Showing papers in "Journal of Public Health Dentistry in 2008"
TL;DR: The majority of studies have evaluated the effectiveness of water fluoridation on the permanent teeth of children, while there are fewer studies on deciduous teeth and in adults; the relationship between fluoride ingestion and bone health needs further clarification; the sociopolitical issues of fluoridation need to be better understood.
Abstract: The nearly 50-year history of community water fluoridation is reviewed with the major emphasis on the benefits and safety of fluoridation. Other aspects of water fluoridation also described include the apparent reduction in measurable fluoridation benefits because of the abundance of other fluoride sources, the diffusion of fluoridation effects into fluoride-deficient communities, preemptive and posteruptive effects, technical and cost aspects, sociopolitical and legal issues that affect the successful fluoridation of communities, and alternatives to community water fluoridation. The majority of studies have evaluated the effectiveness of water fluoridation on the permanent teeth of children, while there are fewer studies on deciduous teeth and in adults; the relationship between fluoride ingestion and bone health needs further clarification; the sociopolitical issues of fluoridation need to be better understood.
175 citations
TL;DR: The results show that children who have both poor oral health and general health are more likely to have poor school performance, and suggest that the improvement of children's oral health may be a vehicle to improve their educational experience.
Abstract: Objectives: The purpose of this study was to examine: a) the sociodemographic and health factors associated with poor school performance among North Carolina children; and b) the impact of poor oral health status on school performance while controlling for other health and sociodemographic factors. Methods: We used data from the 2005 Child Health Assessment and Monitoring Program, a follow-back telephone survey to the Behavioral Risk Factor Surveillance System involving parents/guardians of children 0 to 17. This project includes sections on oral health and school performance. Our principal outcome variable was school performance and our major explanatory variable was children's oral health status, based upon parental report. Results: Our sample consisted of 2,871 school children, weighted to reflect the North Carolina census. Bivariate analysis revealed that sex, race, parental education, low socioeconomic status, poor general health, poor oral health, and the interaction of poor oral health and general health were significantly related to school performance (P < 0.05). Logistic regression analysis demonstrates the effects of poor oral health and general health on school performance. Children with both poor oral health and general health were 2.3 times more likely to report poor school performance. Children with either poor oral health or general health were only 1.4 times more likely to report poor school performance. Conclusions: Our results show that children who have both poor oral health and general health are more likely to have poor school performance. Our findings suggest that the improvement of children's oral health may be a vehicle to improve their educational experience.
162 citations
TL;DR: There appears to be no significant association between childhood obesity and caries experience after controlling forage, race, and poverty/income ratio.
Abstract: Objective: This study assessed the associations between obesity and dental caries in young children participating in a national survey. Methods: Participants included 1,507 children aged 2-6 years who received dental examinations and had at least 10 primary teeth in the National Health and Nutrition Examination Survey 1999-2002. Decayed/filled teeth (dft) counts of primary dentition were obtained, and weight and height were measured. Body mass index (BMI; kg/m2) was calculated, and participants were categorized using age- and gender-specific criteria as underweight ( 85th and 5 dft. When caries experience was compared across BMI categories stratified by age and race characteristics, statistically significant association between caries and obesity was found only for 60- <72-month age group. In the comparison between children with normal and at-risk BMI only, significant associations were also found in the Hispanic and non-Hispanic Black strata. In multivariable logistic regression models to predict caries experience, family income and age were statistically significant predictors for severe early childhood caries only. Conclusions: There appears to be no significant association between childhood obesity and caries experience after controlling for age, race, and poverty/income ratio. However, further studies are needed to better understand this relationship.
138 citations
TL;DR: This report provides an overview of the 2003-04 NHANES oral health component including content descriptions and procedures for oral health assessments conducted for the first time in a national survey in the United States, and evaluations of data quality in terms of examiner reliability statistics.
Abstract: The oral health component for the National Health and Nutrition Examination Survey (NHANES) was changed in 2005 from an examination conducted by dentists to an oral health screening conducted by health technologists rather than dental professionals. The oral health screening included a person-based assessment for dental caries, restorations, and sealants. This report provides oral health content information and presents results of data quality analyses that include dental examiner reliability statistics for data collected during NHANES 2005-08. Oral health data are available on 15,342 persons aged 5 years and older representing the civilian, noninstitutionalized population of the United States who participated in NHANES 2005-08. Overall, interrater reliability findings indicate that health technologist performance was excellent with concordance between examination teams and the survey reference examiner being almost perfect for a number of assessments. Concordance for dental caries and sealants (kappa statistics) between health technologists and the survey reference examiner ranged from 0.82 to 0.90 for the combined 4-year period. These findings support the use of health technologists in the assessment of person-based estimators of dental caries and sealant prevalence as part of an oral health surveillance system.
129 citations
TL;DR: A strong association was found between mean GOHAI and MNA scores, which indicates that oral health-related quality of life in the elderly is affected by malnutrition risk.
