bluuebunny/crossref_metadata_2025 huggingface dataset:
Building the Capacity for the Response of the Dental Profession to the Global HIV Pandemic: A Case Study in International Collaboration
Authors: Kleinman Dushanka V.
Published: April 2007

The world has been united through the most puzzling, devastating, communicable disease of this century—acquired immune deficiency syndrome (AIDS). The unusual biology of the human immunodeficiency virus (HIV), the varying modes of its transmission, the lack of effective primary and secondary preventive measures, and the impact of its related diseases are some of the incredible challenges confronted by health care providers, policy makers, researchers, and all aspects of society for over a decade. From the beginning, dental practitioners, researchers, and educators have actively responded to the epidemic—first in their own cities and countries, then on an international level. This presentation highlights the oral health community's response to the HIV pandemic as a case study in international collaboration.
Dental Caries in Homeless Adults in Boston
Authors: Kaste Linda M. , Bolden Aljemon J.
Published: April 2007

Objectives: Information about the oral health status of the homeless is limited. The purpose of this study is to characterize the dental caries status among users of a dental treatment and referral program at homeless shelters in Boston, MA. Methods: Persons attending the program during a one‐year period were assessed for evidence of dental caries experience by a single examiner. DMFT counts were abstracted from patient records. Results: The population examined (n=73) was 66 percent male with a mean age of 36 years. The racial composition was 51 percent African‐American, 34 percent Caucasian, and 14 percent Hispanic. The 70 dentate people examined had a mean DFT of 11.1 (SD=6.1). The mean percent of DFT that was DT per person was 55.7 percent. Untreated caries was detected in 91.4 percent of those examined. Conclusions: These findings show evidence of previous dental services utilization by these homeless individuals, but demonstrate a high need for preventive and restorative dental therapy.
Prevalence of Dental Caries and Dental Fluorosis in Areas with Optimal and Above‐optimal Water Fluoride Concentrations: a 10‐Year Follow‐up Survey
Authors: Selwitz Robert H. , Nowjack‐Raymer Ruth E. , Kingman Albert , Driscoll William S.
Published: April 2007

Objectives: This paper presents findings for dental caries and fluorosis from an October 1990 follow‐up survey in Illinois and compares results with those obtained from two similar school‐based examinations conducted in 1980 and 1985 within the same communities. Methods: The seven study sites were grouped into four categories according to the approximate relation of their water fluoride concentration to the recommended optimal fluoride level for the area. Tests for differences in dental caries and dental fluorosis across the four water fluoride groupings and three examinations were conducted. Results: DMFS scores for children who resided in communities with above‐optimal water fluoride levels did not change significantly from 1980 through 1990. At the optimal water fluoride concentration, caries scores did not change substantially from 1980 to 1985; however, the mean DMFS score in 1990, 1.9, was significantly lower than caries levels observed during the two previous exams. In the optimally fluoridated area, the proportion of fluorosed tooth surfaces increased significantly from 1980 to 1985, but then declined by 1990 to the level observed in 1980 for both age groups. Conclusions: The results suggest that: (1) in the optimally fluoridated community, the apparent increase in the prevalence of dental fluorosis observed from 1980 to 1985 did not continue from 1985 to 1990; and (2) at above‐optimal water fluoride concentrations, dental fluorosis either remained stable or demonstrated no sustained increase over the decade.
Predetermination as a Cost‐containment Mechanism in a Social Allowances Dental Program in Manitoba
Authors: Cooney Peter V. , Hassard T. H. , Spangen Ulla A.
Published: April 2007

