bluuebunny/crossref_metadata_2025 huggingface dataset:
General Health Status and Changes in Chewing Ability in Older Canadians over Seven Years
Authors: Locker David , Matear David , Lawrence Herenia
Published: May 2007

Objectives: The purpose of this study was to describe the onset of and recovery from chewing problems in an older adult population over a seven‐year period and to describe factors associated with these changes. Of particular interest was the relationship between general health and changes in oral functioning‐ Methods: The data came from a longitudinai study of community‐dwelling individuals who were aged 50 years and older when first recruited. Data were collected at baseline (n=907) and at three (n=611) and seven‐year (n=425) follow‐ups. Oral function was assessed by means of a six‐item index of chewing ability. Data were weighted to account for loss to follow‐up using weights derived from the seven‐year response proportions for dentate and edentulous subjects. Logistic regression analysis using backward stepwise selection was used to identify. predictors of onset and recovery. Results: At baseline, 25 percent of subjects reported a problem chewing. This rose to 26 percent at three years and 34 percent at seven years. The seven‐year incidence of chewing dysfunction was 19 percent. Of those with a chewing problem at baseline, 21 percent did not have a problem at seven years. A logistic regression model predicting the seven‐year incidence of chewing problems indicated that subjects aged 65 years or older, the edentulous, those rating their oral health as poor, those without dental insurance and those without a regular source of dentai care were more likely to be an incident case. In addition, a variable denoting the number of chronic medical conditions at baseline also entered the model. A logistic regression model predicting recovery indicated that older subjects, the edentulous, those from low‐income households, and those with limitations in activities of daily living were less likely to recover over the observation period. Conclusion: The results of this study indicate a marked increase in the prevalence of chewing problems in this older adult population over the seven‐year observation period. Poorer general health at baseline increased the probability of the onset of a chewing problem and decreased the probability of recovery.
Oral Health and Use of Dental Services Among Hispanics
Authors: Stewart Denice C. L. , Ortega Alexander N. , Dausey David , Rosenheck Robert
Published: May 2007

Objectives: This study examined factors related to oral health and dental service use among Mexican‐Americans, Cuban‐Americans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey, 1982–84 (HHANES). Methods: Categorical measures of oral health were created: (1) perceived oral health status, (2) evaluated oral health status, (3) decayed permanent teeth, (4) teeth missing due to caries, (5) total permanent teeth present, and (6) periodontal classification. The effects of acculturation, education, dental insurance, and perceived condition of teeth and gums on dental service use in the past two and five years were examined using logistic regression. All analyses were performed separately for each of the three samples using SAS‐callable SUDDAN. Results: Dental insurance and education were the most important factors in determining use of dental cleanings and use of dental care. For Mexican‐Americans, Cuban‐Americans, and Puerto Ricans, acculturation was a factor in determining use of dental care in the past five years. Conclusions: While dental insurance and education appear to be the most important factors for determining both use of dental cleaning services and use of dental care in all three samples, acculturation also had some impact for determining use of dental care.
Periodontitis in the United States: Beyond Black and White
Authors: Borrell Luisa N. , Burt Brian A. , Gillespie Brenda W. , Lynch John , Neighbors Harold
Published: May 2007

Objectives: This paper examines whether historical disparities in periodontal status between African Americans and whites in the United States have increased, decreased, or remained the same over the 15‐year period between the First National Health and Nutrition Examination Survey (NHANESI,1971–74) and the Third National Health and Nutrition Examination Survey (NHANES III, 1988–94). Methods: This study compared the magnitude of the relative and absolute differences in the periodontal status of African‐American and white adults in NHANES I and again in NHANES III. Results: The prevalence of periodontitis in the US adult population in NHANES I was 31.6 percent, with African Americans exhibiting higher prevalence than whites. In NHANES Ill, using a different case‐definition for periodontitis, the overall prevalence was 11.9 percent, with African Americans again exhibiting higher prevalence than whites. The magnitude of the intrasurvey relative and absolute differences between African Americans and whites increased between NHANES I and NHANES III. This finding remained after adjustment in the logistic regression analyses. After adjustment for all covariates in the model, African Americans were more likely to exhibit periodontitis than whites in both NHANES I (odds ratio [OR]=1.31; 95% confidence intervals [CI]=.78, 2.19) and NHANES Ill (OR=2.09; 95% CI=1.68, 2.60). However, the CI included 1.00 in NHANES 1. Conclusions: Disparities in pendontitis between African Americans and whites are pervasive and have increased over time. This increase appears to be driven by social, cultural, and behavioral factors.
Dental Caries in the Primary Dentition: Assessing Prevalence of Cavitated and Noncavitated Lesions
Authors: Warren John J. , Levy Steven An. , Kanellis Michael J.
Published: May 2007

