bluuebunny/crossref_metadata_2025 huggingface dataset:
ORAL IRRIGATING DEVICES; AN APPRAISAL OF CURRENT INFORMATION*
Authors: St. Leopold Astwood L. A.
Published: April 2007

Dr. Astwood has performed a service for dentists in dental public health by his critical and informative examination of a relatively new aid for the oral hygiene of patients
The Status of Community Advisory Committees in Dental Education
Authors: Burns Mary T. , Jong Anthony
Published: April 2007

A questionnaire survey was undertaken to determine how prevalent community advisory committees have become in the nation's dental schools and what types of committees have been formed. Responses were received from 52 (90 percent) of the 58 dental schools. The data revealed the following:

1. Nine schools (17 percent) have developed consumer committees.

2. The number of committee members varies from five to 29.

3. All the committees are composed of consumer members and school representatives, and, in all but one committee, health care providers are represented.

4. Four (44 percent) committees have advisory functions only, while the remaining five (56 percent) play an advisory and policy‐making role.

5. No committee planned formal training sessions for their consumer members.

6. Of the 43 schools (83 percent) without such a committee, seven (16 percent) replied they foresee implementing a consumer committee in the future.
Noted and Quoted
Authors: Jackson D.
Published: April 2007

Fluoridation in part of Cumbria (formerly Cumberland) was started in October, 1969. The two major towns in the fluoridated sector are Workington and Cockermouth. The two nearest comparable towns in the low‐fluoride sector are Carlisle and Penrith (F=<0.1 ppm). In April and May, 1975 dental examinations were made of first year school entrants who were continuous residents in either one or the other of these communities. To obviate the possibility of bias approximately 40 per cent of the children examined were ‘decoys,’ children not meeting the criteria of age, residence or non‐receipt of fluoride tablets, topicals or sealants. Analyses of the data were carried out independently by specialists in community medicine. Caries experience in the fluoridated community (F=1 ppm) was found to be 46 per cent less than in the non‐fluoridated community. Site attack was correspondingly less by 50 per cent.
The Gingival Health of Eight‐Year‐Old Nigerian Children*
Authors: Adenubi J. O.
Published: April 2007

A total of 860 eight‐year‐old schoolchildren in Lagos Nigeria, were examined between April 1981 and March 1982: 409 from private schools and 451 from government schools. Half were boys and the other half were girls.

The mean Gingival Index score for children in private schools is 0.4 and 0.5 in the government schools. The GI score was slightly higher for boys than for girls in each group. The prevalence of calculus (24.7 percent) and gingivitis (46.5 percent) in the private schoolchildren is significantly lower than that found in the government schoolchildren (59.6 percent and 61.6 percent respectively) (p values < 0.002). The mean OHI‐S score is lower in the private schools (0.8 for boys and 0.7 for girls) than in the government school (1.1 for both boys and girls). These findings suggest better oral hygiene habits in the higher socioeconomic group of private schoolchildren. Among the boys, 47.3 percent had calculus and 52.2 percent had gingivitis while 38.7 percent of the girls had calculus and 56.6 percent had gingivitis. Overall, 43 percent of the children examined had calculus, 54.4 percent had gingivitis. The mean GI Score was 0.4 and the mean OHI Score was 1.0.

The results indicate a trend toward a lower prevalence of gingivitis and better oral hygiene among Nigerian children now when compared with studies reported two decades ago.
Dentist Oversupply (?), Dentistry, and Dental Public Health
Authors: MILL JOHN STUART
Published: April 2007

Great economic and social forces flow like a tide over half‐conscious people. The wise are those who foresee the coming event and seek to shape their institutions and mold the thinking of the people in accordance with the most constructive change. The unwise are those who add nothing constructive to the process, either because of ignorance on the one hand or ignorant opposition on the other.
A Community‐Based Dental Program for Older Adults
Authors: Lang W. Paul , Kerschbaum Wendy E. , Kerns Karen M.
Published: April 2007

The planning and implementation of a community‐based outreach program for older adults is described. Objectives of the program were to provide dental health education to older persons at their place of residence, to improve access to dental care for that population, and to increase the number of older adults treated at a dental facility administered by the Department of Community Dentistry, University of Michigan. Data collected during encounters with participants are reported to supplement the description of the program. In the first year, 98 older adults (mean age 71.3 years)participated in the outreach program which was directed by a dental hygienist. Of those persons whose initial encounter was with the outreach program, 47 percent eventually contacted the dental care facility and 36 percent completed treatment. Persons who elected to seek treatment averaged 3.9 encounters with the hygienist during the program; persons who did not seek treatment averaged 2.2 encounters. Strengths and weaknesses of the program are discussed.
Theoretical Considerations in Applying Benefit‐Cost and Cost‐Effectiveness Analyses to Preventive Dental Programs*
Authors: Niessen Linda C. , Douglass Chester W.
Published: April 2007

