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Dental caries (cavities), one of the most common infectious diseases, is caused by a number of factors. Oral microbes, dietary practices, sociodemographic factors, and dental hygiene all inform caries risk. Assessing the impact of diet is complicated as individuals eat foods in combinations, and the interactions among the foods may alter caries risk. Our study aimed to prospectively assess the association between dietary patterns and caries risk in the postpartum period, a potentially sensitive period for caries development. We analyzed in-person dental assessments and telephone food frequency questionnaires (FFQs) from 879 Caucasian women participating in the Center for Oral Health Research in Appalachia Cohort 2 (COHRA2) that were collected biannually for up to 6 y. One-week recall of food intake frequency was assessed using a Likert scale. We used principal component analysis to summarize the FFQ data; the top 2 components described 15% and 12% of the variance in FFQ data. The first component was characterized by high consumption of fruits and vegetables, while the second component was heavily influenced by desserts and crackers. We used a modified Poisson model to predict the risk of an increase in the number of decayed, missing, and filled teeth in the postpartum period by 1) dietary patterns and 2) individual foods and beverages at the previous study visit, after controlling for other known risk factors, including history of carious lesions. Eating a dietary pattern high in desserts and crackers was associated with a 20% increase in the number of decayed, missing, and filled teeth in the postpartum period (95% confidence interval, 1.03–1.39). However, this effect was attenuated among those who also consumed a dietary pattern high in fruits and vegetables. Dietary patterns should be considered when devising interventions aimed at preventing dental caries.

BACKGROUND Associations among body composition measures have been limited to cross-sectional analyses of different subjects. We identified cross-sectional relationships between body mass index (BMI) and other body composition measures and predicted body composition measures from BMI throughout childhood and adolescence. METHODS BMI was calculated and % body fat (%BF), fat mass index (FMI), and fat-free mass index (FFMI) were measured using dual-energy x-ray absorptiometry at ages 5, 9, 11, 13, 15, and 17 years in a birth cohort (n = 629). Sex-specific body composition measures were calculated for BMI-for-age percentiles; associations between BMI and body composition measures were characterized; and body composition measures were predicted from BMI. RESULTS %BF, FMI, and FFMI generally increased with BMI-for-age percentiles at each age. Correlations between BMI and %BF or FMI were generally higher at BMI-for-age percentiles ≥95% than for lower BMI-for-age percentiles. Correlations between BMI and FFMI were generally higher for participants at very low and very high BMI-for-age percentiles than at moderate BMI-for-age percentiles. Age- and sex-specific predictions from BMI are provided for %BF, FM, and FFMI. CONCLUSIONS Sex-specific body composition measures throughout childhood and adolescence are presented. BMI is a better indicator of adiposity at higher than at lower BMI values. IMPACT Sex-specific body composition measures throughout childhood and adolescence are described. % BF, FMI, and FFMI generally increased with BMI-for-age percentiles for both sexes throughout childhood and adolescence. BMI is a better indicator of adiposity at higher BMI levels than at lower BMI values throughout childhood and adolescence.

PURPOSE The prevalence of food insecurity among undergraduate students is higher than the national average and associated with adverse academic outcomes. Our objective was to describe the prevalence of food insecurity, food access behaviors, and associations between food security status and well-being in a dental student population. METHODS All dental students (N = 328) enrolled in the College of Dentistry at the University of Iowa in the fall 2019 semester were invited to participate. The survey was designed to query demographic variables, food security status (i.e., the United States Department of Agriculture's 10-item Adult Food Security Module), and food- or hunger-related well-being (i.e., sleep, academic performance, and stress). The survey was administered using the Qualtrics survey platform. Following the initial invitation, students were sent two reminders and allowed 3 weeks for completion. RESULTS The survey response rate was 24.7%. Forty-seven percent of respondents were food insecure. Food insecure students were more likely to attend collegiate programming (e.g., lunch and learns) for the primary purpose of obtaining free food than their food secure peers (p

Use of community-based participatory research (CBPR) principles can help identify strategies for development and implementation of studies that can address oral health disparities disfavoring African American youth. This paper summarizes approaches of the Howard Meharry Adolescent Caries Study (HMACS) to provide sustained oral health services beyond the life of a research study.

OBJECTIVE Associations between food insecurity, meal patterns, beverage intake, and body mass index (BMI) were investigated using data from the Howard Meharry Adolescent Caries Study. METHODS Secondary analyses of food security status used the Wilcoxon rank sum, chi-square, and Fisher's exact tests. RESULTS The group of adolescents (n=627) was 42.1% male, 14.2±1.9 years, 86.9% African American, and 19.9% food-insecure. Meal frequency, meal structure, most beverage intake, and BMI did not differ by food-security status. Adolescents from Washington, DC were more likely to be food insecure than adolescents from Nashville, TN (P=0.003). Most had unstructured meal patterns and irregular breakfast intake. Median milk intake was below and sugar-sweetened beverage intake above dietary recommendations. CONCLUSIONS This study extends our knowledge concerning food insecurity in urban African American adolescents and suggests public health initiatives designed to encourage meal structure, increase milk intake, and reduce sugar-sweetened beverage intake can improve diet quality of underserved youth.

Acid produced during bacterial fermentation of carbohydrates dissolves tooth structure, leading to dental caries. Carbohydrates are a nutrient within foods, individual foods contain multitudinous differing nutrients in varying concentrations, and, ultimately, food choices and eating behaviors are associated with the caries process. Consideration of food choices and eating behaviors is necessary for effective caries prevention. This article (1) defines a healthy diet and eating behaviors as a foundation for caries prevention, (2) identifies food choices and eating behaviors associated with caries, (3) identifies diet-related screening and assessment tools for caries risk, and (4) provides counseling strategies to manage dental caries.

Associations among body composition measures have been limited to cross-sectional analyses of different subjects. We identified cross-sectional relationships between body mass index (BMI) and other body composition measures and predicted body composition measures from BMI throughout childhood and adolescence.BMI was calculated and % body fat (%BF), fat mass index (FMI), and fat-free mass index (FFMI) were measured using dual-energy x-ray absorptiometry at ages 5, 9, 11, 13, 15, and 17 years in a birth cohort (n = 629). Sex-specific body composition measures were calculated for BMI-for-age percentiles; associations between BMI and body composition measures were characterized; and body composition measures were predicted from BMI.%BF, FMI, and FFMI generally increased with BMI-for-age percentiles at each age. Correlations between BMI and %BF or FMI were generally higher at BMI-for-age percentiles ≥95% than for lower BMI-for-age percentiles. Correlations between BMI and FFMI were generally higher for participants at very low and very high BMI-for-age percentiles than at moderate BMI-for-age percentiles. Age- and sex-specific predictions from BMI are provided for %BF, FM, and FFMI.Sex-specific body composition measures throughout childhood and adolescence are presented. BMI is a better indicator of adiposity at higher than at lower BMI values.Sex-specific body composition measures throughout childhood and adolescence are described. % BF, FMI, and FFMI generally increased with BMI-for-age percentiles for both sexes throughout childhood and adolescence. BMI is a better indicator of adiposity at higher BMI levels than at lower BMI values throughout childhood and adolescence.

