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

Divaris, Kimon; Joshi, Ashwini

doi:10.1111/jphd.12303

Cited by 13 publications

(14 citation statements)

References 17 publications

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“…The initial study population comprised 300 preschool-age children attending public preschool (Head Start) centers in North Carolina, participants of a community-based, cross-sectional, epidemiologic study (ZOE 2.0) of early childhood oral health (Divaris and Joshi 2020; Divaris et al 2020). Children were between 36 and 71 mo old.…”

Section: Methodsmentioning

confidence: 99%

Metabolomics Insights in Early Childhood Caries

et al. 2021

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Dental caries is characterized by a dysbiotic shift at the biofilm–tooth surface interface, yet comprehensive biochemical characterizations of the biofilm are scant. We used metabolomics to identify biochemical features of the supragingival biofilm associated with early childhood caries (ECC) prevalence and severity. The study’s analytical sample comprised 289 children ages 3 to 5 (51% with ECC) who attended public preschools in North Carolina and were enrolled in a community-based cross-sectional study of early childhood oral health. Clinical examinations were conducted by calibrated examiners in community locations using International Caries Detection and Classification System (ICDAS) criteria. Supragingival plaque collected from the facial/buccal surfaces of all primary teeth in the upper-left quadrant was analyzed using ultra-performance liquid chromatography–tandem mass spectrometry. Associations between individual metabolites and 18 clinical traits (based on different ECC definitions and sets of tooth surfaces) were quantified using Brownian distance correlations (dCor) and linear regression modeling of log2-transformed values, applying a false discovery rate multiple testing correction. A tree-based pipeline optimization tool (TPOT)–machine learning process was used to identify the best-fitting ECC classification metabolite model. There were 503 named metabolites identified, including microbial, host, and exogenous biochemicals. Most significant ECC-metabolite associations were positive (i.e., upregulations/enrichments). The localized ECC case definition (ICDAS ≥1 caries experience within the surfaces from which plaque was collected) had the strongest correlation with the metabolome (dCor P = 8 × 10−3). Sixteen metabolites were significantly associated with ECC after multiple testing correction, including fucose ( P = 3.0 × 10−6) and N-acetylneuraminate (p = 6.8 × 10−6) with higher ECC prevalence, as well as catechin ( P = 4.7 × 10−6) and epicatechin ( P = 2.9 × 10−6) with lower. Catechin, epicatechin, imidazole propionate, fucose, 9,10-DiHOME, and N-acetylneuraminate were among the top 15 metabolites in terms of ECC classification importance in the automated TPOT model. These supragingival biofilm metabolite findings provide novel insights in ECC biology and can serve as the basis for the development of measures of disease activity or risk assessment.

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Section: Methodsmentioning

confidence: 99%

Metabolomics Insights in Early Childhood Caries

et al. 2021

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“…The clinical exams in all ZOE phases followed a previously described standardized protocol (Ginnis et al, ) and were performed in EHS/HS centers during normal school hours. In brief, examination teams (three across the state of NC, in ZOE 2.0 Divaris & Joshi, , including seven clinical examiners) used portable equipment to conduct clinical examinations under field conditions. The examination was performed in the following sequence.…”

Section: Methodsmentioning

confidence: 99%

Traumatic dental injuries in preschool‐age children: Prevalence and risk factors

Born

Jackson

Koroluk

et al. 2019

Clinical & Exp Dental Res

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This study examined the prevalence, socio‐demographic correlates, and clinical predictors of traumatic dental injuries (TDIs) in the primary dentition among a community‐based sample of preschool‐age children. The sample comprised 1,546 preschool‐age children (mean age 49 [range: 24–71] months) in North Carolina public preschools, enrolled in a population‐based investigation among young children and their parents in North Carolina. Information on socio‐demographic, extraoral, and intraoral characteristics was collected and analyzed with bivariate and multivariate methods, including logistic regression modeling and marginal effects estimation. The prevalence of dental trauma was 47% and 8% of TDI cases were “severe” (pulp exposure, tooth displacement, discolored or necrotic tooth, or tooth loss). In bivariate analyses, overjet and lip incompetence were significantly associated with TDI. Overjet remained positively associated with severe trauma in multivariate analysis, OR = 1.4, 95% confidence interval (CI) [1.2, 1.6], corresponding to an absolute 1.3%, 95% CI [0.7, 1.8], increase in the likelihood of severe trauma, per millimeter of overjet. Children with increased overjet (>3 mm) were 3.8, 95% CI [2.0, 7.4], times as likely to have experienced severe TDI compared with those with ≤3 mm. Overjet is a strong risk factor for TDIs in the primary dentition. Incorporating and operationalizing this information may help TDI prevention and related anticipatory guidance for families of preschool‐age children.

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“…The data used for the research application and demonstration of SculptorHD were collected in the ZOE 2.0 pediatric oral health cohort, an IRB-approved (UNC-Chapel Hill IRB approval #14-1992) epidemiologic study of early childhood oral health in North Carolina (NC), United States [18,19]. The goal of ZOE 2.0 is to advance our understanding ECC and its multi-level determinants.…”

Section: Data Used For Clinical and Research Scenario Demonstrationsmentioning

confidence: 99%

A Web-Based Rendering Application for Communicating Dental Conditions

et al. 2021

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The importance of visual aids in communicating clinical examination findings or proposed treatments in dentistry cannot be overstated. Similarly, communicating dental research results with tooth surface-level precision is impractical without visual representations. Here, we present the development, deployment, and two real-life applications of a web-based data visualization informatics pipeline that converts tooth surface-level information to colorized, three-dimensional renderings. The core of the informatics pipeline focuses on texture (UV) mapping of a pre-existing model of the human primary dentition. The 88 individually segmented tooth surfaces receive independent inputs that are represented in colors and textures according to customizable user specifications. The web implementation SculptorHD, deployed on the Google Cloud Platform, can accommodate manually entered or spreadsheet-formatted tooth surface data and allows the customization of color palettes and thresholds, as well as surface textures (e.g., condition-free, caries lesions, stainless steel, or ceramic crowns). Its current implementation enabled the visualization and interpretation of clinical early childhood caries (ECC) subtypes using latent class analysis-derived caries experience summary data. As a demonstration of its potential clinical utility, the tool was also used to simulate the restorative treatment presentation of a severe ECC case, including the use of stainless steel and ceramic crowns. We expect that this publicly available web-based tool can aid clinicians and investigators deliver precise, visual presentations of dental conditions and proposed treatments. The creation of rapidly adjustable lifelike dental models, integrated to existing electronic health records and responsive to new clinical findings or planned for future work, is likely to boost two-way communication between clinicians and their patients.

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

Cited by 13 publications

References 17 publications

Metabolomics Insights in Early Childhood Caries

Metabolomics Insights in Early Childhood Caries

Traumatic dental injuries in preschool‐age children: Prevalence and risk factors

A Web-Based Rendering Application for Communicating Dental Conditions

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