Background: Dental caries in the primary dentition has received renewed attention in recent years because caries in the primary dentition is predictive of later canes experience, and because of efforts to address early childhood caries. More detailed caries diagnostic criteria have been developed and used for the permanent teeth; however, such criteria have not been widely adopted for caries diagnosis in the primary dentition. Methods: As part of the Iowa Fluoride Study, caries diagnostic criteria were developed specifically for the primary teeth. The criteria included noncavitated (d1) lesions and cavitated (d2–3) lesions. Examinations were conducted on 698 children in the primary dentition by two trained examiners who did duplicate examinations on 11 percent (n=67) of these children. Results: Interexaminer agreement for any dl and any d2–3 lesions at the person level was 100 percent. At the tooth level for d1d2–3 there was 98.5 percent agreement and kappa was .91. For d1 at the tooth level, agreement was 97.0 percent agreement and kappa=.24. For d2–3 it was 99.4 percent agreement and kappa=.81. Prevalence of untreated d2–3 was 16.5 percent, while that of d1 was 24.1 percent. Nearly 73 percent had no d2–3 or filled surfaces, while over 63 percent had no (d1, d2–3, or filled surfaces. Decay experience was most common on the primary second molars. About 56 percent of untreated d2–3 decay was located in the pits and fissures, while 58 percent of d1 decay was located on smooth surfaces. Conclusion: Despite some concern with reliability of diagnosing dl lesions, it appears that the d1d 2–3 criteria are informative and useful in assessing the primary dentition.
Validation of Self‐reported Periodontal Measures Among Health Professionals
Authors: Joshipura Kaumudi J. , Pitiphat Waranuch , Douglass Chester W.
Published: May 2007

Objective: The objective of this study was to determine the validity of self‐reported periodontal measures among nondentist health professionals. Valid self‐reported measures could provide a time‐ and cost‐efficient alternative for large epidemiologic studies. Methods: A subsample of 212 male nondenfists sampled on the basis of their reported periodontal severity from the Health Professional Follow‐up Study (HPFS) provided dental radiographs and completed questionnaires assessing self‐reported oral health. Alveolar bone loss was evaluated from the radiographs at 32 posterior sites and used as the standard measure of cumulative periodontal disease. Results: The self‐reported ordinal periodontal measure had a linear relationship with mean radiographic bone loss (r=.61). The positive and negative predictive values of the dichotomized self‐reported periodontal measures were 83 percent and 69 percent. Self‐reported history of periodontal surgery was also a good surrogate for bone loss (predjctjve value positive 78 percent and negative 71 percent). Conclusions: Self‐reports can provide discrimination and ranking information of cumulative periodontal disease among health professionals and can be used to provide valid results in etiologic studies in health professionals' populations.
Validation of Self‐reported Oral Health Measures
Authors: Pitiphat Waranuch , Garcia Raul I. , Douglass Chester W. , Joshipura Kaumudi J.
Published: May 2007

Objectives: To assess the validity of self‐reported oral disease and health care measures in two populations. Methods: Telephone interviews were conducted among a subsample of participants in the VA Dental Longitudinal Study (VADLS) asking them about periodontal disease status and treatment. Radiographic alveolar bone loss evaluated at all the interproximal sites was used as the standard. A separate study was carried out among first‐time patients at the Harvard School of Dental Medicine (HSDM) student clinic. Self‐reported measures were obtained by a self‐administered questionnaire and compared with clinical and radiograph examinations. The measures used were based on published work that demonstrated good validity of self‐reported periodontal measures among health professionals. Results: Among 145 VADLS participants, self‐reports of periodontal disease showed a good specificity (59.8%‐90.7%), but low sensitivity (17.7%‐64.7%). Among 58 HSDM patients, the self‐reported numbers of remaining teeth, fillings, root canal therapy, and prosthesis were strongly correlated with clinical records (r=0.74‐1.0); self‐report was less accurate for measures of periodontal disease (r=0.56) and decayed teeth (k=0.47). Conclusions: Self‐reports provide reasonably valid estimates for numbers of remaining teeth, fillings, root canal therapy, and fixed and removable prostheses. However, they appear to be less useful for the assessment of dental caries and periodontal disease in the two populations we have studied. There remains a need and potential to further develop self‐report oral health measures that are valid for use in large population studies. Such self‐report measures would yield great cost and time savings.
The Association Between Viadent® Use and Oral Leukoplakia—Results of a Matched Case‐control Study
Authors: Mascarenhas Ana Karina , Allen Carl M. , Moeschberger Melvin L.
Published: May 2007

Objectives: Several oral pathologists have described oral leukoplakia of the maxillary vestibule in patients with no traditional risk factors for the condition. On questioning these patients, it was determined that Viadent® mouthrinse or Viadent® toothpaste was commonly used by them. A hypothesis was developed that Viadent® or a component of Viadent® caused the lesions. This paper evaluates the association between oral leukoplakia and use of Viadent® products. Methods: A matched case‐control study was designed to test the hypothesis that use of Viadent® products increases an individual's risk of oral leukoplakia. Cases included 58 patients diagnosed with oral leukoplakia identified through the biopsy service at the Ohio State University, College of Dentistry, Oral Pathology Section. The matched control was a friend or relative of the patient. Cases and controls were administered a questionnaire about their use of Viadent®, and other known risk factors for leukoplakia such as tobacco and excessive alcohol use. Results: An age difference was seen between cases and controls, the cases being older (P<.001). After controlling for confounding factors, results of exact conditional logistic regression analyses showed that use of Viadent® products was a risk indicator for oral leukoplakia (odds ratio= 10.0; 95% confidence interval=2.0, 89.2). Conclusions: Viadent® use is a risk indicator for oral leukoplakia, confirming our previous findings.
Comparison of Two Methods of Estimating 48‐month Tooth Loss Incidence
Authors: Gilbert Gregg H. , Chavers L. Scott , Shelton Brent J.
Published: May 2007

