bluuebunny/crossref_metadata_2025 huggingface dataset:
Fluoride and Bone Health
Authors: Phipps Kathy
Published: April 2007

This paper reviews some of the studies related to the effect of fluoride on the skeletal system of humans and outlines the knowns and unknowns of fluoride and bone health. Current research indicates that, in large enough doses, fluoride stimulates bone formation by osteoblastic stimulation, increases bone formation earlier and to a larger extent in trabecular bone compared to cortical bone, and increases spinal bone density. There is controversy, however, concerning the efficacy of fluoride as a therapeutic agent in the treatment of osteoporosis. Some clinical studies have found a reduction in vertebral fracture rates while others have not. To date, only ecologic studies have been conducted on the association between water fluoridation and hip fractures. The inability of ecologic studies to control for confounding variables makes their interpretation difficult. Based on the literature presented, it is concluded that there are more unknowns than knowns in terms of fluoride's effect on bone, osteoporosis, and fractures. One of the major unknowns in the relationship between fluoride and bone health is dose and duration. Two studies are underway that attempt to describe the dose‐response relationship between waterborne fluoride and osteoporosis. These studies will be completed in the near future and their results, while providing new insight into fluoride's effects on bone, will by no means answer all the questions raised on this issue.
Three‐year Root Caries Incidence and Risk Modeling in Older Adults in North Carolina
Authors: Lawrence Herenia P. , Hunt Ronald J. , Beck James D.
Published: April 2007

Objectives: The purposes of this study were to describe the incidence of root caries and to identify its risk factors in a representative sample of older adults. Methods: Root caries incidence was estimated and multivariate risk assessment models were developed to identify predictors for root caries in a three‐year follow‐up study of 234 black and 218 white noninstitutionalized adults aged 65 and older residing in North Carolina. Results: During the observation period, 29 percent of blacks developed root caries, compared to 39 percent of whites (P<.05). The mean net DFS increment per person was 0.55±0.13 root surfaces for blacks vs 0.80±0.21 for whites (P>.32). Multivariate logistic regression analysis indicated that blacks wearing a partial denture, having some root fragments, having an average gingival recession ≥2 mm, and being free of P. intermedia were at greater risk for developing new root caries. The model for whites showed that retired people with their most severe gingival recession ≥4 mm, an average probing pocket depth ≥2 mm, and taking antihistamines were more likely to develop new lesions. Conclusions: These findings suggest that older blacks had less risk of root caries than whites, and in both groups indicators of poor periodontal status increased the risk of root caries.
Oral Cavity and Pharyngeal Cancer among Department of Veterans Affairs Hospital Discharges
Authors: Fedele Denise J. , Adelson Richard , Niessen Linda C. , Harrison Kathleen
Published: April 2007

Objectives: The purpose of this study is to determine the number of oral cavity and pharyngeal cancers among hospital discharges at Department of Veterans Affairs (VA) medical centers in one 12‐month period. Methods: A SAS file was created from the patient treatment file (PTF) with all discharges during fiscal 1990 having ICD‐9‐CM codes for oral cavity and pharyngeal cancer. Up to 10 discharge diagnoses from the most recent discharge summary were included in the data set. ICD‐9‐CM codes for alcohol dependence syndrome, drug dependence, and nondependent abuse of drugs also were included. ICD‐9‐CM codes for salivary and nasopharyngeal cancers were excluded. Results: There were 3,733 unique individuals discharged with a diagnosis of oral cavity and pharyngeal cancer. The majority of cases (62%) were found in the oral cavity. The age distribution of oral cavity and pharyngeal cancer did not parallel the age distribution of veterans discharged during this year. Race and ethnicity of those discharged with the disease does not differ from that of all VA hospital discharges for 1990. Conclusions: VA data provide descriptive statistics of oral cavity and pharyngeal cancer among VA hospital discharges. VA data sets such as the PTF may offer the opportunity to examine hospital management issues, length of stay, and co‐morbid diagnoses associated with oral cavity and pharyngeal cancer.
Longitudinal Evaluation of Sealing Molars with and without Incipient Dental Caries in a Public Health Program
Authors: Heller Keith E. , Reed Susan G. , Bruner Fred W. , Eklund Stephen A. , Burt Brian A.
Published: April 2007