Benefit‐cost analysis and cost‐effectiveness analysis can be used to evaluate preventive regimens and aid policy‐makers in making resource‐allocation decisions. This paper demonstrates the application of benefit‐cost and cost‐effectiveness analyses to preventive dental programs. The two analyses are defined and described, and the purpose of each technic is compared. For a hypothetical community, four dental preventive programs are described: community water flouridation, school water fluoridation, weekly school‐based mouthrinses, and school‐based sealants. Benefit‐cost ratios and cost‐effectiveness ratios are calculated for each program first assuming steady‐state conditions, i.e., maximum caries reduction, and then for a 20‐year period. Both explicit and implicit costs are included. Underlying assumptions and limitations, as well as the effects of changes in caries rates, differential attack rates, and discount rates on the outcome, are discussed. The analysis reveals that community water fluoridation yields the greatest net benefits and most favorable B/C and C/E ratios. School water fluoridation and mouthrinsing programs are the next most cost‐effective, with similar B/C and C/E ratios when the implicit cost of teachers' time is omitted from the calculations. The school‐based sealant program yields negative net benefits.
Recent Dental Caries and Treatment Patterns in US Children
Authors: Graves Richard C. , Bohannan Harry M. , Disney Judith A. , Stamm John W. , Bader James D. , Abernathy James R.
Published: April 2007

This report† presents dental caries and treatment patterns found in a longitudinal study of US children between 1978 and 1982 who were geographically dispersed across several fluoridated and non‐fluoridated sites. The analyses include first‐and fifth‐grade children examined annually for four years in the National Preventive Dentistry Demonstration Program and who did not receive effective preventive procedures. The results indicate that in association with the caries decline in US children, treatment ratios increased by over 20 percent during the study period. FS/DFS ratios averaged 79 percent for the four grade/fluoridation status cohorts analyzed and were significantly higher in fluoridated than in nonfluoridated sites. The single‐fissured surface was the dominant treatment or disease area observed and these surfaces tended to be restored early. In assessing tooth‐surface status changes annually, tooth surfaces were more than twice as likely to change from sound to filled than from sound to decayed between yearly examinations at fluoridated sites. The lower levels of decay and higher degree of restorative care observed were not observed in lower SES and black children nearly to the extent as those for higher SES and white children in the population. The dental profession should shift its emphasis from the early restoration of fissured‐surface defects to an expanded use of sealants for those with reduced decay and focus resources on a minority of the population with high caries levels who receive limited care.
Developing a Sealant Program: the Massachusetts Approach*
Authors: Callanen Virginia A. , Weintraub Jane A. , French Donna P. , Connolly Gregory N.
Published: April 2007

This paper describes the program structure and strategies being used by the Massachusetts Department of Public Health to promote the utilization of sealants. The program design includes four components: clinical demonstration, consumer education, professional education, and reimbursement. Eighteen Massachusetts neighborhood health centers and six local health departments are participating in the clinical demonstration component. Since March 1984, dental personnel from these sites have applied sealants to 4,398 schoolchildren. The promotional theme “Save Teeth: Seal Them” has been incorporated into brochures designed to increase knowledge and awareness of consumers. Curriculum materials have been developed to educate dentists and dental hygienists to apply sealants and understand the rationale and scientific basis for their use. Since January 1984, 18 sealant educational sessions have been conducted statewide for 630 dental providers. Information is being presented to third‐party carriers, some of whom have subsequently adopted a policy to include reimbursement for sealants.
Prevalence of Dental Fluorosis in Fluoridated and Nonfluoridated Communities—a Preliminary Investigation
Authors: Leverett Dennis
Published: April 2007

As a result of undocumented observations that the prevalence of dental fluorosis in both fluoridated and nonfluoridated communities may be higher than would be predicted on the basis of Dean's data from the 1940s, dental fluorosis assessments using a modification of Dean's Index were made in 1981 as part of routine examinations in a series of clinical trials. A total of 1,663 children in fluoridated or nonfluoridated communities, ranging in age from seven to 17 years, were examined during 1981–82.

The prevalence of dental fluorosis in nonfluoridated communities ranged from 1.7 percent in 16‐year‐olds to 13.9 percent in 10‐year‐olds and, in fluoridated communities, ranged from 17.1 percent in 13‐year‐olds to 33.0 percent in 14‐year‐olds. At all age levels common to the two types of communities, the difference in prevalence of dental fluorosis was statistically significant. Compared with findings in Dean's studies in 1942, for children of comparable age in communities with essentially the same water‐fluoride levels, the prevalence of dental fluorosis in the present study was 3½ times higher in nonfluoridated communities and two times higher in fluoridated communities. Mean fluorosis scores, however, were similar. If additional studies substantiate that the prevalence and intensity of dental fluorosis are increasing, the accepted norms for fluoride dosage need to be reassessed—especially in supplements, dentifrices, and water.
Prevalence of Deep Periodontal Pockets in New Mexico Adults Aged 27 to 74 Years*
Authors: Ismail Amid I. , Eklund Stephen A. , Burt Brian A. , Calderone James J.
Published: April 2007