Objectives: This paper quantifies validity of self‐reported tooth loss, compares incidence using two methods (semiannual self‐report, biannual clinical examination), and compares conclusions about risk factors for tooth loss using these two methods. Methods: The Florida Dental Care Study included persons who at baseline had at least one tooth. in‐person interviews and clinical examinations were conducted at baseline, 24 months, and 48 months, with semiannual telephone interviews in between. Results: Agreement between self‐reported and clinically derived tooth loss was high, although some statistically significant differences by certain baseline characteristics were evident. On a nominal scale (some tooth loss, none), kappa was 0.88 and percent concordance was 94 percent. On a ratio scale, Spearman's correlation was 0.90. Using self‐report, the incidence estimate would have been 34 percent, as compared to 36 percent based on clinical examination. In a single bivariate (loss by self‐report, loss by clinical examination) multiple logistic regression, conclusions about statistical significance and magnitude of seven risk factors for tooth loss did not differ. Conclusions: Validity of self‐reported incidence was excellent. The self‐reported method allowed for semiannual estimates and was less resource intensive. Substantive conclusions about tooth loss using either method were similar, although validity did differ between persons with certain baseline characteristics.
Fluctuations in Public Water Fluoride Level in Bauru, Brazil
Authors: Buzalaf Marilia A. R. , Granjeiro José M. , Damante Carla A. , Ornelas Flávia
Published: May 2007

Objectives: The aim of this study was to monitor the quality of public water supply fluoridation in Bauru, in the state of São Paulo, Brazil. Methods: Water samples collected three times a week during four weeks in 20 areas of distribution of water were supplied by the City Water Department of Bauru, São Paulo, Brazil. fluoride was analyzed using the ion‐specific electrode (Orion model 9409) after sample buffering with an equal volume of TISAB II. Data were compared to fluoride concentration reported by City Water Department. Results: Fluoride content ranged between 0.01 ppm and 9.35 ppm (n=240). There was great variation among the different areas of distribution of water, as showed by the Levene test (P<0.01). Kruskal‐Wallis test showed a statistically significant difference in mean fluoride concentration among different areas (P<.001). Mean fluoride concentration was less than the optimum concentration (0.8 ppm) in 89 percent of samples. The values reported by the City Water Department were always higher than the analyzed fluoride concentrations. Conclusions: Based on the results from this study, more rigorous surveillance and monitoring of water fluoridation in Bauru is recommended.
Factors Influencing the Effect of Race on Established Periodontitis Prevalence
Authors: Borrell Luisa N. , Taylor George W. , Borgnakke Wenche S. , Nyquist Linda V. , Woolfolk Marilyn W. , Allen Doris J. , Lang W. Paul
Published: May 2007

Objective: This paper identifies differences in prevalence of established periodontitis and evaluates factors that might explain the differences between non‐Hispanic African Americans (n=232) and whites (n=199) in the Detroit tricounty area. Methods: Subjects from a disproportionate probability sample of community‐dwelling adults were interviewed regarding demographic, psychosocial and enabling factors, dental health‐related behaviors, and other risk factors, and had comprehensive in‐home dental examinations. Results: The overall prevalence of established periodontitis was 20.8 percent; African Americans exhibited a significantly higher prevalence than whites (29.8% vs 17.7%). The crude association between race and prevalence of established periodontitis was significant (odds ratio [OR]for African Americans=1.98; 95% confidence interval [CI]=1.17,3.34). After controlling for other covariates, we found the effect of race may be modified by dental checkup visit frequency: African Americans with dental checkups at least once a year had almost a fourfold higher odds of established periodontitis (OR=3.64;95% CI=1.43,9.24) than their white counterparts with dental checkups at least once a year (the referent group); while African Americans with a dental checkups once every two years or less often were more than fourfold less likely to have established periodontitis (OR=0.22; 95%CI=0.08, 0.59) than their white counterparts in the referent group. Conclusions: This analysis supports the disparity in periodontal health as part of the black: white health disparity when taking other factors into account. However, periodontal health disparities may be more complex than previously recognized, requiring greater understanding of factors related to dental care utilization in future studies evaluating this disparity.
The Association of Early Childhood Caries and Race/Ethnicity among California Preschool Children
Authors: Shiboski Caroline H. , Gansky Stuart A. , Ramos‐Gomez Francisco , Ngo Long , Isman Robert , Pollick Howard F.
Published: May 2007

