years at recruitment. Urease activity in plaque and in saliva was measured every six months over a three-year period. Caries was detected using Fiber-Optic Trans-Illumination (FOTI) and scored by means of Ekstrand's criteria. Sugar consumption and salivary mutans levels were also monitored. The relationship of urease activity with caries levels over the three-year period was evaluated using a Generalized Latent and Linear Mixed Model (GLLAMM). RESULTS: Plaque urease activity was negatively associated with the numbers of enamel lesions (d1 and d2) (estimated β= -.015, 95% CI:-.025 -.006, p=0.002), but not with advanced lesions with dentinal involvement (≥d3) (p>0.05). In contrast, salivary mutans levels were positively associated with the numbers of advanced lesions but not with enamel lesions (estimated β= .096, 95% CI: .014 .179, p=0.022). Saliva urease was not significantly associated either with enamel or advanced lesions (p>0.05). The attrition rate was 15% in the first and in the second year of the study, and 31% in the third. CONCLUSIONS: Loss of the ability to generate ammonia from urea may be a first sign of increasing cariogenic activity in plaque, while mutans streptococci are apparently associated with later and more advanced stages of caries development. Supported by K23 DE015285 from NIDCR, by RCMI grant #G12 RR 03051, and by RCRII 1P20 RR 11126.
    IADR General Session 2010; 07/2010
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    ABSTRACT: The aim of the present study was to analyse the association between socioeconomic and behavioural factors and the presence of active non-cavitated caries lesions in 12-year-old adolescents in Piracicaba, São Paulo, Brazil. A cross-sectional study was carried out in 1001, 12-year-old adolescents who were selected by the cluster sampling method. A modified version of the World Health Organization criteria for identifying lesions including white lesions (WL) in enamel was used. Information on behavioural and socioeconomic factors was obtained using a semi-structured questionnaire. The outcome variables were DMFS, DMFS+WL and WL. The data obtained were analysed using the chi-square test and a logistic regression model. The mean DMFS was 1.87 (SD = 3.05) and DMFS+WL was 2.27 (SD = 3.66). The logistic regression model showed that income was statistically significantly associated with DMFS, DMFS+WL and WL, whereas educational level of the father, number of residents in the house and number of dental visits were associated with DMFS and DMFS+WL. The onset of toothbrushing was associated with WL. The present study showed that economic factors are associated with all stages of caries development. In addition to these factors, family size, number of dental visits, educational level of the father and onset of toothbrushing could be considered markers of dental health risk.
    Oral health & preventive dentistry 01/2010; 8(4):361-7. · 0.52 Impact Factor
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    ABSTRACT: To determine the oral health status of US women of childbearing age and to analyze the effect of tobacco smoke on their oral health. Data from the 1999-2004 National Health and Nutrition Examination Survey were evaluated for women 15-44 years of age. The association of exposure to tobacco smoke with untreated caries, mean DMFS, gingivitis, and periodontitis were examined in bivariate and regression analyses controlling for potential confounders. The prevalence of untreated caries was 25%, for gingivitis 49%, and for periodontitis 6%. After adjusting for potential confounders, self-reported current smoking was a strong independent risk indicator for untreated caries, periodontitis, and to a lesser extent for greater DMFS count. Women with detectable cotinine levels below 15 ng/mL presented with an increased risk for gingivitis. Independent factors associated with increased risk for untreated caries were being Black, having less than a high school education, Medicaid or no health insurance, previous live births, and infrequent and episodic dental visits. Characteristics associated with gingivitis were being Mexican-American, obese, pregnant, and having infrequent dental visits. Older age, no insurance, and the last dental visit for treatment were independently associated with periodontitis. Dental caries and periodontitis were prevalent among certain subgroups of women of reproductive age. Smoking was found to be a significant risk indicator for various negative oral health outcomes. Barriers to accessing to dental care that were manifested by untreated caries among Black women, mothers, and Medicaid beneficiaries must be better understood.
