bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the Comparative Effectiveness of Fluoride Mouthrinsing, Fluoride Tablets, and Both Procedures in Combination: Interim Findings after Five Years
Authors: Driscoll William S. , Nowjack‐Raymer Ruth , Heifetz Stanley B. , LI Shou‐Hua , Selwitz Robert H.
Published: May 2007

This article presents five‐year interim findings of an eight‐year clinical trial designed to compare the relative caries‐preventive benefits of weekly fluoride mouthrinsing, daily fluoride tablet administration, and both procedures combined. Children in kindergarten and first grade residing in Springfield, Ohio, a non fluoridated community, were assigned randomly in school to one of three groups that (1) rinses once a week in school with a 0.2 percent neutral NaF solution; (2) chews, rinses with, and then swallows daily in school a neutral 2.2 mg NaF tablet; or (3) carries out both procedures. At baseline (1981), 1,640 participants were examined clinically using the DMF surface index. After five years, 789 children were available for reexamination. Findings show that subjects in the combination group experienced a mean caries increment of 1.47 DMFS, 16.5 percent lower than the mean score of 1.76 DMFS for children in the tablet group and 31.3 percent lower than the 2.14 DMFS for those in the rinse group. Only the difference in incremental caries scores between the combined fluoride procedure and the fluoride rinse was statistically significant (P<.05). Despite the finding of an additive caries‐preventive benefit among children who followed the combined regimen, it would be premature to judge which procedure is best before results of the final examinations become known.
Oral Health Status of Mexican‐Americans with Low and High Acculturation Status: Findings from Southwestern HHANES, 1982–84
Authors: Ismail Amid I. , Szpunar Susan M.
Published: May 2007

This article presents the results of a cross‐sectional analysis of the prevalence of dental caries and periodontal disease, as well as the use of dental services, among 395 low acculturated dentate Mexican‐Americans, 12–74 years of age, examined during the southwestern portion of the Hispanic Health and Nutrition Examination Survey (HHANES). Comparisons were carried out with 1,894 dentate Mexican‐Americans who had high acculturation status. Mexican‐American adolescents and adults with low acculturation status had 73 and 116 percent higher mean number of decayed and missing teeth, respectively, compared with those with high acculturation status. The differences between the two groups, however, did not remain statistically significant when the confounding effects of age, sex, education, and income status were taken into account. Gingivitis and periodontal pocketing were highly prevalent in both groups, but those with low acculturation status had significantly higher disease levels than those with high acculturation status. Despite the unmet dental needs and the higher prevalence of dental caries and periodontal disease, Mexican‐Americans with low acculturation status were significantly less likely than those with high acculturation status to have dental insurance and to have visited the dentist as frequently.
The Missouri Elks Mobile Dental Program–Dental Care for Developmentally Disabled Persons
Authors: Dane John N.
Published: May 2007

This article describes the origins, funding, organization, operation, utilization, and outreach program of a statewide mobile dental program for the disabled in Missouri. The article includes information based on analysis of productivity reports and patient records. Comparisons are made between the utilization by mentally retarded (MR) and other disabled patients (MCCS), their county of residence, and the location where service was provided (rural vs urban). The mean number of dental procedures provided per client was 7.3. More procedures (8.35) were provided to urban clients than rural clients (5.81). The utilization rate of urban MR clients was 63.9 percent, compared to 60 percent for rural MR clients. Other findings show 10.7percent urban MCCS clients utilized the mobile dental program, versus 13.5 percent of the rural MCCS clients. The budgeted expenditures for providing care to this underserved group were $46,000 less than the estimated value of dental care provided in a private practice setting.
Evaluating the Impact of P.L. 99‐252 on Decreasing Smokeless Tobacco Use
Authors: Chen Moon S.
Published: May 2007

Literally, Public Law 99‐252 (otherwise known as the Comprehensive Smokeless Tobacco Health Education Act of 1986) includes provisions that are informational in nature. Implicitly, however, this law is considered part of the federal effort in disease prevention and health promotion. This paper reviews the societal and legislative context of that act and presents a plan to evaluate the impact of this law on decreasing smokeless tobacco use. The uniqueness of this plan is its incorporation of nine disciplinary perspectives in the derivation of indicators to measure process, impact, and outcome measures for decreasing smokeless tobacco use. A basic prevention strategy is suggested by this interdisciplinary approach. In addition, specific lessons could be applied from the history of successes in public health to decreasing smokeless tobacco use.
P.L. 99‐252 and the Roles of State and Local Governments in Decreasing Smokeless Tobacco Use
Authors: Capwell Ellen M
Published: May 2007

