BackgroundGingivitis is a common oral health problem. Untreated gingivitis may progress to periodontitis, a common cause of tooth loss. The prevalence of gingivitis and calculus among Puerto Rican children is unknown. Understanding this prevalence can support early public health preventative strategies. This study aims to estimate the prevalence of gingivitis and calculus among 12-year-old Puerto Ricans by health region and to explore differences in distribution by school type (proxy for socio-economic status) and gender.MethodsA probability-based sample of 113 schools was selected proportional to enrollment size and stratified by health region, school type, and gender. Two trained examiners evaluated the presence of gingivitis and both supragingival and subgingival dental calculus. Gingivitis was defined as the presence of gingival bleeding upon gentle probing (BOP) in at least one site, and the extent of the problem was classified according to the percentage of teeth whose gingiva presented BOP (limited: 25–49% of the teeth tested; extensive: >50% of teeth tested). Logistic and linear regression models, adjusted for health regions, were used to compare gingivitis and calculus prevalence and extent between genders and school types.ResultsGingivitis was found in 80.41% of the 1586 children evaluated. Urban-public schoolchildren had a slightly higher prevalence (83.24%) compared to private (79.15%, p = 0.16); those in rural-public (77.59%) and private schools had similar prevalence (p = 0.15). Extensive gingivitis was present in 60.81% of all children. The mean percentage of sites presenting BOP (BOP%) was 17.79%. Rural and urban public schoolchildren presented significantly higher BOP% compared to children from private schools (p = 0.0005, p = 0.002, respectively). Dental calculus was detected in 61.59% of the sample, boys presenting significantly higher (p = 0.005) total and supragingival calculus. Rural-public schoolchildren had a significantly higher prevalence of subgingival calculus compared to private schoolchildren (p = 0.02).ConclusionsGingivitis prevalence is higher among 12-year-old Puerto Ricans compared to data reported for U.S. adolescents. Public schoolchildren presented significantly higher BOP% sites compared to private schoolchildren. Boys presented a significantly higher total and supragingival calculus prevalence than girls. Oral health disparities related to gender and school type were identified by this study. Studies exploring the reasons for these disparities are recommended.Electronic supplementary materialThe online version of this article (10.1186/s12903-017-0471-5) contains supplementary material, which is available to authorized users.

Currently our intra–oral model uses enamel specimens that have been disinfected by soaking in buffered formalin (pH 6.8). However, because of increasing emphasis on infection control, it is important to identify a way to sterilize these specimens. The aim of this study was to determine if autoclaved, or gas sterilized, lesioned enamel responds to fluoride (F) in the same way alcohol–disinfected enamel lesions do. Seventy–two formalin–disinfected, human enamel specimens (3 mm) were lesioned in demineralizing solution for 96 h and were then divided into three groups. One group was autoclaved; one group was gas sterilized (ethylene oxide), and the remaining 24 specimens were further disinfected in 70% ethanol for 10 min. Specimens in each group were then treated 4 times/day for 4 weeks with 0, 250 or 1,100 ppm F dentifrice slurries in an in vitro cycling, remin/demin model. Following treatment, fluoride uptake was analyzed by microdrill biopsy, and lesion depth and mineral content changes (ΔM) were determined by transverse microradiography. Data were analyzed by one–way ANOVA analysis. In all three groups of specimens there were significant (p<0.05) differences in fluoride uptake in response to different fluoride treatments. Autoclaved lesions failed to provide dose– response data with regard to changes in lesion mineral content. Because formalin and 70% alcohol are only disinfectants, and autoclaving altered the responsiveness of enamel lesions, results from this study suggest that, of the methods tested, gas sterilization is the preferred method for sterilizing enamel specimens that will be used in intra–oral studies.

