Precision Dentistry in Early Childhood

Divaris, Kimon

doi:10.1016/j.cden.2017.02.008

Cited by 18 publications

(25 citation statements)

References 44 publications

(46 reference statements)

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“…The term, precision medicine, reflects the emphasis on more precise accounting for individual variability than used previously . Various groups have been exploring the application of precision medicine in oral health care, “precision dentistry” . We will refer specifically to precision medicine throughout this review, which will primarily focus on the applications of precision oral health related to periodontal disease.…”

Section: What Is Precision Medicine?mentioning

confidence: 99%

“…The larger objectives of precision medicine are to inform and improve health care, including the treatment of chronic diseases. 3,4 Chronic diseases account for over 70% of care in the USA, with a projected increase as this population ages. 12 Addressing complex chronic diseases with a precision medicine approach is in its infancy.…”

Section: Precision Medicine and Chronic Diseasementioning

confidence: 99%

“…Various studies have been exploring the application of precision medicine concepts to dentistry. 4,16,33,39 A few examples of these research topics include genomics and oral cancer, orofacial pain, and periodontal disease. 13 It has been suggested that a precision oral health approach would benefit the diagnosis and treatment of periodontal disease, although genetic evidence to support this is scarce.…”

Section: Some Research Areas/hot Topics In Precision Dentistrymentioning

confidence: 99%

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Advances in precision oral health

Beck

Philips

Moss

et al. 2019

Periodontology 2000

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The concept of precision dentistry as it relates to precision medicine is relatively new to the field of oral health. Precision dentistry is a contemporary, multifaceted, data‐driven approach to oral health care that uses individual characteristics to stratify similar patients into phenotypic groups. The objective is to provide clinicians with the information that will allow them to improve treatment planning and a patient's response to treatment. Providers that use a precision oral health approach would move away from using an “average treatment” for all patients with a particular diagnosis and move toward more specific treatments for patients within each diagnostic subgroup. Precision dentistry requires a method or a model that places each individual in a subgroup where each member is the same as every other member in relation to the disease of interest. Precision dentistry is a paradigm shift that requires a new way of thinking about diagnostic categories. This approach uses patients’ risk factor data (including, but not limited to, genetic, environmental, and health behavioral), rather than expert opinion or clinical presentation alone, to redefine traditional categories of health and disease. We review aspects of current efforts to allow precision dentistry to be realized and focus on one of the major innovations that may help precision dentistry to be practiced by periodontists, the World Workshop Model. Another approach is the Periodontal Profile Class system. These two approaches represent examples of supervised and unsupervised learning systems, respectively. This review compares and contrasts these two learning systems for their ability to classify patients into homogeneous disease and risk groups, as well as their feasibility at achieving the objective of enabling precision dentistry. We conclude that: (a) the World Workshop Model concept of stages and grades works as expected, in that periodontal status appears to be more serious in each successive stage. In addition, the seriousness and the complexity of the disease are greater as the grade increases within each stage. Stages and grades are important for precision dentistry because they consider the risk of future disease and the prognosis, and enable practitioners to use more signs, symptoms, and other associated factors when placing a patient in a diagnostic category; (b) the assignment of stages and grades using unsupervised learning systems is superior to using supervised learning systems for the prediction of 10‐year tooth loss and 3‐year attachment loss progression. In addition, the unsupervised learning approach (Periodontal Profile Class stages) results in stronger associations between the periodontal phenotypes and systemic diseases and conditions (prevalent diabetes, C‐reactive protein, and incident stroke). This probably occurs because an unsupervised learning model produces more data‐driven, mutually exclusive, homogeneous groups than a supervised learning model.