Abstract: Objectives: This study examines whether oral health-related quality of life (OHRQoL) is associated with malnutrition risk in the elderly. Methods: A cross-sectional study was designed using a representative sample of Spaniards over 65 years old. Data on sociodemographics and oral health status were gathered by interview and examination. Oral health-related quality of life was evaluated using the Geriatric Oral Health Assessment Index (GOHAI), and malnutrition risk using the Mini Nutritional Assessment (MNA). Results: The final sample included 2,860 elderly, 41.7 percent males and 58.3 percent females, with a mean age of 73.7 ± 6.8 years. Mean GOHAI score was 52.1 ± 7.2, with 70.7 percent of the sample needing oral health care according to this index. The mean MNA score was 24.0 ± 3.31; 3.5 percent of the elderly were malnourished, 31.5 percent were at risk of malnutrition, and 65.0 percent were considered adequately nourished. A strong association was found between mean GOHAI and MNA scores.
95 citations
TL;DR: The study found that CAST services had a protective effect on children's oral health, which supports the recommendation that child protection services should investigate possible dental neglect in physical/sexual abuse and neglect cases.
Abstract: OBJECTIVE: The purpose of this study was to investigate the prevalence of early childhood caries (ECC) in a population of maltreated children in Toronto, Ontario, Canada. METHODS: The sample consisted of preschool-aged children (2 to 6 years) admitted to the care of the Children's Aid Society of Toronto (CAST) between 1991 and 2004. Data were collected by reviewing the dental and social workers' records of CAST ECC was determined using the decayed, missing, and filled deciduous teeth (dmft) index. The type and severity of maltreatment were obtained from the Eligibility Spectrum. RESULTS: The study included 66 children: 37 (56 percent) boys and 29 (44 percent) girls, with an average age of 4.1 years [standard deviation (SD) = 1.2]. Four (6 percent) children had evidence of dental injury, and none had teeth filled or extracted as a result of decay ECC was observed in 58 percent of the abused children. Of these, the mean decayed teeth ("dt") value was 5.63 (SD = 4.17, n = 38) and 3.24 (SD= 4.21) for the whole sample (n = 66). The proportion of children with untreated caries was 57 percent among "neglected" children (n = 53) and 62 percent in physically/sexually abused cases (n = 13). Logistic regression revealed that children in permanent CAST care and those in its care more than once were significantly less likely to have experienced caries. CONCLUSIONS: Abused and neglected young children had higher levels of tooth decay than the general population of 5-year-olds in Toronto (30 percent prevalence, mean dt= 0.42, SD = 1.20, n = 3185). However, this study did not find any difference in ECC prevalence between children with different types of maltreatment. The study did find that CAST services had a protective effect on children's oral health, which supports the recommendation that child protection services should investigate possible dental neglect in physical/sexual abuse and neglect cases. Language: en
83 citations
TL;DR: Differences between educational levels, ethnicities, and rural/urban location suggest that public health programs need to target the social settings in which financial burdens exist.
Abstract: Objective: This study aims to prospectively examine the trends and reasons for the underutilization of free semiannual preventive dental care provided to children with unmet dental needs who participated in the 5-year New England Children's Amalgam Trial. Methods: Children aged 6 to 10 at baseline (1997-99) with ≥2 posterior carious teeth were recruited from rural Maine (n = 232) and urban Boston (n = 266). Interviewer-administered questionnaires assessed demographic and personal characteristics. Reasons for missed appointments were recorded during follow-up and are descriptively presented. We used an ordinal logistic regression to analyze the utilization of semiannual dental visits. Results: On average, urban children utilized 69 percent of the visits and rural children utilized 82 percent of the visits. For both sites, utilization steadily decreased until the end of the 5-year trial. Significant predictors of underutilization in the multivariate model for urban children were non-White race, household welfare use, deep debt, and distance to dental clinic. Among the relatively less-diverse rural children, caregiver education level and a greater number of decayed tooth surfaces at baseline (i.e., need for care) were significantly associated with underutilization. Among all children, the common reasons for missed visits included guardian scheduling and transportation difficulties; reasons among urban participants also indicated a low priority for dental care. Conclusions: Among these children with unmet dental needs, the provision of free preventive dental care was insufficient to remove the disparities in utilization and did not consistently result in high utilization through follow-up. Differences between educational levels, ethnicities, and rural/urban location suggest that public health programs need to target the social settings in which financial burdens exist.
60 citations
TL;DR: Results suggest that not only microbial measures, including MS and plaque levels, are closely associated with caries in very young children, but that other age-related factors may also be associated with Caries.