Purpose: To describe the association between household food insecurity and intake of cariogenic foods that increase risk of dental caries. Methods: Cross-sectional analysis of 842 mothers in Appalachia and their children participating in the Center for Oral Health Research Cohort 2 between 2011 and 2017 when their children were ~2 years of age. Mothers completed a telephone interview regarding cariogenic food consumption and food insecurity. Associations between food insecurity and daily food intake were adjusted for education, income, state residence, and daily snacking. Results: After adjustment for household income, state residence, daily snacking, and maternal education, mothers and children from moderately/severely food insecure households were more likely to consume sugar-sweetened beverages than those from food secure households. Further, mothers and children from moderately/severely food insecure households had lower average consumption of vegetables and fruits and elevated consumption of sweets; differences based on state residence were noted. Conclusions: Food insecurity is associated with higher consumption of foods that increase risk of dental caries, but this association is modified by maternal education, income, and state residence. Food insecurity, and its socioeconomic determinants, should be considered when designing and implementing interventions to prevent dental caries.

Our objective was to identify sex-specific age 5- to 17-year body composition (body mass index (BMI), % body fat, fat mass index, fat-free mass index) trajectories, compare trajectories assigned using age 5 (AGE5) data to those assigned using all available (ALL) data, and compare BMI assignments to other body composition assignments. Cluster analysis was used to identify low, medium, and high trajectories from body composition measures obtained from dual energy x-ray absorptiometry (DXA) scans at 5, 9, 11, 13, 15, and 17 years in a birth cohort followed longitudinally (n = 469). Moderate agreement was observed for comparisons between AGE5 data and ALL data cluster assignments for each body composition measure. Agreement between cluster assignments for BMI and other body composition measures was stronger using ALL data than using AGE5 data. Our results suggest that BMI, % body fat, fat mass index, and fat free mass index trajectories are established during early childhood, and that BMI is a reasonable predictor of body composition appropriate to track obesity in public health and clinical settings.

Background Sugar-sweetened beverages (SSBs) have been associated with childhood caries; however, associations among lifelong beverage intakes and adolescent caries have received less attention. Objective To investigate associations between beverage intakes during childhood and adolescence and caries experience at 17 years of age, while adjusting for fluoride intakes and toothbrushing. Design Descriptive model analyses were conducted on data collected from a longitudinal birth cohort study. Participants/setting Participants included Iowa Fluoride Study members (n = 318) recruited at birth between 1992 and 1995 with at least 6 beverage questionnaires completed from ages 1 to 17 years and a caries examination at age 17. Exposure Predictors included mean daily milk, juice (100% juice and juice drinks before age 9), SSB (including juice drinks after age 9), and water/sugar-free beverage (SFB) intakes; daily fluoride intakes; and daily toothbrushing frequencies for ages 1 to 17. Main outcome measures The outcome was dental caries count at age 17, adjusted for the number of scored tooth surfaces (decayed and filled surfaces attack rate [DFSAR]). Statistical analyses performed Univariable generalized linear models were fit for each predictor and the outcome DFSAR. Multivariable models assessed combined effects of beverage types, fluoride variables, toothbrushing, sex, and baseline socioeconomic status. Results Based on multivariable models, each 8 oz of additional daily juice and water/SFB decreased expected DFSAR by 53% (95% confidence interval [CI]: 17%-73%) and 29% (95% CI: 7%-46%), respectively, and 8 additional oz SSBs increased expected DFSAR by 42% (95% CI: 5%-92%), after adjustment for other beverage intakes, toothbrushing, total fluoride intake excluding SSB fluoride (non-SSB total fluoride), sex, and baseline socioeconomic status. Each additional daily toothbrushing event decreased expected DFSAR by 43% (95% CI: 14%-62%) after adjustment for beverage intakes, non-SSB total fluoride intake, sex, and baseline SES. Conclusions Higher juice and water/SFB intakes and more toothbrushing were associated with lower caries at age 17, while higher SSB intakes were associated with higher caries.

Objectives There is strong affinity between fluoride and calcium, and mineralized tissues. Investigations of fluoride and bone health during childhood and adolescence show inconsistent results. This analysis assessed associations between period-specific and cumulative fluoride intakes from birth to age 11, and age 11 cortical bone measures obtained using peripheral quantitative computed tomography (pQCT) of the radius and tibia (n = 424). Methods Participants were a cohort recruited from eight Iowa hospitals at birth. Fluoride intakes from water, other beverages, selected foods, dietary supplements, and dentifrice were recorded every 1.5-6 months using detailed questionnaires. Correlations between bone measures (cortical bone mineral content, density, area, and strength) and fluoride intake were determined in bivariate and multivariable analyses adjusting for Tanner stage, weight and height. Results The majority of associations were weak. For boys, only the positive associations between daily fluoride intakes for 0-3 years and radius and tibia bone mineral content were statistically significant. For girls, the negative correlations of recent daily fluoride intake per kg of body weight from 8.5 to 11 years with radius bone mineral content, area, and strength and tibia strength were statistically significant. No associations between cumulative daily fluoride intakes from birth to 11 years and bone measures were statistically significant. Conclusions In this cohort of 11-year-old children, mostly living in optimally fluoridated areas, life-long fluoride intakes from combined sources were weakly associated with tibia and radius cortical pQCT measures.

BACKGROUND: Height is an indicator of nutritional status; linear growth faltering has recognized consequences for cognitive, emotional, and chronic disease risk. Although height is routinely studied in developing countries, less attention is given to height in the United States. OBJECTIVE: The objective of this study was to identify longitudinal associations between childhood and adolescent beverage intakes, nutrient adequacy, or energy intake and height in a birth cohort. METHODS: Data for participants through ages 2–17 y (n = 717; 353 males, 364 females) recruited at birth for the longitudinal Iowa Fluoride Study (IFS) were used in the current cohort analyses. Beverage intakes (n = 708) were collected by beverage-frequency questionnaires at 3- to 6-mo intervals, whereas nutrient data (n = 652) were obtained from 3-d food diaries completed at 3- to 6-mo intervals through age 8.5 y and from Block Kids’ food-frequency questionnaires at 2-y intervals after age 8.5 y. Nutrient adequacy ratios were calculated with the use of age- and sex-specific Estimated Average Requirements. Height was measured at clinic visits when the participants were approximately ages 5, 9, 11, 13, 15, and 17 y. Linear mixed models were used to identify longitudinal associations between dietary variables and height. A baseline model that adjusted for changing growth patterns during adolescence was established. Dietary and potential confounding variables were added to this baseline model. RESULTS: Milk intake adjusted for mean adequacy ratio, energy intake, and baseline socioeconomic status was associated with height; for each additional 8 ounces (236 mL) of milk consumed per day throughout childhood and adolescence, height increased, on average, by 0.39 cm (95% CI: 0.18, 0.60 cm; P