The purpose of this study was to describe the distribution of advanced periodontal destruction (pocket depth equal to or deeper than six mm) in continuous residents, aged 27 to 74 years, of Lordsburg and Deming, New Mexico. The distance from the free gingival margin to the base of the gingival crevice or pocket was measured on the facial and mesiofacial sides of six index teeth. The presence of supragingival calculus, subgingival calculus, and plaque, as well as gingival bleeding around the index teeth, also were evaluated. Of the 372 examinees, only 46 individuals (12.4 percent) had at least one deep pocket equal to or deeper than six mm on at least one site on the six index teeth. Age was significantly associated with prevalence of deep pockets, although about 80 percent of those aged 47 to 74 years did not have deep pockets. Of those with deep pockets, 89.1 percent had fewer than four tooth sites (out of 12) affected. The only significant risk factor of the presence of deep pockets, other than age, was the number of teeth with plaque accumulations. Age and the number of teeth with plaque explained only 10.5 percent of the variability in the prevalence of deep pocketing, suggesting that risk factors other than those included in this study may be important. The results of this study indicate that destructive periodontal disease occurs at selected sites within the mouth, and that about 87 percent of the adults over age 27, in this population, do not have deep pockets in the si. index teeth examined.
Eighteen‐month Coronal Caries Incidence in North Carolina Older Adults
Authors: Drake Claude W. , Hunt Ronald J. , Beck James D. , Koch Gary G.
Published: April 2007

In this longitudinal study of a random sample of North Carolinians over the age of 65 and living in their homes, 325 blacks and 280 whites were examined and interviewed 18 months after baseline examinations. Coronal caries incidence was greater among whites than blacks. The increment due to teeth becoming root fragments were similar for both races; however, there were more newly crowned teeth among whites. Newly crowned surfaces were not used as part of the caries increment in logistic regression models to investigate potential risk predictors. For blacks, caries development over the 18‐month period was associated with a higher lactobacillus score and more coronal caries at baseline, more previously filled coronal surfaces, and lack of active membership in clubs or other groups. For whites, having no self‐reported tooth sensitivity, having a lower socioeconomic index score, taking antihistamine medications at baseline, and having the perception of more problems after the age of 40 than before were all associated with the development of coronal caries.
Productivity in Minnesota Dental Practices with Increased Visits by Older Patients
Authors: Shuman Stephen K. , Loupe Michael J. , Davidson Gestur B. , Martens Leslie V.
Published: April 2007

There is little scientific information on the economic impact of treating increased numbers of older adults, despite the current growth in this population. To assess the impact of patient age on dental practice productivity, we evaluated an economic production function that included the proportions of patient visits in two older age groups (61–69 years, 70+ years) as factors that might affect the dental service production process. We used data from 12,818 patient visits to 31 Minnesota dental practices enrolled in the Minnesota Dental Practice Analysis System (DPAS) between 1980 and 1984. Ordinary least squares multiple linear regression was used to detect potential associations between practice productivity, measured in standardized time and monetary outputs, and the proportions of visits by older patients. We found that increases in the proportion of visits by patients aged 70 years and older were associated with decreases in productivity when we controlled for differences in the mix of services used. Our results support the notion that dental practices may be less productive when providing services to older patients compared to younger patients. These findings may have implications for personnel and policy planning. Further investigation of this issue is warranted because of the limited number of practices included in the study.
The Prevalence and Patterns of Dental Caries in Labrador Inuit Youth
Authors: Zammit Mark P. , Torres Alma , Johnsen David C. , Hans Mark G.
Published: April 2007

Objectives: This study was undertaken to examine the prevalence of dental caries in Inuit (Eskimo) youth aged 5–22 years. Methods: Both tooth‐oriented indices and child‐oriented caries patterns were recorded in a field study conducted in 1991 in Nain and Hopedale, Northern Labrador. Seventy‐eight percent (N=347) of all schoolchildren in these two locations were examined by a single examiner. Results: Three percent of the population were caries free and 88 percent of those with caries experience had untreated dental decay. The mean combined dmft and DMFT per child for all ages was 6.85, while the mean combined dmfs and DMFS was 15.72. About 38 percent of subjects had pit and fissure caries; 2 percent had hypoplastic lesions; 4 percent had faciolingual caries; 31 percent had molar‐approximal caries and 22 percent had faciolingual and molar‐approximal caries, the most destructive caries pattern. About 68 percent of the 5–6‐year‐olds and 26 percent of the 15–22‐year‐olds experienced the most destructive pattern of decay in their primary and permanent dentitions, respectively. Conclusions: Preventive measures should start well before the age of 5 years. Describing caries patterns according to the dentition type complemented the traditional indices.
Evaluation of Guamanian Dental Caries Preventive Programs after 13 Years
Authors: Sterritt Gene R. , Frew Ralph A. , Rozier R. Gary
Published: April 2007

