bluuebunny/crossref_metadata_2025 huggingface dataset:
A System of Diagnostic Codes for Dental Health Care
Authors: Leake James L. , Main Patricia A. , Sabbah Wael
Published: May 2007

Objective: We set out to develop and implement a system of diagnostic codes for use in the computerized management information system of the Community Dental Services of the North York Public Health Department, Methods: We received staff input on common diagnoses, reviewed other diagnostic systems and established criteria for an ideal coding system. The codes are consistent with the format of other classification systems used in dental management information in Canada. They were implemented in 1997–98. Results: We developed a system of four‐digit, numeric codes for dental diagnoses. The diagnostic codes are specific at the level of the patient, consistent with current evidence on the natural history and classification of diseases, consistent with conventional measures of oral conditions, and fit the paradigm of the Canadian system of treatment codes. In the first year, 91 percent of 6,740 patients had at least one diagnosis, with a mean of 2.5 per patient. The five most common diagnoses were smooth surface caries, pit and fissure caries, calculus, teeth with deep fissures, and gingivitis. Conclusions: We have developed a coding system for dental diagnoses that has achieved high use and provided more accessible information on the conditions seen by staff dentists.
Fluoride Metabolism and Excretion in Children
Authors: Whitford Gary M.
Published: May 2007

This paper compares fluoride pharmacokinetics (plasma, renal, and extrarenal clearances) and metabolic balances in healthy infants or children with those in young or middle‐aged adults. Regardless of age, the removal of fluoride from the intra‐and extracellular body fluids occurs almost exclusively by uptake in calcified tissues and excretion in the urine. While there can be considerable differences among individuals, the rates at which fluoride is cleared from plasma by calcified tissues and the kidneys in adults are approximately equal. The calcified tissue clearance of fluoride from plasma in children is substantially higher than that by the kidneys. This is due to the greater surface area of the loosely organized crystallites in the developing calcified tissues during growth. Thus, the balance of fluoride (total intake minus total excretion) is typically higher in children than in adults, but it can be positive or negative at any age. Positive balance occurs when chronic fluoride intake is sufficient to prevent plasma concentrations from declining. When positive, the fluoride content of the calcified tissues, which contain more than 99 percent of the body's fluoride, tends to gradually increase. Negative balance, which indicates net mobilization of fluoride from calcified tissues, can occur when plasma concentrations decline due to a reduction in the level of fluoride intake.
The Differential Diagnosis of Fluorosis
Authors: Pendrys David G.
Published: May 2007

Following the introduction of the first fluorosis index by Dean, a series of fluorosis indexes were introduced. While they may differ in the specific way fluorosis is categorized, they all nevertheless use the same underlying diagnostic signs—originally described by Dean, Black, and McKay—that were causally linked to the development of enamel in areas with above‐optimum fluoride in the drinking water. Underlying the various fluorosis indexes is the belief that specific clinical diagnostic criteria, based upon established clinical signs, can be utilized to differentiate fluorotic from nonfluorctic enamel opacities. These criteria repeatedly have been substantiated in studies in which the presence of enamel fluorosis, identified by clinical differential diagnosis, has been associated with fluoride exposure history. Further, to whatever extent nonfluorotic opacities have been misdiagnosed as fluorosis, observed estimates of association derived from analytical studies will have been underestimated.
The Prevalence and Severity of Enamel Fluorosis in North American Children
Authors: Rozier R. Gary
Published: May 2007

The question considered in this review is the extent to which changes in the prevalence or severity of enamel fluorosis have occurred over the last half‐century. Emphasis is given to a review of those studies in which subjects are drinking water that is fluoride deficient and those in which subjects are drinking optimally fluoridated water, either adjusted or natural. Trends in fluorosis were examined using two definitions of fluorosis (definite and any signs) and three types of comparisons—comparisons of pooled estimates from all available studies that include data from different communities and time periods, comparisons of estimates from the same communities at different times, and comparisons of estimates from selected studies in the early years of fluorosis research with results of the US National Fluorosis Survey done by the National Institute of Dental Research. A clear increase in fluorosis among populations drinking community water that contains less than 0.3 ppm fluoride was found. Results of the comparisons using studies with Dean's Index pooled at different time points, comparisons in the same communities over time, and comparisons of prevalence found in selected communities before fluoride was widely available with the National Fluorosis Survey all support this conclusion. An increase in the prevalence of fluorosis in those drinking optimally fluoridated water likely has occurred as well; however, evidence for such a trend is not as clear as for fluoride deficient communities because of mixed results depending on the type of comparison. The majority of fluorosis cases continue to be mild and seem of little esthetic consequence for most of the public or dental profession. But a few cases of more severe fluorosis can be found now in some communities. Because the prevalence of fluorosis is now higher than 50 years ago, we can conclude that fluoride availability to the developing enamel during critical periods when enamel is at risk of fluorosis has increased in North American children.
Overview of the History and Current Status of Fluoride Supplementation Schedules
Authors: Adair Steven M.
Published: May 2007