INTRODUCTION Identification and assessment of Evidence-based dentistry (EBD) outcomes have been elusive. Our objective was to describe EBD skill acquisition during the second (D2) year of pre-doctoral dental education and student competency at the end of the year. METHODS The first and fourth (final) curricular-required EBD Exercises (ie, application of the first 4 steps of the 5-Step evidence-based practice process applied to a real or hypothetical situation) completed by D2 students (n = 151) during 2014-2015 and 2015-2016 were evaluated to measure skill acquisition through use of a novel rubric with measures of performance from novice to expert. Exercises were evaluated on the performance for each step, identification of manuscript details and reflective commentary on manuscript components. Changes in performance were evaluated using the chi-square test for trend and the Wilcoxon signed-rank test. RESULTS Seventy-eight per cent of students scored competent or higher on the Ask step at the beginning of the D2 year; scores improved with 58% scoring proficient or expert on the fourth Exercise (P

Objectives To assess longitudinal associations between permanent tooth caries increment and both modifiable and non-modifiable risk factors, using best subsets model selection. Methods The Iowa Fluoride Study has followed a birth cohort with standardized caries exams without radiographs of the permanent dentition conducted at about ages 9, 13, and 17 years. Questionnaires were sent semi-annually to assess fluoride exposures and intakes, select food and beverage intakes, and tooth brushing frequency. Exposure variables were averaged over ages 7-9, 11-13, and 15-17, reflecting exposure 2 years prior to the caries exam. Longitudinal models were used to relate period-specific averaged exposures and demographic variables to adjusted decayed and filled surface increments (ADJCI) (n = 392). The Akaike Information Criterion (AIC) was used to assess optimal explanatory variable combinations. Results From birth to age 9, 9-13, and 13-17 years, 24, 30, and 55 percent of subjects had positive permanent ADJCI, respectively. Ten models had AIC values within two units of the lowest AIC model and were deemed optimal based on AIC. Younger age, being male, higher mother's education, and higher brushing frequency were associated with lower caries increment in all 10 models, while milk intake was included in 3 of 10 models. Higher milk intakes were slightly associated with lower ADJCI. Conclusions With the exception of brushing frequency, modifiable risk factors under study were not significantly associated with ADJCI. When possible, researchers should consider presenting multiple models if fit criteria cannot discern among a group of optimal models.

Background and Overview Dental erosion occurs after exposure to intrinsic or extrinsic acids. Exposure to intrinsic gastrointestinal acids is associated with anorexia nervosa, bulimia nervosa, rumination syndrome, or gastroesophageal reflux. Extrinsic dietary acids from foods or beverages also can cause erosion, particularly when exposure is prolonged by holding or swishing behaviors. Conclusions Clinicians should screen patients exhibiting dental erosion for anorexia nervosa, bulimia nervosa, rumination syndrome, and gastroesophageal reflux disease. Clinicians should screen patients without a medical explanation for their erosion for exposure to acidic foods and beverages, particularly for habits that prolong exposure. Practical Implications Identification of intrinsic and extrinsic acid exposures and recommendations to minimize exposures are important to prevent erosion and maintain oral health.

OBJECTIVES: This analysis examines the etiology of caries development in adolescents by using structural equation modeling to identify behavioral mediators of the relationship between socioeconomic status (SES) and caries incidence, and to investigate the role of sex on caries preventive behavior and caries. METHODS: This analysis was based on data from the Iowa Fluoride Study, a longitudinal study of a birth cohort. We hypothesized that socioeconomic status earlier in life has a direct effect on caries development and an indirect effect from improved behavioral variables – dental visit attendance, tooth brushing frequency, and percentage of beverage intake consisting of sugar-sweetened beverages – and that sex also plays a role in behavioral variables, as well as caries. A structural equation model was developed based on these hypotheses and direct and indirect standardized path coefficients were calculated, as well as their standard errors. RESULTS: Based on our proposed model, SES at birth significantly influences SES during adolescence, but not adolescent behaviors. The effect of SES during adolescence on caries in the permanent dentition is mediated by adolescent behaviors. Female participants have worse caries than male participants, despite lower self-reported percentages of sugar-sweetened beverage intake and more frequent brushing and dental attendance. CONCLUSIONS: This analysis models the relationships among known causal factors for caries and suggests that the role of SES in caries may not be as important as previously thought and different behaviors that affect oral health between males and females as well as differences in caries between the sexes could begin during adolescence. These findings could help improve caries prevention programs for adolescents.

Objectives There have been very few longitudinal studies of dental caries in adolescents, and little study of the caries risk factors in this age group. The purpose of this study was to describe different caries trajectories and associated risk factors among members of the Iowa Fluoride Study (IFS) cohort. Methods The IFS recruited a birth cohort from 1992 to 1995, and has gathered dietary, fluoride and behavioural data at least twice yearly since recruitment. Examinations for dental caries were completed when participants were ages 5, 9, 13 and 17 years. For this study, only participants with decayed and filled surface (DFS) caries data at ages 9, 13 and 17 were included (N=396). The individual DFS counts at age 13 and the DFS increment from 13 to 17 were used to identify distinct caries trajectories using Ward's hierarchical clustering algorithm. A number of multinomial logistic regression models were developed to predict trajectory membership, using longitudinal dietary, fluoride and demographic/behavioural data from 9 to 17 years. Model selection was based on the akaike information criterion (AIC). Results Several different trajectory schemes were considered, and a three-trajectory scheme—no DFS at age 17 (n=142), low DFS (n=145) and high DFS (n=109)—was chosen to balance sample sizes and interpretability. The model selection process resulted in use of an arithmetic average for dietary variables across the period from 9 to 17 years. The multinomial logistic regression model with the best fit included the variables maternal education level, 100% juice consumption, brushing frequency and sex. Other favoured models also included water and milk consumption and home water fluoride concentration. The high caries cluster was most consistently associated with lower maternal education level, lower 100% juice consumption, lower brushing frequency and being female. Conclusions The use of a clustering algorithm and use of Akaike's Information Criterion (AIC) to determine the best representation of the data were useful means in presenting longitudinal caries data. Findings suggest that high caries incidence in adolescence is associated with lower maternal educational level, less frequent tooth brushing, lower 100% juice consumption and being female.