BackgroundGood oral health has been associated with better quality of life and general health. In the Caribbean, there have been no studies regarding the association between oral health conditions and the quality of life of the population. The main purpose of this study was to investigate the association between gingival parameters and oral health–related quality of life (OHRQoL) in Caribbean adults. A secondary aim of the study was to gain more information on factors that impact OHRQoL in this population.MethodsThis cross-sectional, epidemiological, population-based study was conducted in community settings. After the participants with missing Oral Health Impact Profile (OHIP) data were excluded, the sample size was 1821 (weighted according to the age and gender distribution in each target population). OHIP-14 standardized questionnaires were used to collect information. In addition, a medical/oral health questionnaire including sociodemographics, general health, dental visits, oral hygiene habits and knowledge, the frequency of dental visits, prosthesis use/hygiene, and smoking was administered. A multivariate model included predictors that showed significant associations in the univariate models. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported; statistical significance was set at 0.05.ResultsIn the multivariate analysis, current smokers (OR = 2.34, 95% CI: 1.74–3.14 vs. never smokers), those who visited the dentist only when problems arose (OR = 1.65, 95% CI: 1.13–2.40 vs. those visiting once a year), and participants with any chronic disease/condition (OR = 1.38, 95% CI: 1.06–1.78) had higher odds of being in the highest tertile for OHIP score (poorer health).ConclusionsThe present multicenter study identified potential modifiable risk factors for poor OHRQoL among adults in three Caribbean cities.

BackgroundDental caries is the most prevalent chronic illness worldwide. In the US dental caries has been described as a “silent epidemic”, affecting 58.2 % of 12–15 year-olds, particularly in minority and immigrant groups. Caries is associated with complex yet preventable biological and behavioral factors such as dental plaque and diet, as well as social determinants of health. In developed nations, a higher risk caries has been associated with populations of low socio-economic status (SES), especially in areas with greater income disparity. An island-wide study conducted in Puerto Rico in 1997 revealed a high prevalence of dental caries in 12-year-olds and a significant health disparity between children attending private and public schools. The purpose of the present study was twofold: 1) to estimate caries levels of 12-year-old school Puerto Ricans in 2011; and 2) compare results to data obtained in 1997 to explore any possible change in caries outcomes after a government health insurance (GHI) reform was implemented.MethodsIn this cross-sectional study, a probability sample of 133 out of 1,843 schools was selected proportional to enrollment size, and stratified by 1997 GHI regions, school type, and gender. Calibrated examiners conducted oral soft tissue and caries examinations. Dental caries prevalence was estimated. Mean Decayed Missing Filled Tooth/Surface (DMFT/S) indices and mean Significant Caries Index (SiC) were calculated and compared retrospectively to data obtained in 1997.ResultsThe final sample included 1,587 school-enrolled children. About 53 % of participants were female and 77 % attended public schools. Between 1997 and 2011, reductions were observed in caries prevalence (81 to 69 %), mean DMFT scores (3.8 to 2.5), mean DMFS scores (6.5 to 3.9), and mean SiC index (7.3 to 5.6) in both private and public schools, with a more prominent decrease in private schools. Between 1997 and 2011, overall the filled component increased (50 to 67 %), while decayed and missing component decreased (42 to 30 %) and (8 to 3 %), respectively.ConclusionsAmong 12-year-old schoolchildren in Puerto Rico between 1997 and 2011, caries prevalence, extent, and severity decreased as well as the DMFT missing component, while the filled component increased. Dental caries prevalence was high and the health disparity persists between children enrolled in public and private schools after more than a decade of the GHI implementation. The relationship between GHI implementation and other potentially relevant co-factors for caries warrants further research, as does the seemingly entrenched disparity across groups.