Clinical trials of dietary fluoride supplements began in the 1940s in an effort to bring the benefits of fluoride to those who did not receive it through their drinking water. Following the early success of these trials, the Council on Dental Therapeutics of the American Dental Association (ADA) published its first recommendations for fluoride supplementation in 1958. The American Academy of Pediatrics (AAP) followed with its own recommendations in 1972. During the 1970s a variety of alternative schedules appeared in the literature, most in reaction to the findings of unexpectedly high levels of enamel fluorosis in children being supplemented with the AAP schedule. In 1979 the ADA and AAP agreed on essentially identical schedules. During the 1980s, however, the prevalence of enamel fluorosis continued to increase, and fluoride supplements were found in some studies to be a risk factor for fluorosis. This finding prompted another round of dosage schedule recommendations in the early 1990s. This paper presents a history of fluoride dosage recommendations and reviews the recent proposals for reducing supplement dosage.
The Case for Reducing the Current Council on Dental Therapeutics Fluoride Supplementation Schedule
Authors: Newbrun Ernest
Published: May 2007

The milder forms of dental fluorosis have increased in prevalence since the original epidemiologic surveys of the 1930s. Most studies of fluorosis have identified the use of supplements as a major risk factor. Fluorosis could be prevented, in part, by stopping the improper prescription of fluoride supplements in optimally fluoridated areas and by lowering the dosage currently recommended by the Council on Dental Therapeutics supplemental fluoride schedule. At a 1991 workshop at the University of North Carolina, five alternatives to the present ADA Council on Dental Therapeutics schedule were suggested; however, no consensus on dosage was reached. Recently, the Federation Dentaire International adopted a dosage schedule of 0.25 mg F from birth to 3 years of age, 0.5 mg F from 3 to 5 years, and 1 mg F thereafter. At a 1992 Canadian workshop it was proposed that supplements should not be started until age 3, should be given only to those “at high risk” of caries, and only 0.25 mg F should be prescribed from 3 to 5 years of age. Similarly, in some European countries supplements are not recommended until 3 years, at which time 0.5 mg F is prescribed, but only “for children at risk.” Australia is considering a dosage schedule starting with 0.25 mg Fat 6 months, again only for those “particularly at risk of caries.” Serious problems exist in limiting fluoride supplementation only to high‐caries‐risk children because they are not easily identifiable at a young age. Ideally, a dosage schedule should be based on body surface area or weight rather than simply age, and supplements should be in the form of lozenges for children over 2 years of age. A reduced fluoride supplement dosage schedule is proposed.
Oral Cancer Educational Materials for the General Public:1998
Authors: Chung Vicki , Horowitz Alice M. , Canto Maria T. , Siriphant Piya
Published: May 2007

Objective: Previous studies have shown that US adults are not well informed about oral cancers and only 15 percent ever have had an oral cancer examination. This study sought to determine the quantity and adequacy of educational materials designed to inform or educate US adults about risks for, and signs and symptoms of, oral cancer and the need for an oral cancer examination. Methods: Letters requesting copies of oral cancer educational materials produced by the organization or agency—leaflets, fact sheets, pamphlets, videos, posters—were sent to 172 national and state organizations or agencies. To determine the adequacy of the items, a previously developed, tested, and used form based on current science was adapted for this study. In addition, the SMOG index was used to determine readability for printed items. Results: Seventy‐seven percent or 132 of the selected organizations responded to queries. A total of 59 items were received that focused on or included the topic of oral cancer. Twenty of these 59 items focused specifically on oral cancer; the balance, on other topics, but mentioned oral cancer. The readability ranged from sixth to 13th grade. Conclusions: This study demonstrates a dearth of educational materials about oral and pharyngeal cancers; most are written at too high a grade level for the general public. These findings may help to explain why the public is so uninformed about these neoplasms.
A Comparison of Sealant Placement Techniques and 12‐month Retention Rates
Authors: Kanellis Michael J. , Warren John J. , Levy Steven M.
Published: May 2007

Objective: This study compared time required and 12‐month retention for two methods of sealant placement: traditional acid‐etch technique and air‐abrasion technique without acid etch. Methods: Sealants were placed on the permanent first molars of 84 children in grades 1–4 who were randomly assigned to treatment groups. All sealants were placed in a school setting by the same clinician. Chair time required for sealant placement was recorded, and retention rates were determined for each technique 12 months after placement. Results: Mean chair time for placement of sealants on four first molars using the air‐abrasion technique was significantly less than for the acid‐etch technique (7:36 minutes vs 10:56 minutes). Fifty‐eight children were available at 12‐month follow‐up; an examiner not involved in sealant placement and masked as to the technique used determined retention. Rates of complete retention for occlusal surfaces were not significantly different for the two techniques, although the rate for acid etch was higher than that for air abrasion (95% vs 87%). The complete retention rates for the acid‐etch technique were significantly higher than air abrasion for buccal and distolingual surfaces. These rates were 65 percent and 58 percent, respectively, for acid etch and 6 percent and 28 percent, respectively, for air abrasion. Conclusion: Although more research is needed to improve air‐abrasion applications, it does not appear that air abrasion without acid etching offers a significant advantage over traditional sealant placement methods and, in fact, appears to be inferior to the acid‐etch technique for use in public health settings.
Dean's Fluorosis Index: an Assessment of Examiner Reliability
Authors: Kumar Jayanth V. , Swango Philip A. , Opima Pandy N. , Green Elmer L.
Published: May 2007