Objectives The Akaike Information Criterion (AIC) is a well-known tool for variable selection in multivariable modeling as well as a tool to help identify the optimal representation of explanatory variables. However, it has been discussed infrequently in the dental literature. The purpose of this paper is to demonstrate the use of AIC in determining the optimal representation of dietary variables in a longitudinal dental study. Methods The Iowa Fluoride Study enrolled children at birth and dental examinations were conducted at ages 5, 9, 13, and 17. Decayed or filled surfaces (DFS) trend clusters were created based on age 13 DFS counts and age 13-17 DFS increments. Dietary intake data (water, milk, 100 percent-juice, and sugar sweetened beverages) were collected semiannually using a food frequency questionnaire. Multinomial logistic regression models were fit to predict DFS cluster membership (n=344). Multiple approaches could be used to represent the dietary data including averaging across all collected surveys or over different shorter time periods to capture age-specific trends or using the individual time points of dietary data. Results AIC helped identify the optimal representation. Averaging data for all four dietary variables for the whole period from age 9.0 to 17.0 provided a better representation in the multivariable full model (AIC=745.0) compared to other methods assessed in full models (AICs=750.6 for age 9 and 9-13 increment dietary measurements and AIC=762.3 for age 9, 13, and 17 individual measurements). The results illustrate that AIC can help researchers identify the optimal way to summarize information for inclusion in a statistical model. Conclusions The method presented here can be used by researchers performing statistical modeling in dental research. This method provides an alternative approach for assessing the propriety of variable representation to significance-based procedures, which could potentially lead to improved research in the dental community.

OBJECTIVES: Dental caries experience, which affects 91% of US adults, is a consequence of a carious process influenced by diet. Although individual foods have been implicated, we hypothesized that dietary patterns might be important predictors of caries presence. METHODS: We analyzed data from 4467 people ≥18 years old participating in the 2013–2014 National Health & Nutrition Examination Survey, a nationally representative sample of the US population. Data from 24-hour dietary recalls were classified into standard food categories and reduced to 3 dietary patterns using principal components analysis. We used regression to model the log transformed decayed, missing, and filled teeth (DMFT) score and the prevalence of any caries experience by quartiles of principal component scores, controlling for potential confounders. Dietary patterns differed by age with respect to dental caries so 18–30-year-olds (n=1074) and >30-year-olds (n=3393) were analyzed separately. RESULTS: Similar dietary patterns existed among individuals aged 18–30 years and >30 years, but the prevalence of DMFT score>0 and the median of DMFT was greater in those >30: 78.7% (95% CI: 76.1%, 81.3%) vs 92.6% (95% CI: 91.4%, 93.7%) and 4 (95% CI: 4, 5); vs 12 DMFT (95% CI: 11, 13), respectively. In those 18–30, no dietary pattern was associated with greater prevalence or severity of dental caries experience. Among those >30, the prevalence of DMFT>)was higher by 2% for those in each subsequent quartile of a diet high in sugar-sweetened beverages and sandwiches (adjusted PR: 1.02, 95% CI: 1.001, 1.03) - thus, the prevalence of dental caries experience was 6% higher among those in the uppermost quartile than in the lowest quartile. For every subsequent quartile in the same pattern there was a 1.98% higher (95% CI: (0.15%, 3.85%)) DMFT score. However, analysis using the two strongest loading food groups from any of the principal components did not identify any predictors of caries experience. CONCLUSIONS: Dietary patterns were associated with the prevalence of dental caries experience, with differing findings by age. Although effect sizes were small, the population impact may be substantial. While food groups high in sugar were associated with caries prevalence and severity, associations were more apparent in the context of overall diet. Prospective studies are needed to confirm whether particular dietary patterns are causally related to the development of dental caries.

Background Sugar-sweetened beverages (SSB) are considered a risk factor for obesity. Objective The objective of the current study was to investigate associations between the predictors of beverage and energy intakes and mean adequacy ratios (MARs), and the outcome of body mass index (BMI) z scores, in a birth cohort using longitudinal models. Design This was a longitudinal analysis of secondary data. Participants/setting Participants in the Iowa Fluoride and Iowa Bone Development Studies with two beverage intake questionnaires completed between ages 2 and 4.7 years or 5 and 8.5 years or one questionnaire between ages 9 and 10.5, 11 and 12.5, 13 and 14.5, or 15 and 17 years (n=720); two food and beverage diaries completed between ages 2 and 4.7 years or 5 and 8.5 years or completion of the Block’s Kids’ Food Frequency Questionnaires at age 11, 13, 15, or 17 years (n=623); and anthropometric measures at the corresponding age 5-, 9-, 11-, 13-, 15-, or 17-year examination(s). Predictors Mean daily 100% juice, milk, SSB, water/sugar-free beverage, and energy intakes and MARs averaged over ages 2 to 4.7, 5 to 8.5, 9 to 10.5, 11 to 12.5, 13 to 14.5, or 15 to 17 years were predictors. Outcome BMI z score was the outcome. Statistical analyses Linear mixed models were fit for each beverage, energy, and MAR variable, with the beverage, energy, or MAR variable as the predictor and BMI z score as the outcome. Beverage models were adjusted for energy and MAR and baseline socioeconomic status. Results SSB intake adjusted for energy intake, MAR, and baseline socioeconomic status was associated with BMI z score; each additional 8 oz SSB consumed/day throughout childhood and adolescence increased the BMI z score an average 0.050 units (95% CI 0.022 to 0.079; P=0.001). Adjusted water/sugar-free beverage intake (0.026 units; 95% CI 0.006 to 0.046; P=0.013) was modestly associated with BMI z score, while 100% juice (–0.001 units; 95% CI –0.059 to 0.057; P=0.97) and milk (0.022 units; 95% CI –0.007 to 0.052; P=0.13) intakes were not associated with BMI z scores. Conclusions Higher SSB intakes were associated with increased BMI z scores throughout childhood and adolescence in Iowa Fluoride Study participants. Public health initiatives targeting SSB consumption during childhood and adolescence remain relevant.

Article Title and Bibliographic Information Vegetarian diet and its possible influence on dental health: A systematic literature review. Community Dent Oral Epidemiol. Smits KPJ, Listl S, Jevdjevic M. 2020; 48(1):7-13. Source of Funding No financial support. Type of Study/Design Systematic review with meta-analysis.

