bluuebunny/crossref_metadata_2025 huggingface dataset:
The Case for Eliminating the Use of Dietary Fluoride Supplements for Young Children
Authors: Burt Brian A.
Published: May 2007

Fluoride supplements have been used for years to prevent dental caries; nevertheless, there are three reasons why their use is inappropriate today among infants and young children in the United States. Evidence for the efficacy of fluoride supplements when used from birth or soon after is weak, supplements are a risk factor for dental fluorosis, and fluoride has little preemptive effect in caries prevention. While there are many reports on the caries‐preventive efficacy of supplements, few meet standards for acceptability as clinical trials, and those that do have tested chewable tablets or lozenges under supervision in school‐aged children. North American children today are exposed to fluoride from many sources—drinking water, toothpaste, gels, rinses, and in processed foods and beverages. The additional cariostatic benefits that accrue from using supplements are marginal at best, while there is strong risk of fluorosis when young children use supplements. Available evidence suggests that the public is more aware of the milder forms of fluorosis than was previously thought; thus, it is prudent for caries‐preventive policies to aim at maximizing caries reductions while minimizing the risk of fluorosis. It is therefore concluded that the risks of using supplements in infants and young children outweigh the benefits. Because alternative forms of fluoride for high‐risk individuals exist, fluoride supplements should no longer be used for young children in North America.
An Exploratory Qualitative Study Examining the Social and Psychological Processes Involved in Regular Dental Attendance
Authors: Gibson Barry J. , Drennan Jackie , Hanna Sarah , Freeman R.
Published: May 2007

Objective: This study aimed to provide a description of the psychosocial process involved in regular dental attendance. Methods: The study design was a qualitative cross‐sectional study using unstructured and semistructured interviews and observations of regular dental visits. The study participants included 12 men and 18 women attending general dental practices and six men and four women attending an emergency dental service. The data were systematically recorded and subjected to line‐by‐line grounded theory coding around the main concerns of those attending the dentist. Results: The main concern of those attending for a regular dental visit was checking their oral health. The six‐month recall was conceptualized as a checking cycle in six phases: recalling, responding, inducing (i), waiting, inducing (ii), and telling. The possible outcomes of the cycle were maintaining oral health, sustaining oral health, and a further checking cycle. Variations in checking cycles resulted from reordering and normalizing pressures within participants' lifestyles. Conclusions: The findings of this study suggest that people's patterns of dental attendance are similar to those of other chronic illnesses. An understanding of the dynamic psychosocial processes involved in frequent dental attendance may be achieved when further research into this phenomenon is conducted.
Medication and Dry Mouth: Findings from a Cohort Study of Older People
Authors: Thomson W. Murray , Chalmers Jane M. , Spencer A. John , Slade Gary D.
Published: May 2007

Objective: The aim of this study was to examine the association between medication exposure and (1) unstimulated whole‐salivary flow rate and (2) the severity of xerostomia among older people while adjusting for multiple medication use. Methods: Data were obtained from participants remaining at the five‐year follow‐up phase of a cohort study of community‐dwelling older South Australians. Medication exposure information was available at baseline and at five years, enabling examination of the effects on dry mouth of long‐term exposure to medications. At the five‐year follow‐up, unstimulated salivary flow was estimated using the spit method, and xerostomia severity was estimated using the 11‐item Xerostomia Inventory. Because of the potential difficulties posed by polypharmacy, a two‐stage analytical approach was employed: (1) Classification and Regression Tree (CART) analysis was used as an exploratory device to elucidate the relationships among the dependent and independent variables, and (2) linear regression analysis was used as a complementary procedure. Results: Unstimulated flow rate was lower among individuals who were female or taking antide‐pressants at both baseline and five years, and higher among smokers or people who were taking hypolipidemic drugs. Xerostomia severity was higher among females, or individuals taking: (1) an anginal at baseline and five years, (2) an anginal without a concomitant betablocker at five years, (3) thyroxine and a diuretic at five years, or (4) antidepressants or antiasthma drugs at both baseline and at five years. Conclusions: These results suggest that polypharmacy can be accounted for to a certain extent by using CART analysis in conjunction with more conventional approaches; and that the relationship between medications and dry mouth is a complex one, and differs according to which aspect of dry mouth is being examined.
Professionally Applied Topical Fluoride and Restorative Care in Insured Children
Authors: Eklund Stephen A. , Pittman James L. , Heller Keith E.
Published: May 2007