Objective: This report describes the interexaminer reliability achieved using Dean's Index in a study of dental fluorosis, and shows the effect on kappa values of assigning different weights to the various components of Dean's Index. Methods: Three dentists conducted replicate fluorosis examinations on 202 children in Newburgh and Kingston, NY. Examiner reliability was assessed by computing percent agreement and weighted and unweighted kappa statistics. Results: Agreement on the presence or absence of fluorosis using Dean's definition of fluorosis ranged from 92 to 97 percent and the respective kappa values ranged from 0.75 to 0.94. A comparison of subject‐level severity scores for Dean's Index resulted in percent agreement ranging from 79.6 percent to 86.8 percent and kappa values ranging from 0.67 to 0.76. Weighting the kappa statistics improved agreement and reduced the differences. Conclusions: Examiners showed good to excellent agreement beyond chance in the use of the index. Subject level kappa scores were higher than tooth‐level scores.
Identification of Adult Populations at High Risk for Dental Caries Using a Computerized Database and Patient Records: A Pilot Project
Authors: Powell Virginia , Leroux Brian G. , Martin Jean A. , White B. Alexander
Published: May 2007

Objective: The purpose of this study is to test the usefulness of dental insurance claims history, supplemented with radiographic caries diagnoses, as a means of identifying caries‐active and caries‐inactive working adults, as determined by bacterial levels. Computerized identification of at‐risk groups may facilitate subject selection for clinical trials designed to test caries‐preventive strategies. Methods: Two groups of subjects were initially selected from an insurance database based upon their dental service utilization during a one‐year period: a “low restorative” group of individuals defined as persons who had received no restorative treatment, and a “high restorative” group comprised of individuals who had received at least three multisurfaced restorations. A chart review confirmed a diagnosis of caries in the high restorative group and an absence of caries in the low restorative group. Subjects were then approached for saliva collection. The low and high restorative groups were compared for salivary mutans streptococci and lactobacilli levels, stimulated flow rate, and buffer capacity (n=48). Results: The high and low restorative groups differed in mutans streptococci levels, but not on other measures. Conclusions: A group of subjects who had recently received multisurfaced restorations that were placed for reasons of caries had significantly higher levels of mutans streptococci and potential for continued caries activity when compared to a group of subjects who had received no restorations and were caries free. [J Public Health 2000;60(2):82–84]
Water Consumption and Nursing Characteristics of Infants by Race and Ethnicity
Authors: Heller Keith E. , Sohn Woosung , Burt Brian A. , Feigal Robert J.
Published: May 2007

Objective: The purpose of this project was to determine racial/ethnic differences in water consumption levels and nursing habits of children younger than 2 years old. Methods: Data from the 1994–96 Continuing Survey of Food Intakes by Individuals (CSFII) were used for these analyses. Water consumption and breast‐feeding data on 946 children younger than 2 years old were used. Results: For black non‐Hispanic children younger than 2 years old (n=121), 5.3 percent of the children were currently being breast fed. This percentage was less than that seen in other racial/ethnic groups. For white non‐Hispanic children (n=620), this percentage was 10.8 percent; for Hispanic children (n=146), 12.2 percent; for “other” children, 18.5 percent (n=59). Black non‐Hispanic children had the highest total water consumption (128.6 ml/kg/day) among all groups, white non‐Hispanic had the lowest (113.2 ml/kg/day). These differences were not statistically significant in multivariate regression modeling. Black non‐Hispanic children also drank moretap water (21.3 ml/kg/day) than white non‐Hispanic children (12.7 ml/kg/day) and Hispanic children (14.9 ml/kg/day). The difference was statistically significant in multivariate regression modeling. Conclusions: The differences in breast feeding and water consumption observed among black children younger than 2 years of age could be a factor in the observed higher levels of fluorosis in black children compared to other children.
Access and Use of Specific Dental Services in HIV Disease
Authors: Mascarenhas Ana Karina , Smith Scott R.
Published: May 2007