Objectives: To address the high prevalence of dental caries in Guamanian children, a school‐based fluoride mouthrinse program, a clinic‐based pit and fissure sealant program, and community water fluoridation were phased in over a 13‐year period. The purpose of this paper is to evaluate the impact of these programs on the prevalence of dental caries. Methods: Cross‐sectional samples representative of schoolchildren in grades 1 through 8 were selected in 1976, 1979, 1984, 1986, and 1989. These years include the starting years for each of the three interventions and varying follow‐up periods for each. About 1,000 children in each of the survey years were examined to derive DMF surface scores. Results: After eight years of fluoride mouthrinsing, DMFS scores were reduced by 25.4 percent in 6–14‐year‐olds. With two additional years of fluoride mouthrinsing and with pit and fissure sealants, overall DMFS scores declined an additional 44.4 percent. In 1989, three years after community water fluoridation was initiated on the island and continuation of the other two programs, there was a further decline in overall DMFS scores of 34.5 percent. Over the entire study period—during which there were 13 years of fluoride mouthrinsing in the schools, five years of sealant application, and three years of community water fluoridation—DMFS scores declined 72.8 percent overall (5.14 surfaces per child) and 71.9, 71.0, and 78.8 percent for occlusal, buccal‐lingual, and proximal surfaces, respecttively. Conclusions: An intensified preventive dentistry program introduced on an island with high caries prevalence twice that of the US mainland was successful, and contributed to a reduction in the prevalence of caries to a level equivalent to that of the United States at the end of the study period.
Impact of HIV on VA Dental Services: Report of a Survey
Authors: Manz Michael C. , Weyant Robert J. , Adelson Richard , Sverha Susan K. , Durnan J. Richard , Geboy Michael J.
Published: April 2007

Objectives: This study assessed knowledge, attitudes, and behaviors related to the treatment of HIV‐infected patients by Department of Veterans Affairs (VA) dental personnel. Methods: A questionnaire was mailed to all VA dentists, hygienists, and EFDA assistants and completed anonymously in May 1991. Descriptive results are reported along with comparisons between the findings from this study and a similar VA survey conducted in 1988, as well as several national surveys of non‐VA dentists. Results: Nearly all VA respondents reported participation in some type of continuing education on HIV and infection control. They also reported high compliance with recommended infection control procedures. Furthermore, the findings suggest that VA dentists and hygienists have a high willingness to treat HIV‐infected patients, far exceeding that expressed by non‐VA dentists. However, a high level of anxiety related to occupational exposure to HIV seems to exist. Most respondents perceived a higher risk of HIV infection from commonly encountered occurrences in the workplace than actually exists based on current knowledge. Conclusions: While efforts to further reduce the risk of infection and improve care should continue, future efforts also should be directed toward reducing the anxiety of VA dental personnel in the treatment of infectious patients.
Understanding Dental Service Use by Older Adults: Sociobehavioral Factors vs Need
Authors: Tennstedt Sharon L. , Brambilla Donald L. , Jette Alan M. , McGuire Sheila M.
Published: April 2007

Objectives: This study investigated correlates of dental care use in a representative sample of adults aged 70 and older throughout New England. Methods: Data were collected in in‐home interviews and dental examinations. Following Andersen's behavioral model of health services utilization, varied measures of sociodemographic characteristics, dental health attitudes and practices, perceived need for care, and need objectively determined by clinical examination were included as potential correlates. Results: Recency of last visit was associated with positive attitudes toward dental care, regular dental hygiene, and having a usual source of care. Among dentulous subjects, recency of last visit also was related to sex and living arrangements. Frequency of visits for dentulous subjects was associated with the same variables, as well as with age and social class or education, in addition to need for care. For edentulous subjects, only a usual sourse of care and higher social class were associated with more frequent visits. Conclusions: Perceived need and attitudes toward dental care are important influences on use of care. Older persons must be convinced of the importance of regular dental care.
Developing vs Importing Oral Health Resources: The PHS Experience in the Pacific
Authors: Louie Reginald
Published: April 2007

Before beginning my presentation, I would like to spend a few moments to recall a friend and colleague of mine who was also a member of this association. My friend was Dr. Gene Sabino from the Sonsorol Islands just north of the Equator in Palau. Gene died this past summer from the ravages of chronic hepatitis, which is very prevalent in Micronesia. I first met Gene in 1976 in Colonia, Yap, where he was a public health dentist with a tremendous social conscience. Shortly thereafter, he moved his family to Minnesota, were he received his master's degree in public health. Upon returning to Micronesia, Gene became the dental chief in the Northern Mariana Islands. In addition, he was to serve for more than a decade as the president of the Micronesian Dental Association. He promoted oral health wherever and with whomever he could. This ranged from promoting a dental nurse retraining program, to conducting a pilot sealant program on preschool children, to organizing oral exams for collecting data. Furthermore, he was a tireless advocate for developing local resources. He also recognized the need to supplement these resources with those from elsewhere. So you see, in many ways, Dr. Gene Sabino made it possible for me to share the following information with you. For this I am grateful.
Differences in Judgments of Persuasive Argument Quality by Three Population Groups in Iowa
Authors: Bolden Aljernon J. , Logan Henrietta L.
Published: April 2007