Abstract: OBJECTIVES Dental caries in early childhood is an important public health problem. Previous studies have examined risk factors, but they have focused on children during the later stages of the disease process. The purpose of this study was to assess the factors associated with caries in children aged 6 to 24 months as part of a cross-sectional analysis. METHODS Two hundred twelve mothers with children 6 to 24 months of age were recruited from Special Supplemental Nutrition Program for Women, Infants, and Children clinic sites in southeastern Iowa for participation in a longitudinal study of dental caries. Baseline assessments included detailed questions regarding the children's beverage consumption, oral hygiene, and family socioeconomic status. Dental caries examinations using the d(1)d(2-3)f criteria and semiquantitative assessments of salivary mutans streptococci (MS) levels of mother and child were also conducted. Counts of the number of teeth with visible plaque were recorded for maxillary and mandibular molars and incisors. RESULTS Of the 212 child/mother pairs, 187 children had teeth. Among these children, the mean age was 14 months, and 23 of the children exhibited either d(1), d(2-3), or filled lesions. Presence of caries was significantly associated with older age, presence of MS in children, family income <$25,000 per year, and proportion of teeth with visible plaque. CONCLUSIONS Results suggest that not only microbial measures, including MS and plaque levels, are closely associated with caries in very young children, but that other age-related factors may also be associated with caries. Continued study is necessary to more fully assess the risk factors for caries prevalence and incidence in preschool children.
57 citations
TL;DR: The majority of children attending general dental practice remained caries-free and did not experience pain or extraction over 3 years, and it was unable to demonstrate that restoring carious primary molar teeth prevents pain and extraction.
Abstract: Objectives: To describe the occurrence of dental pain and extractions in young children in relation to the caries and restoration history of their primary molar teeth. Methods: A prospective cohort study of 739 children aged 2.8 to 6.2 years attending 50 dental practices in the North West of England followed for 3 years. Incidence rates for pain and extraction in primary molar teeth were calculated for children with and without dental caries. Tooth years at risk of extraction or pain were calculated for each primary molar according to whether they were caries-free, carious and unrestored, or restored. Results: A total of 119 (16.1 percent) children had caries at recruitment and 157 developed caries during follow-up. Each year approximately one in five children with caries, but only one in 100, who was caries-free, presented with dental pain. In the whole population, each year, approximately one in 40 children had a primary molar tooth extracted but in children with caries it was one in 10. In the total cohort, incidence of pain was higher in unrestored carious teeth than restored, but incidence of extraction was higher in restored than in unrestored teeth. Conclusion: The majority of children attending general dental practice remained caries-free and did not experience pain or extraction over 3 years. Children with caries had a substantial risk of developing pain or having an extraction. The study was unable to demonstrate that restoring carious primary molar teeth prevents pain and extraction.
56 citations
TL;DR: It is suggested that increasing dental workforce diversity to match the diversity of the general US population can potentially improve access to dental care for poor and minority Americans, and may serve as an important force in reducing disparities in dental care.
Abstract: Objectives: Medicaid enrollees disproportionately experience dental disease and difficulties accessing needed dental care. However, little has been documented on the factors associated with the acceptance of new Medicaid patients by dentists, and particularly whether minority dentists are more likely to accept new Medicaid patients. We therefore examined the factors associated with the acceptance of new Medicaid patients by dentists. Methods: We analyzed 2001 data from the Wisconsin Dentist Workforce Survey administered by the Wisconsin Division of Health Care Financing, Bureau of Health Information. We used descriptive statistics and logistic regression analysis to examine the factors associated with the outcome variable. Results: Ninety-four percent of Wisconsin licensed dentists (n = 4,301) responded to the 2001 survey. A significantly higher likelihood of accepting new Medicaid patients was found for racial/ethnic minority dentists (35 versus 19 percent of White dentists) and dentists practicing in large practices (31 versus 16 percent for those in smaller practices). In the multivariable analysis, minority dentists [odds ratio (OR) = 2.06, 95 percent confidence interval (CI) = 1.30, 3.25] and dentists in practices with >3 dentists (OR = 2.25, 95 percent CI = 1.69, 3.00) had significantly greater odds of accepting new Medicaid patients. Conclusions: Racial/ethnic minority dentists are twice as likely as White dentists to accept new Medicaid patients. Dentists in larger practices also are significantly more likely than those in smaller practices to accept new Medicaid patients. These findings suggest that increasing dental workforce diversity to match the diversity of the general US population can potentially improve access to dental care for poor and minority Americans, and may serve as an important force in reducing disparities in dental care.
48 citations
TL;DR: A thorough consideration of the factors that drive Hispanics' oral health care usage will aid US researchers and practitioners in improving this population's health and access to care.
Abstract: The need to study the health and health care determinants of US Hispanics is mandated by their rapid population growth. Nonetheless, it is challenging to study such a diverse population that incorporates many similarities and differences in values and experiences. This paper aims to highlight the factors that should be considered in Hispanic oral health research in the United States, and presents, in a theoretical framework, the relationships between these factors. The proposed ecological framework is supported by an extensive literature review, with an emphasis on the factors that are reported to differ among ethnic groups. It has a foundation in social science and is based on existing models from different fields of knowledge. To be comprehensive, the framework simultaneously addresses individual and environmental constructs. Within these, antecedent factors shape the intention to seek oral health care, while empowerment factors play a mediating role between intention and actual receipt of care. Individual antecedent factors incorporate risk markers, need, and predisposing factors. Environmental antecedent factors are represented by social constructs that allude to the population's health culture. Empowerment factors explain the level of control that a person perceives or the environment provides in receiving care. A thorough consideration of the factors that drive Hispanics' oral health care usage will aid US researchers and practitioners in improving this population's health and access to care.