Evaluation of the impact of the Comprehensive Smokeless Tobacco Health Education Act of 1986 (P.L. 99‐252) will help determine the level of progress being made to reduce smokeless tobacco use and will help determine changes or new strategies needed to prevent or reduce smokeless tobacco use. Indicators of progress made toward implicit goals and explicit provisions of P.L. 99‐252 are proposed as appropriate for local, state, and federal government health agencies to address. Examples of roles that can be played by health agencies relative to implicit goals of the law are drawn from experiences of public health professionals in Ohio and other states. These roles relate to work with the media, research and evaluation, surveillance activity, support for development of materials and implementation of programs, and funding for community educational programs. Indicators to measure impact of explicit provisions of the law focus on provisions specified in the ' public education section of the law. Proposed indicators involve monitoring the development and availability of programs, materials and media, monitoring research and dissemination of findings, and monitoring technical assistance and grants available. Possible measurement and evaluation strategies are discussed. Survey methodology seems most suitable for monitoring level and type of anti‐smokeless tobacco activity in which health agencies engage and for determining awareness of resources available through the law.
Periodontal Health of 14‐17‐year‐old US Schoolchildren
Authors: Bhat Mohandas
Published: May 2007

This paper describes the findings related to periodontal health in 14‐17‐year‐old children who participated in the National Survey of Oral Health in US Schoolchildren, conducted by the National Institute of Dental Research (NIDR) during 1986‐87. Gingivitis was observed in approximately 60 percent of children in this age group. The proportion of examined sites per child with gingivitis, however, was less than 6 percent. Gingivitis was most common in molar areas in the maxilla and incisor areas in the mandible. Supragingival calculus was observed in nearly 34 percent of the children, and subgingival calculus in approximately 23 percent. The proportion of teeth per child with calculus was approximately 8 percent for supragingival and 4 percent for subgingival calculus. Both types of calculus showed a predilection for molars in the maxilla and incisors and cuspids in the mandible. The mean periodontal attachment loss was 0.33 mm. The teeth most frequently affected by attachment loss of 2 mm or more were maxillary molars and bicuspids, followed by mandibular molars and cuspids.
On‐site Screening for Urinary Hg Concentrations and Correlation with Glomerular and Renal Tubular Function
Authors: Naleway Conrad , Chou Hwai‐Nan , Muller Tommy , Dabney Jacquelyn , Roxe David , Siddiqui Farrida
Published: May 2007

At the American Dental Association 1985 and 1986 Annual Sessions, an on‐site screening for mercury was conducted as part of the Health Screening Program (HSP) to identify dentists having elevated urinary mercury concentrations. The data generated from this study were used to examine the relationship between elevated urinary mercury exposure and kidney dysfunction. Kidney dysfunction was assessed by measurement of serum and urine β2microglobulin concentrations, serum creatinine, and creatinine clearance. The mean values found for urinary mercury were 5.8 μg Hg/L and 7.6 μg Hg/L for 1985 and 1986, respectively. Urinary mercury concentrations for this population were found to fall within the range of not detected to 115 μg Hg/L. Of the total number of participants assayed in 1985 and 1986, roughly 10 percent of the sample exhibited elevated mercury concentrations above 20 μg Hg/L. An analysis of the clinical markers indicated no clear relationship between elevated urinary mercury concentrations and kidney dysfunction. In addition to mercury testing, all dentists who participated in the 1985 and 1986 HSP were issued a questionnaire soliciting information as to their professional exposure. Those participants who were identified as having elevated urinary mercury concentrations in the 1985 HSP were issued a followup questionnaire that addressed psychological and neuropsychological symptoms. From these questionnaires three significant relationships were found. These relationships were associated with mercury/amalgam handling and skin contact, the number of amalgams placed by the dentist, and the number of hours of practice per week. The reported absence of a clear relationship between urinary mercury concentrations and potential kidney dysfunction is in agreement with other findings at the mercury concentrations tested. Based on the data generated from this study, these results support the use of an on‐site screening procedure as a quick and accurate measure of total mercury excretion.
A Critique of Topical Fluoride Methods (Dentifrices, Mouthrinses, Operator‐, and Self‐applied Gels) in an Era of Decreased Caries and Increased Fluorosis Prevalence
Authors: Ripa Louis W.
Published: May 2007

Within the last 20 years there has been a decrease in the caries prevalence of US schoolchildren, a change in the intraoral caries pattern, and a slowing of the progress of lesions. Simultaneously, the prevalence of enamel fluorosis has increased. The increase principally is in the milder, cosmetically acceptable forms and is more noticeable in fluoride‐deficient communities than those with optimal or above‐optimal water fluoride concentrations. Circumstantial evidence indicates that a principal contributor to the caries decline is the extensive use of fluoride dentifrices. Conversely, although use of a fluoride dentifrice can add to the total daily amount of ingested fluoride in preschool children, there is little evidence to suggest that dentifrice ingestion is a principal factor causing the fluorosis increase. The value of fluoride methods may be assessed in relative or absolute terms. The relative, or percentage, caries reduction attributed to fluoride mouthrinses and gels appears to be a property intrinsic to the methods themselves and generally is little affected by the caries activity of the population being treated. Conversely, the absolute, or numerical, caries reduction is dependent upon the level of disease in the population. Thus, the reported caries decline reduces the number of surfaces prevented from developing caries, even though the percentage reduction remains substantially unchanged. Although inadvertent ingestion of fluoride can result from the use of mouthrinses and gels, there is little evidence to suggest that they have contributed to the fluorosis increase. When using topical methods, prudence should prevail to avoid ingestion of fluoride. Fluoride dentifrices should continue to be used routinely, and although lower potency dentifrices may be considered, the literature does not provide strong support for their need. Use of fluoride mouthrinses and gels for individual patients should be predicated upon their caries activity or risk. Use of these methods in public health programs is a matter of cost‐effectiveness, which will be influenced by the caries prevalence of the target population.
Reaction Paper: The Use of Topical and Systemic Fluorides in the Present Era
Authors: DePaola Paul F.
Published: May 2007