Objectives: This study undertook a retrospective evaluation of the effect of sealants on the caries experience of initially sound and incipient permanent first molar pit and fissure surfaces. Methods: Records of children with complete five‐year records were obtained from a school‐based dental sealant program in a fluoridated community. Sealants were placed on 677 tooth surfaces in 96 children; 120 tooth surfaces in 17 children who received baseline examinations were not sealed because of lack of caregiver consent. Tooth surfaces were initially diagnosed as being sound or having incipient lesions, and evaluated for caries status after five years. Results: For initially incipient surfaces the five‐year decay rate was 10.8 percent (41 of 380 surfaces) for sealed surfaces and 51.8 percent (29 of 56 surfaces) for nonsealed surfaces with an odds ratio of 8.88 (95% Cl=4.56, 17.35). Initially sound surfaces had a decay rate of 8.1 percent (24 of 297 surfaces) for sealed surfaces and 12.5 percent (8 of 64 surfaces) for nonsealed surfaces with an odds ratio of 1.63 (95% Cl=0.63, 4.08). The two odds ratios were significantly different. Conclusions: Initially sound tooth surfaces were unlikely to become decayed in five years, and did not benefit greatly from the application of sealants. Within the limitations of this study, there were clear efficiencies in sealing incipient, but not sound, surfaces. The targeting of teeth with incipient caries for sealants is therefore recommended.
Risk Factors for Dental Fluorosis in Pediatric Dental Patients
Authors: Skotowski Mary Catherine , Hunt Ronald J. , Levy Steven M.
Published: April 2007

Objectives: Concerns have been raised recently about whether a substantial amount of dental fluorosis is resulting from the increased use of fluoride from various sources. The purposes of this study were to determine the prevalence and severity of dental fluorosis in a sample of pediatric patients seeking dental treatment in a university pediatric dental clinic and to evaluate sources of fluoride as risk factors for dental fluorosis. Methods: A convenience sample of 157 children aged 8 to 17 years were examined for dental fluorosis using the Tooth Surface Index of Fluorosis (TSIF). Fluoride history questionnaires assessing previous exposure to fluoride during the first eight years of life were completed by the children's parents. Fluoride exposures were compared among 54 cases and 54 matched controls using a case‐control retrospective design. Results: Fluorosis was found in 72 percent of the children, but was generally quite mild. The risk of fluorosis was significantly greater for children who had greater exposure to fluoridated water and who used larger amounts of fluoridated toothpaste up to age eight. Conclusions: This study provided evidence that increased use of fluoride toothpaste may be a risk factor for dental fluorosis. The results suggest prudent use of dentifrice by young children to minimize the risk of fluorosis.
Enamel Opacities and Dental Esthetics
Authors: Ellwood Roger Philip , O'Mullane Denis
Published: April 2007

Objectives: The purpose of this study was to determine the esthetic importance of different types of developmental enamel defect. Methods: In the first method used, individual subjects from three different populations with less than 0.1, 0.7, and 0.9 ppm fluoride in their drinking water, were asked about the appearance of their teeth and results compared to assessments of clinical photographs made by a single examiner. In the second method used, dentist and lay observers were asked to assess the appearance of the dentition of selected individuals who had a range of enamel defects. Results: According to the first method, both the size of demarcated opacities and the degree of enamel hypomineralization (TF index) were related to satisfaction with appearance. However, there was no difference in satisfaction with the appearance of the teeth among the three areas included in this study. In the second method, similar types of enamel defects were found to be esthetic stimuli as with the first study, but the dentists responded more strongly to the stimulus of enamel hypomineralization than the lay examiners. Conclusions: Both demarcated opacities and enamel hypomineralization may be important when assessing differences between populations. Further, esthetic ratings by dentists may not be a suitable means of assessing the esthetic importance of different types of enamel defects.
Variation in Dentists' Clinical Decisions
Authors: Bader James D. , Shugars Daniel A.
Published: April 2007

Objectives: The first comprehensive review of the recent literature regarding variation in dentists' clinical treatment decisions is presented. Methods: Variation among dentists in the clinical decisions they make as well as the methods used for assessing this variation are examined at three levels of aggregation of clinical decisions: the dental practice (or dentist), the patient, and the individual tooth. Results: The extent to which differences in dentists' clinical decisions have been examined is limited. Studies are particularly sparse at the level of the dental practice, where the aggregate of dentists' treatment decisions is reflected. Further, the methods and measures used to assess variation tend to be different across studies, making quantification of variation difficult. Nevertheless, the available information reflects substantial variation in measures such as rates of provision of specific procedures; cost and numbers of procedures recommended for specific patients; and diagnoses, intervention decisions, and treatment selections for individual teeth. Conclusions: Even when differences in patients are controlled, variation in dentists' clinical decisions is ubiquitous. While its consequences remain undetermined, the variation in basic clinical decisions such as caries diagnosis signals the need to consider the extent to which the appropriateness of care is affected.
Dental Care Satisfaction: the Reliability and Validity of the DSQ in a Low‐income Population
Authors: Golletz Daniel , Milgrom Peter , Mancl Lloyd
Published: April 2007