Objectives: This study describes a method for studying the perceived persuasiveness of rationales for adopting preventive health behaviors. Methods: Using the Elaboration Likelihood Model, we surveyed 156 individuals as to the level of persuasiveness that each of several categories of reason presented in adopting target “prevention” behaviors such as eliminating the use of smokeless tobacco or seeking regular dental care. Results: Significant differences between what the public reported as persuasive reasons and those selected by future dental practitioners were found. Patients saw potential cost savings, elimination of future pain, and being told by an authority person to adopt a behavior as highly persuasive reasons to adopt a target behavior. Nonwhite patients gave significantly higher scores than did white patients to arguments centering on social/aesthetic appeal. On the negative side, episodic care seekers felt significantly more strongly than regular care seekers that their practicing dental prevention activities (e.g., regular checkups, brushing, and flossing) benefited someone other than themselves (dental profession and dental manufacturers). Conclusions: Results of this study suggest that one way to improve persuasive public health preventive messages is to consider whether the fundamental arguments on which preventive health campaigns are built have broad patient appeal.
Considerations in Establishing a Dental Program for the Homeless
Authors: Bolden Aljernon J. , Kaste Linda M.
Published: April 2007

The homeless are a diverse group who present the dental profession with a number of difficult challenges in the delivery of oral health services. Utilization of dental services by the homeless is low when provided in traditional settings and access is limited. The purpose of this case study is to review program planning issues focusing on the unique aspects of establishing dental programs for the shelter‐based homeless. This paper is based on experiences in developing a dental program for homeless persons in Boston. The establishment of a portable dental program in 1988 for persons residing in shelters in the greater Boston area involved many administrative and clinical considerations. These factors included determination of needs and barriers to dental care, resource identification and development, program planning and implementation, evaluation, and the development of constituency support. The diversity of the homeless population in combination with the variation of space and medical resources at different shelter sites dictates flexibility in the development of programs to address the oral health needs of the homeless.
Introduction to the Symposium
Authors: Burt Brian A.
Published: April 2007

January 25, 1995, is the 50th anniversary of the first controlled addition of fluoride to a public water supply. Those 50 years have seen extraordinary advances in oral health and consequent quality of life, for which fluoride use is generally considered the primary reason. More extensive exposure to fluoride in the modern era, however, has led to both a continuing decline in caries experience and an increased prevalence of dental fluorosis in children. At the other end of life, fluoride's role in bone strength among older people is not well defined. This symposium examines several aspects of fluoride use in the United States today, and has the purpose of helping to define the balance between maximizing the benefits of fluoride while minimizing its undesirable side effects.
Commentary on and Recommendations for the Proper Uses of Fluoride
Authors: Horowitz Herschel S.
Published: April 2007

Fluorosis has been associated with the fluoride concentration of drinking water, use of dietary fluoride supplements, early use of dentifrices, and prolonged use of infant formula. The literature, however, does not show associations between fluorosis and use of fluoride mouthrinses, professionally applied fluorides, bottled waters, carbonated beverages, and juices. It is unwise to issue laundry lists of items that may be implicated as problem‐causing when, in fact, they may not be. Although usually classified without fluorosis, children in Dean's “questionable” category would be classified with the condition if the TFI or TSIF were used. Accordingly, Dean, in 1942, really reported only 52.8 percent of children without fluorosis in Kewanee, a community with 0.9 ppm fluoride in drinking water. Because the morbidity and sequelae of dental caries have declined, undue emphasis has been placed recently on the risks of using fluoride rather than on its profound beneficial effects. Although of paramount importance, conclusions cannot be drawn on whether fluoride protects against, contributes to, or has no effect on bone fractures or is valuable in treating osteoporosis. Careful thought is required before making recommendations that may reduce health benefits because of unfounded concerns about perceived risks. There should be greater regulation of extraneous fluoride sources, rather than reliance on educational efforts or recommendations to eliminate use of highly effective preventive regimens.
Dental Fluorosis and Caries Prevalence in Children Residing in Communities with Different Levels of Fluoride in the Water
Authors: Jackson Richard D. , Kelly Sue A. , Katz Barry P. , Hull James R. , Stookey George K.
Published: April 2007

Objectives: This study investigated the prevalence of dental fluorosis and caries in 7–14‐year‐old children residing in communities with negligible (NF: 0.2 ppm), optimal (OPF: 1.0 ppm), and four‐times optimal (4X OPF: 4.0 ppm) naturally occurring fluoride in their water systems. Methods: Examinations were performed on 344 children who were lifetime residents of their communities. Results: Whether using the tooth surface index of fluorosis or Dean's index, children examined in the 4X OPF community had the highest prevalence of dental fluorosis. While the severity of fluorosis seen in the OPF and NF communities was mild in appearance, the results indicate that fluorosis does occur in optimally and negligibly fluoridated communities. Compared to the NF community, DMFT and DMFS scores in the OPF community were 9.2 percent and 21.2 percent lower, respectively. Conclusions: The ingestion of water containing 1 ppm or less fluoride during the time of tooth development may result in dental fluorosis, albeit in its milder forms. However, in these times of numerous products containing fluoride being available, children ingesting water containing 1 ppm fluoride continue to derive caries protection compared to children ingesting water with negligible amounts of fluoride. Thus, the potential for developing a relatively minor unesthetic condition must be weighed against the potential for reducing dental disease.
Smoking and Oral Health: a Population Survey in Finland
Authors: Telivuo Matti , Kallio Pekka , Berg Mari‐Anna , Korhonen Heikki J. , Murtomaa Heikki
Published: April 2007