Objective: This study evaluates the association between use of professionally applied topical fluoride and use of interproximal restorations in primary and permanent teeth of children. Methods: Insurance claims from 15,190 children, for treatment provided by 1,556 different dentists, were analyzed to look for associations between frequency of use of professionally applied topical fluoride and use of interproximal restorations. The average follow‐up period for the children included in the analysis was 5.3 years, with the range from 3.0 to 7.9 years. Results: Both tabular and regression results failed to demonstrate an association between frequency of use of professionally applied topical fluoride and use of interproximal restorations in either the primary or permanent dentition. The most powerful predictor of restorative care for these children was the overall propensity of the dentist to place restorations in children. Conclusions: In this group of insured children, we were unable to find an association between the frequency of use of professionally applied topical fluoride and restorative care. Further, despite numerous recommendations that professionally applied topical fluorides should be used only in moderate‐ and high‐caries children, approximately two‐thirds of these children received topical fluoride at every recall visit, nearly two times per year.
Factors Related to Decisions to Extract or Retain At‐risk Teeth
Authors: Warren John J. , Hand Jed S. , Levy Steven M. , Kirchner H. Lester
Published: May 2007

Objective: Decisions to extract a tooth may be among the most critical in dentistry. The aim of this study was to prospectivety investigate both clinical and nonclinical factors related to decisions to extract or retain teeth in private general dental practice. Methods: A convenience sample of 196 Iowa dentists in private general dental practice reported on 549 cases where decisions were made to extract or retain teeth as they occurred in their practices during a one‐month period in May 1997. Bivariate and multivariate analyses were used to identify factors that differentiated between cases where a tooth (or teeth) was extracted and cases where an at‐risk tooth was retained. Results: Of the 549 cases, 67 percent involved extraction, while the remainder involved alternatives to extraction. In comparing extraction cases to alternative treatment cases, we excluded 150 extraction cases because dentists reported that no alternative to extraction was available. Using Generalized Estimating Equations (GEE), we identified cost of treatment, presence of tooth mobility, poor prognosis of alternative treatment, and presence of gross caries as significant factors associated with extraction, while previous treatment of the tooth and concerns with patients' health were significantly associated with alternatives to extraction. Conclusions: For teeth at risk for extraction, cost, substantial periodontal disease, and several clinical factors were predictive of extraction.
The Availability and Distribution of Dentists in Rural ZIP Codes and Primary Care Health Professional Shortage Areas (PC‐HPSA) ZIP Codes: Comparison with Primary Care Providers
Authors: Knapp Katherine K. , Hardwick Kevin
Published: May 2007

Objective: This paper maps dentists, primary care physicians, physician assistants, nurse practitioners, and nurse midwives in rural areas and rural areas meeting criteria as underserved for primary health care. Methods: Computer‐based mapping was used to localize health care provider groups by five‐digit ZIP code. For each rural and each rural primary care health professional shortage area (PC‐HPSA) ZIP code, the number of providers in each group was determined. The different combinations of providers were determined. Results: All providers in rural areas were present at levels substantially lower than national averages, particularly in PC‐HPSA areas. Dentists were approximately equal in number to primary care physicians in rural areas and the largest group in PC‐HPSAs. Approximately 75 percent of rural residents lived in ZIP code areas with dentists available. Over 5.8 million rural residents and over 50 percent of rural PC‐HPSA residents had no providers available in their ZIP code areas. Conclusions: Rural areas continue to have a short supply of primary care providers and dentists. Dentists were present in many areas where primary care provider presence was absent or very low. These data, including those relating to provider co‐presence, can be used to develop strategies to overcome health care access problems due to provider shortages.
The Prevalence of Dental Caries and Fluorosis in Japanese Communities with Up to 1.4 ppm of Naturally Occurring Fluoride
Authors: Tsutsui Akihito , Yagi Mlnoru , Horowitz Alice M.
Published: May 2007

Objective: The purpose of this study was to determine the relationship between the concentration of fluoride in drinking water and the prevalence of dental caries and fluorosis in seven Japanese communities with different concentrations of fluoride occurring naturally in the drinking water. Methods: A total of 1,060 10‐ to 12‐year‐old lifetime residents were examined to determine the prevalence of dental caries and fluorosis in communities with trace amounts to 1.4 ppm fluoride in the drinking water in 1987. Systemic fluorides (drops or tablets) have never been available in Japan and the market share of fluoride‐containing toothpaste was 12 percent at the time of the study. Results: The prevalence of dental caries was inversely related and the prevalence of fluorosis was directly related to the concentration of fluoride in the drinking water. The mean DMFS in the communities with 0.8 to 1.4 ppm fluoride was 53.9 percent to 62.4 percent lower than that in communities with negligible amounts of fluoride. Multivariate analysis showed that water fluoride level was the strongest factor influencing DMFS scores. The prevalence of fluorosis ranged from 1.7 percent to 15.4 percent, and the increase in fluorosis with increasing fluoride exposure was limited entirely to the milder forms. Conclusions: The findings of this study conducted in 1987 in Japan parallel those reported by Dean et al. in the early 1940s.
How Do Routines of Daily Activities and Flexibility of Daily Activities Affect Tooth‐cleaning Behavior?
Authors: Abegg Claides , Croucher Ray , Marcenes Wagner S. , Sheiham Aubrey
Published: May 2007