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Section: What Is Precision Medicine?mentioning

confidence: 99%

Section: Precision Medicine and Chronic Diseasementioning

confidence: 99%

Section: Some Research Areas/hot Topics In Precision Dentistrymentioning

confidence: 99%

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Advances in precision oral health

Beck

Philips

Moss

et al. 2019

Periodontology 2000

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“…ECC is best understood as a supragingival biofilm‐mediated dysbiotic disease, whereas social, environmental, and behavioral determinants, as well as innate susceptibility are known influences on its incidence . There is promise and expectation that meaningful improvements in early childhood oral health, both in context of public health and clinical practice, can be made via the advent of precision medicine in the oral health domain .…”

Section: Improving Children's Oral Health Via the Advancement Of Precmentioning

confidence: 99%

“…There is promise and expectation that meaningful improvements in early childhood oral health, both in context of public health and clinical practice, can be made via the advent of precision medicine in the oral health domain (6,7).…”

Section: Improving Children's Oral Health Via the Advancement Of Precmentioning

confidence: 99%

The building blocks of precision oral health in early childhood: the ZOE 2.0 study

Divaris

Joshi

2018

J Public Health Dent

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Improving children's oral health is a long‐standing area of priority and sustained efforts by many stakeholders. Despite these efforts, dental caries, particularly early childhood caries (ECC), persists as a clinical and dental public health problem with multilevel consequences. Despite recent successes in the non‐restorative management of dental caries, remarkably little has been done in the domain of ECC prevention. There is promise and expectation that meaningful improvements in early childhood oral health and ECC prevention can be made via the advent of precision medicine in the oral health domain. We posit that precision dentistry, including genomic influences, may be best examined in the context of well‐characterized communities (versus convenience clinical samples) and the impact of contextual factors including geography and social disadvantage may be explainable via mechanistic (i.e., biological) research. This notion is aligned with the population approach in precision medicine, which calls for the latter to be predictive, preventive, personalized, and participatory. The article highlights research directions that must be developed for precision dentistry and precision dental public health to be realized. In this context, we describe the rationale, activities, and early insights gained from the ZOE 2.0 study – a large‐scale, community‐based, genetic epidemiologic study of early childhood oral health. We anticipate that this long‐term research program will illuminate foundational domains for the advancement of precision dentistry and precision dental public health. Ultimately, this new knowledge can help catalyze the development of effective preventive and therapeutic modalities via actions at the policy, community, family, and person level.

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Measurement of Early Childhood Oral Health for Research Purposes: Dental Caries Experience and Developmental Defects of the Enamel in the Primary Dentition

Ginnis

Zandoná

Slade

et al. 2019

Methods in Molecular Biology

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Epidemiological investigations of early childhood oral health rely upon the collection of high-quality clinical measures of health and disease. However, ascertainment of valid and accurate clinical measures presents unique challenges among young, preschool-age children. The paper presents a clinical research protocol for the conduct of oral epidemiological examinations among children, implemented in ZOE 2.0, a large-scale population-based genetic epidemiologic study of early childhood caries (ECC). The protocol has been developed for the collection of information on tooth surface-level dental caries experience and tooth-level developmental defects of the enamel in the primary dentition. Dental caries experience is recorded using visual criteria modified from the International Caries Detection and Assessment System (ICDAS), and measurement of developmental defects is based upon the modified Clarkson and O’Mullane Developmental Defects of the Enamel Index. After a dental prophylaxis (toothbrushing among all children and flossing as needed), children’s teeth are examined by trained and calibrated examiners in community locations, using portable dental equipment, compressed air, and uniform artificial light and magnification conditions. Data are entered directly onto a computer using a custom Microsoft Access-based data entry application. The ZOE 2.0 clinical protocol has been implemented successfully for the conduct of over 6000 research examinations to date, contributing phenotype data to downstream genomics and other

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Precision Dentistry in Early Childhood

Cited by 18 publications

References 44 publications

Advances in precision oral health

Advances in precision oral health

The building blocks of precision oral health in early childhood: the ZOE 2.0 study

Measurement of Early Childhood Oral Health for Research Purposes: Dental Caries Experience and Developmental Defects of the Enamel in the Primary Dentition

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