Exploring tooth survival using Bayesian spatial models Caries and severe periodontal disease eventually lead to tooth loss, and this remains a major public health burden in the US. Future dental treatment plans will benefit from development of advanced statistical methods to integrate efficient risk assessment and short-term prediction of tooth loss. Dental datasets come with many interesting statistical challenges which severely limit the potential of currently available methods. In addition to tooth-within-mouth clustering, the times to events are spatially dependent, non-stationary (varying with tooth-locations), and experience heavy censoring. These factors also complicate the interpretation of clinical findings, which are needed at the conditional (subject-level) and the marginal (population) levels. Currently available statistical methods might handle some, but not all of these within an unified paradigm. Goals: Using a Bayesian framework, the proposed study will assess and monitor dental disease status of a population of interest and identify covariates associated with tooth- loss leading to efficient short-term prediction. Subjects: The statistical methods will be initially evaluated on a dataset of about 100 dentate subjects from the McGuire and Nunn data who were monitored at a private dental practice in the Houston area for about 16 years. For generalizability, the methods will be tested on a 4-year longitudinal database consisting of about 16,500 patients collected at Creighton University. Study design: A clustered-longitudinal study design with time to event endpoint comprises the databases that recorded age, gender, race, complete restorative and periodontal records with follow-up, smoking status, diabetes status, oral hygiene, and other essential parameters. Significance: The current project will provide new knowledge to unravel the complex covariate-response relationship that determines tooth loss, and can be easily generalized to other dental datasets. The long-term goal is to be able to achieve accurate predictive inference on tooth survival enabling dental practitioners to develop cost-effective dental treatment plans.
This proposed research has the potential to exert tremendous impact from a dental public health perspective because it combines the various complexities of available dental time-to-event data within a unified paradigm to study complex covariate-response relationships determining tooth-loss. The long term goal is to bridge the gap between academic dental basic science researchers and practitioners who can rely on accurate predictive inference on tooth survival to develop cost-effective treatment plans.
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