Objective: This study examined factors associated with the use of specific dental services by persons with HIV disease. Methods: The data were derived from 1,588 adults who participated in a series of up to six interviews as part of the AIDS Cost and Service Utilization Surveys. Use of dental services such as examinations, x‐rays, cleaning, fillings, extractions, root canals, crown and bridge or dentures, andperiodontal procedures were evaluated using logistic regression and generalized estimating equations were applied. Results: Multivariate analyses showed that medical insurance, an education beyond high school, income higher than $1,300 per month, high ambulatory visits, and receipt of psychological counseling were generally associated with higher service use. Blacks, those with an inpatient admission, and CD4+ cell counts less than 500 cells/μL were significantly less likely to use most types of dental services. Conclusions: The study concludes that disparities exist in the use of several dental services similar to those seen in the general population.
Health Care Savings from Microbiological Caries Risk Screening of Toddlers: a Cost Estimation Model
Authors: Zavras Athanasios I. , Edelstein Burton L. , Vamvakidls Athanasios
Published: May 2007

Objective: Modeling new biomedical technologies and determining their expected cost is necessary before initiating formal clinical trials. This paper estimates an economic model for the potential cost impact of microbiological screening of toddlers for caries risk compared to the traditional method of managing pediatric caries. Methods: Potential cost savings were calculated based on screening test properties (sensitivity and specificity) derived from a population of 1,180 children aged 1 to 3 years with a caries prevalence of 15 percent. An algorithm was then developed to allocate prevalent and anticipate incident caries, treatment effectiveness assumptions, and existing regional treatment costs. Results: The cost analysis model conservatively predicts savings of 7.3 percent from screening and early intervention. Cumulative dental treatment costs for a child at age 4 years are $367.90 if the child has been screened and $396.70 otherwise. The model further predicts that cost savings increase significantly as caries prevalence increases. Conclusions: Microbiologic risk assessment for pediatric caries may be an example of a preventive public health screening technique that results in both clinical benefits and cost savings. If the model is validated by randomized clinical trials, microbiologic screening could be used by pediatric primary care providers to identify toddlers who require early referral to dentists for further risk assessment and early caries management.
Perceived Impact of Oral Health Conditions Among Minority Adolescents
Authors: Broder Hillary L. , Slade Gary , Caine Rufus , Reisine Susan
Published: May 2007

Objective: This study assessed the perceived impact of oral health conditions, and the relationship of two measures of self‐reported outcome, the RAND SF‐36 and the Oral Health Impact Profile (OHIP), to clinical indicators of oral health among inner‐city adolescents. Methods: A convenience sample of 93 minority adolescents completed the RAND SF‐36 and the OHIP and 76 of them completed a clinical dental examination assessing DMFS. Results: Participants averaged 14.4 (SD=1.2) years old; 52 percent were female; and 86 percent were African‐American. The mean DMFS was 8.8 (SD=6.3). Participants reported relatively poor general health on the SF‐36 as well as poor oral health on the OHIP. None of the SF‐36 subscales were significantly related to DMFS. OHIP subscales were consistently related to DMFS—those with worse oral health reported more impacts. With the exception of the bodily pain subscale of the SF‐36, the SF‐36 and OHIP subscales were significantly correlated with Pearson's correlations ranging from ‐.21 to ‐.57 (P<.05). Conclusions: Although the SF‐36 and the OHIP were correlated, the OHIP appears to be more highly associated with the impacts of oral health conditions than the SF‐36 among inner‐city adolescents who reported low general and oral health quality of life.
Access to Dental Care for Head Start Enrollees
Authors: Edeistein Burton L
Published: May 2007

Objective: The objectives of this review are to characterize the oral health and dental access of Head Start children, describe barriers to their care, advance strategies to address those barriers, and consider how Head Start Performance Standards can be utilized to maximize oral health and access to dental care. Methods: Published, programmatic, and solicited data describing oral health status and dental service utilization are reviewed together with reports of conferences exploring access barriers. Head Start performance measures for child health and development services, child health and safety, family partnerships, and community partnerships are individually evaluated for their potential to improve oral health. Results: Head Start children, like all low‐income children, enjoy the highest rates of dental coverage (because of Medicaid and the State Child Health Insurance Program), yet these children also experience the highest rates of tooth decay, the most unmet dental care needs, the highest rates of dental pain, and the fewest dental visits. Getting children the dental care they need is problematic because of: multiple barriers associated with public and private dental delivery systems, Medicaid program funding and administration, dental workforce sufficiency and distribution, and issues of culture and communication that stand between parents, children, and caregivers. Conclusions: To move beyond screening and to access necessary dental care requires integration between medical and dental care, recognition and elimination of barriers to care, an understanding of dental provider types and their capacities, a formally structured referral process, and regular monitoring to ensure that complete care is obtained. Action steps are suggested that can maximize the effectiveness of Head Start Performance Standards. Head Start holds tremendous potential to actively develop and implement policies that can markedly improve both access to needed dental services and the oral health status of young disadvantaged children.
Systemic Diseases and Their Treatments in the Elderly: Impact on Oral Health
Authors: Ghezzi Elisa M. , Ship Jonathan A.
Published: May 2007