Objectives: This paper explores the role of race/ethnicity in the occurrence of early childhood caries (ECC) among California Head Start (HS) and non‐HS preschool children. Methods: Using oral examination and questionnaire data from the 1993‐94 California Oral Health Needs Assessment of Children, we computed the prevalence of ECC using various definitions and fitted logistic regression models to explore the effect of race/ethnicity on ECC, separately for HS and non‐HS children, adjusting for bedtime feeding habits and other covariates. Results: Among 2,520 children, the largest proportion with a history of falling asleep sipping milk/sweet substance was among Latinos/Hispanics (72% among HS and 65% among non‐HS) and HS Asians (56%). HS Asians and Latinos/Hispanics had the largest prevalence of ECC (30%‐33%) and untreated caries (49%‐54%). The estimated risk for ECC was more than three times higher in HS Asians compared to HS whites and among non‐HS African Americans and Asians compared to non‐HS whites controlling for socioeconomic status variables. The risk of ECC was also significantly higher among children who fell asleep while sipping milk or any sweet substance compared to those who did not. Conclusion: Studies of the cultural/behavioral patterns that may be specific to ethnic subgroups with the highest risk for ECC seem essential to the development of effective prevention strategies.
Oral Health Care Utilization by US Rural Residents, National Health Interview Survey 1999
Authors: Vargas Clemencia M. , Dye Bruce A. , Hayes Kathy
Published: May 2007

Objective: To compare the dental care utilization practices of rural and urban residents in the United States. Methods: Data on dental care utilization from the 1999 National Health Interview Survey for persons 2 years of age and older (n=42,139) were analyzed by rural/urban status. Percentages and 95 percent confidence intervals were calculated to produce national estimates for having had a visit in the past year, the number of visits, reasons given for last dental visit and for not visiting a dentist, unmet dental needs, and private dental insurance. Results: Rural residents were more likely to report that their last dental visit was because something was “bothering or hurting” (23.3% vs 17.6%) and that they had unmet dental needs (10.1% vs 7.5%). Urban residents were more likely to report having a dental visit in the past year (57.7% vs 66.5%) and having private dental insurance (32.7% vs 37.2%), compared to rural residents. There were no significant differences in most reasons given for not visiting the dentist between rural and urban respondents. Conclusion: Dental care utilization characteristics differ between rural and urban residents in the United States, with rural residents tending to underutilize dental care.
Socioeconomic and Demographic Disparities in Symptoms of Orofacial Pain
Authors: Riley Joseph L , Gilbert Gregg H. , Heft Marc W.
Published: May 2007

Objectives: The purpose of this study was to document the association between socioeconomic status (SES) and the prevalence and impact of orofacial pain by anatomical location. In addition, differential effects of SES on orofacial pain across levels of sex, race, and age were documented. Methods: The subjects were 724 participants in the Florida Dental Care Study, a study of oral health among dentate adults, aged 45 years and older at baseline. Pain prevalence and subjective ratings were assessed for a range of orofacial pain sites using a standardized telephone interview. Results: Lower SES was associated with reporting pain and pain impact at many, but not all, of the orofacial sites. Some sex, race, and age cohort differences in orofacial pain were found when adjusting for differences in socioeconomic position. The most consistent result, as evidenced by similar findings across orofacial pain sites, was that the effects of SES on orofacial pain appear to have a sex‐differentiated effect. Conclusion: Consistent with findings for other subjective measures of oral health, persons of lower SES are at increased risk for orofacial pain and pain‐related behavioral impact.
Updated Comparison of the Caries Susceptibility of Various Morphological Types of Permanent Teeth
Authors: Macek Mark D. , Beltran‐Aguilar Eugenio D. , Lockwood Stuart A. , Malvitz Dolores M.
Published: May 2007

In 1941, Klein and Palmer published a landmark study that ranked the relative susceptibility to dental caries of various morphological tooth types. Specifically, Klein and Palmer used a four‐step approach, which included derivation of: (1) an eruption schedule; (2) posteruptive tooth age; (3) cumulative number of decayed, missing, and filled teeth and cumulative posteruptive tooth age; and (4) relative susceptibility values. Their study was conducted when dental caries prevalence and severity were generally high in the United States, prior to the introduction of preventive measures such as fluoride and dental sealants. This investigation used more recent data to assess whether declines in dental caries prevalence over time have been accompanied by changes in the relative susceptibility of permanent tooth types. Methods: The data source for this investigation was the oral examination component of the Third National Health and Nutrition Examination Survey. This investigation used analytical methods to derive the relative susceptibility values that were identical with those used during the Klein and Palmer study. Full sample weights were used with SUDAAN so that the descriptive estimates would be representative of the US population. Analysis was limited to children aged 4 through 20 years. Results: The investigation found six categories of susceptibility, with molars being more susceptible than incisors, canines, or premolars. In general, susceptibility values declined since the Klein and Palmer study, providing additional evidence for a caries decline in the United States. First and second molar susceptibility values from the NHANES III data, however, intersected with those of Klein and Palmer, suggesting that factors specific to the molars, such as the selective use of dental sealants on these teeth, might be playing an additional role. Conclusions: Future research should explore factors that might explain the changes in relative susceptibility values over time.
Clinical Evaluation of Three Restorative Materials Applied in a Minimal Intervention Caries Treatment Approach
Authors: Zanata Regia L. , Navarro Maria F. L. , Barbosa Silvia H. , Lauris Jose R. P. , Franco Eduardo B.
Published: May 2007