Objectives: A review of dental consultant actions during predetermination of benefits in the publicly insured indemnity program in Manitoba under which Social Allowances Health Services certificate holders receive dental care was under‐taken to determine the value of this process as a cost‐containment mechanism. Methods: Dollar amounts of services denied by a dental consultant during eight predetermination sessions selected to represent the 96 sessions during the 1990–91 fiscal year were determined and grouped according to category of service. Results: Approximately one‐third of average total expenditures each month were reviewed by the dental consultant through the predetermination process. Of the requested dollar amount reviewed, 26 percent was denied, a savings of 8.5 percent of average total monthly expenditures. The categories of services that made up the denied requests were: prosthodontics (30%); endodontics (32%); restorative (5%); periodontics (12%); and miscellaneous (21%), including diagnostic, surgical, preventive, orthodontic, and adjunctive. Conclusions: A properly administered predetermination process can save a third party 8.5 percent of total plan expenditures; dollar changes to altered treatment plans amount to a 26 percent reduction of expenditures relating to these requests. A predetermination process with an unbiased appeal mechanism provides a system to advise and protect providers regarding what treatment is covered.
Factors Affecting Self‐ratings of Oral Health
Authors: Matthias Ruth E. , Atchison Kathryn A. , Lubben James E. , De Jong Fred , Schweitzer Stuart O.
Published: April 2007

Objectives: The purpose of this study is to determine the relationship of self‐rated oral health to a comprehensive battery of clinical, sociodemographic, physical health, and mental health measures in a well‐elderly urban population. Methods: Results are based on telephone interviews and clinical assessments of 550 subjects over 65 years of age participating in a Los Angeles‐based Medicare project during 1990. Subjects were mostly female, white (89%), with above‐average income. Results: Findings show that: (1) the DMF measure is not as strongly related to self‐rated oral health as was a single measure of missing teeth; (2) the major predictors of self‐rated oral health were “worry about teeth” and “appearance of teeth” followed by total missing teeth, race, education, and depression scores; and (3) self‐rated general health is related to self‐rated oral health. Conclusion: Self‐rated oral health may be, for older adults, a better measure of “health” than of “morbidity.”
Differences between Racial Groups in the Impact of Oral Disorders among Older Adults in North Carolina
Authors: Hunt Ronald J. , Slade Gary D. , Strauss Ronald P.
Published: April 2007

Objectives: This study investigated variations in impact of oral disorders between older black adults and older white adults living in North Carolina. Methods: Using the Oral Health Impact Profile (OHIP) questionnaire, 440 participants aged 70 and older provided data on their perceptions of the impact of oral disease on aspects of their lives during the previous 12 months. Results: For 22 of the 49 items queried in the OHIP questionnaire, older blacks reported more frequent impact than older whites (P<.05). For none of the OHIP items did whites report more frequent impact. The impacts reported were diverse and included items reflecting pain, physical disability, psychological disability, and social disability. When the number of items occurring fairly often or very often were summed for dentate participants, blacks reported more items than did whites (3.7 vs 1.1, P<.0001). This difference decreased to 2.7 vs 2.0 (P<.346) after controlling statistically for greater mean periodontal pocket depth, more unreplaced missing teeth, and more episodic dental visits among blacks. Conclusions: Older dentate blacks reported more impact from oral problems than older dentate whites. The differences in reported impact likely are linked to differences in oral status and dental visit history between these two racial groups in North Carolina.
Treatment and Posttreatment Effects of Fluoride Mouthrinsing after 17 Years
Authors: Kobayashi Seigo , Kishi Hiroshi , Yoshihara Akihiro , Horii Kin‐ichi , Tsutsui Akihito , Himeno Tatsuo , Horowitz Alice M.
Published: April 2007