The lifespan of the US population is increasing, with the elderly desiring successful aging. This goal is jeopardized as multiple systemic conditions and their treatments become more prevalent with age, causing impaired systemic and oral health and influencing an older person's quality of life. To obtain successful aging, a compression of morbidity must be obtained through prevention and management of disease. This paper describes the most common systemic diseases causing morbidity and mortality in persons aged 65+ years: diseases of the heart, malignant neoplasms, cerebrovascular diseases, chronic obstructive pulmonary disease, pneumonia, influenza, diabetes mellitus, trauma, Alzheimer's disease, renal diseases, septicemia, and liver diseases. Disease prevalence and the impact of medications and other therapeutic measures used to treat these conditions are discussed. Oral sequelae are reviewed with guidelines for early detection of these deleterious consequences, considerations for oral treatment, and patient management. An understanding of the impact of systemic diseases and treatment on oral health is imperative for dental practitioners to appropriately treat and manage older patients with these conditions. With a focus on early detection and prevention, oral health care providers can improve the quality of life of this population and aid in the attainment of successful aging.
Oral Health and Nutrition in Older People
Authors: Walls Angus W. G. , Steele Jimmy G. , Sheiham Aubrey , Marcenes Wagner , Moynihan Paula J.
Published: May 2007

The theoretical link between foods choice and masticatory efficiency has long been established. Recent evidence has confirmed this association, demonstrating a progressive alteration in food choice with decreasing numbers of teeth, with the greatest effect being among those who are edentulous. This altered food selection results in significant differences in the hematological status for some key nutrients in the one study in which this association was investigated. This paper summarizes some of the literature relevant to diet as a risk factor for systemic disease and identifies areas where altered food choice as a consequence of reduced masticatory efficiency might be placing individuals at increased risk of life‐threatening conditions, such as atherosclerosis and cancer.
Public Policy on Oral Health and Old Age: a Global View
Authors: Barmes David E.
Published: May 2007

This paper reviews major trends in the global demography and oral health status of populations, the challenges faced in ensuring successful aging because of these trends, and basic principles to guide public policy responses. Virtually all populations in which the dental caries prevalence reached high levels in the first half of the 20th century have experienced large reductions. A feared increase of the disease in the developing world has been far less than expected. Some countries that did suffer large increases dating from the 1960s already have managed to return to their former low levels because of timely use of preventive measures. Improving oral hygiene and a consequent reduction in the occurrence and severity of periodontal diseases further bolster the mainly positive trend in global oral health. Only in the former socialist economies is oral health status worsening. These positive changes have brought the expectation that an intact and well‐functioning dentition should last for life, no matter how extended the lifespan becomes. But these changes take us into “uncharted waters” and the most appropriate strategies for preserving health in old age are unknown because they have never been tried. However, public policies to support community awareness and acceptance of broad‐based preventive behaviors to preserve oral health in old age are essential. Policies also must provide guidance on how to proceed when disabling disease occurs, provide for regular research and updating of information, and ensure access to cost‐effective and high‐quality services for all.
Clinical Factors Related to Noncompletion of Root Canal Therapy
Authors: Caplan Daniel J. , White B. Alex
Published: May 2007

Objectives: This study identified clinical factors related to noncompletion of root canal therapy (RCT) among patients in a dental health maintenance organization (HMO) based in Portland, OR. Methods: A secondary analysis of a case‐control study was conducted using data from 303 individuals enrolled continuously in the HMO from January 1, 1987, through December 31, 1994, who received endodontic access on a permanent nonwisdom tooth in 1987 or 1988. Person‐ and tooth‐level characteristics were evaluated to compare patients whose accessed tooth was obturated by December 31, 1994, with patients whose accessed tooth was not obturated by that date. Written and electronic records were reviewed to ascertain study variables, and multivariate logistic regression models were developed to describe differences between the two groups. Results: Incomplete RCT was more common among patients who were symptomatic prior to access and had more missing first molars at access. It also was more common among teeth that were decayed, had more pockets ≥5 mm, and had fewer decayed or filled surfaces at access. Conclusions: Because patients with greater evidence of past and current oral disease were less likely to have completed RCT, they may require additional counseling about the importance of carrying through with prescribed treatment.
A Cluster Randomized Controlled Trial of a Dental Health Education Program for 10‐year‐old Children
Authors: Worthington Helen V. , Hill Kirsty B. , Mooney Jeanette , Hamilton Fiona A. , Blinkhorn Anthony S.
Published: May 2007