Objectives: This paper reports on a longitudinal evaluation of three materials (glass ionomer, zinc oxide‐eugenol cement, and composite) employed in a minimal restorative intervention approach of 81 high caries‐active pregnant women selected for a preventive oral health program in Brazil. The aim of the study was to evaluate the clinical behavior of the glass ionomer cement, currently indicated in programs for control of carious lesions. Methods: The patients were randomly divided into two groups. Both groups were engaged in an oral health promotion approach. In Group 1, 417 glass ionomer restorations were placed in 43 individuals, involving all types and sizes of cavities. In the second group, 213 posterior zinc oxide‐eugenol (ZOE) restorations and 127 anterior composite restorations were placed in 38 patients. Minimal cavity preparations were made, in which only soft or infected dentin was removed, on the basis of clinical judgment. Results: After two years, the restorations were clinically evaluated by two examiners for marginal integrity, amount of wear, presence of fracture, carious lesions, and lost restorations. Statistical analysis (chi‐square test) identified statistically significant difference between glass ionomer and ZOE (90.6% vs 9.2%). Comparing glass ionomer and composite, similar survival rates were observed. The success rate observed for the glass ionomer cement ranged from 77.1 percent to 92.5 percent, depending on the type and size of cavity in which it was applied. Four teeth restored with glass ionomer cement and one tooth restored with composite showed caries signs. Regarding the ZOE restorations, caries was always associated with other causes of failure such as excessive wear, restoration loss, or marginal defects, with no possibility of separate evaluation. Despite the preventive and therapeutic measurements employed, a mean increase of 2.15 new surfaces with cavities was observed in Group 1, as well as 2.83 surfaces presenting the same status in Group 2. Conclusions: This study demonstrated that highly viscous glass ionomer cement applied in a minimal intervention approach provided high‐quality preventive and restorative care after two years to a population at high risk for caries. The composite was employed in cavities exposed to lower stress, such as in the anterior teeth, and its behavior was comparable to that of the glass ionomer cement. The reinforced ZOE presented a high failure rate, thus contraindicating its use for such purpose. [J Public Health Dent2003;63(4):221‐26)
Relationship Between Oral Health Behaviors and General Health Behaviors in a Japanese Adult Population
Authors: Tada Akio , Matsukubo Takashi
Published: May 2007

Objective: The aim of this study was to analyze the relationship between oral health behaviors and general health beha viors in adults. Methods: A total of 2,467 adults (1,208 men and 1,259 women aged 20‐59 years) who consulted dentists in Chiba City were administered a questionnaire. Results: Women, older participants, and those living with family had better health behaviors than the other subjects studied. Additive indices for oral and general health behaviors were significantly correlated. Toothbrushing frequency was significantly correlated with five items of general health behavior (smoking, drinking, exercise, eating breakfast, and having medical check‐ups). Having dental check‐ups was significantly correlated with having medical check‐ups. There was a negative correlation between dental flossing and drinking. Conclusions: Of all oral health behaviors examined, toothbrushing frequency was the most predictive indicator of general health behavior.
Using Insurance Claims and Demographic Data for Surveillance of Children's Oral Health
Authors: Heller Keith E. , Eklund Stephen A. , Burt Brian A. , Briskie Daniel M. , Lawrence Leslie M.
Published: May 2007

Objectives: This paper examines the utility of using private insurance and Medicaid dental claims as well as demographic data for assessing the oral health of children aged 5–12 years in Genesee County, Michigan, communities. Methods: Dental insurance claims data from Delta Plan of Michigan and Michigan Medicaid, plus demographic data from the 1990 US Census (percent poverty) and from the 1995 National Center for Educational Statistics (percent free or reduced lunch eligibility), were compared to findings from two school‐based oral health surveys. These surveys were the 1995 Genesee County Oral Health Survey and the 1998–2001 Mott Children's Health Center oral health screenings. Data were analyzed using zip codes, representing communities, as the comparison unit. Statistical comparisons using correlation coefficients were used to compare the findings from the six data sets. Results: Using the insurance claims and school‐based data, some communities consistently demonstrated high levels of dental caries or treatment for the primary dentition. The demographic measures were significantly associated with many of the primary dentition survey measures. The demographic data were more useful in identifying communities with high levels of dental disease, particularly in the primary teeth, than the insurance claims data. Conclusions: When screening is not practical, readily available demographic data may provide valuable oral health surveillance information for identification of high‐risk communities, but these data do not identify high‐risk individuals. In these analyses, demographic data were more useful than dental insurance claims data for oral health surveillance purposes.
Estimating Prevalence and Severity of Caries in the Mixed Dentition: a Comparison of Two Screening Protocols
Authors: Griffin Susan O. , Griffin Paul M. , Beltrán‐Aguilar Eugenio D. , Malvitz Dolores M. , Heiden Kathleen D.
Published: May 2007