Objective: The aims of this study were: (1) to investigate the level of routines and flexibility of people's daily activity and to identify how tooth cleaning fits into these activities; and (2) to evaluate the impact of different levels of routines and flexibility in daily living on pattern (frequency of tooth cleaning), structure (range of items used in tooth cleaning), performance (relative effectiveness of tooth cleaning) and the outcome of performance (gingival bleeding on probing) in tooth cleaning. Methods: A convenience sample of 471 Brazilians aged 24 to 44 years was selected from factories, offices, banks, shops, and hospitals. Behavioral, socioeconomic, and clinical data were collected through structured interviews. Dental plaque and gingival bleeding were assessed by clinical examination. Data were analyzed by means of logistic regression. Results: A highly significant relationship was observed between routines of daily activities and tooth‐cleaning pattern (OR=2.3; 95% CI=1.34, 3.92) after adjusting for age, sex, marital status, and socioeconomic status. No significant associations were observed between routines of daily activities and gingival bleeding. A significant association was observed between tooth‐cleaning frequency (OR=1.6; 95% CI=1.07, 2.49), performance (OR=2.7; 95% CI=1.77, 4.14), outcome (OR=2.3; 95% 01=1.31, 3.18), and flexibility of daily activities. Those who had more flexibility of daily activities had lower gingival bleeding scores. Conclusion: People who have a less routinized and more flexible day have higher tooth‐cleaning frequency than those who have a less flexible and more routinized day. In this study, those with a more flexible day also cleaned their teeth more effectively than those who had a less flexible day, and had reduced gingival bleeding.
Rampant Early Childhood Dental Decay: an Example from Italy
Authors: Petti Stefano , Cairella Giulia , Tarsitanl Gianfranco
Published: May 2007

Objective: This study sought to estimate the prevalence and related prediction factors for dental caries in 3‐to 5‐year‐old children in Rome, Italy. Methods: From a sample of 2,025 children, 1,494 (73.8%) were included in the analysis. Children with at least two primary maxillary incisors showing evidence of caries experience were considered affected by rampant early childhood dental decay (RECDD). Behavioral and socioeconomic variables, mutans streptococci counts, diet, and nutritional status were investigated for their association with RECDD using regression analysis. Results: The prevalence of any caries was 27.3 percent, and was 7.6 percent for RECDD. Among all children, mean dft and dt scores per person were 1.1 (SD=2.4) and 0.9 (SD=2.3), respectively; among those classified as having RECDD, scores were 6.9 (SD=4.2) and 6.7 (SD=4.3), respectively. Children with RECDD had 56 percent of all the decayed teeth in the sample. Low and medium social classes, use of a baby bottle filled with sweetened beverages, high salivary mutans streptococcal levels, and malnutrition were directly associated with RECDD; milk and yogurt consumption and low Plaque Index scores were inversely associated with the condition. Conclusions: The high prevalence of RECDD suggests that the implementation of preventive programs should be a priority for dental public health. Because of its high prevalence among children as young as 3 years of age, preventive measures targeted toward pregnant women and toddlers should be developed and tested, while kindergarten students could be used for monitoring RECDD prevalence and for detection of communities at risk.
Low Birth Weight and Dental Fluorosis: Is There an Association?
Authors: Kumar Jayanth V. , Swango Philip A.
Published: May 2007

Objective: The association between low birth weight and dental fluorosis was explored in a cross‐sectional study to explain the higher prevalence of dental fluorosis among African‐American children. Methods: Birth weight data on 960 children were obtained from the New York State Birth Registry. Data on race, fluoride exposure, sociodemographic characteristics, and dental fluorosis were available from a cross‐sectional study conducted in Newburgh and Kingston. Associations among birth weight, race, and fluoride exposure from fluoridated water, regular use of supplements, brushing before the age of 2 years, and subject‐level dental fluorosis were explored using logistic regression procedures. Results: The regression coefficients for the main effects and the two‐way interaction effects associated with low birth weight, race, and fluoride exposure were not statistically significant. Even after controlling for low birth weight and fluoride exposure, African‐American children had a statistically significant higher odds ratio (OR=2.0). An analysis of the data limited to mandibular permanent first molars showed similar effects, except for evidence of effect modification in low birth weight children exposed to fluoride supplements. Conclusions: Lower birth weight did not explain the higher prevalence of dental fluorosis observed among African‐American children.
Caries Risk Assessment and Prevention: Strategies for Head Start, Early Head Start, and WIC
Authors: Kaneilis Michael J.
Published: May 2007