Objectives: Studies examining satisfaction with dental health care among the poor are quite rare. This study was done to confirm the internal structure and reliability of the Dental Satisfaction Questionnaire (DSQ), a measure of dental care satisfaction, among a low‐income population, and provide normative data regarding dental satisfaction among low‐income people. Methods: Subjects were 895 mothers of school‐aged children who were administered the DSQ as part of a larger study of dental utilization and dental fears in Seattle. Results: Factor analysis largely confirmed the factor structure of the DSQ. Results also suggested subjects in this sample were less satisfied with pain management than nonpoor people. Self‐reported dental health and dental appearance were associated with satisfaction with pain management, quality of care, access to care, and overall satisfaction. Race/ethnicity, education level, marital status, nation of origin, and type of insurance predicted differences in satisfaction with pain management and access. Conclusions: Barriers to dental care and quality of care among low‐income populations are discussed. Uses and research with the DSQ are suggested.
Relative Contribution of Caries and Periodontal Disease in Adult Tooth Loss for an HMO Dental Population
Authors: Phipps Kathy R. , Stevens Victor J.
Published: April 2007

Objectives: This study examined the reasons for tooth loss in an adult population with dental insurance. Methods: Computerized records were used to identify Kaiser Permanente Dental Care patients aged 40–69 years who had an extraction during 1992 (n=1,877). A random sample of 839 dental charts were reviewed. Results: Slightly more than 51 percent of the teeth were extracted for periodontal disease, 35.4 percent for caries, 9.5 percent for a combination of the two, and 3.5 percent for other reasons. When considering patients as the unit of analysis, 58.4 percent of the patients had an extraction for caries, 39.9 percent for periodontal disease, 5.0 percent for both, and 2.6 percent for other reasons. Conclusions: In this population both caries and periodontal disease play a role in tooth loss. For this reason, prevention programs focusing on the prevention of both disease processes should be developed for adults.
Frustrating Patient Visits
Authors: Milgrom Peter , Cullen Tom , Whitney Coralyn , Fiset Louis , Conrad Douglas , Getz Tracy
Published: April 2007

Objectives: This study, part of a national mail survey of dentist malpractice liability claims, reports the reliability and validity of a new 22‐item instrument measuring frustrating patient visits. Methods: The items were subjected to factor analysis and subscales constructed. Reliability was assessed using Cronbach's alpha. Validity was assessed by comparing subscale scores to self‐reports of satisfaction and liability claims. Results: Factor analysis revealed four subscales representing unpleasant feelings, lack of communication, compliance, and practice organization (alpha=0.60–0.86). Compliance was the most important factor, Subscale scores were related to satisfaction with practice and the proportion of patient visits in the practice that were frustrating to the dentist. Dentists who reported frustrating patient visits as quite typical of their practices were more likely to have had a malpractice liability claim within the last five years. Conclusion: This instrument may be of value in detecting patient‐dentist communication difficulties that are the precursor to liability claims.
The Use of Dental Sealants by Ohio Dentists
Authors: Siegal Mark D. , Garcia A. Isabel , Kandray Diane P. , Giljahn Lynn K.
Published: April 2007

Objectives: To assess the extent to which Ohio dentists report using pit and fissure sealants and factors associated with sealant use. Methods: A mail survey of a random sample of Ohio dentists was conducted in 1989 and repeated in 1992 with a newly drawn sample. Only responses from general dentists were analyzed using univariate analyses and multiple regression. Results: Dentists who reported using sealants increased from 79.4 percent in 1989 to 91.8 percent in 1992. In 1992, 42.9 percent were low‐level users (<15% of school‐aged patients), 41.7 percent were moderate‐level users (15–39%), and 15.3 percent were high‐level users (>39%). Over three‐fourths of sealant‐using dentists expressed some degree of willingness to seal incipient caries. The level of sealant use was associated with dentists' knowledge about sealants, conservative management of dental caries, number of children seen in the practice, and influence of insurance coverage for sealants. The regression model explained 22.0 percent of the variance. Clinical factors associated with the level of use were: dentists' willingness to seal premolars; caries‐free teeth; teeth with deep, narrow pits and fissures; teeth with small, frank occlusal caries; and patients 18 years of age or older. This regression model explained only 15.1 percent of the variance. Conclusion: The great majority of Ohio dentists report using sealants. The percent of reported sealant users increased between 1989 and 1992. Ohio dentists are not consistent with regard to the percent of their child patients for whom they apply sealants or their willingness to seal incipient caries. Dentists continue to identify lack of insurance coverage for sealant application as a major barrier to patients receiving the service.
The Risk of Fluorosis in Students Exposed to a Higher than Optimal Concentration of Fluoride in Well Water
Authors: Ismail Amid I. , Messer James G.
Published: April 2007