Systemic fluoride may enhance the resistance of the tooth by way of (1) an alteration in tooth morphology, and (2) a conversion of the hydroxyapatitic mineral to a fluoridated state with an attendant reduction in solubility and an enhancement of the re mineralization phase of the caries process. It has been reported by a number of investigators, although it is not universally accepted, that the posterior teeth from fluoridated areas have a distinct morphology that is less susceptible to caries attack. Fluorapatite and hydroxy apatite do not differ appreciably with respect to the amount of mineral that dissolves at a specified concentration of acid. However, if solubility is considered as a function of pH at equilibrium, i.e., the final pH after the dissolution products have entered the solvent‐a model more akin to the in vivo situation‐hydroxyapatite is the conspicuously more soluble of the two minerals. In this connection, epidemiologic data suggest that children with unusually high levels of surface enamel fluoride have little or no caries. This observation is consistent with the finding that the solubility of solid apatite solutions with varying degrees of fluoride substitution was inversely related to fluoride content, with minimal solubility at 0.5 substitution, a value observed in natural teeth at the very outermost surface of the enamel. Evidence of a preemptive effect of fluoride has also been shown in field studies in which subjects had reduced levels of caries with fluoride exposure in childhood only.
Predicting Concerns for the Mouth among Institutionalized Elders
Authors: MacEntee Michael I. , Hill Patricia M. , Wong Glen , Mojon Philippe , Berkowitz Jonathan , Glick Ned
Published: May 2007

There is a widespread belief that old people do not have healthy mouths, although the reason for this neglect is not clear. A random sample of 41 long‐term care facilities in Vancouver was selected–653 residents were examined and about three‐quarters of them were interviewed–to find associations between variables that might influence a concern for oral health and to assess the effectiveness of multivariate models for predicting this concern. A bivariate analysis of the data, using chi‐square tests, assessed any significant associations between the variables, and three classification techniques–discriminant analysis, logistic regression, and CART (classification and regression trees)–were used to assess the usefulness of the multivariate models. Complaints of oral problems were heard from half (53%) of the sample. Most (85%) of the participants expressed a desire for treatment, while fewer than half (44%) of the participants had used a dental service since entering the facility or in the previous year. The complaints were associated significantly with the subjects who had been to a dentist recently, with those dissatisfied with the cost or quality of previous treatment, and with women. The desire for treatment was associated significantly with the recent use of dental services, and with a lack of concern for the cost of dental treatment, while the use of services was associated significantly with subjects who were younger, dentate, or from the higher socioeconomic groups. The multivariate classification techniques offered a wide range of prediction rates for complaints (62‐74%), desire for treatment (63‐91%), and use of services (56‐97%); however, the complexity of the techniques and the range of the results suggest that they were not particularly useful for predicting the concerns of this population.
The Reorganization of the City of Toronto Dental Services: A Community Development Model
Authors: Lee Jack
Published: May 2007

The dental program of the Department of Public Health, City of Toronto, is over 75 years old. Recently, the department engaged in extensive community‐based planning, which culminated in the closing of forty‐eight school based clinics and the opening of eight community clinics. A geriatric dental program also was established. This paper will describe the data utilized, the analysis of which enabled the department to focus its efforts on those at high risk for dental disease. These groups included immigrants and institutionalized seniors. This analys is also enabled the department to locate its clinics in those areas of the city with greatest need. The community development model, quite unique to major reorganizations, is also described. It was this wide support that resulted in the unanimous approval by the city council of the reorganization and gave impetus to personnel changes resulting in the ability of staff to communicate in the major languages of a city where over 50 percent speak a language other than English or French.
Dental Public Health: New Opportunities–New Responsibilities*
Authors: Wotman Stephen
Published: May 2007

Major changes affecting oral health in the United States have provided new leadership challenges for public health dentistry. Two new roles for dental public health are proposed: leadership in the incorporation of expanded public health skills into the education of every clinical dentist; and a broadening of the specialty in a manner similar to that of preventive medicine, involving the creation of subspecialties in public health dentistry, occupational environmental dentistry, and management policy dentistry. The current status of community dentistry departments in dental schools and programs of public health education for dental personnel in schools of public health are reviewed. Content is suggested for the incorporation of expanded public health skills into the education of every clinical dentist.
University of North Carolina Caries Risk Assessment Study. III. Multiple Factors in Caries Prevalence
Authors: Graves Richard C. , Abernathy James R. , Disney Judith A. , Stamm John W. , Bohannan Harry M.
Published: May 2007