TL;DR: A high prevalence of dental fluorosis was observed in Mexican adolescents residing in three naturally fluoridated locales at high altitudes above sea level, and such prevalence is considered to be a dental public health problem.
Abstract: Objective: The purpose of this study was to determine the prevalence and severity of dental fluorosis in Mexican adolescents. Materials and Methods: A cross-sectional epidemiological study was carried out in 1,024 adolescents 12 and 15 years old residing in three naturally fluoridated locales at high altitudes above sea level (>2,000 m or >6,560 ft) in Tula de Allende, Hidalgo, Mexico. Participants had lived in those communities from birth to their sixth birthday. Both the Modified Dean Index and the Community Fluorosis Index were calculated. Results: The overall fluorosis prevalence was 83.8 percent. Fluorosis prevalence in El Llano (3.07 ppmF), San Marcos (1.38 ppmF), and Tula Centro (1.42 ppmF) was 94.7, 89.8, and 81.9 percent, respectively. Overall, the Community Fluorosis Index was 1.85. We observed a high prevalence of dental fluorosis ‐ mostly very mild (35.9 percent), but also uncommonly severe (20.6 percent). Conclusions: At least 8 out of 10 adolescents had some level of fluorosis, and such prevalence is considered to be a dental public health problem. A relationship between fluoride concentration in water in each community and fluorosis was observed. The high fluorosis prevalence and severity might possibly be associated with the high altitude of the communities.
TL;DR: The level of school absence for dental-related conditions and care was low per child but cumulatively was considerable; the time missed because of dental reasons was substantially less than the time missing because of other health and social reasons.
Abstract: Objectives: To assess the number of school hours missed for dental reasons per 1,000 grade 5 primary school children in 1 school year and compare dentally related school absences with those related to medical and social reasons. Methods: A longitudinal study using a multistage sampling technique was carried out on a sample of 1,211 children attending schools in Lampang province, Thailand. Data on absence were collected from daily school attendance records for 1 year and from children and parents questionnaires and school dental clinic records. Clinical examinations were done using the World Health Organization criteria. Results: A total of 1,158 children (response rate: 95.7 percent) aged 9 to 13 years were examined and returned completed questionnaires. Their caries level was relatively low (DMFT 1.4 +/- 1.7). The children (22.5 percent) reported school absence for any dental reason. The mean number of hours of school absence per year for dental care was 434 hours per 1,000 children (613 hours per 1,000 children when dental screening was included). Among those who actually missed school for dental reasons, the numbers of hours missed were 1,923 hours per 1,000 children. Conclusions: The level of school absence for dental-related conditions and care was low per child but cumulatively was considerable. The time missed because of dental reasons was substantially less than the time missed because of other health and social reasons.
TL;DR: Immigrant caregivers' mistaking of the baby bottle's nipple as the source of decay indicates the need for more effective oral health promotion and the Mexican immigrants' conceptions of a lack of calcium as a major factor in their children's decay may illustrate a strong cultural link between teeth and milk.
Abstract: Objective: The aim of this study was to examine Latino immigrant caregivers’ explanatory models of the causes of early childhood caries (ECC) Methods: In a rural area, we conducted 71 open-ended qualitative interviews with 26 Mexican immigrant and 12 Salvadoran immigrant caregivers of children under 6 about the causes of ECC Two researchers independently read each interview and classified each interviewee’s response Results: Caregivers mentioned three biomedical causes of oral disease (sweets, poor oral hygiene, and bottle-feeding) and two lay or popular causes (lack of milk consumption and “bad” genes) Although caregivers were aware that the consumption of sweet foods causes decay, they expressed particular confusion about how bottle-feeding causes decay Nineteen caregivers attributed decay specifically to bottle-feeding, yet 14 believed the cause of decay was the bottle’s nipple Seven Mexican immigrant caregivers attributed their children’s decay specifically to a lack of calcium, and six immigrant caregivers to “bad teeth genes” Conclusions: Conceptions of oral disease derived from the caregivers’ own dental experiences, their conceptions of the body, and interactions with dental professionals The fact that biomedical explanations dominate the list of causes of caries for both groups indicates that the caregivers’ explanatory models of oral disease are powerfully shaped by interactions with health professionals Immigrant caregivers’ mistaking of the baby bottle’s nipple as the source of decay indicates the need for more effective oral health promotion Yet the Mexican immigrants’ conceptions of a lack of calcium as a major factor in their children’s decay may illustrate a strong cultural link between teeth and milk
TL;DR: There appears to be a trend toward a higher prevalence of incipient and overt periodontal disease among Native Americans over time, and it appears that the prevalence of Periodontal Disease Among Native Americans is increasing.