Objectives: In December 1991 the residents of the community of Rigolet, Labrador, Canada, discovered that they were exposed to higher than 2.0 ppm fluoride in the drinking water from the new town well, which became operational in December 1983. In 1993 an investigation of the occurrence of fluorosis in children exposed to the high‐fluoride water during different ages of life was carried out. Methods: A dental examination for fluorosis was conducted using Pendrys' Fluorosis Risk Index. Out of 84 students in Rigolet, 74 were examined and the parents of 60 students agreed to be interviewed. Out of the 60 students, 48 lived all of their first six years of life in Rigolet. Results: Of the 48 children with life‐long residence, the odds ratio of fluorosis on enamel zones that began forming during the first year of life was 8.31 (95% Cl= 1.84, 38.59) for children exposed since birth or during the first year of life relative to those exposed after 1 year of age. The odds that a child had a maxillary central incisor with fluorosis were 5.69 (95% Cl=1.34, 24.15) times higher if exposure occurred during the first year of life compared with exposure after 1 year of age. Only those exposed to the high‐fluoride water during the first year of life developed fluorosis on the mandibular central incisors. Conclusion: Within the limitations of this small population study, age relative to the date when the new water well became operational was a significant risk factor in development of fluorosis. The first year of life was a significant period for developing fluorosis on the mandibular and maxillary central incisors.
Etiology of Nursing Caries: a Microbiologic Perspective
Authors: Berkowitz Robert
Published: April 2007

A compelling body of scientific evidence supports the concept that nursing caries is an infectious and transmissible disease. This evidence makes a strong case to support the tenet that infants who are colonized by mutans streptococcl, and who have feeding habits characterized by frequent and prolonged oral exposure to cariogenic substrates, are likely to have a drastic increase in their oral mutans streptococci populations. Such an increase is associated with a high risk for rampant dental caries. This evidence strongly suggests that the first step in the etiology of nursing caries is primary infection by mutans streptococci; the second step is accumulation of these organisms to pathogenic levels as a consequence of frequent and prolonged oral exposure to cariogenic substrates; and the third step is rapid demineralization and cavitation of enamel resulting in rampant dental caries. This three‐step model might provide an important framework for the design of clinical trials targeted at prevention of nursing caries.
The Association Between Developmental Enamel Defects and Caries in Populations with and without Fluoride in Their Drinking Water
Authors: Ellwood Roger Philip , O'Mullane Denis
Published: April 2007

Objectives: The purpose of this study was to consider the association between developmental enamel defects and dental caries in children from areas with different levels of fluoride in their drinking water. Methods: children (mean age= 14.1±0.3 years) were examined from areas with less than 0.1 ppm (n=267) and 0.7 ppm (n=196) in their drinking water. These areas were chosen to contain subjects with a similar social profile. Two types of enamel defect were considered: those consistent with the diagnostic criteria of the Thylstrup Fejerskov (TF) index and demarcated opacities. Dental caries was recorded for surfaces at the level of the dentinal lesion. Results: Subjects with one or more demarcated opacities had more dental caries than those without these opacities present. Children with enamel defects scored with the TF index tended to have less dental caries than those without these defects present. However, the difference was only statistically significant in the area without fluoride in the drinking water. Conclusion: Developmental enamel defects may be useful markers of caries susceptibility, which should be considered in the risk‐benefit assessment for use of fluoride. Further studies are required to clarify the relationship between developmental enamel opacities and dental caries and the reasons for any associations.
Atraumatic Restorative Treatment (ART): Rationale, Technique, and Development
Authors: Frencken Jo E. , Pilot Taco , Songpaisan Yupin , Phantumvanit Prathip
Published: April 2007

Despite long‐term efforts to use appropriate dental equipment for treating dental caries in economically less developed countries, the predominant treatment remains extraction. The reasons for this failure to save teeth are given in this paper. Supported by results of research undertaken in economically developed countries, a 15‐step treatment module for dental caries is presented. This technique, which is called Atraumatic Restorative Treatment (ART), is based on removing decalcified tooth tissue using only hand instruments and restoring the cavity with an adhesive filling material. The technique does not require electricity. The advantages and limitations of the technique are discussed and its use in a school oral health program in Zimbabwe presented. We conclude that ART can make restorative oral care more available to a larger part of the world population than it is today.
Temporal Changes in Dental Caries Levels and Patterns in a Native American Preschool Population
Authors: Douglass Joanna M. , O'Sullivan David M. , Tinanoff Norman
Published: April 2007

Objectives: The purposes of this study were to assess current dental caries experience and levels of mutans streptococci in Apache children in 1993 and to determine how caries levels and patterns were different from 15 years before. Methods: Four‐year‐old Head Start children (n=127) were examined for dental caries and sampled for salivary mutans streptococci in 1993. Dental caries information on 113 4‐year‐old children from the same location was obtained from a chart audit of the 1978–79 Head Start dental examinations. Results: Neither the caries prevalence (95%) nor the prevalence of caries patterns differed between the 1978–79 and 1993 cohorts. However, the level of treatment received in 1993 was greater than that in 1978–79. Children with nursing caries (64%) had a greater severity of fissure caries and a greater prevalence of posterior proximal caries compared with caries‐positive children without nursing caries. The mean dmfs and dmft of the children categorized in the high mutans streptococci range were greater than those of children categorized in the moderate range. Conclusion: The caries prevalence found in these preschool Native Americans is among the highest reported for this age group and does not differ from that found at this location 15 years before. It appears that children with nursing caries in this population are at greater risk for posterior caries patterns.
Consequences of Success: Do More Teeth Translate into More Disease and Utilization?
Authors: Joshi Anil , Douglass Chester W. , Feldman Henry , Mitchell Paul , Jette Alan
Published: April 2007