Objective: Using a cluster randomized trial, this study tested the effectiveness of a dental health education program designed to improve the oral hygiene and dental knowledge of 10‐year‐old children. Methods: Thirty‐two primary schools in the northwest of England participated. After a baseline assessment of plaque and the completion of a dental knowledge questionnaire by the children, the schools were allocated randomly to active or control groups. Children in schools allocated to the active group received the dental health program, which consisted of four one‐hour lessons. After four months the children were examined clinically and scored for plaque, and a second questionnaire was administered. The schools in the control group were then allocated randomly to receive the program or not over the following three months, the program being withdrawn from the schools who initially received it. A further assessment of plaque was made and a questionnaire administered seven months after the baseline of the study. Results: The active groups had 20 percent and 17 percent lower mean plaque scores than the control group at four and seven months (P<.001). The children's knowledge of which type of toothbrush should be used and the role of disclosing tablets improved in the initial test group when compared with the control group and this was retained over the second part of the study. Conclusion: The children receiving the program had significantly lower mean plaque scores and greater knowledge about toothbrushes and disclosing tablets than the control children who had not received the program.
Prevalence of Dental Fluorosis in the Primary Dentition
Authors: Warren John J. , Levy Steven M. , Kanellis Michael J.
Published: May 2007

Objectives: This paper presents data on the prevalence of primary tooth fluorosis among children residing in Iowa, and the relationships between fluorosis prevalence and selected measures of fluoride exposures. Methods: Children in the study cohort were followed prospectively during the first year of life. This study assessed their home water fluoride concentrations and use of fluoride dentifrice or dietary fluoride supplements. A total of 637 children (320 females and 317 males) were examined for fluorosis using a modification of the TSIF index at age 4 1/2 to 5 years, with 90.4 percent having intact primary dentitions. Results: 74 children (11.6%) had fluorosis present on one or more of their primary teeth, and 71 children (11.1%) had two or more teeth affected. Nearly all fluorosis was mild, with the primary second molar teeth most commonly affected. Fluorosis was significantly associated with higher water fluoride concentration, but not with the use of dentifrice or fluoride supplements. Conclusions: The results of this study show that primary tooth fluorosis is relatively uncommon, but is most frequently seen on the posterior teeth, particularly the primary second molars, which form at later stages of development. This finding suggests that primary tooth fluorosis is mostly a postnatal phenomenon, and is associated with higher water fluoride levels.
US Drinking Water: Fluoridation Knowledge Level of Water Plant Operators
Authors: Lalumandier James A. , Hernandez Leonor C. , Locci Ana B. , Reeves Tom G.
Published: May 2007

Objectives: We determined the knowledge level of water plant operators who fluoridate drinking water, and we compared small and large water plants. Methods: A pretested survey was sent to 2,381 water plant operators in 12 states that adjust the fluoride concentration of drinking water. A z‐test for proportion was used to test for statistical difference between small and large plants at α=0.05. Small water plants were those treating less than 1 million gallons of water daily. Results: Eight hundred small and 480 large water plant operators responded, resulting in a response rate of 54 percent. Two‐thirds of water plant operators correctly identified the optimal fluoride level, but more than 20 percent used a poor source for choosing the optimal level. Only one‐fourth of operators were able to maintain the fluoride concentration to within 0.1 mg/L of the optimal concentration. A significantly greater proportion of operators at large water plants than at small water plants reported that they were able to maintain a fluoride concentration to within 0.1 mg/L of the optimal concentration (33.5% vs 21.3%, z=4.74, P <.05). Conclusions: Although most operators correctly identified the optimal fluoride level, small water plant operators were less likely to use accurate reasoning for choosing that level and in maintaining fluoride concentrations within 0.1 mg/L of that level than large water plant operators.
Community‐oriented Oral Health Promotion for Infants in Jerusalem: Evaluation of a Program Trial
Authors: Sgan‐Cohen Harold D. , Mansbach Ivonne Kleinfeld , Haver Dana , Gofin Rosa
Published: May 2007

Objectives: This study sought to measure the effect of a community health education program on reported infants' bottle‐feeding practices and infants' toothbrushing behavior, with or without distribution of toothpaste and tooth‐brushes. Methods: In this quasi‐experimental comparison group design study conducted in mother and child health centers in Jerusalem, parents of 727 children were surveyed by telephone at baseline and six months later. The cohort of infants was aged 6–12 months at baseline. The program group received structured health education. The control group received no organized educational intervention. Within the program and control groups, half of the centers were randomly given toothpaste and toothbrushes. Results: Parents' reports revealed a secular 32.5 percent increase in toothbrushing for infants with no intervention, 45.1 percent for infants only receiving toothpaste and toothbrushes, 43.7 percent for infants only receiving the health education program, and a 60.4 percent increase for infants receiving health education together with toothpaste and toothbrushes (chi‐square, P=.0002). Modification of bottle‐drinking practices, in this program, was unsuccessful. Conclusion: The free distribution of toothpaste and toothbrushes, together with an oral health education program, is recommended as a potentially practical and effective method of promoting early oral hygiene practices.
Elder Mistreatment: Implications for Public Health Dentistry
Authors: Cowen Howard J. , Cowen Perle Slavik
Published: May 2007