Objectives: A survey was conducted to study smokers' oral health behaviors and attitudes, and to determine if smokers were advised by their dentists to quit smoking. Methods: A random sample of 1,200 adults 15 to 64 years of age living in the province of North Karelia, Finland, was selected in each of two study years (1990 and 1991) and surveyed using a mail questionnaire. The 102‐item questionnaire solicited information on smoking status, oral health behaviors, missing teeth, perceptions of tobacco's harmful effects on oral health, smoking status and quitting, and advice on smoking cessation provided by dentists. Variations in behaviors and opinions according to smoking status were analyzed. Results: Nonsmokers reported more frequent healthy oral health behaviors than did daily smokers, with the exception that no difference in toothbrushing frequencies existed among women. Daily smoking was associated with increased use of sugar in tea or coffee, and with more frequent alcohol consumption. Daily smoking was correlated with the number of missing teeth in bivariate analyses, but not in multivariate analyses. Fewer daily smokers than nonsmokers considered smoking to have harmful effects on oral health. The majority of daily smokers, however, wanted to quit. Eight percent of daily smokers reported that they had been advised by their dentist to quit. Conclusions: Dentists need to provide patients with counseling on tobacco use because of the desire of many smokers to quit. Counseling of smokers by the oral health team requires special attention and skills, because smokers' health behaviors and attitudes appear to be less favorable to oral health compared to nonsmokers.
Attitudes of College Football Coaches Regarding NCAA Mouthguard Regulations and Player Compliance
Authors: Ranalli Dennis N. , Lancaster Diana M.
Published: April 2007

Objectives: The purpose of this study was to assess the attitudes of Division 1‐A college head football coaches regarding the NCAA mouthguard regulations, current patterns of use by players, and responsibility for enforcement; and to compare the coaches' responses with those of officials studied previously. Methods: A 15‐item questionnaire was mailed to all 106 Division 1‐A football coaches to assess their attitudes. Percent frequency distributions of coaches' responses to each item were computed and compared to the officials' responses. Results: Responses were received from 98 coaches (92.45%). While 87 percent of coaches reported having a team dentist, the majority reported that the team trainer was responsible for selecting the type of mouthguard used. Most coaches (53%) reported that all players wore mouthguards, but that quarterbacks were least compliant. Most coaches reported that mouthguard rules were beneficial in determining player compliance and resulted in more frequent use. Seventy‐four percent would warn the player of a violation themselves, yet only 26 percent felt the coach had the greatest influence on players wearing mouthguards. Seventy‐six percent felt the current enforcement of the rules is appropriate. Coaches opinions varied from those of officials. Conclusions: Coaches view themselves, the players, or the trainer as most responsible for players wearing mouthguards, not referees. This finding coincides with the officials' opinion that the coaches should be accountable.
Fluoride Supplement Use by Children in Fluoridated Communities
Authors: Pendrys David G. , Morse Douglas E.
Published: April 2007

Objectives: The purpose of this study is to describe patterns of inappropriate fluoride supplementation among a sample of Connecticut schoolchildren living in optimally fluoridated areas. Methods: Fluoride exposure histories were obtained via a written questionnaire with a response rate of 89 percent and an overall reliability of 87 percent agreement. Results: A total of 575 subjects lived the entire first eight years of life in a fluoridated community. Of these, 26.1 percent had a history of inappropriate supplementation sometime during that period, including 31.8 percent of subjects with mild to moderate fluorosis and 22.8 percent of subjects without fluorosis. There were no significant supplement history differences related to current age, sex, or socioeconomic status. Overall, 71 percent of these subjects used only vitamins with fluoride, while only 14 percent were reported to have used fluoride supplements alone. Sixty‐eight percent of the subjects who were supplemented while breast feeding, continued supplementation after cessation of breast feeding. Conclusions: These findings reinforce the need for health professionals to be targeted more aggressively at the school, residency, and private practice levels to better promote a full understanding of the proper utilization of fluoride supplements.
The Prevalence of Dental Fluorosis in a School‐based Program of Fluoride Mouthrinsing, Fluoride Tablets, and Both Procedures Combined
Authors: Nowjack‐Raymer Ruth E. , Selwitz Robert H. , Kingman Albert , Driscoll William S.
Published: April 2007