Objective: This review updates the evidence regarding caries risk assessment for infants, toddlers, and preschool children and formulates recommendations for preventive strategies for WIC, Head Start, and Early Head Start. Methods: Literature on caries risk assessment and preventive strategies for infants, toddlers, and preschool children were reviewed and synthesized. Recommendations for WIC, Head Start, and Early Head Start were made based on the review. Results: Individual caries risk for children in WIC, Head Start, and Early Head Start should be based on: (1) previous caries experience, (2) precavity lesions, (3) visible plaque, and (4) perceived risk by examiners. Recommended preventive strategies for WIC and Head Start populations include: (1) daily toothbrushing in Head Start centers using fluoridated toothpaste; (2) fluoride varnish application to children enrolled in WIC, Head Start, and Early Head Start; (3) use of chlorhexidine gets and varnishes (following FDA approval); and (4) increased use of sealants on children with precavity pit and fissure lesions. Conclusions: Early screening, risk assessment, and preventive programs in WIC, Head Start, and Early Head Start populations hold a great deal of promise for preventing dental decay in high‐risk children.
Successful Aging: Implications for Oral Health
Authors: Kiyak H. Asuman
Published: May 2007

The past few years have seen a growing emphasis in gerontology on the concept of “successful” or “robust” aging. This represents a major paradigm shift in the field from a focus on declines in physical and social functioning, assumptions of the aging process as a downward spiral, and studies on how to manage these declines. Leading the way toward this new perspective on aging, the MacArthur Studies of Successful Aging asked the fundamental question: “What genetic, biomedical, behavioral, and social factors are crucial to maintaining health and functional capacities in the later years?” These studies examined longitudinally a large cohort of independent elders on several physical, cognitive, emotional, and social parameters. Other researchers have focused on the theme of robust aging; however, common predictors have emerged, such as remaining active physically and cognitively, maintaining social contacts, and avoiding disease. This research is timely, given the expanding population of the oldest old, and with successive cohorts demonstrating the “compression of morbidity” phenomenon. Such a paradigm shift is critical in geriatric dentistry as well, where successful aging is evident in the growing number of older adults who have retained their natural dentition into advanced old age. This presentation draws parallels between successful aging at the systemic and oral health levels, with illustrations from epidemiologic studies that demonstrate trends in improved health and quality of life among newer cohorts of older adults.
Demonstrating Successful Aging Using the International Collaborative Study for Oral Health Outcomes
Authors: Atchison Kathryn A. , Andersen Ronald M.
Published: May 2007

As the lifespan increases and people are faced with 15 to 20 years of “old age,” we ask what one considers successful aging with respect to oral health. We propose a comprehensive combination of outcome variables, maintenance of teeth, manageable periodontal condition, positive perceived oral health, satisfaction with their access to and receipt of dental services, and minimal functional problems, that together comprise a definition of successful aging. The International Collaborative Study for Oral Health Outcomes provides a data set for exploring the oral health of a diverse sample of older adults in US and international sites using the modified Andersen Behavioral Model. The percent of adults who report no natural teeth ranged from 16 percent in San Antonio to 59 percent in New Zealand. Seventy percent or more of the adults from each site rated their oral health as good/fair or better except in Poland. The current cohort of older adults is faring better on some indicators than others; nevertheless, ethnic minorities and poorer countries still demonstrate inequities. Dentistry must attempt to educate individuals early in their lifespan that a combination of personal oral health practices and current dental techniques offers the potential for successful oral health throughout one's lifetime.
Successful Aging—the Case for Prosthetic Therapy
Authors: Budtz‐Jørgensen EJvlnd , Chung Jean‐Pierre , Mojon Philippe
Published: May 2007

Reduced chewing ability in community‐dwelling older people is linked to the presence of removable dentures and having fewer than 20 natural teeth present. Compensation is provided by chewing longer and swallowing larger food particles. Replacement of posterior tooth loss by fixed or removable prostheses increases the activity of the masticatory muscles, and reduces chewing time and the number of chewing strokes until swallowing. In residents of nursing homes and long‐term care facilities undernutrition is prevalent because of general medical problems, reduced appetite, and poor quality of life. Poor oral health and xerostomia are often present and may have a negative effect on masticatory function and nutrition, precipitating avoidance of difficult‐to‐chew foods. There is no evidence that the provision of prosthetic therapies can markedly improve dietary intakes; however, it might improve oral comfort and quality of life and avoid enteral alimentation.
The Delivery of Oral Care Services to Elderly People Living in a Noninstitutionalized Setting
Authors: Fiske Janice
Published: May 2007

Advances in medical science are enabling people to survive more illness and disability. As people live longer, their mobility and/or ability for self‐care often are reduced by physical or mental disability and other chronic diseases. It may become unreasonable or impractical for them to access mainstream dental services. Increasing numbers of dentate elderly people with expectations of oral health higher than earlier cohorts of elderly people are likely to bring increasing demands to the dental profession for their continuing care. Thus, the oral care for disabled elderly people in noninstitutionalized settings may pose a challenge. The oral care options available to this group of people include the dental surgery/operatory, a mobile dental service, home‐based or domiciliary dental care, a mix‐and‐match combination of surgery‐based and domiciliary care, and cyberspace. Noninstitutionalized, disabled elderly people may have to rely on domiciliary care services for their oral health care. This paper explores the training implications, the necessary knowledge and skills base, the benefits and limitations to both the service provider and user, the equipment a vailable, and the cost/funding of domiciliary dentistry. Domiciliary dental care services need to be developed by improving pre‐and postdoctoral training programs and by establishing realistic remuneration for dental teams providing this care so that noninstitutionalized, disabled elderly people can access oral health care.
Oral Care for Successful Aging in Long‐term Care
Authors: MacEntee Michael I.
Published: May 2007