BackgroundThe prevalence of childhood overweight and obesity has become a public health problem worldwide. The objectives of the study were: 1) to establish the BMI prevalence in 12-year olds residing in Puerto Rico, and 2) to determine BMI differences by sex, public-private school type, and geographic regions.MethodsData was obtained from an island-wide probabilistic stratified sample of 1,582 twelve-year-olds (53% girls and 47% boys). The BMI was determined using the National Health and Nutrition Examination Survey procedures. Children were categorized as underweight, healthy weight, overweight or obese using the Center for Disease Control and Prevention’s age and gender specific growth charts. A logistic regression model was used to estimate BMI category prevalence. Odds ratios were calculated using a multinomial regression.ResultsIn this study, 18.8% of the children were overweight and 24.3% were obese. A higher prevalence of obesity was observed in boys as compared to girls, 28.2% vs. 20.2%, respectively. The estimated prevalence of overweight and obesity in children from public schools was lower than for those from private schools. After adjusting for type of school and region, boys had a significantly higher risk of being obese (64%) as compared to girls. In public schools, boys had a lower prevalence of being overweight while girls had a higher prevalence compared to children attending private schools. Girls attending private schools had a higher obesity prevalence (27.8%) compared to girls from public schools (19.8%). The prevalence of underweight (2.7%) is slightly lower than in the United States.ConclusionsThe prevalence of overweight and obesity of 12-year-olds residing in PR was 18.8% and 24.3%, respectively; higher than in the U.S. (by groups). Boys were at higher risk of obesity than girls. There is an urgent need to implement public health policies/programs to reduce the prevalence of overweight and obesity in children in PR.

Mucous membranes are the main route of transmission of human immunodeficiency virus (HIV). Interestingly, some viral inhibitory activities have been found in saliva. The purpose of this study was to determine the level of salivary immunoglobulin A (IgA) antibodies to gp41 in HIV+ patients at various disease stages to identify whether gp41 was able to induce vigorous humoral responses. Unstimulated saliva samples were obtained from three groups of subjects (n=37): group A (HIV-), group B (HIV+, CD4+ <200/mm3), and group C (HIV+, CD4+ >200/mm3). IgA antibody levels to purified gp41 were determined by enzyme-linked immunosorbent assay (ELISA). Western blot analyses were performed using HIV+ saliva to confirm IgA reactivity to gp41. ELISA demonstrated that HIV+ subjects had higher IgA antibody to gp41 than HIV- individuals. No significant differences were noted between HIV+, CD4+ <200/mm3 and CD4+ >200/mm3 subjects. High (81.25%) IgA reactivity to gp41 was demonstrated by Western blotting of saliva from all HIV+ individuals. In conclusion, gp41 responses are important in the HIV disease process, as indicated by the high IgA levels and gp41 reactivity in saliva of HIV+ patients.

The aim of the SmoCar (Smoking in the Caribbean) study was to estimate the prevalence of smoking and the disparities in the smoking practices of three regions in the Caribbean: Jamaica, Dominican Republic, and Puerto Rico. The secondary objective was to assess the prevalence and severity of gingivitis in relation to the smoking practices. The study population comprised 1,847 (weighted N = 1,830) individuals (18 years and older) who were volunteer participants from the capitals of Jamaica, Dominican Republic, and Puerto Rico. A structured interview was used to assess the participants’ smoking behaviors. The gingival index was used to determine the extent of gingival inflammation. Polytomous regression was used to estimate the adjusted odds ratios (aORs) for smoking status (current, past, or never), according to risk factors (sex, age-group, education, marital status, tooth-brushing frequency, and city of residence). Logistic regression models were used to assess the associations between different smoking status variables and mild to moderate/severe gingivitis. The majority of the participants were never-smokers, with current smokers being found most commonly in Kingston (33.22%), followed by San Juan (12.76%) and Santo Domingo (8.8%). Both current (aOR = 2.22, 95% confidence interval [1.45, 3.40]) and past (aOR = 1.87, 95% confidence interval [1.19, 2.93]) smoking (vs. never smoking) was strongly associated with severe gingivitis. Smoking was the most prevalent in Jamaicans and the least prevalent in Dominicans. The study population of current smokers was found to have a fourfold increased risk of severe gingivitis and a twofold increased risk of moderate gingivitis.

No abstract