Objectives: This study assessed the treatment and posttreatment effects of a school‐based, fluoride mouthrinse regimen. Methods: Children in a nonfluoridated community in Japan participated in a daily rinse program using a 0.05 percent NaF solution in nursery and primary schools, and a weekly rinse with 0.2 percent NaF in junior high school. Students were examined at least annually for dental caries and dental treatment was provided in a public dental clinic through the ninth grade. Incipient carious lesions with no cavitation were not restored. Results: The percent of children in grades one through nine (6–14 years of age) with caries‐free permanent teeth increased from 13.4 percent in 1974 to 73.0 percent in 1991, while the mean DMFT decreased by 86 percent during this period. For 12‐year‐olds, mean DMFT scores declined to about one tooth per child after 1982. For adults 20 years of age, there was a 64 percent difference in DMFS between the treatment group who started the rinse regimen at 4 years of age and continued for 11 years, and the controls who lived in different districts and did not participate in a fluoride rinse regimen. Conclusions: Children who began rinsing at 4 or 5 years of age benefited the most from the program. The program was inexpensive, simple to implement and well accepted by families and teachers. The conservative treatment policy in the public clinic likely contributed to the benefits derived by participants.
The Impact of Recent Changes in the Epidemiology of Dental Caries on Guidelines for the Use of Dental Sealants
Authors: Brown L. Jackson , Selwitz Robert H.
Published: April 2007

This paper reviews recent changes in the epidemiology of dental caries and assesses their potential impact on the diagnosis and management of the disease and the planning and operation of sealant programs. These changes, such as the decline in caries and slowing of the rate of progression of the disease, have important implications for diagnosing and treating incipient lesions, predicting caries risk, and conducting effective disease preventive programs. Traditional paradigms for restoring carious lesions are being replaced by newer strategies that emphasize disease prevention and conservation of tooth structure. The search continues for the identification of practical models for predicting caries risk at the individual level. This paper describes a method useful for targeting resources in sealant placement programs by enabling one to determine the relative effectiveness of sealing alternative tooth surfaces in the oral cavity. One guide serves as a widely adopted manual for those who use or intend to use dental sealants in caries prevention programs. This paper provides a brief review of that document, “Preventing Pit and Fissure Caries: A Guide to Sealant Use,” as well as guidelines for sealant utilization provided by the American Dental Association, and information regarding dental sealant programs under Medicaid. The final portion of the paper provides a synthesis of the epidemiology reviewed and summarizes the implications of findings for sealant programs.
Reactor Paper The Impact of Recent Changes in the Epidemiology of Dental Caries on Guidelines for the Use of Dental Sealants: Clinical Perspectives
Authors: Söderholm Karl‐Johan M.
Published: April 2007

When used properly, sealants result in improved dental health. However, their use on all occlusal tooth surfaces for preventive reasons will result in wasted dental care resources. To optimize the preventive effects of sealants, a delivery model should be initiated that uses specially trained dental hygienists or dental assistants who visit schools to explain oral health‐related issues, conduct visual inspections of clinical oral health status, identify patients at risk for dental caries, and generate a central database for program operation. When a high‐risk patient is identified, auxiliary personnel could place sealants and recall the patient for a new visual inspection six months later. If caries is suspected at that time, the patient could be sent to a dentist for additional treatment.

To offset the negative effects caused by overutilization of sealants, their usage should be divided into two categories. First, a preventive option should be available, and the fee for use of sealants in this option should be lower compared to the fees used today. By using specially trained auxiliary personnel to place such sealants, the fee could be kept reasonably low. Second, a sealant treatment option that targets treatments of incipient lesions also should be available. The fee for such a treatment should be close to that of the traditional occlusal restoration, and the application should be by a dentist.

By using such a fee structure based on market forces, one would expect that sealant usage would increase among patients suffering from early carious lesions, while the usage of preventive sealants would remain the same or decline. This utilization pattern for dental sealants would contribute to improved efficiency of sealant usage in the treatment of dental caries, particularly at a time when caries frequency is declining. The improved efficiency could release dental care resources that should be used to target risk groups with improved education in dental health. By using such a strategy, the long‐term effect would be not only the placement of fewer restorations, but an improvement in dental health among adolescents and adults.
The RCI Revisited after 15 Years: Used, Reinvented, Modified, Debated, and Natural Logged
Authors: Katz Ralph V.
Published: April 2007