The oral health of frail elders residing in long‐term care facilities is very poor, probably because access to dental services is limited and help with daily mouth care is almost nonexistent. Recent concerns and interest have been raised through the cooperation of administrators, nursing staff, and dental personnel to address this apparent neglect. Moreover, evidence shows that caries and periodontal disorders can be managed successfully in geriatric populations. Consequently, there is a basis on which to develop a practical strategy for mouth care that should reduce the morbidity and early mortality in long‐term care and to assist an increasingly frail and dependent population to age successfully.
A Comparison of Unmet Needs for Dental and Medical Care Among Persons with HIV Infection Receiving Care in the United States
Authors: Heslin Kevin C. , Cunningham William E. , Marcus Marvin , Coulter Ian , Freed James , Der‐Martirosian Claudia , Bozzette Samuel A. , Shapiro Martin F. , Morton Sally C. , Andersen Ronald M.
Published: May 2007

Objective: Oral health conditions associated with HIV disease are frequently more severe than those of the general population, making access to both dental and medical care important. Using the domains specified in the Behavioral Model of Health Services Use, this paper examines the correlates of unmet needs for dental and medical care in a nationally representative sample of patients with HIV. Methods: This investigation is a cross‐sectional study using baseline data from the HIV Cost and Services Utilization Study (HCSUS), the first nationally representative study of persons in care for HIV. Using probability‐based techniques, 4,042 people were randomly selected in January 1996, and 2,864 (71%) completed a structured interview that included questions on unmet needs for dental and medical care. Regression analysis was used to identify variables associated with having unmet needs for dental care only, medical care only, and both medical and dental care. Results: Of the estimated 230,900 people in treatment for HIV in the United States, approximately 58,000 had unmet medical or dental needs based on self‐reported data. Unmet dental needs were more than twice as prevalent as unmet medical needs (32,900 vs 14,300), and 11,600 people were estimated to have both types of unmet needs. Multinomial logit regression showed that persons with low income had increased odds of reporting unmet needs for both dental and medical care. The uninsured and those insured by Medicaid without dental benefits had more than three times the odds of having unmet needs for both types of care than did the privately insured. Conclusions: To serve both the dental and medical needs of diverse populations affected by HIV disease, greater coordination of services is needed. In addition, state insurance programs for people with HIV should consider the feasibility of expanding their benefit structure to include dental care benefits.
Successful Implementation of Community Water Fluoridation via the Community Diagnosis Process
Authors: Brumley David E. , Hawks Rebecca W. , Gillcrist James A. , Blackford Jennifer U. , Wells William W.
Published: May 2007

Objectives: This paper describes the community diagnosis process and how it was used to implement community water fluoridation in Tennessee. Methods: Public health dental staff developed a survey instrument to collect community‐specific data on the oral health status of schoolchildren. Key survey findings were presented to county health councils who were determining and prioritizing the health needs of their communities. Results: Community‐specific data showed higher caries levels in children without access to an optimally fluoridated community water supply. Presentation of local survey findings to county health councils resulted in fluoridation being a high‐priority health issue in several counties. With health council support, opposition to fluoridation by utility district officials was overcome when decision makers were challenged with local survey findings. The community diagnosis process resulted in the successful fluoridation of six community water systems serving a total of 33,000 residents. Conclusions: The community diagnosis approach was successful in implementing community water fluoridation in geographic areas historically opposed to this public health measure. The success of these fluoridation initiatives was attributed to: (1) current, community‐specific assessments of children's oral health; (2) identification of communities with disparate oral health needs, problems, and resources; and (3) effective presentation of community‐specific oral health survey data to community leaders, stakeholders, and decision makers.
A Community Participatory Oral Health Promotion Program in an Inner‐city Latino Community
Authors: Watson Maria Rosa , Horowitz Alice M. , Garcia Isabel , Canto Maria T.
Published: May 2007