Objective: Most oral health surveys examine and record data on individual teeth or surfaces (STD), providing valid estimates of caries prevalence and severity. Simplified screening protocols based on assessments at the person level (Stop‐After‐First‐Encounter—SAFE) have been validated for assessment of prevalence. We developed an alternative protocol (SENTINEL), which examined the 12 teeth at highest risk for caries and compared how it performed to SAFE and STD for surveillance and evaluation. Methods: We used data from the Third National Health Nutrition and Examination Survey for children aged 8 to 12 years to analyze the feasibility of assigning STD estimates of severity to children designated by SAFE as having caries. SENTINEL was tested for accuracy of estimating prevalence and severity against STD. In addition, we used subsampling to test the frequency with which SAFE and SENTINEL agreed with STD in identifying the highest risk population. Finally, we compared the mean number of teeth and the recorded data elements for each protocol. Results: Assigning national estimates of severity to SAFE provided inaccurate estimates. SENTINEL agreed with STD in identifying the survey group with the highest severity more frequently than did SAFE (96 percent vs 74 percent). SAFE on average examined nine more teeth than SENTINEL. Conclusions: Both SAFE and SENTINEL could serve as surveillance tools, depending on the system's purpose/objectives. However, it is unlikely that SAFE would provide adequate information to evaluate sealant programs.
Is 75 Percent of Dental Caries Really Found in 25 Percent of the Population?
Authors: Macek Mark D. , Heller Keith E. , Selwltz Robert H. , Manz Michael C.
Published: May 2007

Objectives: Dental caries prevalence is used to quantify inequalities and to target high‐risk populations for interventions. Prevalence can be described via measures of centrality; however, some have used cumulative frequency distribution curves (Lorenz curves). This investigation provides dental caries Lorenz curves for the primary and permanent dentitions at selected ages. Results provide accurate age‐specific and dentition‐specific X values for the general statement, “75 percent of dental caries is found in X percent of the population.”Methods: Data were derived from the Third National Health and Nutrition Examination Survey, a cross‐sectional study conducted between 1988 and 1994. Cumulative frequency distributions for total dfs or DMFS were plotted against cumulative frequency distributions for the total population. Results: X values varied substantially between dentitions and across ages. Total dental caries experience in the permanent dentition was more dispersed than it was in the primary dentition, and the total dental caries experience in older persons was more dispersed than it was in younger persons. For those aged 2–5 years, 75 percent of dental caries (primary dention) was found in 8.1 percent of the population. For those aged 6 years or older, 75 percent of dental caries (permanent dentition) was found in 33.0 percent of the population. Conclusions: For accuracy and relevancy, the statement, “75 percent of dental caries is found in X percent of the population” must be applied to a particular dentition or age group, and must account for appropriate severity and prevalence reference points.
Predictors of Tooth Loss in Two US Adult Populations
Authors: Copeland Lynn B. , Krall Elizabeth A. , Brown L. Jackson , Garcia Raul I. , Streckfus Charles F.
Published: May 2007

Objectives: This study determines tooth loss rate over a 10‐year period and identifies predictors of tooth loss in two separate US adult longitudinal study populations. Methods: Subjects from the Baltimore Longitudinal Study of Aging (BLSA), consisting of 47 men and 47 women, ages ranging from 30 to 69 years, were compared to subjects from the VA Dental Longitudinal Study (VADLS) in Boston, MA, consisting of 481 men in the same age range. Baseline and follow‐up examinations were performed on each cohort over a 10‐year period. Using multivariate regression models, significant predictors of tooth loss were identified. Results: A mean rate of tooth loss of 1.5 teeth lost per 10 years was noted in the VADLS cohort compared to 0.6 teeth lost per 10 years in the BLSA (P<.001). Combining subjects from both populations, significant predictors of tooth loss were baseline values of: percent of teeth with restorations, mean probing pocket depth score, age, tobacco use, alcohol consumption, number of teeth present, and male sex. However, the set of significant predictor variables differed between the two populations and sexes. In BLSA men, number of teeth present, percent of teeth with restorations, mean probing pocket depth score, and alcohol consumption, but not age, were significant, while in BLSA women, only age was a significant predictor. Conclusions: Over a 10‐year period, the incidence of tooth loss, the rates of tooth loss, and the predictors of tooth loss were found to vary by population and by sex. These results illustrate the limits of generalizing tooth loss findings across different study cohorts and indicate that there may exist important differences in risk factors for tooth loss among US adult populations.
Primary Tooth Fluorosis and Amoxicillin Use During Infancy
Authors: Hong Liang , Levy Steven M. , Warren John J. , Bergus George R. , Dawson Deborah V. , Wefel James S. , Broffitt Barbara
Published: May 2007