The baseline caries experience of approximately 5,000 children in South Carolina and Maine was used as the dependent variable in caries risk assessment analyses. Clinical, microbiologic, and demographic factors served as independent variables in a multivariate relationship to caries through regression and discriminant function analyses. Four factors–number of dental visits by the child in the past year, presence of white spot lesions, and both the urgency of need for restorative care and the future caries increment predicted by the examiner–associated significantly and consistently with caries prevalence in primary and permanent teeth of first and fifth graders at both study sites. Several factors associated significantly with caries prevalence at only one site or grade within a site, suggesting that wide applicability of a specific caries risk assessment model may be limited. In these analyses, sensitivity ranged from .60 to .72 and specificity varied from .86 to .91 in the four grade‐site groups. The ultimate goal of this longitudinal study is to identify highly caries‐prone children in time to prevent the occurrence of a future caries increment. Although the lack of consistent association of many variables, including microbiologic factors, with baseline caries prevalence was unexpected, it is expected that some of these variables will contribute predictive power in the prospective study.
Educating Dentists about Fissure Sealants: Effects on Knowledge, Attitudes, and Use
Authors: Lang W. Paul , Farghaly Mahassen M. , Woolfolk Marilyn W. , Ziemiecki Thomas L. , Faja Barbara W.
Published: May 2007

This study evaluated the effects of three modes of education on dentists' knowledge, attitudes, and use of pit and fissure sealants. A randomly selected group of dentists was invited to participate in a sealant education initiative. During a 12‐month period, a total of 662 dentists either (1) attended continuing education courses, (2) received written materials and videotapes by mail, or (3) received only written materials by mail. A comparison group (n=337) received no materials until after the education phase and evaluation had been completed. Pre‐and postintervention surveys were used to measure changes in knowledge, attitudes, and sealant use. Response rates to the two surveys were 62 percent and 76 percent, respectively. Preintervention values for knowledge scores, an attitude scale, and sealant use were similar among the four groups. At followup, the three education groups had significantly higher knowledge scores than the comparison group. Attitude values for all but one group were not significantly different, and sealant use by all groups was identical. The numbers of respondents not using sealants declined slightly between surveys in the three education groups while rising slightly in the No‐Education Group. Because program outcomes were similar to those of another sealant initiative, it can probably be concluded that continuing education will increase dentists' knowledge about sealants, but have little effect upon their attitudes or their use of the technique. The changes observed in this investigation maybe due to the particular capacity for cognitive and affective change's of participants, characteristics of the technology being promoted, and external forces in the professional environment.
The Estimated Cost of Treating Unmet Dental Restorative Needs of Mexican‐American Children from Southwestern US HHANES, 1982‐83
Authors: Pollick Howard F. , Pawson Ivan G. , Martorell Reynaldo , Mendoza Fernando S.
Published: May 2007

The dental restorative treatment needs of Mexican‐American children, aged 1‐17years, were assessed from the 1982‐83 Southwestern US Hispanic Health and Nutrition Examination Survey (HHANES). This report analyzed those needs and applied a dollar cost to them, using 1982 median fees of US general practitioners. The total estimated cost required to meet those needs for the population estimate of 3,396,770 children was $236,856,772(95% CI:$198,575,174 to $275,138,370). The mean cost per child was $69.73 (SE: 5.75). Although a majority of the children had no unmet need, 15‐, 16‐, and 17‐year‐olds had extensive needs for crowns, endodontics, and prosthetic replacement of teeth, with accompanying high costs: mean total cost per examinee was $177 (SE: 28.97), $161 (SE: 32.20), and $237 (SE: 33.26), respectively. The treatment needs were compared with the previously published regional data from the 1979‐80 NIDR survey, which used the same dental restorative treatment needs (DRTN) index. The findings indicated a great need for dental treatment among Mexi‐can‐American children that appeared to exceed that of the general school‐aged population. Our analysis, in providing estimates of the cost of needed treatment, might be useful in planning dental treatment programs and in comparing surveys.
Dental Treatment Needs in an Elderly Population
Authors: Drake Claude W. , Beck James D. , Graves Richard C.
Published: May 2007