Introduction The integration of evidence-based dentistry (EBD) into pre-doctoral dental curricula requires the identification of desired outcomes, development of curricular content and design of assessment strategies which guide student performance whilst documenting achievement of desired curricular outcomes. Models for developing EBD curriculums have been described in the literature; however, the logistics of designing assessment instruments to progressively document student performance have received less attention. The objective of this article is to describe the University of Iowa's College of Dentistry's development and implementation of assessment strategies to guide student learning of EBD knowledge, application and assimilation to serve as a model for other institutions developing EBD assessment protocols. Assessment Development Desired EBD knowledge and behaviour outcomes guided the development of curricular content and progressive formative and summative assessment strategies. Vertically and horizontally integrated educational activities enabling students to demonstrate EBD knowledge whilst modelling desired behaviours were identified, whilst assessment principles guided development of learning guides and assessment instruments to document achievement of desired outcomes. Consistent EBD language and educational activities are utilised throughout the 4-year interdisciplinary curriculum with stepwise assessment protocols matched to the curriculum. Examples of student learning guides and assessment instruments are provided. Summary Curricular design guides development of assessment strategies. Assessment protocols provide consistent formative and summative feedback to enable continuous student growth to become proficient EBD practitioners.

OBJECTIVES: Sugar-sweetened beverage (SSB) intakes have been associated with obesity, generally assessed using body mass index (BMI). BMI is a surrogate measure of obesity, with % body fat (%BF) and fat mass index (FMI) considered more direct measures of BF. Our objectives were to predict age 5- to 17-year low, middle, and high BMI, %BF, and FMI cluster assignments from age 2- to 5-year beverage and energy intakes. METHODS: Iowa Fluoride Study/Iowa Bone Development Study participants were recruited at birth and followed longitudinally. Participants (n = 299) with at least two beverage questionnaires and 3-day diet records completed between 2–5 years and at least four of six dual-energy X-ray absorptiometry (DXA) scans at 5, 9, 11, 13, 15, and 17 years were included in analyses. Beverage intakes (i.e., SSB, juice, water, milk) were calculated from beverage questionnaires and energy intakes from diet records. %BF and FMI were obtained from DXA scans. Ward's method for hierarchical clustering was used to identify low, medium, and high BMI, %BF and FMI clusters. Multinomial cumulative logit models were used to predict the dependent variables (BMI, %BF and FMI cluster assignments) from the independent variables (beverage and energy intakes) with adjustment for sex and/or socioeconomic status (SES). RESULTS: In multivariable models, SSB intake adjusted for other beverage intakes and sex was significantly associated with BMI, %BF, and FMI cluster, while energy intake adjusted for sex was also significantly associated with BMI, %BF, and FMI cluster. In a full model including all beverage and energy intakes, which was adjusted for sex and SES, both SSB and energy intakes were significantly associated with BMI, but not %BF or FMI. In the full model, for each 8 oz/day increase in SSB at 2–5 years, the odds of being in a higher BMI cluster as opposed to a lower cluster at 5–17 years increased by 73% (95% CI: 7%, 179%). In the full model, each 100 kcal/day increase in energy increased the odds of being in a higher BMI cluster by 11% (95% CI: 1%, 21%). CONCLUSIONS: In separate models, both SSB and energy intakes predicted BMI, %BF and FMI cluster. When included in the same model, both SSB and energy intakes predicted BMI, yet neither predicted %BF or FMI, likely due to collinearity resulting from the association between SSB and energy intakes. FUNDING SOURCES: NIH; RJ Carver Trust; Iowa Delta Dental.

Our objective is to retrospectively describe longitudinal beverage intakes and anthropometric measures according to adolescent beverage patterns. Data were collected from Iowa Fluoride Study participants (n = 369) using beverage questionnaires at ages 2&ndash, 17 years. Weight and height were measured at ages 5, 9, 13 and 17 years. Cluster analyses were used to identify age 13- to 17-year beverage patterns. Treating age and beverage cluster as explanatory factors, sex-specific generalized linear mixed models were used to identify when differences in beverage intakes and anthropometric measures began. Predominant beverage intakes were higher in each of the corresponding clusters by 9&ndash, 12.5 years, females with high milk intakes during adolescence and males with high 100% juice or sugar-sweetened beverage intakes during adolescence reported higher intakes of that beverage beginning at 2&ndash, 4.7 years. Females and males in the 100% juice cluster had lower weights than other clusters beginning at 13 years, while females and males in the neutral cluster were shorter beginning at 13 years. Females in the water/sugar-free beverage cluster had higher body mass indices (BMIs) beginning at 9 years. Females and males in the 100% juice cluster had lower BMIs beginning at 5 and 9 years, respectively. Childhood beverage intakes and growth patterns differ according to adolescent beverage patterns.

The purposes of this study were to describe primary tooth emergence in an American Indian (AI) population during the first 36 mo of life to compare 1) patterns of emergence between male and female children and 2) tooth emergence between these AI children and other U.S. ethnic groups. Data were derived from a birth cohort of 239 AI children from a Northern Plains tribe participating in a longitudinal study of early childhood caries, with examination data at target ages of 8, 12, 16, 22, 28, and 36 mo of age (±1 mo). Patterns of emergence in AI children were characterized and sex comparisons accomplished with interval-censored survival methodology. Numbers of erupted teeth in AI children at each age were compared via Kruskal-Wallis tests against those in children of the same age, as drawn from a cross-sectional study of dental caries patterns in Arizona; these comparisons were based on the dental examinations of 547 White non-Hispanic and 677 Hispanic children. Characterization of time to achievement of various milestones-including emergence of the anterior teeth, the first molars, and the complete primary dentition-provided no evidence of sex differences among AI children. AI children had significantly more teeth present at 8 mo (median, 3) than either White non-Hispanic (P 0.05). These results provide evidence of earlier tooth emergence in AI children than in the other 2 ethnicities. Although the underlying etiology of the severity of early childhood caries in AI children is likely to be multifactorial, earlier tooth emergence may be a contributing factor. Knowledge Transfer Statement: The findings of this study have practical implications for practitioners providing childhood oral health care to ethnic groups with early tooth emergence. It may be important to provide parents with information on toothbrushing, dentist visits, and other practices supportive of good oral health as early as possible to protect their children's primary dentition.

The aim of this study was to seek the views of a national sample of dental educators regarding the importance of learning domains in dental education, their defined outcomes of those domains, and their perceived effectiveness of their schools in guiding learning in those domains. The study defined the educational domains important for training future dentists as knowledge, technical skills, critical thinking, ethics, social responsibility, and interprofessional education/practice (IPE/IPP). A survey of members of the American Dental Education Association (ADEA) Special Interest Group on the Scholarship of Teaching and Learning was conducted in 2017. In addition to reporting their demographics, participants were asked to rate and rank the importance of each learning domain as well as answer open-ended questions. Of the 89 respondents (response rate 12.5%), 31% were course directors, and 48% had been dental faculty members for more than ten years. Knowledge was ranked as the most important domain, followed by critical thinking, technical skills, clinical decision making, ethics, problem-solving, social responsibility, and finally IPE/IPP. When rating the absolute importance of these domains in the training of dental students, the respondents gave all but IPE/IPP and social responsibility the highest rating. Knowledge and technical skills were rated highest for respondents’ confidence in defining student outcomes with similar high ratings for their confidence in guiding this learning. There was little consensus concerning a definition of critical thinking, and a third of the respondents were uncertain of specific learning outcomes for it. Participants expressed even less confidence in defining outcomes for ethics, IPE/IPP, and social responsibility. This baseline information will be used for a future in-depth study to aid in the development of strategies for articulating outcomes, guiding learning, and assessing performance in U.S. dental schools.