Objective: It has been speculated that amoxicillin use could be associated with enamel defects, but there have been few studies of this possible relationship. This study assessed the association between amoxicillin use during the first year of life and primary tooth fluorosis. Methods: Subjects (n=490) were recruited at birth and followed prospectively with a series of questionnaires to gather information on fluoride intake and amoxicillin use. Primary tooth fluorosis was assessed by calibrated examiners at approximately 5 years of age. Results: Amoxicillin use for 6 weeks to 3 months and 3 months to 6 months significantly increased the risk for fluorosis of primary second molars in bivariate analyses. However, after controlling for fluoride intake, the adjusted risks of fluorosis were not significant for amoxicillin use. No other antibiotics were significantly associated with fluorosis in the bivariate analyses. In multivariate analyses with logistic regressions, only fluoride intake was statistically significantly related to fluorosis. Conclusion: Fluoride exposure was the sole predictor of primary tooth fluorosis in a multivariate model. However, bivariate results suggest that amoxicillin could play a contributing role in the development of primary tooth fluorosis, especially for children exposed to lower levels of fluoride. An investigation of the relationship between amoxicillin intake and fluorosis of permanent teeth is warranted.
Problems in Exposure Assessment of Fluoride in Drinking Water
Authors: Bassin Elise B. , Mlttleman Murray A. , Wypij David , Joshipura Kaumudi , Douglass Chester W.
Published: May 2007

Objectives: We developed a source documentation approach that identified fluoride content of drinking water at the state or local level to estimate fluoride concentrations from public water systems. We then compared estimates from this approach with estimates obtained from a single source, the 1992 Centers for Disease Control and Prevention (CDC) Fluoridation Census. Methods: We used residential histories from a case‐control study. For each residence we attempted to determine fluoride concentrations using the 1992 CDC Fluoridation Census. For the source documentation method we utilized multiple sources from state and local contacts to verify and collect additional data. We compared the fluoride estimates obtained by the two methods. Results: When fluoride values were found using both methods, there was good correlation (Kendall's tau/0.85; 95% confidence interval=0.79, 0.90) and concordance was 96 percent. We obtained over 99 percent of the fluoride values needed using source documentation as compared to 49 percent of the values needed when we used a single publication. When fluoride values were missing using the 1992 CDC Fluoridation Census, 21 percent had source documentation estimates of at least 0.7 ppm. Conclusions: Researchers need to consider limitations of using a secondary data source to estimate fluoride in drinking water, particularly in studies where exposure to fluoride is the primary exposure of interest.
Institutional Barriers to Providing Oral Health Services for Underserved Populations in New York City
Authors: Ramos‐Rodriguez Cálix , Schwartz Mark D. , Rogers Vincent , Alos Victor
Published: May 2007

Objectives: We sought to explore institutional barriers to the provision of oral health services for the underserved among inner‐city health centers. Methods: Mail‐based survey of Medicaid‐approved health centers in New York City without oral health services. The importance of four barrier categories was rated: resource issues, dental provider difficulties, referral problems, and low priority of dental care. Results: 36 health centers completed the survey. The most important barriers were resource issues (66.7% agreed), dental provider difficulties (29.4%), referral problems (24.2%), and low priority (15.2%). Top individual barriers were lack of start‐up funds (88%), lack of physical space (74%), lack of available funding sources (71%), and low reimbursement rates for dental services (69%). Most centers (78%) identified a need for dental services for their patients. Conclusions: Access to oral health care remains a large problem for the underserved. Institutional barriers will need to be addressed to close the gap.
Identifying Children with Dental Care Needs: Evaluation of a Targeted School‐based Dental Screening Program
Authors: Locker David , Frosina Caroline , Murray Heather , Wiebe David , Wiebe Peter
Published: May 2007

Objectives: It has been suggested that changes in the distribution of dental caries mean that targeting high‐risk groups can maximize the cost effectiveness of dental health programs. This study aimed to assess the effectiveness of a targeted school‐based dental screening program in terms of the proportion of children with dental care needs it identified. Methods: The target population was all children in junior and senior kindergarten and grades 2, 4, 6, and 8 who attended schools in four Ontario communities. The study was conducted in a random sample of 38 schools stratified according to caries risk. Universal screening was implemented in these schools. The parents of all children identified as having dental care needs were sent a short questionnaire to document the sociodemographic and family characteristics of these children. Children with needs were divided into two groups: those who would and who would not have been identified had the targeted program been implemented. The characteristics of the two groups were compared. Results: Overall, 21.0 percent of the target population were identified as needing dental care, with 7.4 percent needing urgent care. The targeted program would have identified 43.5 percent of those with dental care needs and 58.0 percent of those with urgent needs. There were substantial differences across the four communities in the proportions identified by the targeted program. Identification rates were lowest when the difference in prevalence of need between the high‐ and low‐risk groups was small and where the low‐risk group was large in relation to the high‐risk group. The targeted program was more effective at identifying children from disadvantaged backgrounds. Of those with needs who lived in households receiving government income support, 59.0 percent of those with needs and 80.1 percent of those with urgent needs would be identified. Conclusions: The targeted program was most effective at identifying children with dental care needs from disadvantaged backgrounds. However, any improvements in cost effectiveness achieved by targeting must be balanced against inequities in access to public health care resources.
Validation of a Hebrew Version of the Oral Health Impact Profile 14
Authors: Kushnir Daniel , Zusman Shlomo P. , Robinson Peter G.
Published: May 2007