Objectives: Increased tooth retention coupled with increased numbers of older adults means that the actual number of teeth at risk to dental disease will increase sharply. Whether this increase in the number of teeth will translate into more disease and utilization in unknown. The purpose of this study was to test this “more teeth, therefore more dental disease” theory using cross‐sectional data. Methods: In‐home personal interview and oral examination data were obtained on a probability sample of elders aged 70 years and older living in the six New England states using the Medicare beneficiary list as a sampling frame. Data on dental utilization, number of teeth, dental caries, and periodontal disease were included in the current analysis. Results: Analysis of variance on subjects with 1–10 (Group 1), 11–24 (Group 2), and 25–32 (Group 3) teeth show that the extent of bleeding on probing, pocket depth, and loss of attachment all increase as numbers of teeth increase. Similarly, a greater number of restored coronal and root surfaces were found in Group 3 relative to the other two groups. Mean numbers of decayed and filled coronal surfaces were 8.4 in Group 1,33.0 in Group 2, and 50.3 in Group 3. In contrast, unrestored coronal and root surfaces were significantly higher in Group 1 (mean root DS=1.3) than Group 3 (mean root DS=0.3). Utilization patterns of those with successful aging dentitions (Group 3) show that they are visiting dentists more frequently than the compromised group (Group 1). Conclusion: These cross‐sectional data obtained from a probability sample of New England elders show that subjects who retained higher numbers of teeth have more periodontal disease and dental caries experience, and visit the dentist more frequently.
Relationship Between Dental and General Health Behaviors in a Canadian Population
Authors: Payne Barbara J. , Locker David
Published: April 2007

Objectives: Because the promotion of healthier life styles has become a public health issue of increasing interest, a survey was conducted to compare levels of preventive oral and general health behaviors. Methods: A randomly selected population of voters aged 19 years and older living in a multicultural suburb of metropolitan Toronto, Canada, participated in a mail survey. Results: Dentate respondents (n=976) reported high optimal levels for at least daily toothbrushing (96%); moderate levels of preventive yearly dental examination (69%); and low levels for flossing (22%), using an interdental device (25%), not snacking between meals (12%), and consuming fewer than two cariogenic foods on the previous day (26%). For the general health behaviors, the majority did not smoke (75%), had low alcohol intake (89%), used seat belts (69%), and exercised three times weekly (50%). Additive indices for the oral and general health behaviors were significantly, although weakly, correlated (r=.13; P<.001) and few respondents (31.3%) scored high on both indices. OLS regression on a combined index of oral and general health behaviors found that females, older respondents, and those with higher incomes were more likely to engage in a higher level of health behaviors. Conclusion: These results indicate the need to develop health promotion life style programs that incorporate both dental and general health components and to target these programs to younger age groups, males, and those with low incomes.
A Taxonomy for Lay Risk Perceptions of Dentistry
Authors: Deahl S. Thomas , Kromer Megan E.
Published: April 2007

Objectives: This paper aims to develop and organize a set of variables that can be used to: (1) test the widely held but unproven assumption that lay risk perceptions can adversely affect dental care, (2) investigate the possible influence of lay risk perceptions on dental care, and (3) permit the evaluation of risk communication strategies in dentistry. Methods: We reviewed the literature regarding risk perception and risk communication in health care and technology. We then selected a set of variables that could be measured in a study of the general public and organized these in a taxonomy to suggest likely relationships among the variables. Results: The central relationship of the proposed taxonomy is between a lay person's perception of dental risk and a set of measurable outcomes that could affect that person's dental care. The taxonomy lists three possible influences on the lay person's risk perception: attributes of the individual, attributes of the dental procedure or technology perceived as risky, and attributes of the dental practice. Conclusion: Systematic testing of the proposed variables should demonstrate whether lay risk perceptions substantially influence dental care, and if so, which factors most strongly influence risk perceptions. A model of lay risk perceptions of dentistry then could be developed and strategies could be devised to minimize the detriment, if any, to dental care from risk perception.
Cost Implications of Differences in Dentists' Restorative Treatment Decisions
Authors: Shugars Daniel A. , Bader James D.
Published: April 2007