Objectives: The objective of the study was to describe and compare the prevalence and severity of dental fluorosis in children who participated in an eight‐year clinical trial of the effectiveness of school‐based fluoride procedures according to three treatment regimens and age of regimen initiation. Methods: At baseline in 1981, 1,640 kindergarten and first grade children residing in a fluoride‐deficient community (Springfield, OH) were assigned randomly to a group that(1) rinsed once a week with a 0.2 percent neutral NaF solution; (2) chewed, rinsed, and swallowed daily a neutral 2.2 mg NaF tablet; or (3) carried out both procedures. DMFS examinations were conducted at baseline and after two, five, and eight years of treatment. As a follow‐up in 1992, fluorosis examinations using Dean's index were conducted on 448 remaining subjects. Results: Overall, the prevalence of fluorosis was 4.4 percent with 20 children classified as having some definitive level of the condition. No statistically significant differences existed in the prevalence or severity of fluorosis: (1) among the preventive regimens; (2) among children who began the regimens at ages 5, 6, or 7; or (3) by eruptive status of teeth. Conclusion: These results reiterate the safety of school‐based fluoride mouthrinse, fluoride tablet, or combined regimens in communities with fluoride‐deficient water supplies.
Associations Between Exposure to Fluoridated Drinking Water and Dental Caries Experience among Children in Two Australian States
Authors: Slade Gary D. , Davies Michael J. , Spencer A. John , Stewart Judy F.
Published: April 2007

Objectives: This study assessed associations between exposure to fluoride in water and dental caries experience among children in two Australian states. Methods: Cross‐sectional data were obtained from 9, 690 South Australian children aged 5–15 years and 10, 195 Queensland children aged 5–12 years. School dental service practitioners recorded DMFS and dmfs data. A questionnaire to parents gained information about residential history that was used to calculate children's percent of lifetime exposed to fluoridated water. Results: Greater exposure to fluoride in water was associated with lower dmfs and DMFS in both states (P<.01), although in South Australia the effect for DMFS was statistically significant only after controlling for extent of unknown fluoridation exposure and for fluoride supplements. Caries‐fluoridation associations were stronger for dmfs compared with DMFS and for Queensland (5% of population fluoridated) compared with South Australia (70% of population fluoridated). Effects for DMFS persisted after controlling for socioeconomic factors. Conclusions: Fluoridation was associated with lower caries experience. The weaker association with DMFS in South Australia may be due to less caries and more fissure sealants in that state, and is consistent with a “diffusion” effect, whereby a high proportion of the population exposed to fluoridation diminishes differences among exposure groups.
Dental Caries‐reducing Effects of a Milk Fluoridation Project in Bulgaria
Authors: Pakhomov Guennadi N. , Ivanova Katerina , Moller Ingolf J. , Vrabcheva Maria
Published: April 2007

Objectives: The aim of the present study was to investigate the effects of a community‐based milk fluoridation project on dental caries. Methods: Fluoridated milk was provided to about one‐half of kindergarten and other schoolchildren in Asenovgrad, a town in the southern part of Bulgaria. The estimated daily milk consumption was 200 ml containing 1 mg of fluoride (∼5 ppm F). Cross‐sectional samples of 61/2‐year‐olds in Asenovgrad and Panaguriche (a nearby town selected as the reference community) were examined at the start of the study in 1988 and after three years. Additional cross‐sectional samples of 7 1/2‐year‐olds in Asenovgrad who were and were not drinking fluoridated milk were examined at baseline and at three years to provided an internal control group. Samples of 6 1/2‐and 8 1/2‐year‐olds from Asenovgrad and Karlovo were examined in 1993 to provide for five‐year follow‐up comparisons. Results: In 6 1/2‐year‐old children who had consumed fluoridated milk for three years, there was a decrease in the mean dmft per child of 40 percent and in the mean DMFT of 89 percent compared to children examined at baseline. Children in Asenovgrad who were 4 1/2 years old at the start of the study and had been drinking fluoridated milk for three years had on average 44 percent fewer dmft and 83 percent fewer DMFT at 7 1/2 years of age than those not drinking fluoridated milk. After five years the dmft index was 40 percent less and the DMFT index 79 percent less in those children who had participated in the full five years of the program compared to the control group. Conclusions: Results seem to confirm the caries‐reducing effects of milk fluoridation found in previous studies. Unexpected large caries reductions obtained in this nonexperimental study, however, probably cannot be attributed to the fluoridation of milk alone. The mere introduction of the project might have led to other changes affecting dental caries, such as improved oral hygiene and better dietary habits.
Refining the Estimate of the Critical Period for Susceptibility to Enamel Fluorosis in Human Maxillary Central Incisors
Authors: Evans R. Wendell , Darvell Brian W.
Published: April 2007