Objective: This study determined the validity of a Hebrew version of the Oral Health Impact Profile in a cross‐sectional study of a general dental practice in Israel. Methods: The original English version of a short‐form oral health impact profile (OHIP‐14) was translated into Hebrew using the back‐translation technique. Participants were interviewed and examined clinically by a calibrated dentist. Information on the subjects' sociodemographic background and oral health conditions was collected. Results: A total of 142 persons were interviewed and clinically examined. The Cronbach's alpha and the standardized item alpha for OHIP‐14 were both 0.88. Cronbach's alpha of the translated OHIP‐14 subscales ranged from 0.48 to 0.76. Construct validity of the translated Hebrew version was supported by the finding that the total OHIP score correlated with the number of decayed teeth, missing teeth, need for prosthodontic treatment, and pattern of dental attendance. Participants with oral pain were more likely to report impact on one of the OHIP subscales and to have more impacts than participants who were pain free. Conclusions: The Hebrew version of OHIP‐14 presented acceptable validity and reliability. Further research is needed to assess the value of this measure in Israel.
Use of Clinical Services Compared with Patients' Perceptions of and Satisfaction with Oral Health Status
Authors: Maupomé Gerardo , Peters Dawn , White B. Alex
Published: May 2007

Objectives: To examine the relationship between rates of clinical service use and self‐reported perception of and satisfaction with oral health status. Methods: Dental services provision rates were calculated using health maintenance organization electronic data for members 55 years of age and older with at least four years of eligibility between 1990 and 2000. A mail survey yielded 986 responses (response rate=65.7%). Poisson regression was used to examine the relationship between service utilization rates and self‐reported perception of and satisfaction with oral health status, controlling for age, education, sex, and marital status. Results: Perceptions of oral health status and levels of satisfaction with oral health status generally were closely associated. Greater dissatisfaction with oral health status and perception of poorer oral health status were associated with higher usage of nonpreventive dental services. Less satisfaction with oral health status was associated with higher restorative services usage and lower preventive services usage and slightly associated with periodontal service usage. Perception of a less favorable oral health status was strongly associated with higher restorative and periodontal services usage, but had only a weak association with preventive services usage. Conclusions: Dental plan members' service use is associated with their perception of their oral health status and their level of satisfaction with it. Future work should seek to clarify whether opinions on oral health status and satisfaction are a result of clinical experiences over time or whether the behavior and the values associated with seeking and obtaining care instead shape opinions on status and satisfaction.
Change in Caries Prevalence after Implementation of a Fluoride Varnish Program
Authors: Dohnke‐Hohrmann Sylvia , Zimmer Stefan
Published: May 2007

Objective: In 1996 the caries prevalence of schoolchildren living in Neukölln, a district of Berlin, Germany, was higher than the mean of total Berlin. Hence, a special preventive program including the application of fluoride varnish was initiated. All 49 primary schools of the district joined the project. The aim of the present study was to evaluate in a cross‐sectional study whether the preventive program resulted in a reduced caries prevalence. Methods: The complete program included oral health education as well as the application of a highly concentrated fluoride varnish (Duraphat®). All children whose parents' consent was given could receive fluoride varnish twice a year. All children were examined once a year by four calibrated dentists. The baseline examination was conducted in 1995–96, the final examination in 1999–2000 (1995–96: n= 7,748; 1996–97: n= 15,673; 1997–98: n= 19,362; 1998–99: n= 19,822; 1999–2000: n= 17,984). Results: A total of 80,589 dental records were used for data analysis. A decline of DMFT‐values was observed in all age groups and school years. The major improvement was found in school year 1999–2000, when the program had been established for four years. Conclusion: The described program may be an effective public health measure for 6‐ to 12‐year‐old children with high caries prevalence.
Oral Health Care Knowledge and Practices of a Group of Deaf Adolescents in Lagos, Nigeria
Authors: Oredugba Folakemi A.
Published: May 2007

Objective: This study sought to determine the oral health care knowledge and practices of a group of deaf adolescents in Lagos. Methods: The study involved 50 students of Wesley School 1 for the Deaf, Lagos (26 males and 24 females, aged 10–19 years, mean 13.3±2.8). Information about previous dental care, oral hygiene, and snacking habits were obtained through a questionnaire and sign language by the teachers. Results: Only 12 percent of pupils had received dental care. Eight percent and 72 percent, respectively, gave correct answers to causes of tooth decay and bleeding gums. Ninety‐four percent brushed their teeth once daily, with no significant sex difference (P>.05). Reported dental problems include bleeding gums (36%), tooth discoloration, and tooth decay. The majority of pupils (60%) preferred biscuits and soft drinks as snacks. More than 90 percent were willing to have a dental check‐up. Conclusions: The oral health knowledge and practices of this group of children will improve through a controlled school‐based oral health education program.