Objectives: This study sought to determine the effects of variation in both dentists' decisions to treat and choice of treatment on the costs of care. Methods: Each of 37 patients was examined individually by several practicing dentists (between 3–22, x=6.2). For each dentist's recommended treatment for each patient, the total cost of restorative treatment was calculated first using the least expensive treatment possible for each tooth indicated as needing treatment, and second using the costs of specific treatment selected by each dentist. Results: Considerable variation was found among dentists in each patient's cost of treatment using both methods. The mean of the median cost per patient of the specific treatment selected was three times larger than the cost per patient of basic treatment. Few dentists were found to consistently recommend higher or lower cost treatment plans. Conclusion: These findings suggest that inconsistencies in both dentists' decisions to intervene and dentists' selection of treatment can have a profound effect on cost. Further, focusing utilization review on “outlier dentists” is likely to be much less productive in containing costs and improving quality than comprehensive attempts to improve consistency across the profession.
The Fluoridation War: a Scientific Dispute or a Religious Argument?
Authors: Newbrun Ernest
Published: April 2007

Communal water fluoridation is not considered controversial by the vast majority of the scientific community; however, politically it has persisted as an issue that many legislators and community leaders have avoided because of an aura of dispute. it has been a battleground for vigorous opposition by a very small but outspoken minority who have fought it with the dedication of religious zealots. This paper reviews the nature of the opposition, who they are, the broad thrust of their arguments, some of the specific issues they have raised, and their techniques.
The Dental Curriculum: What Should Be New in the 21st Century?
Authors: Baum Bruce J.
Published: April 2007

Dental education is at a critical juncture. The success of water fluoridation has reduced the caries burden of Americans and, consequently, has raised questions about the disproportionate technical emphasis on treating the sequelae of caries in US dental schools. Additionally, several powerful external factors—such as changing demographics, advances in biological science, fundamental changes in our health care delivery system, and a modest US economy—are forcing dental educators to question the appropriateness of retaining the current dental curriculum into the 21st century. The author considers these factors, suggests what type of dentist will be needed by society in approximately 20 years, and concludes that today's dental educational system is inadequate to produce such a dentist Several elements, in addition to technical excellence, are required for the dental curriculum, including major changes in pedagogy, relevant science training, practical fluency in medicine, an increased mix of stomatologic skills, and broader contact with other health care providers.
Factors Associated with Having Oral Cancer Examinations Among US Adults 40 Years of Age or Older
Authors: Horowitz Alice M. , Nourjah Parivash A.
Published: April 2007

Objectives: This study describes factors associated with having an oral cancer examination among US aduits 40 years of age or older. Methods: Data used in this study are from the Cancer Control supplement of the 1992 National Health Interview Survey, which included questions about having had an oral cancer screening examination and knowledge of risk factors for oral cancers. The survey was administered to a national sample 18 years of age and older (n=12,035). Questions regarding beliefs and opinions about cancers in general also were asked and their associations with responses to having had an oral cancer examination studied. Analyses are limited to those respondents 40 years of age and older (n=6,538). Results: Fifteen percent of the adults reported having had an oral cancer examination. Of these, 48 percent had the exam during the past year and 31 percent had an exam one to three years ago. Respondents who were above the poverty level, white, non‐Hispanic, 40 to 64 years of age, and who had more than a high school education and a higher level of knowledge about risk factors for oral cancer were more likely to have had an oral cancer examination. Conclusion: These findings demonstrate the need for vigorous health education and health promotion interventions aimed at health care providers and the public to increase knowledge about risk factors for oral cancers and to increase oral cancer examinations.
Cancer Prevention in the Dental Practice: Oral Cancer Screening and Tobacco Cessation Advice
Authors: Martin Linda M. , Bouquot Jerry E. , Wingo Phyllis A. , Heath Clark W.
Published: April 2007

Objectives: In this paper we describe the proportion of US adults who report receiving oral cancer screening and tobacco cessation counseling and assistance from dentists and other health professionals. Methods: Data from the 1992 National Health Interview Survey (NHIS) Cancer Control Supplement, a nationally representative sample of 12,035 adults 18 years of age and older, are analyzed. Results: In 1992, less than 10 percent of adults reported oral cancer screening by a dentist or hygienist within the past three years. White adults (10.1%; 95% Cl=9.3,10.9) reported an oral cancer screening three times more frequently than black (3.2%; 95% Cl=1.9, 4.5) or Hispanic (3.4%; 95% Cl=2.1, 4.7) adults. About half of adult current smokers had seen a dentist within 12 months, and of those only 24.1 percent (95% Cl=21.7, 26.5) had been advised to quit smoking. Heavy smokers (two or more packs a day) were more likely to have been advised to quit than light (pack or less per day) or occasional smokers. A similar proportion (24.3%; 95% Cl=17.6, 31.0) of white adult men who reported using smokeless tobacco products had been told by a dentist to quit using tobacco. Conclusions: Results from this population‐based survey indicate that cancer screening and tobacco cessation advice are underutilized in the dental practice. Increased patient awareness and implementation of screening and tobacco cessation interventions could improve oral cancer incidence and mortality and have a public health benefit for other tobacco‐related morbidity and mortality as well.
Evaluation of Bias and Logistics in a Survey of Adults at Increased Risk for Oral Health Decrements
Authors: Gilbert Gregg H. , Duncan R. Paul , Kulley Andrew M. , Coward Raymond T. , Heft Marc W.
Published: April 2007