A random sample of 1,019 adults 65 years of age and older, living in their own homes, consented to a clinical dental examination and an interview. Eight hundred nine subjects were dentate and 210 were edentulous. Each dentate person was examined for caries and periodontal conditions, as well as a separate determination of restorative and extraction treatment needs. Most people in this study lacked restorative treatment needs of any kind. Blacks required restorative treatment and extractions more often than whites. Carious coronal and root surfaces, pocket depths, number of teeth, as well as educational level and time since last visit to the dentist were related to treatment needs. While clinical findings were related to treatment needs, precise determinations of treatment needs of this elderly population generally could not be based solely on clinical findings. Additional behavioral, social, and health factors appear to play a role in dentists' decisions when determining treatment needs of older persons.
Ultraconservative Sealed Restorations: Three‐year Results
Authors: Mertz‐Fairhurst Eva J. , Williams J. Earl , Schuster George S. , Smith C. Douglas , Pierce Karen L. , Mackert J. Rodway , Sherrer Jack D. , Wenner Karen K. , Davis Quince B. , Garman Thomas A. , Ergle Janet W.
Published: May 2007

The overall objective of this clinical study was to determine the feasibility of using a sealed composite restoration to arrest caries without the removal of the carious lesion and without the traditional cavity preparation. The minimal tooth preparation (a bevel in enamel) usually did not require any anesthetic injection and conserved tooth structure. These ultraconservative sealed composite restorations placed over caries (CompS/C) have been compared with ultraconservative sealed amalgam restorations (AGS) and with the traditional outline form (unsealed) amalgam restorations (AGU). This clinical study has shown that: (1) caries can be arrested by the CompS/C restoration for a period of three years; (2) the marginal integrity of the AGS restorations showed a definite trend toward improvement as compared to the AGU restorations; and (3) complete sealant retention over posterior restorations was similar in both the CompS/C and the AGS groups during the first two years; however, at Year 3 complete sealant retention was 16 percent higher in the CompS/C than in the AGS group.
An Epidemiologic Estimate of the Critical Period during which Human Maxillary Central Incisors Are Most Susceptible to Fluorosis
Authors: Evans R. Wendell , Stamm John W.
Published: May 2007

The temporal relation between a declining fluorosis gradient and an abrupt downward shift in community drinking water fluoride concentration was evaluated through multiple correlation analysis to determine the critical time frame during which developing maxillary central incisors are most susceptible to fluoride challenge. Fluorosis data were scrutinized through a time‐related series of epidemiologic “windows” or time frames of varying lengths. The placement of these time frames was in turn related to the presumed start of enamel mineralization (at birth), and ranged from zero to 60 months later. In this way, the susceptibility of developing enamel to changes in water fluoride concentration was localized. The greatest risk was associated with a four‐month critical period commencing at 22 months following birth. The risk of fluorosis from exposures to a fluoride challenge acting during shorter periods was better localized than risk associated with longer exposures. We concluded (1) that human maxillary central incisors are most susceptible to fluorosis during a critical period of as little as four months' duration, commencing at 22 months of age; and (2) that for these incisors, fluoride exposure during the months prior to this period carries less risk than continued exposure for up to 36 months beyond this critical time.
Expanding Health Insurance Coverage and the Implications for Dentistry
Authors: Damiano Peter C. , Shugars Daniel A. , Johnson Jeffrey D.
Published: May 2007

Numerous proposals have been suggested for expanding health insurance coverage to the over 30 million Americans without health insurance. These proposals range from establishing a program of national health insurance modeled after the Canadian system to establishing statewide risk pools. Many of these proposals could have an impact on financial access to dental care for the approximately 120 million people without dental insurance. Dental insurance coverage has been shown to increase access to dental services and improve oral health status. Oral health professionals could facilitate discussions concerning health insurance expansion by informing policymakers about important preventive benefits to be gained by improving access to dental services. Dental public health professionals can serve as a bridge between organized dentistry and health policymakers by providing information to help formulate the priorities and characteristics of a dental health insurance program. This visibility and influence in the health policy arena would be beneficial to dentistry and could ultimately result in greater access to dental services and improved oral health for the uninsured.
A Mobile Dental System in Southern Africa
Authors: Rudolph Michael J. , Chikte Usuf M. E. , Lewis Helen A.
Published: May 2007

Recent studies indicate a great need for dental treatment and preventive services in dentally underserved communities in southern Africa. Geographic inaccessibility, limited financial resources, and a maldistribution of dental personnel are the main barriers to oral health care. This project describes the evolution and utilization of unique, purpose‐built, mobile dental unit (MDU). From a compact 2 times 2.5 meter box trailer, an enclosed area of 8 times 9 meters is formed by deploying a cover system housed on top of the trailer. Once deployed, the unit becomes four fully equipped dental operatories and a combined waiting and educational area, with all‐weather protection. Comprehensive care is provided by dental auxiliaries. The underlying philosophy of the service is based on the primary oral health care approach. To date, the MDU has visited a wide variety of rural and urban communities where several thousand patients have been examined and treated. Assessment of the MDU indicates that it is an effective and viable alternative oral health delivery system.
Dental Caries and Sealant Prevalences in Schoolchildren in Tennessee
Authors: Gillcrist James A. , Collier Durward R. , Wade George T.
Published: May 2007