Objectives: The purpose of this article is to review the status of the Root Caries Index (RCI) 15 years after it was first introduced in the dental literature as a method for the reporting of supragingival root lesions. This review focuses on the extent to which the RCI has been used by epidemiologic researchers, as well as on the issues concerning the RCI as a useful index that have been raised and debated in the literature by those epidemiologic researchers. Methods: The debated points are categorized into six issues, including whether: (1) the RCI underestimates the prevalence of root caries by omitting subgingival root caries lesions; (2) the RCI overestimates the prevalence of root caries by using too rigid a definition of when recession can be visualized; (3) the RCI makes the assumption that there is a linear relationship between root caries lesions and the occurrence of at‐risk surfaces, i.e., surfaces with recession; (4) the RCI, by ignoring missing teeth, distorts the descriptive epidemiologic picture of root caries; (5) recession is a predictor of root caries versus merely being an antecedent state; and (6) the imprecision of diagnosing gingival recession renders the RCI useless. Results: Given both the evidence from recent studies and the professional interest in subgingival root caries, as addressed in the first debated point, it seems reasonable to modify the RCI to include a separate reporting of subgingival root caries. Of the remaining debated points over the past 15 years, three of these (points #2, #4, and #5 above) seemingly serve to clarify specific aspects of the RCI that were intended as inherent elements of the RCI as originally presented. The question as to whether there is an assumption of a linear relationship between root caries lesions and the occurrence of at‐risk surfaces (point #3) is answered in the negative. The final debated point (#6), while addressing a fundamental periodontal tissue measurement issue—namely the reliability of identifying gingival recession—and while theoretically interesting, should not undermine the current use, or utility, of the RCI, but rather suggests the need for improved periodontal diagnostic techniques for the condition of recession. Conclusion: After 15 years, the RCI appears to be one of the two most common methods of reporting root caries in the epidemiologic literature (along with DFS counts). In fact, the best overall descriptive picture of root caries is achieved when these two reporting methods are presented in the same study accompanied by descriptive presentations of missing teeth and at‐risk surfaces. Of all the debated points in the literature, the suggested modification of including subgingival lesions in the RCI leads now to the recommendation to collect subgingival data, but to do so in a manner that allows for separate presentation of supra‐ and subgingival root caries findings.
The Association of Early Dental Caries Patterns with Caries Incidence in Preschool Children
Authors: O'Sullivan David M. , Tinanoff Norman
Published: April 2007

Objectives: This study assessed the development of caries in preschool children over two years according to baseline caries pattern. Methods: Connecticut Head Start children (n=142, mean age=3.8 years) were examined for dental caries at baseline (spring 1991) and once annually for two years. Children were categorized at baseline as caries‐free, having pit and fissure (PF) caries, or having maxillary anterior (MA) caries. Results: After two years, children who presented at baseline with MA or PF caries had a mean posterior dmfs of greater than seven and four times, respectively, that of children who were caries‐free at baseline. When dental caries of the primary dentition was categorized by specific posterior patterns (i.e., posterior proximal [PPJ] and buccal/lingual [BL]), change in dmfs for the PP and BL patterns in the group that presented with pit/fissure caries at baseline were nearly four and three times greater, respectively, than for those in the caries‐free group. The group that presented with maxillary anterior caries at baseline had PP and BL caries increments eight times those of children who began caries‐free. Conclusion: Dental caries presentation in 3‐ to 4‐year‐old children can identify those children and tooth surfaces that will be at the greatest risk for future caries development.
Introduction to the Symposium on Minimal Intervention Techniques for Caries
Authors: Horowitz Alice M.
Published: April 2007

Although dental caries has declined precipitously in many industrialized countries, this disease has escalated in less developed countries. Moreover, dental caries remains a public health problem even in most industrialized countries because the disease frequently is more prevalent among subpopulations without access to preventive regimens and treatment. In some developing countries where dental facilities and providers are rare, alternative measures for managing frank lesions are being used. One example of these minimal intervention techniques is “Atraumatic Restorative Treatment” (ART). This procedure, endorsed and actively promoted by the World Health Organization, requires no anesthetic and its costs are minimal. This symposium addresses several aspects and issues of minimal intervention techniques for caries management.
Glass Ionomer as Fissure Sealant—a Critical Review
Authors: Simonsen Richard J.
Published: April 2007