Elder mistreatment has increasingly been recognized as a serious and complex health issue affecting large numbers of elders each year. Health professionals have been found to lack knowledge regarding assessment, diagnosis, intervention, and reporting criteria of this problem. In dentistry, there have been recent calls for more research and publications as well as requests for professional policy statements and guidelines. Public health dentistry, with its emphasis on prevention, can lend guidance and leadership at the primary, secondary, and tertiary levels. This article reviews the types and prevalence of elder mistreatment, discusses predisposing variables, and offers an ecological model that serves as a guide to interventions directed at all levels of elder mistreatment prevention.
Perspectives of Maryland Adult and Family Practice Nurse Practitioners on Oral Cancer
Authors: Siriphant Piya , Horowitz Alice M. , Child Wendy L.
Published: May 2007

Objectives: Because oral and pharyngeal cancer mortality in Maryland ranks seventh among states and sixth for black males, a statewide oral cancer needs assessment was conducted. The purposes of this qualitative descriptive study were to obtain indepth information on nurse practitioners' awareness and opinions of oral cancer, oral cancer examinations, and related factors. These findings were intended to supplement a previous survey conducted among Maryland nurse practitioners. Methods: A professional focus group moderator conducted one face‐to‐face focus group with 11 nurse practitioners and one telephone focus group with eight nurse practitioners. Criterion‐purposeful sampling and qualitative content analysis were employed. Results: Findings showed that oral cancer is a neglected public health problem and, based on their formal training, not one considered by nurse practitioners to be their responsibility. Although aware of other cancers, none of the nurse practitioners recognized that oral cancer was a public health problem in the state. Numerous barriers were cited for this neglect, including their lack of training and, in one case, unpleasant feelings about examining the mouth. Participants concluded that oral cancer is part of their responsibilities and that they are interested in related continuing education courses. Conclusions: The focus groups of nurse practitioners provided rich and insightful suggestions for future strategies to help solve the oral cancer problem in Maryland, which supplemented the quantitative mail survey conducted earlier. (J Public Health Dent 2001;61(3):145‐49]
At First Glance: Social Meanings of Dental Appearance
Authors: Eli Liana , Bar‐Tat Yoram , Kostovetzki Ina
Published: May 2007

Objectives: An important factor in social interaction is physical appearance. Major elements in the evaluation of physical appearance are the mouth and teeth. The purpose of this study was to evaluate the effect of tooth appearance on the development of a first impression of the other person, with regard to the sex of both the respondent and the target. Methods: Eight facial photographs of individuals with intact upper teeth were manipulated: one set was left untouched and the other was professionally altered so that the front anterior teeth appeared decayed. The photographs were randomly aligned in sets of eight, each set consisting of four individuals with an original, intact dentition and four other individuals with a “decayed” dentition. The sets of photographs were then presented to 115 respondents (65 males and 50 females). Evaluations were made according to three categories of traits—esthetic, social, and professional. Results: For all three evaluation categories, the difference in scores between decayed and intact dentition given to targets were significantly higher when participants of one sex evaluated targets of the opposite sex, as compared to evaluating targets of their own sex. Conclusions: The effect of tooth appearance on the physical attractiveness stereotype is more evident when males evaluate females and vice versa, rather than when evaluating their own sex.
Measuring Orthodontic Treatment Satisfaction: Questionnaire Development and Preliminary Validation
Authors: Bennett M. Elizabeth , Camilla Tulloch J. F. , Vlg Katherine W. L. , Phillips Ceib L.
Published: May 2007

Objectives: The aims of this study were to develop a reliable self‐report measure of consumer satisfaction with orthodontic treatment, and to preliminarily assess its validity. Method: Transcripts of qualitative interviews with patients, their parents, and practicing orthodontists together with items from existing dental satisfaction questionnaires were used to develop a pool of 41 items assessing satisfaction with various aspects of orthodontic care. These items were paired with five‐point Likert scales (1=strongly disagree, 5=strongly agree) and were administered to 299 parents of children who had completed orthodontic treatment at two university‐based clinics. Results: Factor analyses and reliability analyses identified three main subscales with high reliabilities: 13 items assessing satisfaction with treatment process (Cronbach's alpha=.92), seven items assessing satisfaction with psychosocial effects of treatment (Cronbach's alpha=.87), and five items assessing satisfaction with overall treatment outcome (Cronbach's alpha=.79). Relationships among these three subscales and pre‐ and posttreatment variables were examined in a subset of 86 parents/patients. Forward stepwise regression with backward overlook revealed no significant relationships between any satisfaction subscale and demographic variables. Posttreatment overjet was inversely related to parental satisfaction with orthodontic treatment process (R2=.13; P<.001), and parent satisfaction with treatment outcome (R2=.28; P<.0001). improvement in esthetics as measured by improvement in IOTN Aesthetic Component scores was positively related to satisfaction with psychosocial outcomes (R2=.28; P<.0001). Conclusions: The present instrument is reliable and can be used to assess three dimensions of parental satisfaction with their child's orthodontic treatment. Relationships between visible orthodontic outcome variables and parent satisfaction provide preliminary validity support for the instrument.
Mutans Streptococci Oral Colonization in 12‐30‐month‐old Brazilian Children over a One‐year Follow‐up Period
Authors: Mattos‐Graner Renata O. , Correa Maria Salete N. P. , Latorre Maria do Rosário de O. , Peres Regina C. R. , Mayer Marcia P. A.
Published: May 2007