Objectives: Designing research to include sufficient respondents in groups at highest risk for oral health decrements can present unique challenges. Our purpose was to evaluate bias and logistics in this survey of adults at increased risk for oral health decrements. Methods: We used a telephone survey methodology that employed both listed numbers and random digit dialing to identify dentate persons 45 years old or older and to oversample blacks, poor persons, and residents of nonmetropolitan counties. At a second stage, a subsample of the respondents to the initial telephone screening was selected for further study, which consisted of a baseline in‐person interview and a clinical examination. We assessed bias due to: (1) limiting the sample to households with telephones, (2) using predominantly listed numbers instead of random digit dialing, and (3) nonresponse at two stages of data collection. Results: While this approach apparently created some biases in the sample, they were small in magnitude. Specifically, limiting the sample to households with telephones biased the sample overall toward more females, larger households, and fewer functionally impaired persons. Using predominantly listed numbers led to a modest bias toward selection of persons more likely to be younger, healthier, female, have had a recent dental visit, and reside in smaller households. Blacks who were selected randomly at a second stage were more likely to participate in baseline data gathering than their white counterparts. Comparisons of the data obtained in this survey with those from recent national surveys suggest that this methodology for sampling high‐risk groups did not substantively bias the sample with respect to two important dental parameters, prevalence of edentulousness and dental care use, nor were conclusions about multivariate associations with dental care recency substantively affected. Conclusion: This method of sampling persons at high risk for oral health decrements resulted in only modest bias with respect to the population of interest
Do Root Lesions Tend to Develop in the Same People Who Develop Coronal Lesions?
Authors: Beck James D. , Drake Claude W.
Published: April 2007

Objectives: The three purposes of this study are to: (1) describe the relationship between the prevalence of coronal caries and root caries; (2) describe the relationship between the three‐year incidence of coronal caries and root caries; and (3) if the two conditions are associated, develop a multiple regression model that identifies characteristics distinguishing people who had increments of both root caries and coronal caries from people who had increments of either coronal caries or root caries, or who had no new caries. Methods: Dental examinations and interviews were conducted in the homes of a randomly selected, stratified sample of people over the age of 65 years in five North Carolina counties. The relationships between coronal and root D and DF were analyzed through contingency table analyses, and ordinal logistic regression was used to identify characteristics that differentiated people who had both coronal and root D over the three years from people who had either coronal or root D and people who had no new disease. Results: Evidence of root and coronal caries in whites was much more likely to be in the form of fillings, while for blacks, it was more likely to be in the form of untreated decay. Prevalence rates of coronal and root D and DF were significantly associated for both blacks and whites. Incidence rates based on DF indicated that root and coronal caries were not associated in whites, but were associated in blacks. People more likely to experience both types of caries had more gingival recession at baseline, greater average attachment loss over the three years, and lactobacilli at baseline. In addition, the presence of Porphymonas gingivalis at three years was important for whites. Conclusion: It appears that coronal and root caries do tend to appear together in the same individuals, but fillings attenuate that relationship. The impact of dental treatment on the epidemiology of dental caries appears to be considerable and calls into question whether the F component of the caries index is related to disease as defined by epidemiologic criteria.
Dental Caries and Dental Fluorosis at Varying Water Fluoride Concentrations
Authors: Heller Keith E. , Eklund Stephen A. , Burt Brian A.
Published: April 2007

Objectives: The purpose of this study was to investigate the relationships between caries experience and dental fluorosis at different fluoride concentrations in drinking water. The impact of other fluoride products also was assessed. Methods: This study used data from the 1986–87 National Survey of US Schoolchildren. Fluoride levels of school water were used as an indicator of the children's water fluoride exposure. The use of fluoride drops, tablets, professional fluoride treatments, and school fluoride rinses were ascertained from caregiver questionnaires. Only children with a single continuous residence (n=18,755) were included in this analysis. Results: The sharpest declines in dfs and DMFS were associated with increases in water fluoride levels between 0 and 0.7 ppm F, with little additional decline between 0.7 and 1.2 ppm F. Fluorosis prevalence was 13.5 percent, 21.7 percent, 29.9 percent, and 41.4 percent for children who consumed <0.3, 0.3 to <0.7, 0.7 to 1.2, and >1.2 ppm F water. In addition to fluoridated water, the use of fluoride supplements was associated with both lower caries and increased fluorosis. Conclusion: A suitable trade‐off between caries and fluorosis appears to occur around 0.7 ppm F. Data from this study suggest that a reconsideration of the policies concerning the most appropriate concentrations for water fluoridation might be appropriate for the United States.
Validity of Self‐reported Tooth Counts During a Telephone Screening Interview
Authors: Gilbert Gregg H. , Duncan R. Paul , Kulley Andrew M.
Published: April 2007