Objectives: This paper reports the planning, implementation, process evaluation, and refinement of an oral health community participatory project in Mount Pleasant, an inner‐city Latino neighborhood of Washington, DC. The main goal was to explore the feasibility of implementing such a project. Methods: The PRECEDE‐PROCEED model was used to guide the planning and process evaluation of this project, in conjunction with community organizational methods. A steering committee, which met periodically, was formed to assist in program planning, implementation, and evaluation. The needs assessment of the community identified extensive dental health problems among children and deficiencies in their parents' oral health knowledge, opinions, and practices. In response, culturally appropriate health education and promotion activities were planned and implemented in collaboration with local community organizations, volunteers, and local practitioners. Process evaluation was used to provide feedback into the refinement of the community approach, which included record keeping and an inventory approach to activities completed and resources used. The overall impact and usefulness of this program were assessed informally using an anonymous open‐ended questionnaire directed to members of the steering committee, and an outreach survey using a convenience sample at a local Latino health fair. Results: The implementation of such a community participatory approach was feasible and useful for building upon existing local resources and addressing oral health concerns in a community not reached by traditional dental care and health promotion initiatives. Individuals in this community showed a substantial interest in oral health matters and participated in a variety of oral health prevention activities. The community approach adhered to community‐based research principles.
Patterns of Fluoride Intake from Birth to 36 Months
Authors: Levy Steven M. , Warren John J. , Davis Charles S. , Kirchner H. Lester , Kanellis Michael J. , Wefel James S.
Published: May 2007

Objectives: Dental fluorosis prevalence has increased in the United States, Canada, and other nations due to the widespread availability of fluoride in many forms, with fluoride ingestion during the first three years of life appearing most critical in fluorosis etiology. With few contemporary studies of fluoride ingestion in this age group, the purpose of this paper is to describe patterns of estimated fluoride ingestion from birth to 36 months of age from water, dentifrice, and dietary fluoride supplements and combined. Methods: Repeated responses to separate series of questions about water intake, use of fluoride dentifrice, and use of fluoride supplements were collected by questionnaire as part of the longitudinal Iowa Fluoride Study and used to estimate fluoride intake. Estimated intake is reported by source and combined at different ages. Effects of subject age and other covariates on fluoride intake were assessed using regression methods appropriate for the analysis of correlated data. Results: For most children, water fluoride intake was the predominant source, especially through age 12 months. Combined daily fluoride intake increased through 9 months, was lower at 12 and 16 months, and increased again thereafter. Mean intake per unit body weight (bw) was about 0.075 mg F/kg bw through 3 months of age, 0.06 mg F/kg bw at 6 and 9 months, 0.035 mg F/kg bw at 12 and 16 months, and 0.043 mg F/kg bw from 20–36 months. Depending on the threshold chosen (e.g., 0.05 or 0.07 mg F/kg bw), variable percentages of the children exceeded the levels, with percentages greatest during the first 9 months. Regression analyses showed fluoride intake (mg F/kg bw) from 1.5–9 months to decrease with increasing child's age, mother's age, and mother's education, with a complex three‐way interaction among these factors. From 12–20 months, fluoride intake increased with increasing child age and decreased with increasing mother's age. No statistically significant relation‐ships were found for fluoride intake from 24–36 months. Conclusions: There is considerable variation in fluoride intake across ages and among individuals. Longitudinal studies may be necessary to fully understand the relationships between fluoride ingestion over time and development of fluorosis.
An Economic Evaluation of Community Water Fluoridation
Authors: Griffin Susan O. , Jones Kari , Tomar Scott L.
Published: May 2007

Objective: The purpose of this research was to assess the local cost savings resulting from community water fluoridation, given current exposure levels to other fluoride sources. Methods: Adopting a societal perspective and using a discount rate of 4 percent, we compared the annual per person cost of fluoridation with the cost of averted disease and productivity losses. The latter was the product of annual dental caries increment in nonfluoridated communities, fluoridation effectiveness, and the discounted lifetime cost of treating a carious tooth surface. We obtained or imputed all parameters from published studies and national surveys. We conducted one‐way and three‐way sensitivity analyses. Results: With basecase assumptions, the annual per person cost savings resulting from fluoridation ranged from $15.95 in very small communities to $18.62 in large communities. Fluoridation was still cost saving for communities of any size if we allowed increment, effectiveness, or the discount rate to take on their worst‐case values, individually. For simultaneous variation of variables, fluoridation was cost saving for all but very small communities. There, fluoridation was cost saving if the reduction in carious surfaces attributable to one year of fluoridation was at least 0.046. Conclusion: On the basis of the most current data available on the effectiveness and cost of fluoridation, caries increment, and the cost and longevity of dental restorations, we find that water fluoridation offers significant cost savings.
Fluid Consumption Related to Climate among Children in the United States
Authors: Sohn Woosung , Heller Keith E. , Burt Brian A.
Published: May 2007