Objectives Early childhood caries (ECC) is rampant among American Indian children, but there has been relatively little study of this problem. This article reports on risk factors for caries for a group of American Indian children at age 36 months as part of a longitudinal study. Methods Pregnant women from a Northern Plains Tribal community were recruited to participate in a longitudinal study of caries and caries risk factors. Standardized dental examinations were completed on children, and questionnaires were completed by mothers at baseline and when children were 4, 8, 12, 16, 22, 28, and 36 months of age. Examinations were surface-specific for dental caries, and the questionnaires collected data on demographic, dietary, and behavioral factors. Nonparametric bivariate tests and logistic regression models were used to identify risk factors for caries at 36 months, and negative binomial regression was used to identify factors related to caries severity (dmf counts). Results Among the 232 children, and caries prevalence for cavitated lesions was 80%, with an additional 15% having only noncavitated lesions. The mean dmfs was 9.6, and of the total dmfs, nearly 62% of affected surfaces were decayed, 31% were missing, and 7% were filled. Logistic regression identified higher added-sugar beverage consumption, younger maternal age at baseline, higher maternal DMFS at baseline, and greater number of people in the household as significant (P < 0.05) risk factors. Negative binomial regression found that only maternal DMFS was associated with child dmf counts. Conclusions By the age of 36 months, dental caries is nearly universal in this population of American Indian children. Caries risk factors included sugared beverage consumption, greater household size, and maternal factors, but further analyses are needed to better understand caries in this population.

Background and Overview The World Health Organization has recommended a reduction in free sugars intake throughout one’s life span to decrease the burden of noncommunicable diseases, including caries and obesity. The author defines sugars’ nomenclature, describes sugars’ roles in food, and identifies current sugars intake. Conclusions The oral health care practitioner can identify added sugars intake and provide guidance to patients to decrease their intake of added sugars while improving nutrient intake and reducing caries risk. Practical Implications Intake of added sugars increases the burden of chronic diseases in the United States. The oral health care practitioner is in a position to provide dietary guidance to patients to reduce both oral and systemic diseases.

Background The results of several studies conducted in the United States show no association between intake of 100 percent fruit juice and early childhood caries (ECC). The authors examined this association according to poverty and race/ethnicity among U.S. preschool children. Methods The authors analyzed data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) for 2,290 children aged 2 through 5 years. They used logistic models for caries (yes or no) to assess the association between caries and intake of 100 percent fruit juice, defined as consumption (yes or no), ounces (categories) consumed in the previous 24 hours or usual intake (by means of a statistical method from the National Cancer Institute). Results The association between caries and consumption of 100 percent fruit juice (yes or no) was not statistically significant in an unadjusted logistic model (odds ratio [OR], 0.76; 95 percent confidence interval [CI], 0.57-1.01), and it remained nonsignificant after covariate adjustment (OR, 0.89; 95 percent CI, 0.63-1.24). Similarly, models in which we evaluated categorical consumption of 100 percent juice (that is, 0 oz; > 0 and ≤ 6 oz; and > 6 oz), unadjusted and adjusted by covariates, did not indicate an association with ECC. Conclusions Our study findings are consistent with those of other studies that show consumption of 100 percent fruit juice is not associated with ECC. Practical Implications Dental practitioners should educate their patients and communities about the low risk of developing caries associated with consumption of 100 percent fruit juice. Limiting consumption of 100 percent fruit juice to 4 to 6 oz per day among children 1 through 5 years of age should be taught as part of general health education.

Currently, research is lacking regarding the use of spill-proof beverage containers (SPBCs). The purpose of this study was to assess the relationship between daytime SPBCs use for sugared beverages, caries, socioeconomic status, and other covariates in high-caries risk 12- to 49-month-old children attending a Women, Infants and Children (WIC) program.Data were analyzed using baseline information from 415 Iowa WIC-enrolled children who participated in a psychoeducational study. Mothers completed a series of detailed questionnaires regarding their SES and their child's beverage consumption. Dental examinations using d1d2.3 (noncavitated and cavitated carious lesions) criteria were completed for the children. Bivariate relationships for consumption of any sugared beverage using SPBCs were assessed and followed by multivariable modeling using logistic regression (alpha=0.05).Only 18 children (four percent) reported using SPBCs for any sugared beverage during the night versus 290 (70 percent) during the day. Daytime consumption of sugared beverages from SPBCs was less likely to be reported in older children (P.001) and in African American children when compared to both Hispanics (P.001) and Caucasians (P=.001).Iowa WIC children primarily consume sugared beverages using spill-proof beverage containers during the day; children who were younger and Hispanic or Caucasian were more likely to use SPBCs to consume sugared beverages.

OBJECTIVES: To assess longitudinal associations between permanent tooth caries increment and both modifiable and non-modifiable risk factors, using best subsets model selection. METHODS: The Iowa Fluoride Study has followed a birth cohort with standardized caries exams without radiographs of the permanent dentition conducted at about ages 9, 13, and 17 years. Questionnaires were sent semi-annually to assess fluoride exposures and intakes, select food and beverage intakes, and tooth brushing frequency. Exposure variables were averaged over ages 7-9, 11-13, and 15 – 17, reflecting exposure two years prior to the caries exam. Longitudinal models were used to relate period-specific averaged exposures and demographic variables to adjusted decayed and filled surface increments (ADJCI) (n=392). The Akaike Information Criterion (AIC) was used to assess optimal explanatory variable combinations. RESULTS: From birth to age 9, 9-13, and 13-17 years, 24%, 30%, and 55% of subjects had positive permanent ADJCI, respectively. Ten models had AIC values within two units of the lowest AIC model and were deemed optimal based on AIC. Younger age, being male, higher mother’s education, and higher brushing frequency were associated with lower caries increment in all 10 models, while milk intake was included in 3 of 10 models. Higher milk intakes were slightly associated with lower ADJCI. CONCLUSIONS: With the exception of brushing frequency, modifiable risk factors under study were not significantly associated with ADJCI. When possible, researchers should consider presenting multiple models if fit criteria cannot discern among a group of optimal models.