This article presents findings on the prevalence of dental caries and dental sealants from the 1988 oral health survey of schoolchildren in Tennessee. The purpose of the study was to describe the prevalence of dental caries, dental sealants, and periodontal disease, as well as the need for restorative, exodontia, and periodontal treatment among schoolchildren. A multistage probability sample was designed to represent 927,000 children en‐rolled in grades K–12 in public and private schools across the state. Analyses of the data collected from the examination of 2,588 children aged 5–17 revealed that 55 percent were caries free in their permanent dentition and that the mean DMFS score was 2.86. For those aged 5–9, the mean dfs score was estimated to be 5.52. Only 10 percent of schoolchildren in Tennessee had dental seal‐ants on their teeth. Comparisons of the results of this survey with those reported from earlier state surveys indicated that caries levels have declined steadily. We assumed that the reduction in caries experience observed in Tennessee is the result of widespread exposure of children to systemic and topical fluorides. Further reduction in caries experience is possible with continued fluoridation of community water supplies, in conjunction with increased utilization of pit and fissure sealants.
Maryland Residents' Attitudes Toward AIDS and the Use of Dental Services
Authors: Cohen Leonard A. , Grace Edward G. , Ward Michael A.
Published: May 2007

This project was conducted to examine the impact of Maryland residents' attitudes about AIDS on dental services utilization. A telephone survey of 1,477 households was conducted (response rate 68.9%). Less than 7 percent of the respondents volunteered a concern about contracting AIDS in the dental office. When asked directly, approximately 35 percent stated they would change dentists if their dentist were treating AIDS patients. Respondents who were most aware of the wide‐spread treatment of AIDS patients by dentists were more likely to believe their dentist was treating AIDS patients. Also, they were less likely to report that they would leave the practice of dentists with AIDS or those who treated AIDS patients. It is critical for the public to be educated properly about the continued safety of the dental office and to receive accurate information about AIDS.
Understanding Dentists' Restorative Treatment Decisions
Authors: Bader James D. , Shugars Daniel A.
Published: May 2007

A critical review of the literature is presented that examines variation in dentists' restorative treatment decisions and the factors associated with this variation. Substantial variation has been documented in dentists' assessment of caries, in dentists' decisions to intervene, and in the selection of treatment recommended to the patient. However, the factors associated with this variation are not well documented. Following discussion of this review, a model is proposed to help guide further studies of dentists' restorative treatment decisions. This explanatory model incorporates the factors identified in the review, as well as others either observed informally or found in the medical literature. The implications of variation in dentists' treatment decisions highlight the importance of a full explication of the process dentists follow in making treatment decisions. Understanding this process, which heretofore has been examined only superficially because it has been regarded as a function of “clinical judgment” is fundamental to determinations of normative treatment needs, to interventions designed to reduce the frequency of inappropriate treatment, and to the development of valid practice parameters.
A Comparison of the Caries‐preventive Effects of Fluoride Mouthrinsing, Fluoride Tablets, and Both Procedures Combined: Final Results after Eight Years
Authors: Driscoll William S. , Nowjack‐Raymer Ruth , Selwitz Robert H. , Li Shou‐Hua , Heifetz Stanley B.
Published: May 2007

This paper presents final results of an eight‐year clinical trial designed to compare the caries‐preventive benefits of two self‐administered fluoride procedures when used separately and in combination with one another. Children in kindergarten and first grade residing in Spring‐field, Ohio, a nonfluoridated community, were assigned randomly within school to one of three groups that either (a) rinsed once a week in school with a 0.2 percent neutral NaF solution; (b) chewed, rinsed with, and then swallowed daily in school a neutral 2.2 mg NaF tablet; or (c) carried out both procedures. At baseline (1981), 1,640 participants were examined clinically using the DMF surface index. Findings for 640 children remaining after eight years show that subjects in the combination group experienced a mean caries increment of 2.40 DMFS, 15.2 percent lower than the mean score of 2.83 DMFS for children in the tablet group and 32.8 percent lower than the 3.57 DMFS for those in the rinse group. Only the difference in incremental caries scores between the combined fluoride procedure and the fluoride rinse was statistically significant (P < 05). The pattern of these findings is similar to that found on the two interim examinations. Even though the combined regimen showed an additional caries‐preventive benefit compared with the rinse, considerations of cost effectiveness and feasibility do not support changing an ongoing rinse program to one that employs both procedures. For new programs the best choice appears to be the tablet procedure alone.
A Pilot Study of Dental Students' Esthetic Perceptions of Computer‐generated Mild Dental Fluorosis Compared to Other Conditions
Authors: McKnight Carrie B. , Levy Steven M. , Cooper Stephanie E. , Jakobsen Jane R. , Warren John J.
Published: May 2007