Objective: Recommended fluoride concentrations in US public water systems are between 0.7–1.2 ppm, depending on the mean daily maximum temperature. This range assumes that water intake is higher in warmer than in cooler climates, based on research from the 1950s. The aim of this analysis is to relate fluid consumption among American children aged 1–10 years to the local climate under modern conditions. Methods: The quantities of daily total fluid intake per body weight (ml/kg) and plain water intake per body weight (ml/kg) of children were calculated from the 24‐hour recall diet survey in the third National Health and Nutrition Examination Survey (NHANES III, 1988–94). The mean daily maximum temperature from 1961 to 1990, averaged for the month during which the NHANES III exam was conducted, was obtained for each survey location from the US Local Climate Historical Database. Multiple regression analysis was conducted using SAS and SUDAAN. Results: Fluid intake was significantly associated with age, sex, socioeconomic status (SES), and race and ethnicity. No significant association could be found between the amount of either total fluid or plain water intake and mean daily maximum temperature, either before and after controlling for sex, age, SES, and race or ethnicity. Conclusions: Results indicate that there is no evidence that fluid consumption among children is significantly related to mean temperature in modern conditions. This suggests that the national temperature‐related guidelines for fluoride concentration in drinking water may be due for reevaluation.
Training Status and Interest in Certification of Nondiplomate Faculty Teaching Predoctoral Dental Public Health
Authors: Kaste Linda M. , Sadler Zara E. , Weintraub Jane A. , Niessen Linda C. , Narendran Sena , Hayes Kathy L.
Published: May 2007

Objectives: A survey was conducted to better understand the training needs of faculty members without dental public health (DPH) specialty board certification who teach DPH to dental students. Methods: An 11‐item questionnaire was sent to 193 non‐DPH diplomate faculty members at US dental schools who were dentists and at least one of the following: a member of the American Association of Dental Schools Community and Preventive Dentistry Section, a referral from an academic American Board of Dental Public Health diplomate, a DPH faculty listed on the school's Web pages, a DPH contact from the AADS Institutional Directory, or the school's dean if no other contact. Results: A 70 percent response rate was obtained. Seventy‐nine percent of the respondents taught at least one national board‐related DPH topic. Among these faculty members, 67 percent have or are in training for the master of public health, 26 percent have completed or are in a DPH residency, and 63 percent desire training in one or more of the DPH topics. The majority (64%) does not plan to take the specialty exam, while 28 percent plan to take the exam within five years. About half reported no personal incentives to take the exam and 39 percent perceived no institutional incentives. Conclusions: These nondiplomate teachers of predoctoral DPH desire training, but appear to have barriers and perceive few benefits to achieving DPH board certification.
A Two‐year Longitudinal Study of Dental Caries in Permanent First Molars of Korean Elementary Schoolchildren
Authors: Cho Bon‐Kyoung , Kwon Ho‐Keun , Kim Kwon‐Soo , Kim Young‐Nam , Caplan Daniel J.
Published: May 2007

Objective: This longitudinal study investigated dental caries increment in permanent first molars of Korean elementary schoolchildren. Methods: A convenience sample of 722 children aged 7–9 years attending one urban elementary school was examined at baseline, with follow‐up examinations at one and two years. Coronal surfaces of permanent first molars were scored with regard to caries experience and sealant status. Results: Among sound occlusal surfaces at baseline, 21 percent of upper and 25 percent of lower surfaces developed caries during the two‐year interval. In teeth that erupted between baseline and the first follow‐up exam, over 10 percent of occlusal surfaces developed caries. Pit and fissure caries accounted for 93 percent of all new carious surfaces, while sealants had been placed on 16 percent of occlusal surfaces during the study. Conclusions: Recognizing the limitations of this convenience sample, dental sealants should be used more widely in this Korean population, and should be applied soon after tooth eruption.
Community Fluoridation Status and Caries Experience in Children
Authors: Gillcrist James A. , Brumley David E. , Blackford Jennifer U.
Published: May 2007

Objective: This study compares dental caries experience in fluoridated and nonfluoridated communities. Methods: A dental health survey designed to collect data on caries experience and treatment needs for community‐specific public health planning purposes was conducted in public elementary schools during the 1996–97 school year. Oral examinations of 17,256 children were completed, representing 93 percent of children residing in 62 East Tennessee communities. Results: The analysis showed that water fluoridation was significantly related to caries experience in the primary (dfs) and permanent (DMFS) dentitions and to the proportion of caries‐free children in the primary and permanent dentitions. When the data were adjusted for socioeconomic status, race, and age, caries levels were 21 percent lower in the primary dentition and 25 percent lower in the permanent dentition in fluoridated communities than in nonfluoridated communities. In addition, the proportion of children who were caries free was larger in fluoridated as compared with non fluoridated communities by 19 percent in the primary dentition and 6 percent in the permanent dentition. Conclusion: Although the design of the study prevented the collection of individual fluoride and residency histories, findings suggest there was substantially lower caries experience in fluoridated communities than in non fluoridated communities.
Identifying Communities with Low Dentist Supply in California
Authors: Mertz Elizabeth A. , Grumbach Kevin
Published: May 2007