Abstract: Objective The primary purpose of this paper is to provide information on the periodontal disease status of Native Americans using a variety of data sources. The impact of periodontal disease on the provision of dental care within the Indian Health Service (IHS) is also discussed. Methods Four data sources were used to evaluate the periodontal disease status of Native Americans: IHS periodontal disease monitoring system (1962-78), 1984 IHS Patient Oral Health Survey, 1990 WHO community-based survey (ICS-II), and the 1991 IHS Patient Oral Health Survey. Results There appears to be a trend toward a higher prevalence of incipient and overt periodontal disease among Native Americans over time. The prevalence of overt periodontal disease (periodontal pockets > 5.5 mm) is higher among Native American diabetic patients than nondiabetic patients (34% vs 19%). Conclusions Due to the variety of indices used by the IHS during the last 20 years, it is difficult to make direct comparisons of the available periodontal disease data. However, it appears that the prevalence of periodontal disease among Native Americans is increasing. Type II diabetes accounts for significant increases in periodontal disease and tooth loss in Native American populations. Certain forms of early onset periodontal disease also may pose significant threats to the oral health of Native Americans.
TL;DR: Prevalent disparities in the unmet dental needs of the immigrants' children were quickly ameliorated during participation in the 5-year New England Children's Amalgam Trial (NECAT).
Abstract: Objectives: Previous research shows increased dental decay among immigrants, but little is known about the oral health of the growing population of children of immigrants. We compared the children of immigrants to the children of US-born caregivers in their caries experience at enrollment and their new caries increments during the 5-year New England Children's Amalgam Trial (NECAT).
Methods: NECAT recruited 283 Boston-area children aged 6 to 10 with untreated caries and offered free semiannual preventive and restorative dental care during the trial. Sociodemographic factors and caregiver immigrant status were assessed through interviews. Multivariate negative binomial models evaluated the association between caregiver immigrant status and clinically assessed carious surfaces.
Results: Forty percent of these Boston-area children had immigrant caregivers. At baseline, the children of immigrants had more carious surfaces (11.5 versus 9.4, adjusted for race/ethnicity, age, gender, and caregiver smoking status). Caregiver language preference explained some of this association. Immigrant status and language preference were not associated with 5-year caries increments.
Conclusions: Prevalent disparities in the unmet dental needs of the immigrants' children were quickly ameliorated during participation in NECAT. Dental initiatives that target neighborhoods and are sensitive to acculturation levels may help improve and maintain the oral health of immigrant families.
TL;DR: Preliminary evidence of the sensitivity to change of the COHQoL questionnaires when used with children receiving orthodontic treatment is provided, however, the study needs to be repeated in different treatment settings and with a larger sample size in order to confirm the utility of the measure.
Abstract: Objective: This study aimed to assess the ability of the Child Oral Health Quality of Life Questionnaire (COHQoL) to detect change following provision of orthodontic treatment. Methods: Children were recruited from an orthodontic clinic just prior to starting orthodontic treatment. They completed a copy of the Child Perception Questionnaire, while their parents completed a copy of the Parents Perception Questionnaire and the Family Impact Scale. Normative outcomes were assessed using the Dental Aesthetic Index (DAI) and the Peer Assessment Rating (PAR) index. Change scores and effect sizes were calculated for all scales. Results: Complete data were collected for 45 children and 26 parents. The mean age was 12.6 years (standard deviation = 1.4). There were significant pre-/posttreatment changes in DAI and PAR scores and significant changes in scores on all three questionnaires (P < 0.05). Effect sizes for the latter were moderate. Global transition judgments also confirmed pre-/posttreatment improvements in oral health and well-being. Conclusion: The results provide preliminary evidence of the sensitivity to change of the COHQoL questionnaires when used with children receiving orthodontic treatment. However, the study needs to be repeated in different treatment settings and with a larger sample size in order to confirm the utility of the measure.
TL;DR: A community health partnership led to a successful and sustainable model extending care to pregnant women and is being extended to promote preventive care for both new mothers and their offspring.
Abstract: Objective: This paper describes a community-based intervention to provide a dental home for women covered by Medicaid in Klamath County, Oregon. In 2001, 8.8 percent of pregnant women served by Medicaid in Oregon received care. The long-term goal of the program is to promote preventive oral care for both mothers and their new infants. Methods: Pregnant women received home/Women, Infant and Children visits and were assigned a dental home under a dental managed care program [Dental Care Organization (DCO)]. All initial care was provided at the Oregon Institute of Technology Dental Hygiene Clinic under the contract with the DCO. Emergency, preventive, and restorative care was provided. Results: Between February 2004 and January 2006, 503 pregnant women were identified; 421 women were contactable. Of these, 339 received home visits (339/421, 80.5 percent) and 235 received care (235/339, 69.3 percent). Overall, 55.8 percent of eligible women received care (235/421). Most who did not have a visit either moved or were not the caretaker of the baby. The missed appointment rate was 9 percent. Conclusion: A community health partnership led to a successful and sustainable model extending care to pregnant women and is being extended to promote preventive care for both new mothers and their offspring.
TL;DR: Dental faculty conducting clinical research investigations should be cognizant of the fact that a portion of adults, especially older adults, may have difficulty reading written instructions, informational letters of consent, prescriptions, and other documents.