    Journal of Public Health Dentistry 05/2009; 69(4):231-41. · 1.21 Impact Factor
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    ABSTRACT: OBJECTIVE: Toevaluate the relationship of plaque urease with dental caries in children 3 to6 years of age according to lesion type and severity. METHODS: Thesample consisted of 80 healthy children 3 to 6 years of age from Puerto Rico,stratified randomly by gender, age and caries status. Dental plaque was collected from all available smooth dentalsurfaces and pooled. Ureaseactivity in plaque samples was expressed as mmolesurea hydrolyzed min-1 mg-1. Caries lesions were detected using Fiber-OpticTrans-Illumination (FOTI) and classified according to lesion depth byEkstrand's visual criteria. RESULTS: Plaqueurease activity was significantly lower in children with 3 or more early enamellesions (Ekstrand categories1 and 2) compared to children with fewer earlylesions (P=0.026). Similarly,urease activity was significantly lower when only smooth-surface lesions wereconsidered (P=0.036). Nosignificant differences in plaque urease were observed when enamel lesionsinvolving pits and fissures were considered (P>0.05). No significant differences wereobserved in urease levels among carious lesions that extended beyond the enamel(Ekstrand categories 3 to 5), irrespectively of lesion type (smooth surfacesvs. fissures), or among DMFS level groups (P>0.05). CONCLUSIONS: The findings of this study suggest that low levels of urease activity inthe dental plaque of young children may be associated with the initialdevelopment of smooth-surface caries, but not with advanced lesions. An ongoing prospective study willdetermine whether plaque urease levels can actually predict the development ofnew caries lesions in children 6 months to 3 years in advance. Supported byDEO12585, G12 RR03051, P20 RR11126
    IADR General Session 2009; 04/2009
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    ABSTRACT: OBJECTIVE: Toevaluate the distribution of urease activity in the dental plaque and saliva ofchildren 3 to 6 years of age in relation to salivary levels of mutansstreptococci, gender, type of dentition (primary vs. mixed), sugar consumption,and whether fasting or non fasting prior to sample collection. METHODS: Ureaseactivity was measured in the dental plaque and saliva of a convenience sampleof 80 healthy 3 to 6 years-old children from Puerto Rico. Supragingival plaque was collected fromall available smooth surfaces and pooled. Whole unstimulated saliva was collected using a sputum trap attached tothe dental suction. Ureaseactivity was expressed as mmoles ureahydrolyzed min-1mg-1. Sugar consumption was measured using a 24hour dietrecall. Mutans streptococci insaliva were determined by plating on selective media. RESULTS: Ureaseactivity in plaque ranged between 0.26 to 36.5 units (mean 4.265.53, median2.8) and in saliva between 0 to 1.17 units (mean 0.15 0.26, median 0.05). Children with high levels of mutansstreptococci in their saliva (³ 105CFU/ml) had significantly lowerlevels of urease activity in their plaque compared to children with lowsalivary mutans levels (P=0.009), but higher levels of urease in their saliva(P=0.006). Saliva samplescollected under non-fasting conditions had higher urease activity compared tothose collected under fasting conditions (P=0.002). Neither plaque or saliva urease differ significantly(P>0.05) in response to gender, sugar consumption, and type ofdentition. Regression analysis wasused to confirm these observations. CONCLUSIONS: Levels of urease activity in the dental plaqueand in the saliva of small children are strongly, though differentiallyassociated with the salivary levels of mutans streptococci. Saliva urease activity is alsoinfluenced by whether it is measured under fasting or non-fasting conditions. Supported by DEO12585, G12RR03051, P20RR11126
    IADR General Session 2009; 04/2009
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    ABSTRACT: This investigational study assessed the suppressive effect of 10 percent povidone iodine (PI) coupled with elimination of active carious lesions on salivary mutans streptococci (MS) populations in children with severe early childhood caries (S-ECC). 77 children (38 females, 39 males) were treated for S- ECC in one session; a 0.2 ml PI solution was applied to the dentition after dental surgery was completed and immediately wiped off. The subjects aged from 2 to 5 years (mean = 3.78 years) at baseline. Whole nonstimulated saliva samples were obtained at baseline, 30 days, 60 days, and 90 days post dental surgery. Samples were placed on ice and processed within 2 hours. The MS level in each sample was expressed as colony forming units (CFUs) per ml of saliva. Approximately 50 percent of subjects had a >95 percent reduction in CFU/ml of saliva at each time point after baseline. The percentages of subjects with a >50 percent reduction in MS level were 85 percent at 30 days, 83 percent at 60 days, 84 percent at 90 days. The median (25th, 75th percentiles) CFUs/ml of saliva counts were 8.40 x 10(5) (1.49 x 10(5), 5.00 x 10(6)) at baseline (n= 77), 4.12 x 10(4) (8.40 x 10(3), 1.89 x 10(5)) at 30 days (n = 74), 4.62 x 10(4) (7.00 x 10(3), 1.36 x 10(5)) at 60 days (n = 70), and 5.09 x 10(4) (1.16 x 10(4), 1.00 x 10(5)) at 90 days (n = 70). The changes from baseline to 30 days, 60 days, and 90 days were statistically significant (P < 0.0001). PI coupled with dental surgery has a significant suppressive effect on salivary MS levels in the setting of S-ECC for at least 90 days. These data strongly suggest that treatment with PI may be an important adjunct to dental surgery for S-ECC.