Objectives: This study estimates the supply and geographic distribution of dentists in California and examines the community characteristics associated with supply of dentists. Methods: The number of practicing dentists was estimated from American Dental Association data on licensed dentists in California. Each dentist's address was geocoded and matched to a Medical Service Study Area (MSSA). Dentist‐to‐population ratios were computed, and the association between dentist supply and community characteristics was analyzed in regression models. Results: Approximately 20 percent of California communities may have a shortage of dentists. Two‐thirds of dental shortage communities are rural. Communities with a lower supply of dentists have higher percentages of minorities, children, and low‐income persons. Minority dentists were more likely to practice in minority communities. Conclusions: Geographic maldistribution of dentists may contribute to poor access to dental care in many communities, especially in rural, low‐income, and minority communities. Minority dentists are more likely to practice in minority communities, but are a small portion of the dental workforce.
Is Depressive Symptomatology Associated with Worse Oral Functioning and Well‐being Among Older Adults?
Authors: Kressin Nancy R. , III Avron Spiro , Atchison Kathryn A. , Kazis Lewis , Jones Judith A.
Published: May 2007

Objectives: Although depression negatively affects individuals' physical functioning and well‐being, its association with oral functioning and well‐being has not been examined previously. The objective of this study was to examine the association between depressive symptomatology and oral quality of life. Methods: We utilized data from two samples of older adults: community‐dwelling participants who used community primary care physicians in Los Angeles (n=7,653) and individuals who sought ambulatory care through four Department of Veterans Affairs facilities in the Boston metropolitan area (n=212). Depressive symptomatology was measured with the CES‐D scale; Oral Quality of Life was measured with the Geriatric Oral Health Assessment Instrument and the Oral Health‐related Quality of Life measure. We conducted hierarchical regression analyses to examine the effects of depression on oral quality of life, controlling for self‐reported oral health, age, education, income, and marital status. Results: Individuals with more depressive symptoms reported worse oral quality of life, controlling for socio demographic factors and self‐reported oral health. This finding persisted across multiple samples and both sexes, and using two measures of oral quality of life. Conclusion: These findings further emphasize the importance of treating depression among older adults, and suggest that both dentists and physicians have a role in recognizing and referring patients for such treatment.
Determinants of Dropout in a Community Intervention Trial on the Caries‐preventive Effect of Chewing Gums
Authors: Machiulskiene Vita , Nyvad Bente , DDS Vibeke Baelum
Published: May 2007

Objectives: This study describes determinants of dropout in a three‐year community intervention trial of the effects of sugar‐substituted chewing gums on caries progression rates. Methods: A total of 602 children aged 9–14 years from 28 school classes in five secondary schools in Kaunas, Lithuania, were given a clinical and radiographic baseline caries examination. The schools were assigned randomly to one of the following interventions: sorbitol/carbamide gum, sorbitol gum, xylitolgum, placebo gum, or no gum. Children in the four intervention schools were asked to chew at least five pieces of chewing gum per day, preferably after meals. The children were reexamined clinically after one, two, and three years of study, and radio graphically after three years. Results: A total of 33 children (6%) had dropped out before the one‐year clinical examination, an additional 29 children (5%) dropped out before the two‐year examination, and a further 108 children (18%) dropped out before the final three‐year clinical examination. A total of 230 children (39%) were not available or refused to participate in the three‐year radiographic examination. Analyses using random effect logit models showed that, irrespective of time of follow‐up, most of the cluster variation in dropout was related to school classes within the primary randomization units, the schools. The most important predictors of individual dropout were age and baseline caries experience, whereas sex was not associated with dropout. Conclusions: The results show that a community intervention trial of chewing gums carried out among schoolchildren is subject to cluster effects. Dropout was not primarily related to the randomization units themselves, i.e. the schools, but rather to sub clusters of classes within the schools. These findings should be considered when designing community intervention trials and practical preventive programs among schoolchildren.
On Adding a Dental Practice Component to an Ongoing Longitudinal Population‐based Study of Oral Health
Authors: Gilbert Gregg H. , Rose John S. , Cantey Elmire D. , Earls Janet L. , Eiford Ellen I. , Eldreth Mary Anne , Shelton Brent J.
Published: May 2007

Objective: To determine the feasibility and effectiveness of adding a dental practice component to the Florida Dental Care Study (FDCS). Methods: The FDCS was a study of dental health in which no treatment was provided. In‐person interviews and clinical examinations were conducted at baseline, 24 months, and 48 months, with six‐month telephone interviews between those times. Participants reported any dentists visited and treatment received. All but four of the 764 participants at the 24‐month session gave written permission to review their dental records. Dental hygienist research assistants abstracted information on treatment that was received during the 48‐month interval. Results: Of the 286 practices named by FDCS subjects, all but 10 (of whom five refused) practices participated. Eight practices allowed access to records, but did not allow us to record fees. Fees were unavailable at another 13 practices. Of the 764 persons who participated for the 24‐month interview, 677 ultimately reported at least one dental visit during the first 48 months of the study. Of those 677, we located dental records on 619. We also found records on four of the 111 persons who reported no dental visits, by querying practices while recording information on other participants. Charts varied in comprehensiveness; nevertheless, in conjunction with office staff consultation, all practices had adequate record of what procedures were performed. Conclusions: Although time intensive, this method of collecting data substantially increased information about dental treatment received, compared to relying on participant self‐report and clinical examination.