Objective: Few studies have considered people's opinions about the esthetics of dental fluorosis. Assessments of fluorosis esthetics can be confounded by differences in a number of clinical factors, including tooth shape, color, contour, and gingival status. This pilot study compared esthetic perceptions of mild fluorosis and other conditions using computer‐generated images made from a base set of normal appearing teeth. Methods: Entering dental students (n=61) completed questionnaires about four sets of paired photographs. Three sets consisted of fluorotic teeth (very mild to mild) versus other conditions (diastema, isolated enamel opacity, “normal”/control) and the other pair compared two presentations of mild fluorosis (generalized versus limited to incisal one‐third). Six questions, both qualitative and quantitative, were asked about each pair of photographs. Results: Mild fluorosis was assessed less favorably than normal/control, midline diastema was less favorable than mild fluorosis, and mild fluorosis was less favorable than isolated opacity. Conclusions: This approach allows fluorosis to be better compared with other oral conditions because the images are standardized. Additional research with this method is warranted, including more variations in conditions, more comparisons, and other study populations.
Hepatitis B Prevalence and Infection Control Among Dental Health Care Workers in a Community in South Korea
Authors: Song Keun Bae , Choi Kum Suk , Lang W. Paul , Jacobson Jed J.
Published: May 2007

Objective: The objectives of this study were to investigate the prevalence of hepatitis B vaccine and use of infection control procedures by dental health care workers in Taegu, South Korea. Methods: Information was obtained with a mailed questionnaire sent to 300 private dental practices. Surveys were received from 177 dentists, 104 dental hygienists, and 46 dental assistants. All dental health care workers were asked to donate a blood sample for analysis of hepatitis B surface antigen (HBsAg) and antibody (anti‐HBs). Results: Vaccination against hepatitis B virus was reported by 63 percent of the respondents. About 40 percent of all participants answered that they were anti‐HBs positive, while another 43 percent did not know their status. About 89 percent of dentists reported that they wore a mask with all patients, while hygienists (13.6%) and assistants (13.0%) were less likely to do so. Reported use of gloves (4.5%) and protective eyewear (14%) with all patients was extremely low in every group. Among the 56 dentists who were tested for HB V markers, 23 did not receive the vaccine against hepatitis B, and 13 percent (3 of 23) were positive for HBsAg as carriers. Conclusions: About 37 percent (120 of 327) of dental health care workers surveyed in this study in Korea did not receive the vaccine against HBV infection. Basic barrier techniques to prevent cross‐contamination were not being used consistently. Nationwide guidelines for barrier techniques and hepatitis vaccinations should be developed and disseminated to dental personnel.
Willingness to Pay for Periodontal Therapy: Development and Testing of an Instrument
Authors: Matthews Debora C. , Sci Dipl Periodont , Birch Stephen , Gafni Amiram , DiCenso Alba
Published: May 2007

Objective: The objective of this study was to develop and test the feasibility and validity of a willingness to pay (WTP) tool in a dental setting. Methods: A questionnaire measured individuals' preferences among alternative treatments for periodontal disease and the maximum they would be willing to pay for their treatment of choice in terms of dental insurance premiums. The questionnaire provides detailed information, in probabilistic terms, of the risks and benefits of treatment choices for moderate to advanced adult periodontitis. It was pilot tested on 23 periodontal patients and 18 dental school faculty and staff. Results: The majority (92.6%) felt the questionnaire was an accurate representation of treatments and outcomes, establishing face and content validity. In terms of construct validity, four hypotheses were tested: (1) manipulation of the outcomes of the preferred treatment led to a predictable shift in preferences for 38 subjects (92.7%); (2) although periodontal patients were not more likely to choose periodontal surgery than nonpatients (P=.14), those with a history of surgery were more likely to choose surgery again (P=.06); (3) WTP was positively related to income level (P=.05); and (4) subjects were willing to pay more for coverage for themselves than for others. Periodontal surgery was the preferred treatment for moderate to advanced periodontal disease, and was more strongly preferred than other choices (i.e., a higher WTP) for all income groups. The intraclass correlation coefficient for treatment preferences was 0.95 (P<.001) and the kappa for WTP was 0.78 (P<.001). Conclusion: This pilot study supports some of the criteria concerning validity of the WTP questionnaire to measure preferences for alternative periodontal therapies. Further testing on larger samples is required to confirm these results.
Caries Experience of Urban and Rural Children in Saudi Arabia
Authors: Al‐Shammery Abdullah R.
Published: May 2007

Objective: Caries experience and restorative treatment needs often are reported to be higher in urban than rural areas in developing countries. The purpose of this study was to compare caries experience in 12‐and 13‐year‐old children in urban and rural areas of Saudi Arabia, a young, oil‐rich, developing country. Methods: A random sample of 1,873 schoolchildren aged 12–13 years from urban and adjoining rural areas of 10 administrative regions in the Kingdom of Saudi Arabia were examined for dental caries. Questionnaires also were administered to elicit information on the frequency of snacking as well as consumption of sweets and soft drinks. Results: No statistically significant differences were found between urban and rural children in caries experience in permanent teeth (mean DMFT=2.69 in urban areas; 2.65 in rural areas), frequency of snacking, or frequency of consumption of sweets and soft drinks. The percentage of DMFT found to be D was equally high (>89%) in both urban and rural areas, indicating a high level of restorative treatment need. Conclusion: In Saudi Arabia, an economically prosperous developing country, exposure to cariogenic diet in urban and rural areas does not differ. Also, a difference in caries experience in urban and rural areas often reported for developing countries does not apply to Saudi Arabia.
Periodontal Disease Estimates in NHANES III: Clinical Measurement and Complex Sample Design Issues
Authors: Winn Deborah M. , Johnson Clifford L. , Kingman Albert
Published: May 2007