INTRODUCTION Assessment of evidence-based dentistry (EBD) knowledge and behaviour is hampered by lack of explicit competency criteria. This void impedes instructional design and assessment of student growth during the educational process. METHODS Knowledge and cognitive domains supporting educational objectives in a pre-doctoral dental programme were identified for each level of the EBD five-step process. We articulated educational objectives with behavioural expectations for each level of skill acquisition at each step of the EBD process. Outcome evaluation criteria identify students' progressive level of skill acquisition from novice to expert. RESULTS The educational objectives, type of knowledge, and nature of the cognitive process supporting these objectives are presented for each step of the EBD process. For example, educational objectives of the "Ask" step include (i) to construct a question from the patient presentation and knowledge limitations that addresses the clinical problem and (ii) to articulate the Problem, Intervention/Exposure, Comparison, Outcome (PICO) components. Achievement of these objectives requires both factual information regarding the PICO format and the cognitive process of understanding. Educational outcome criteria consistent with a competent clinician include clear articulation of the PICO with identifiable pieces that relate to the clinical situation. DISCUSSION Assessment strategies for progression towards EBD competency are limited due to the complexity associated with evaluating EBD knowledge and behaviours. To evaluate performance, the EBD academic community must define competency expectations for entry into unsupervised general dental practice. CONCLUSION This framework offers measurable outcome evaluation criteria to initiate a conversation with academic peers regarding current gaps in EBD assessment.

Introducing critical thinking and evidence-based dentistry (EBD) content into an established dental curriculum can be a difficult and challenging process. Over the past three years, the University of Iowa College of Dentistry has developed and implemented a progressive four-year integrated critical thinking and EBD curriculum. The objective of this article is to describe the development and implementation process to make it available as a model for other dental schools contemplating introduction of critical thinking and EBD into their curricula. The newly designed curriculum built upon an existing problem-based learning foundation, which introduces critical thinking and the scientific literature in the D1 year, in order to expose students to the rationale and resources for practicing EBD in the D2 and D3 years and provide opportunities to practice critical thinking and apply the EBD five-step process in the D2, D3, and D4 years. All curricular content is online, and D3 and D4 EBD activities are integrated within existing clinical responsibilities. The curricular content, student resources, and student activities are described.

OBJECTIVES: Observational studies in children and adolescents suggest that sugar-sweetened beverage (SSB) intakes are a risk factor for obesity, with obesity generally assessed using body mass index. Our objective was to investigate associations between child and adolescent beverage intakes collected longitudinally and % body fat at age 17. METHODS: Iowa Fluoride Study/Iowa Bone Development Study participants were recruited at birth and followed longitudinally with detailed questionnaires sent at least every 6 months. Mean daily (area under the curve) beverage intakes of participants (n = 174 male, n = 201 female) were calculated for the age ranges 1.00–3.00, 3.01–5.00, 5.01–9.00, 9.01–11.00, 11.01–13.00, 13.01–15.00, and 15.01–17.00 years from beverage questionnaire-reported intakes of milk, 100% juice, SSBs and water-based sugar-free beverages (WBB). Three-day diaries and food frequency questionnaires were used to calculate mean energy intakes for these age ranges. Percent body fat (%BF) was assessed by dual energy x-ray absorptiometry (DXA) at age 17-year clinic exams. Generalized linear models based on the gamma distribution and a log link function were used to examine associations between the independent variables of beverage intakes (at a specific age range), baseline socioeconomic status (SES), sex, and energy intakes, and the dependent variable %BF at age 17. RESULTS: Adolescent, but not early childhood, milk and 100% juice intakes were negatively associated with mean %BF at age 17. For example, the estimated effect of 8 additional ounces of milk daily at ages 15.01–17.00 years was a 4% decrease in %BF at age 17 (95% CI 6% decrease, 1% decrease), and the estimated effect of 8 ounces of 100% juice was an 11% decrease in %BF (95% CI 18% decrease, 3% decrease). Neither childhood nor adolescent SSB or WBB intakes were meaningfully associated with %BF at age 17. Adjustment for baseline SES, sex and energy intakes had a marginal impact on estimated effects. CONCLUSIONS: Adolescent milk and 100% juice, but not SSB or WBB, intakes were associated with lower %BF at age 17. The results suggest that associations between beverage intakes and obesity may depend on how obesity is measured. FUNDING SOURCES: National Institutes of Health (R03-DE023784, R01-DE12101, R01-DE09551, UL1-RR024979, UL1-TR000442, UL1-TR001013, M01-RR00059); The Roy J. Carver Charitable Trust; Delta Dental of Iowa Foundation.

Background Dietary intake of sugar-sweetened beverages (SSBs) has increased during the past 30 years, and SSB intake is associated with caries. Download full-size image Conclusions SSBs vary in the quantity and nature of sugars they contain; however, all of the sugars are fermentable by oral bacteria and potentially cariogenic. Practical Implications Oral health care practitioners should assess patients’ SSB intakes by asking questions regarding the quantity, frequency and duration of SSB intake. In response to individual behaviors, practitioners should tailor recommendations when providing anticipatory guidance to help patients decrease their exposure to SSBs for caries prevention. In light of the association between SSB intake and caries risk, as well as the increased consumption of SSBs, all dental practices should assess patients’ SSBs intake.

Objective To study the association of having minor children and contribution to household income on weekly work hours of Iowa female dentists. Methods A 28-question survey was mailed to all active Iowa dentists. This study represents female dentists who responded to the survey (n = 192; response rate = 63 percent). The dependent variable was whether dentists currently worked full- or part-time (≥32 versus 60 percent to household income (57.8 percent) were 3.0 times as likely to work full-time (P = 0.0129). The final regression model indicated that those who contributed >60 percent to household income (P = 0.0096) and had no leave of absence longer than 45 consecutive days within the prior 2 years (P = 0.0483) were more likely to work full-time compared with their counterparts. Conclusion Iowa female dentists who provided more than 60 percent to household income and had not taken a leave of absence during the past 2 years were more likely to work full-time. The inclusion of leave of absence as a predictor variable negates any additional influence of the presence or absence of minor children in the regression model, indicating that these variables are highly correlated for this population.