Abstract: Objective: The purpose of this investigation was to gather data concerning the level of health literacy in adults who frequently volunteer for our clinical research programs. Methods: A convenience sample of 99 adults was recruited from our database of subjects taking part in an ongoing series of investigations. Health literacy was measured using the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Additional demographic and socioeconomic data were collected by means of a questionnaire. Results: The results indicated that 13 percent of the cohort of subjects scored in the “inadequate” or “marginal” categories as described by the criteria of the S-TOFHLA. Inadequate or marginal health literacy was associated with race, gender, and age. Unfortunately, the sample size was too small to determine the interaction of these variables. Conclusions: Dental faculty conducting clinical research investigations should be cognizant of the fact that a portion of adults, especially older adults, may have difficulty reading written instructions, informational letters of consent, prescriptions, and other documents. Researchers should make every effort to ensure that information provided in text form is provided in a manner that is easily understandable to the reader. Technical terminology and jargon should be avoided or if used, it should be explained in plain, simple language. If a potential subject is having difficulty, the investigator is obligated to take the additional time to educate the potential subject using alternative methods.
TL;DR: Findings from the 1991 IHS patient survey indicate that Native Americans experience a much higher prevalence of dental caries in their primary and permanent dentitions than the general US population.
Abstract: Objectives This paper reports findings from the 1991 IHS Patient Oral Health Status and Treatment Needs Survey (1991 IHS patient survey) and presents trends in caries among American Indian and Alaska Native (Native American) populations since 1957. Methods The 1991 IHS patient survey obtained data from approximately 10 percent (25,000) of the dental patients seen annually at IHS, tribal, and urban Indian clinics. The results of this survey are compared descriptively with previous surveys conducted by the IHS beginning in 1957. Results Findings from the 1991 IHS patient survey indicate that Native Americans experience a much higher prevalence of dental caries in their primary and permanent dentitions than the general US population. However, caries rates in Native American children peaked in 1983-84 and have been going down since that time. Conclusions While progress has been made in preventing dental caries among Native Americans, the high prevalence and severity at all ages in this rapidly growing population have resulted in a large backlog of untreated disease with an overwhelming demand on the resources available to provide care. Continued emphasis on dental caries prevention and health promotion is an important part of the solution. New strategies such as targeting preventive services toward individuals and groups with the highest risk of disease and the use of modern conservative treatment methods to control disease must be employed. Full implementation of these strategies and identification of the resources required will depend upon new and ongoing partnerships among tribes, federal and state governments, and the private sector.
TL;DR: Results indicate that families who agree to participate in programs offering reduced cost or free dental care may present with varying amounts of dental need based on geographic location.
Abstract: Objectives: To compare the prevalence of caries between rural and urban children with unmet dental health needs who participated in the New England Children's Amalgam Trial.
Methods: Baseline tooth and surface caries were clinically assessed in children from rural Maine (n = 243) and urban Boston (n = 291), who were aged 6 to 10 years, with two or more posterior carious teeth and no previous amalgam restorations. Statistical analyses used negative binomial models for primary dentition caries and zero-inflated models for permanent dentition caries.
Results: Urban children had a higher mean number of carious primary surfaces (8.5 versus 7.4) and teeth (4.5 versus 3.9) than rural children. The difference remained statistically significant after adjusting for sociodemographic factors and toothbrushing frequency. In permanent dentition, urban children were approximately three times as likely to have any carious surfaces or teeth. However, rural/urban dwelling was not statistically significant in the linear analysis of caries prevalence among children with any permanent dentition caries. Covariates that were statistically significant in all models were age and number of teeth. Toothbrushing frequency was also important for permanent teeth.
Conclusions: Within this population of New England children with unmet oral health needs, significant differences were apparent between rural and urban children in the extent of untreated dental decay. Results indicate that families who agree to participate in programs offering reduced cost or free dental care may present with varying amounts of dental need based on geographic location.
TL;DR: This study shows that lesions are more common in patients with advanced immune suppression and low level of schooling, and their relationship to immunologic, sociodemographic, and therapeutic factors is investigated.
Abstract: Objectives: We investigated the oral manifestations of HIV-infected patients in Salvador, Brazil, and their relationship to immunologic, sociodemographic, and therapeutic factors. Methods: This was a cross-sectional study that used data from adult patients’ medical records in the dentistry service of the AIDS Reference Center in Salvador, Brazil. We reviewed the patients’ records to collect information concerning oral health status and data on socioeconomic status, immunologic status, and treatment. Results: A total of 993 patients were included in the study, of whom 473 (47.6 percent) were male. Approximately 5.5 percent of the patients presented with any oral lesions. Oral lesions were the most common in the patients with fewer than 350 CD4+ T lymphocytes (8.4 percent) and with viral loads greater than 10,000 copies (8.3 percent). Conclusions: Our study shows that lesions are more common in patients with advanced immune suppression and low level of schooling. Oral candidiasis and angular chelitis were the most common lesions seen.
TL;DR: Women with diabetes are underutilizing dental care services, which may be a result of the barriers to dental care that disproportionately affect women, and additional research should test the plausibility of these explanations.