Objective: This paper evaluates the possibility that examiner bias or other factors contributed to an observed decline in pocket depth and gingivitis between the two three‐year sequential periods of time (or phases) covered by the Third National Health and Nutrition Examination Survey (NHANES III). Methods: Prevalences of periodontal conditions were analyzed using data from two sets of repeat oral health examinations by examining dentists of NHANES III sample persons. The first set includes sample persons who were examined twice by the same examining dentist at an interval of one to six weeks. The second set includes sample persons who were assessed on the same day by both an examining dentist and a reference dentist. Other possible sources of error also were evaluated. Results: Overall kappa statistics measuring agreement between or within dental examiners were within the range observed for other periodontal disease surveys. While differences were found among dentists in the prevalence of pocket depth of 4 mm or more, for each group of sample persons assessed by a reference examiner‐examining dentist pair, the reference examiner's periodontal measurements closely corresponded to measurements made by the examining dentists. Conclusions: Differences between dental examiners in prevalences of periodontal conditions may be due in pan to the fact that examinees were not randomly assigned to examiners. As a result, the sample persons examined by each dentist may not have been alike in characteristics thought to affect periodontal disease status. These findings suggest that the observed declines in periodontal health status between phases is not due to examiner bias. This unexplained decline may be the result of sampling variation. It is recommended that combined six‐year survey results be presented whenever possible.
A Primer on Outcomes in Dentistry
Authors: Bader James D. , Ismail Amid I.
Published: May 2007

Expectations for evidence of “value” on the part of dental care purchasers and growth in the evidence‐based dentistry movement are beginning to demonstrate the narrow and incomplete nature of dentistry's knowledge of the outcomes of dental conditions and treatment. In this paper a classification scheme for dental outcomes is described that illustrates the broad range of outcomes information important to patients, health care providers, purchasers, and society. The uses for outcomes information are discussed and suggestions are offered for improving dentistry's knowledge of outcomes through the cooperative involvement of dental research, dental education, and dental practice.
Evaluation of Audit‐based Performance Measures for Dental Care Plans
Authors: Bader James D. , Shugars Daniel A. , White B. Alex , Rindal D. Brad
Published: May 2007

Objective: Although a set of clinical performance measures, i.e., a report card for dental plans, has been designed for use with administrative data, most plans do not have administrative data systems containing the data needed to calculate the measures. Therefore, we evaluated the use of a set of proxy clinical performance measures calculated from data obtained through chart audits. Methods: Chart audits were conducted in seven dental programs—three public health clinics, two dental health maintenance organizations (DHMO), and two preferred provider organizations (PPO). In all instances audits were completed by clinical staff who had been trained using telephone consultation and a self‐instructional audit manual. The performance measures were calculated for the seven programs, audit reliability was assessed in four programs, and for one program the audit‐based proxy measures were compared to the measures calculated using administrative data. Results: The audit‐based measures were sensitive to known differences in program performance. The chart audit procedures yielded reasonably reliable data. However, missing data in patient charts rendered the calculation of some measures problematic—namely, caries and periodontal disease assessment and experience. Agreement between administrative and audit‐based measures was good for most, butnotall, measures in one program. Conclusions: The audit‐based proxy measures represent a complex but feasible approach to the calculation of performance measures for those programs lacking robust administrative data systems. However, until charts contain more complete diagnostic information (i.e., periodontal charting and diagnostic codes or reason‐for‐treatment codes), accurate determination of these aspects of clinical performance will be difficult.
Dentist Reliability in Classifying Disease Risk and Reason for Treatment
Authors: Bader James D. , White B. Alex , Olsen Oralee , Shugars Daniel A.
Published: May 2007

Objective: The reliability of practicing dentists' classifications of patients' caries risk and periodontal disease risk and reason for treatment for individual teeth were determined. The risk classification protocols had been in use in a group practice for more than a year, and the reason‐for‐treatment protocol had been introduced six months previously. Methods: Eight dentists' classifications for caries (n=66) and periodontal disease risk (n=66), and six dentists' classifications for reason for treatment (n=73) were compared to those of a nominal standard examiner. Reliability was expressed as percent agreement and kappa values. Results: Percent agreement was 76 percent, 83 percent, and 74 percent for caries, periodontal disease, and reason for treatment, respectively, with kappa values of 0.56, 0.70, and 0.69. Conclusions: Dentists can attain reasonable levels of reliability using simple classification protocols with little formal training, although misclassification may be problematic for specific administrative or research‐related purposes.