Background Sugar-sweetened beverages (SSBs) have been associated with obesity in children and adults; however, associations between beverage patterns and obesity are not understood. Objective Our aim was to describe beverage patterns during adolescence and associations between adolescent beverage patterns and anthropometric measures at age 17 years. Design We conducted a cross-sectional analyses of longitudinally collected data. Participants/setting Data from participants in the longitudinal Iowa Fluoride Study having at least one beverage questionnaire completed between ages 13.0 and 14.0 years, having a second questionnaire completed between 16.0 and 17.0 years, and attending clinic examination for weight and height measurements at age 17 years (n=369) were included. Exposure Beverages were collapsed into four categories (ie, 100% juice, milk, water and other sugar-free beverages, and SSBs) for the purpose of clustering. Five beverage clusters were identified from standardized age 13 to 17 years mean daily beverage intakes and named by the authors for the dominant beverage: juice, milk, water/sugar-free beverages, neutral, and SSB. Outcomes Weight, height, and body mass index (BMI; calculated as kg/m 2 ) at age 17 years were analyzed. Statistical analyses We used Ward's method for clustering of beverage variables, one-way analysis of variance and χ 2 tests for bivariable associations, and γ-regression for associations of weight or BMI (outcomes) with beverage clusters and demographic variables. Linear regression was used for associations of height (outcome) with beverage clusters and demographic variables. Results Participants with family incomes P =0.070) and were heavier (2.0±0.7 BMI units; P =0.002) than participants with family incomes ≥$60,000/year. Adjusted mean weight, height, and BMI estimates differed by beverage cluster membership. For example, on average, male and female members of the neutral cluster were 4.5 cm ( P =0.010) and 4.2 cm ( P =0.034) shorter, respectively, than members of the milk cluster. For members of the juice cluster, mean BMI was lower than for members of the milk cluster (by 2.4 units), water/sugar-free beverage cluster (3.5 units), neutral cluster (2.2 units), and SSB cluster (3.2 units) (all P Conclusions Beverage patterns at ages 13 to 17 years were associated with anthropometric measures and BMI at age 17 years in this sample. Beverage patterns might be characteristic of overall food choices and dietary behaviors that influence growth.

Critical thinking skills are essential for the successful dentist, yet few explicit skillsets in critical thinking have been developed and published in peer-reviewed literature. The aims of this article are to 1) offer an assessable critical thinking teaching model with the expert's thought process as the outcome, learning guide, and assessment instrument and 2) offer three critical thinking skillsets following this model: for geriatric risk assessment, technology decision making, and situation analysis/reflections. For the objective component, the student demonstrates delivery of each step in the thought process. For the subjective component, the student is judged to have grasped the principles as applied to the patient or case. This article describes the framework and the results of pilot tests in which students in one year at this school used the model in the three areas, earning scores of 90% or above on the assessments. The model was thus judged to be successful for students to demonstrate critical thinking skillsets in the course settings. Students consistently delivered each step of the thought process and were nearly as consistent in grasping the principles behind each step. As more critical thinking skillsets are implemented, a reinforcing network develops.

Objective To examine risk factors for non-cavitated caries, as well as cavitated caries. Methods Subjects were participants in the Iowa Fluoride Study cohort. Dietary data were collected at 36, 48, and 60 months old using 3-day dietary diaries, and a dental examination was conducted at about age 5. We compared the frequencies of dietary intakes of three groups: a) children having only d1caries (n = 41); b) children having only cavitated (d2+f) caries (n = 46); and c) children having both d1 and d2+f caries (n = 49) with a forth group; d) those of caries-free children (n = 257). Results Multinomial and binomial logistic regression was used, where the categorical outcome was based on the 4 caries groups, and the caries-free group was designated as the reference. In the final model, sevenvariables were associated with the caries outcome. Lower milk consumption frequency at meals and greater presweetened cereal consumption frequency at meals were significantly associated with a greater likelihood of being in the d1 group. Greater regular soda pop consumption frequency and greater added sugar consumption frequency at snacks were significantly associated with being in the cavitated caries (d2+f and/or d1d2+f) groups. Lower socioeconomic status and less frequent toothbrushing increased the likelihood of being in the d1 group. Conclusions The results suggest that different food and beverage categories are associated with being in the d1 group compared with the cavitated caries groups. More frequent toothbrushing, greater milk consumption at meals, and avoiding presweetened cereal consumption at meals might reduce the risk of developing non-cavitated caries.

Objectives: This paper reports the prevalence and severity of caries in a group of 16-month-old American Indian children. Methods: The study is an ongoing longitudinal study of risk factors for caries in children from a Northern Plains Tribal community. Children were examined for caries and risk factor data collected at approximately 1, 4, 8, 12, and 16 months of age. Surface-specific caries data were collected and the presence of precavitated “white spot” lesions was recorded at the subject level. Results: The mean age was 15.4 months for the sample of 232 children. Caries prevalence was 31.9 percent, while an additional 29.3 percent had white spot lesions only. Mean dmfs was 1.57, and ranged from 0 to 44 surfaces. Nearly 3 percent of all erupted tooth surfaces were affected and maxillary central incisors had the highest prevalence of caries (22 percent). Conclusions: Among the very youngest children, dental caries prevalence was very high among these American Indian children.

Successful integration of critical thinking and evidence-based dentistry (EBD) concepts throughout didactic and clinical dental curricula require faculty support. Critical thinking and EBD definitions and practice continue to evolve, and not all dental faculty members were exposed to such concepts during their education. The objective of this study was to understand faculty members’ perspectives on both critical thinking and EBD. An online survey was designed to assess full- and part-time faculty members’ understanding, practice and teaching of critical thinking and EBD, interest in and perceived significance of EBD, and perceived barriers to teaching critical thinking and EBD at one U.S. dental school. Forty-three faculty members completed the survey for a 41 percent response rate. Most respondents (46 percent) defined critical thinking as the use of evidence or the scientific method in decision making and EBD as clinical practice based on “science only” (39 percent) or “quality science only” (34 percent). Based on their individual definitions, over 75 percent of the respondents reported incorporating critical thinking into didactic and clinical teaching; 79 percent and 47 percent, respectively, reported incorporating EBD into their didactic and clinical teaching. While these faculty members confirmed the importance of teaching students EBD, they identified barriers to teaching as time, knowledge, and resources. These results, which reflect one school’s efforts to understand faculty perceptions and practices of EBD, suggest that faculty training and resource support are necessary for successful curricular integration of critical thinking and EBD.

Academic dental institutions today seek to provide curricular content and learning opportunities for students to develop an essential skill set for evidence-based practice. To support that effort, studies that explore current practice patterns are valuable in identifying factors that influence the evidence-based habits and behaviors of dental school graduates. The purpose of this study was to explore the knowledge, perceptions, and behavior of private practice dentists in the state of Iowa with respect to evidence-based dentistry and to determine the influence of the dentist's education and the scope of his or her practice on those opinions and habits. A questionnaire addressing practitioners' familiarity with, understanding of, and adoption of an evidence-based philosophy of practice was mailed in September 2009 to all dentists licensed and practicing in Iowa. Questionnaires were returned by 518 practitioners, for an overall response rate of 38.4 percent. The majority of respondents reported awareness, understanding, and adoption of an evidence-based approach to their practice of dentistry. Recent graduates were more likely to report insufficient time as the primary obstacle to practicing evidence-based dentistry. Dental specialists indicated a higher level of comfort in assessing scientific information, as well as implementing current reliable, valid published research in practice, than did general practitioners.