Purpose: The purpose of this study was to determine an improved estimate of the critical period for susceptibility to fluorosis in human maxillary central incisors. Methods: The fluorosis score, S, of the incisal (I), middle (M), and cervical (C) third divisions on the labial surface of right maxillary central incisors of subjects (a representative sample of 1,085 Hong Kong Chinese children aged 7 to 12 years surveyed in 1986) was determined according to the Chronological Fluorosis Assessment (CFA) Index. Subject data were grouped by month of birth relative to June 1978, when the designated concentration for waterborne fluoride in the community water supply was reduced from 1.0 to 0.7 mg/L. The analytical task was one of finding the correlation maximum in a system of 12 variates and adjustable parameters including the waterborne fluoride concentration, [F‐], and the fluorosis score. Results: The main findings were: (1) the peak correlation of S vs [F‐] for the male incisal third centered at 17.5 months after birth; (2) and six months later for females; (3) the correlation of S with [F‐] is maximized for S(M) following S(I) by two months, and S(C) following S(M) by a further two months for both males and females; and (4) the critical period for exposure to fluoride is of about four months' duration for each third. Conclusions: The maxillary central incisor, as a whole, appears most at risk to fluorosis from dietary fluoride between age 15 and 24 months for males and between 21 and 30 months for females.
Description and Epidemiology of Nursing Caries
Authors: Milnes Alan R.
Published: April 2007

Nursing caries is a virulent form of tooth decay that affects the primary dentition of infants and preschool children. The purpose of this paper is to review the scientific literature to describe the clinical characteristics of this disease and to report on its prevalence in various locations and populations around the world. A Medline search was completed using the key words below. All English‐language articles that reported on the prevalence of caries involving the primary maxillary incisors in preschool children in association with feeding habits were included in the review. Nursing caries is associated with ad libitum bottle feeding, particularly at naptime or nighttime, and has been reported in children who engage in demand breastfeeding. A substantial body of literature from numerous countries now exists that documents the prevalence of nursing caries. In developed countries the prevalence is reported to vary between 1 percent and 12 percent However, in developing countries and within disadvantaged populations in developed countries, the prevalence has been reported to be as high as 70 percent in the preschool population. A universally accepted definition for nursing caries does not exist and methods used to define the condition, establish study populations, and collect prevalence data vary widely among studies. This review provides a detailed clinical description of nursing caries, reviews the characteristics of children who may be at risk for nursing caries, and reviews the prevalence data for nursing caries for countries that have reported it, and suggests directions for research into nursing caries etiology and prevalence.
Research Recommendations: Pleas for Enhanced Research Efforts to Impact the Epidemic of Dental Disease in Infants
Authors: Weinstein Philip
Published: April 2007

Infant caries is an infectious disease with microbiological, dietary, and host risk factors. The disease is of epidemic proportions in immigrant and Native American populations studied. This paper reviews progress in current research and suggests a number of new approaches focusing on behavioral and chemotherapeutic methods.
Using Area‐based Measures of Socioeconomic Status in Dental Health Services Research
Authors: Locker David , Ford John
Published: April 2007

Objectives: This paper reports the results of a study to assess the value of an area‐based measure of socioeconomic status in dental health services research. Methods: Data on oral health were collected using a telephone interview survey of a random sample of persons aged 50 years and older living independently in Ontario, Canada. Postal codes and a computerized census database were used to identify the mean household income of the enumeration area in which each subject lived. Analyses were undertaken to determine the extent to which the area‐based measure of household income substitutes for and supplements self‐reported household income in predicting oral health outcomes. Results: The results indicate that the enumeration area mean was not a good predictor of self‐reported household income in this population. However, the area‐based measure identified as much variation in nine oral health outcome variables as did the self‐reported measure. Also, the socioeconomic status of the area in which the subjects lived had an effect on health and health‐related behaviors that was independent of their household socioeconomic status. Conclusion: The use of area‐based measures in dental health services research is promising and warrants further exploration.
The State of the Nation's Oral Health: Mid‐decade Assessment of Healthy People 2000
Authors: Gift Helen C. , Drury Thomas F. , Nowjack‐Raymer Ruth E. , Selwitz Robert H.
Published: April 2007

Objectives: This communication reviews the history and process of establishing and assessing national health objectives, presents the status of oral health objectives in Healthy People 2000, and summarizes major issues related to the outlook for the nation's oral health from the perspectives of participants in a July 1995 briefing session with the US Assistant Secretary for Health. Methods: Data obtained from sources such as the third National Health and Nutrition Examination Survey—Phase 1, the 1991 Indian Health Service Survey, and 1989–92 National Health Interview Surveys were examined in relation to specific indicators and populations defined at baseline using mid‐1980s data. Results: Examination of baseline measures and progress data shows that the indicators for objectives are, for the most part, stable or improving slightly. Deaths due to oral cancer have decreased. Edentulousness is declining. Placement of dental sealants on children's teeth is increasing. Adult dental visits are on the expected course. Little change has been observed in water fluoridation. Apparent declines in dental visits and increases in untreated dental decay for young children are potential concerns. Four objectives have no data for progress evaluation. Conclusion: The persistent and often dramatic race‐ethnicity and socioeconomic differences on many objectives, in combination with possible alterations in the public health infrastructure, indicate that concentrated and collaborative efforts are needed to achieve Healthy People 2000 targets.