Objectives: The infection levels of mutans streptococci were investigated during a one‐year follow‐up in children aged 12 to 30 months attending school nurseries where a sucrose‐rich diet was provided. Methods: Oral levels of mutans streptococci obtained from 101 children at baseline and aftera one‐year follow‐up were compared by age, number of teeth, feeding habits, and presence of visible plaque at baseline. Baseline predictors and changes in mutans streptococci levels during the study were compared to caries incidence after one year. Results: Fluctuations in mutans streptococci levels during the follow‐up period were not related to feeding habits or presence of visible plaque. Mutans streptococci levels increased after one year among children aged 12 to 24 months, while a significantly higher proportion of those aged 25–30 months showed a decrease in mutans streptococci levels during the study. Multiple logistic regression analysis suggested that high levels of mutans streptococci (≥100 cfu) at baseline were associated with a higher caries increment, while reduction in mutans streptococci was negatively associated with caries incidence. Conclusions: Our data suggest that despite early mutans streptococci infection and high exposure to sucrose, mutans streptococci may achieve relatively stable levels after 2 years of age. Heavy colonization by mutans streptococci in an early age was related to an extremely high caries incidence during childhood, while decreasing levels of mutans streptococci can be associated to the decrease in caries activity.
Toothbrushing Competency Among High‐risk Grade One Students: an Evaluation of Two Methods of Dental Health Education
Authors: Hawkins Robert J. , Zanetti Debra L. , Main Patricia A. , Otchere Daniel F. , Dwyer John J. M. , Jokovic Aleksandra , Locker David
Published: May 2007

Objective: To evaluate the effectiveness of two methods of dental health education (DHE) for improving toothbrushing competency among grade one students at high risk for dental diseases. Methods: Fifty elementary schools in the former city of North York, Ontario, Canada, were assigned to one of two groups. In one group, students received a classroom‐based DHE lesson that was reinforced by two small group sessions (n=243). In the other group, students received only a single classroom‐based DHE lesson (n=206). Trained examiners assessed 11 toothbrushing skills at pre‐ and postintervention. Results: At the preintervention test, few significant differences were found between the groups and many students did not display competency in fundamental oral health skills, such as placing a toothbrush at the gum line. Following DHE interventions, students in both groups demonstrated improvements in most skills. A significantly higher proportion of students who received both classroom and small group sessions displayed gains in competency in three skills, compared to students receiving only a classroom lesson. These skills were brushing anterior lingual surfaces, brushing posterior lingual surfaces, and brushing all areas in a routine fashion. Students receiving only a classroom session did not display greater improvements in any skill areas compared to “classroom plus small group” students. Some students in both groups still lacked fundamental skills at the end of the DHE program. Conclusions: While one must exercise caution in interpreting the results due to several methodologic limitations, findings suggest that for high‐risk grade one students, a classroom‐based lesson combined with small group sessions is a more effective method of improving toothbrushing skills compared to a single classroom‐based lesson.
A Scoring System for the Early Detection of Oral Submucous Fibrosis Based on a Self‐administered Questionnaire
Authors: Chiu Chung‐Jung , Lee Wen‐Chung , Chiang Chun‐Pin , Hahn Liang‐Jiunn , Kuo Ying‐Shiung , Chen Chien‐Jen
Published: May 2007

Objectives: The aims of the present study were to evaluate the frequent clinical complaints of oral submucous fibrosis (OSF) and to develop a scoring system for early detection of the disease by a self‐administered questionnaire. Methods: A total of 296 subjects were recruited, including 123 OSF patients without oral cancer and 173 betel quid chewers without OSF or oral cancer. A self‐administered questionnaire was used to collect the symptom profile from study subjects. Their maximal mouth opening (MMO) between upper and lower incisor edges was measured and recorded by well‐trained nurses. A binary logistic regression model examining the likelihood of OSF based on the eight symptoms of interest was used to develop the scoring system. Results: Among 79 OSF subjects with an MMO c35 mm, the most frequent complaint was trismus (87.3%), followed by burning sensation (76.0%) and xerostomia (72.2%). Among 44 OSF subjects with an MMO 235 mm, burning sensation (68.2%) was the most frequent complaint, followed by trismus (54.5%) and xerostomia (54.5%). Six frequent complaints including trismus, burning sensation, xerostomia, sore throat, numbness, and oral ulceration were utilized to develop a scoring system for the early detection of OSF. The scoring system had an area under the receiver operating characteristic curve of 0.90. Conclusion: This study suggests a screening questionnaire of frequent complaints for the early detection of OSF.