Abstract: Objectives Regular dental assessments are beneficial to adults with diabetes. This analysis evaluates nationally representative data to test the relation between diabetes status and dental care visits, and to compare diabetes care, foot care, eye care, and dental care visits among dentate adults with diabetes. Methods Data from the 2003 National Health Interview Survey were used to test whether diabetes status was associated with dental care visits among dentate adults aged > or =25 years, controlling for available covariates. Results There was a significant interaction between diabetes status and sex for the odds of having a dental care visit. Among dentate men, there was no significant association between diabetes status and dental care visits. Dentate women with diabetes were significantly less likely to have had a dental care visit than were dentate women without diabetes. Of the four types of health care visits compared, dentate adults with diabetes were least likely to have had a dental care visit in the preceding year. Disparities in health care visit rates across race/ethnicity, poverty status, and education categories were most pronounced for dental care. Conclusions Having diabetes is associated with a variety of adverse health outcomes, including periodontitis. Adults with diabetes would benefit from regular health care visits to address these concerns, but this report shows that women with diabetes are underutilizing dental care services. The underutilization may be a result of the barriers to dental care that disproportionately affect women. Additional research should test the plausibility of these explanations and the influence of sex.
TL;DR: Various predisposing, enabling, and oral health needs variables were associated with higher dental health services utilization in Nicaragua, confirming that utilization inequalities exist between socioeconomic groups.
Abstract: Objective: To determine the factors associated with the dental health services utilization among children ages 6 to 12 in Leon, Nicaragua. Material and Methods: A cross-sectional study was carried out in 1,400 schoolchildren. Using a questionnaire, we determined information related to utilization and independent variables in the previous year. Oral health needs were established by means of a dental examination. To identify the independent variables associated with dental health services utilization, two types of multivariate regression models were used, according to the measurement scale of the outcome variable: a) frequency of utilization as (0) none, (1) one, and (2) two or more, analyzed with the ordered logistic regression and b) the type of service utilized as (0) none, (1) preventive services, (2) curative services, and (3) both services, analyzed with the multinomial logistic regression. Results: The proportion of children who received at least one dental service in the 12 months prior to the study was 27.7 percent. The variables associated with utilization in the two models were older age, female sex, more frequent toothbrushing, positive attitude of the mother toward the child’s oral health, higher socioeconomic level, and higher oral health needs. Conclusion: Various predisposing, enabling, and oral health needs variables were associated with higher dental health services utilization. As in prior reports elsewhere, these results from Nicaragua confirmed that utilization inequalities exist between socioeconomic groups. The multinomial logistic regression model evidenced the association of different variables depending on the type of service used.
TL;DR: Social inequalities across age among the very old individuals in relation to dental caries experience were identified, with older adults with low education, low occupational status, and poor income tended to have more active dentalCaries compared to their counterparts.
Abstract: Objectives: The purpose of this study was to analyze the life-course effects of education, occupation, and income at ages 70, 75, 80, and 85 years, respectively, on dental caries experience of 85-year-olds.
Methods: The present study includes follow-up data from a population-based study, which comprised a sample of 176 individuals aged 85 years. Data on social position were collected at ages 70, 75, 80, and 85 years by means of structured personal interviews. Clinical oral health examinations were conducted to obtain data on dental caries at age 85. Dental caries was recorded at tooth surface level and caries experience was expressed by the DMF Index: the decayed tooth surfaces (D component), missing tooth surfaces (M component), and filled tooth surfaces (F component).
Results: The participants in the present study demonstrated a high level of dental caries experience; the prevalence rate for active dental caries (D-S) was 80 percent. Older adults with low education, low occupational status, and poor income tended to have more active dental caries compared to their counterparts. In contrast, individuals with high education (F-S = 35.5) and high occupational status (F-S = 36.0) had significantly more filled surfaces than persons with low education (F-S = 24.0) and low occupational status (F-S = 25.6). Individuals with high income at ages 75, 80, and 85 years had more filled surfaces (F-S = 31.9, 33.2, 34.1) compared to persons with low income (F-S = 25.5, 23.5, 22.8).
Conclusion: The study identified social inequalities across age among the very old individuals in relation to dental caries experience.
TL;DR: There was significant improvement in homeless veterans' perception of their oral health after receiving dental care and the impact that oral disease and treatment have on self-assessed quality of life.
Abstract: Objective The aim of this study was to assess homeless veterans' perception of their oral health and the impact that oral disease and treatment have on self-assessed quality of life. Methods Outcomes included measures of general and oral-specific quality of life and functional status. Single-item self-report of oral health and the General Oral Health Assessment Index were assessed at baseline and after treatment. Results One hundred and twelve veterans completed the baseline questionnaire, and 48 completed the follow-up. Veterans who were eligible for ongoing dental care had improved General Oral Health Assessment scores, while patients who received only emergency dental care saw a decreased score (2.46 versus -2.12). General Oral Health Assessment improvement was significantly related to fewer teeth at baseline (18 versus 23), a lower baseline General Oral Health Assessment (23.6 versus 28.1), having a denture visit (22 versus 35 percent), and improvement in self-reported oral health (25 versus 42 percent). Conclusion There was significant improvement in homeless veterans'perceived oral health after receiving dental care.