    Journal of Public Health Dentistry 03/2009; 69(3):163-7. · 1.21 Impact Factor
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    ABSTRACT: The prevalence of overweight children in the United States continues to increase. To examine the relationship between being overweight and caries in primary and permanent dentition in a nationally representative sample of children. Data from the NHANES III (1988-1994) were analyzed using logistic regression and controlling for potential confounders for 10 180 children 2-18 years of age and from the NHANES 1999-2002 for 7568 children 2-18 years of age. For children 2-5 years of age, there was no difference in caries experience among normal weight, at risk for overweight or overweight children for NHANES III and for NHANES 1999-2002. For children 6-11 years of age (NHANES III), at risk for overweight and overweight children were less likely to have caries experience in the primary dentition than normal weight children; overweight children were less likely to have caries experience in the permanent dentition than normal weight children. For children 12-18 years of age (NHANES III), overweight children were less likely to have caries experience in the permanent dentition than normal weight children. For children 6-11 years of age and 12-18 years of age (NHANES 1999-2002), there was no difference in having caries experience among normal, at risk for overweight and overweight children. The data from NHANES III and NHANES 1999-2002 provide no evidence to suggest that overweight children are at an increased risk for dental caries. Although no differences in caries rates by weight were found in younger children, interestingly results from NHANES III suggest that being overweight may be associated with decreased rates of caries in older children.
    Community Dentistry And Oral Epidemiology 05/2008; 36(2):157-67. · 1.80 Impact Factor
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    ABSTRACT: Despite limited epidemiologic evidence, concern has been raised that breastfeeding and its duration may increase the risk of early childhood caries. The objective of this study was to assess the potential association of breastfeeding and other factors with the risk for early childhood caries among young children in the United States. Data about oral health, infant feeding, and other child and family characteristics among children 2 to 5 years of age (N = 1576) were extracted from the 1999-2002 National Health and Nutrition Examination Survey. The association of breastfeeding and its duration, as well as other factors that previous research has found associated with early childhood caries, was examined in bivariate analyses and by multivariable logistic and Poisson regression analyses. After adjusting for potential confounders significant in bivariate analyses, breastfeeding and its duration were not associated with the risk for early childhood caries. Independent associations with increased risk for early childhood caries were older child age, poverty, being Mexican American, a dental visit within the last year, and maternal prenatal smoking. Poverty and being Mexican American also were independently associated with severe early childhood caries, whereas characteristics that were independently associated with greater decayed and filled surfaces on primary teeth surfaces were poverty, a dental visit within the last year, 5 years of age, and maternal smoking. These data provide no evidence to suggest that breastfeeding or its duration are independent risk factors for early childhood caries, severe early childhood caries, or decayed and filled surfaces on primary teeth. In contrast, they identify poverty, Mexican American ethnic status, and maternal smoking as independent risk factors for early childhood caries, which highlights the need to target poor and Mexican American children and those whose mothers smoke for early preventive dental visits.
    PEDIATRICS 11/2007; 120(4):e944-52. · 4.47 Impact Factor
  • D T Kopycka-Kedzierawski, R J Billings
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    ABSTRACT: Markov modeling is a useful mathematical procedure for calculating probabilities of disease prognosis. Increasingly, Markov models are being applied in medical and health services research and also in social sciences research. The purpose of our study was to use the Markov process to determine time-dependent transition probabilities for caries-free children to convert to a caries-active state and to assess the impact of salivary mutans streptococci (MS) levels on caries status. Our analysis was based on data obtained from a 6-year longitudinal study of risk factors associated with caries onset in children. Based on a two-state Markov model, the probability that a caries-free child would convert to a caries-active state during the study ranged between 0.0046 and 0.0471. The highest probability of converting from a caries-free state to a caries-active state was 0.0471 at age 8.5 years. In addition to standard statistical methods of analyzing longitudinal caries data, Markov models show promise for use in the analysis of caries risk.
    Community Dentistry And Oral Epidemiology 05/2006; 34(2):123-9. · 1.80 Impact Factor

Publication Stats

525 Citations
58.06 Total Impact Points

Institutions

  • 1988–2013
    • University of Rochester
      • School of Medicine and Dentistry
      Rochester, New York, United States
  • 2012
    • University of Florida
      Gainesville, Florida, United States
  • 1991–2010
    • University Center Rochester
      Rochester, Minnesota, United States
  • 2009
    • University of Washington Seattle
      • Department of Epidemiology
      Seattle, WA, United States
  • 2004
    • Dalhousie University
      Halifax, Nova Scotia, Canada