Objectives: Telephone screening has become a common method used in health services research to identify efficiently persons in specific populations of interest. In this research, we used a large‐scale telephone screening survey to assess: (1) the effectiveness of the telephone method in gathering tooth count information by measuring response rate (cooperation) to specific questions and (2) the validity of subjects' reports of the number of remaining natural teeth. Methods: We used a telephone screening methodology to identify dentate persons (at least one natural tooth remaining) who were 45 years old or older and resided in one of four counties of north Florida. At a second stage, a sample of the telephone screening participants was selected for further study, which consisted of a baseline in‐person interview and a clinical examination. We compared the number of remaining teeth reported during the telephone interview with the number determined at baseline examination. Results: The telephone method was effective at gathering tooth count information, although response rates varied with the level of specificity required. Almost all subjects reported the number of teeth at least at the nominal and ordinal levels, but fewer than three‐fourths reported the number at the interval level. When the unit of analysis was the overall sample, self‐reported number of teeth was a valid measure of the true number. When the unit of analysis was the individual subject, validity was associated with certain clinical and sociodemographic factors. Conclusion: When the unit of analysis is the overall sample, these results suggest that self‐reported tooth counts during a telephone interview are sufficiently valid to meet all but the most stringent data requirements. When the unit of analysis is the individual subject, these tooth counts may not be valid, depending upon the degree of specificity required and subject characteristics.
Validity of Two Methods for Assessing Oral Health Status of Populations
Authors: Beltrán Eugenio D. , Malvitz Dolores M. , Eklund Stephen A.
Published: April 2007

Objective: This investigation assessed two methods for estimating epidemiologic indicators of oral health status among children: (1) a visual‐only screening, performed independently by a dental hygienist and a registered nurse; and (2) a parent‐ or guardian‐completed questionnaire. The indicators included dichotomous variables measuring dental caries and treatment needs, presence of sealants, injuries to the anterior teeth, and dental fluorosis. Methods: Following training and calibration, data were collected over an eight‐day period in April 1994 among 632 elementary schoolchildren (aged 5 to 12 years) in Monticello, Georgia. Both screening and questionnaire findings were compared pairwise with results from visual‐tactile examinations done by a dentist. Validity, represented by sensitivity, specificity, and predictive values, was assessed for screening results from the dental hygienist, the nurse, and the parent‐completed questionnaire. Results: Validity was high for screening for caries and treatment needs (>90% for sensitivity, specificity, and predictive values in a sample having 30% to 40% prevalence). Less valid data — mainly an effect of false negatives — were obtained for fluorosis, injuries, and presence of sealants. No significant difference in validity was observed between the nurse and the dental hygienist. One‐third of respondents to the questionnaire did not know if their children needed fillings (a proxy for untreated decay) or had received sealants; only knowledge of restorations was comparable to results from screening. Intraexaminer reliability for the two screeners ranged from 85 to 100 for percent agreement and 0.70 to 0.93 for kappa scores. Conclusions: Screening by dental hygienists or nurses can provide valid data for surveillance of dental caries and treatment needs. Training for visual assessment of fluorosis and injuries must be improved to diminish the proportion of false negatives. A parent‐completed questionnaire is less effective than visual screening for evaluating oral health status in children.
Comparing the Impact of Oral Disease in Two Populations of Older Adults: Application of the Geriatric Oral Health Assessment Index
Authors: Kressin Nancy R. , Atchison Kathryn A. , Miller Donald R.
Published: April 2007

Objectives: This study compares the distributional and psychometric properties of the Geriatric Oral Health Assessment Index (GOHAI) in two samples of older adults, and examines how the self‐perceived impact of oral disease, as measured by the GOHAI, varies in accordance with sample sociodemographic and health characteristics. Methods: Results are based on survey data from two samples of older men: a Medicare sample of patients using community physicians (n=799; mean age=74) and users of VA ambulatory health care (n=542; mean age=72). Results: The findings indicated significant differences between samples in mean GOHAI scores, with the VA sample exhibiting worse scores. A number of similarities in psychometric properties of the instrument across the two samples were found: high internal consistency reliability and similar inter‐item and item‐scale correlations. Factor analyses revealed somewhat different structures between the two samples, but explained similar amounts of variance; regression analyses indicated that income and self‐rated oral health were significant predictors of GOHAI scores in both samples. Conclusions: The GOHAI exhibits satisfactory psychometric properties in both samples and is sensitive to sociodemographic differences among and between two samples of older men. Results suggest continued use of the GOHAI as an indicator of the impact of oral conditions on functioning and well‐being in a variety of samples.