TL;DR: Parental abscess and parent's report of the child's oral health-related OOL are risk indicators for poor oral health outcomes that could be used by nondental personnel to identify young children in need of early preventive intervention and dental referral.
Abstract: Objectives: To identify the predictors of early childhood caries and urgent dental treatment need among primarily African-American children in child care centers in the Delta region of Mississippi. The purpose of this study was to replicate predictors of caries and urgent dental treatment needs that were identified in an earlier study conducted in Delta child care centers and to assess additional caries risk factors not collected in the original study.
Methods: Children in 19 child care centers were examined by the dentists, and the parents provided data on oral health practices, oral health history, and on children's oral health-related quality of life (QOL). The dentists also assessed visible plaque and tested levels of mutans streptococci. Predictors of caries and treatment need among children 24 to 71 months of age were examined using logistic regression.
Results: Two parent predictors of caries identified in the earlier study (parent flossing and soft/sugary drink consumption) were not predictive in the current study. Parent history of abscess continued to predict their child's urgent need for treatment. Young children's level of salivary mutans streptococci, maxillary incisor visible plaque, and parents' reports of child oral health-related QOL measures predicted the presence of both caries and urgent treatment need. Some expected predictors, such as frequency of child's toothbrushing, were not predictive of caries.
Conclusions: Parental abscess and parent's report of the child's oral health-related QOL are risk indicators for poor oral health outcomes that could be used by nondental personnel to identify young children in need of early preventive intervention and dental referral.
TL;DR: In this article, the authors compared the treatment result and compliance for orthodontic Medicaid patients with non-Medicaid patients of similar initial severity and found no clinically important differences were seen between the two groups with respect to initial PAR, final PAR, percent PAR reduction, broken appointments, broken appliances, or poor oral hygiene.
Abstract: Treatment result and compliance for orthodontic Medicaid patients were assessed and compared to non-Medicaid patients of similar initial severity. All 55 North Carolina practices providing orthodontic treatment covered by Medicaid were asked to submit their last five Medicaid cases and five non-Medicaid cases of similar initial treatment complexity. Nine practices agreed to participate. Initial models, final models, and progress notes were obtained for all subjects. Casts were scored using the Peer Assessment Rating (PAR) Index to assess initial and posttreatment orthodontic status, and progress notes were reviewed for compliance data. No clinically important differences were seen between the Medicaid and non-Medicaid groups with respect to initial PAR, final PAR, percent PAR reduction, broken appointments, broken appliances, or poor oral hygiene. In this study, Medicaid and non-Medicaid patients did not differ substantially with respect to effectiveness of treatment received or their compliance with treatment.
TL;DR: The addition of fluoride to public water supplies was an important ally in the improvement of the oral health of Baixo Guandu inhabitants.
Abstract: Objectives: This study aimed to verify the dental caries prevalence in Baixo Guandu, the first Brazilian city to fluoridate its public water supplies; to compare the findings with the data from the national survey; and also to compare the prevalence in the 12-year-old age group with the data obtained before the beginning of the fluoridation. Methods: All the lifetime residents aged 5, 12, 15 to 19, and 35 to 44 years old were clinically examined (World Health Organization). Results: The means of dmft/DMFT were lower than in the Brazilian population living in fluoridated communities. The DMFT Index in 12-year-old residents decreased between 1953 and 2005 from 8.61 to 1.55. Conclusions: The addition of fluoride to public water supplies was an important ally in the improvement of the oral health of Baixo Guandu inhabitants.
TL;DR: Routine examination of the mouth by primary care providers as part of a physical examination would provide the best opportunity for improving the low oral cancer examination rates in minority populations.
Abstract: Objectives: This study documents the level of oral cancer awareness and examination among New York State adults and evaluates the determinants of disparities in oral cancer detection. Methods: The 2003 New York State Behavioral Risk Factor Surveillance System gathered information on current awareness of oral cancer and receipt of oral cancer examination from 5,544 adults. To assess whether the racial/ethnic factor remains important for the awareness, receipt, and source of oral cancer examination after controlling for other socioeconomic and health care access variables, bivariate and multiple logistic regression analyses were conducted using SAS and SUDAAN. Results: Even though a majority of State adults (80.4 percent) had heard about oral cancer, about three-quarters of these adults (74.3 percent) had never heard about an oral cancer test or examination. Only 35 percent of the adults reportedly received an oral cancer examination in their lifetime. Adults with Hispanic origin were less likely to have heard about and received an oral cancer examination. Regarding the source of the examination, some 72 percent of the examinations were conducted by a dental professional; the remaining 28 percent were performed by a physician, nurse, or nurse practitioner. Non-Hispanic Blacks were more likely to have received an oral cancer examination from health care providers other than a dentist or dental hygienist. Conclusions: These data suggest the need to improve the oral cancer awareness and examination rate in New York State. Routine examination of the mouth by primary care providers as part of a physical examination would provide the best opportunity for improving the low oral cancer examination rates in minority populations.