This paper presents a review of the literature on glass ionomer cements used as fissure sealants. An objective assessment of the presently available scientific literature on the use of glass ionomer materials as pit and fissure sealants is not encouraging in terms of retention, but appears somewhat more positive for caries prevention. At the time of this writing, the published literature indicates that retention for resin‐based sealants is better than for glass ionomer sealants, but differences in caries prevention remain equivocal. Future research should concentrate on assessing the effects of fluoride‐releasing, resin‐modified, glass ionomer materials.
Dentists' Stated Restorative Treatment Thresholds and Their Restorative and Caries Depth Decisions
Authors: Lewis Donald W. , Kay Elizabeth J. , Main Patricia A. , Pharoah Michael G. , Csima Adele
Published: April 2007

Objective: This study examines the relationships between stated restorative treatment thresholds of 16 dentists and both their restorative decisions and caries depth determinations for approximal tooth surfaces based on bitewing radiographs. Methods: Sixteen dentists independently examined 15 pairs of experimental bitewing radiographs. They separately recorded restorative and dental caries depth decisions for 4,864 unrestored approximal tooth surfaces, 304 identical surfaces per dentist. In addition to caries depth and restorative decision data, these dentists provided their restorative thresholds using a five‐point scale. Results: Three dentists stated it would be appropriate to restore enamel lesions, nine would wait until caries had reached the dentinoenamel junction, and four would wait until caries extended into the dentine. Although dentists stating an enamel restorative threshold intended definitely or probably to restore relatively more surfaces and recorded relatively more surfaces with dentinal caries, ANOVA analyses revealed that the differences among the restorative and the depth means according to the restorative thresholds were not significant. Considerable variation existed in both the restorative and depth decisions among the dentists in each threshold group. Conclusion: Although interesting trends occurred in the restorative and depth decisions relative to the stated thresholds, this study suggests, like others in Europe, that these thresholds cannot be taken at face value to explain restorative decisions
Factors Influencing the Amount and Type of Dental Services Received by Older Adults in Four Municipalities in Ontario, Canada
Authors: Leake James L. , Hawkins J. Robert , Locker David
Published: April 2007

Objectives: The purpose of this study was to investigate the factors influencing the pattern (amount and types) of dental care provided to dental visitors participating in the baseline stage of the Ontario Study of the Oral Health of Older Adults. Methods: We interviewed and examined older adults from four municipalities in Ontario and obtained dental service records for the previous two years for those reporting a dental visit. Individual services and their corresponding time and values were aggregated into categories. We compared the pattern of care for dentate and edentulous subjects, and by age, municipality of residence, and social, demographic and economic characteristics. Results: The 473 subjects received 5,031 services, more than four hours of dental care per subject over the two years. The 29 edentulous subjects received about one‐third the number of services compared with the dentate; however, there were no differences in relative time units (RTUs) or relative value units (RVUs). Among the dentate the amount of care (RVUs) varied by municipality of residence and by visiting behavior, but not by age, income, or other socioeconomic variables. Conclusion: Both dentate and edentulous visitors received over two hours of care per person per year. Dental care patterns were influenced by dental status, area of residence, and visiting behaviors.
Self‐disclosure Experience of People with HIV Infection in Dedicated and Mainstreamed Dental Facilities
Authors: Barnes Donna B. , Gerbert Barbara , McMaster James R. , Greenblatt Ruth M.
Published: April 2007

Objectives: People infected with HIV choose dental care in dedicated or mainstreamed facilities. In this study, people with HIV were asked whether they sought care in dedicated or mainstreamed dental facilities, their reasons for choosing this source of care, their HIV disclosure experiences, and what, if any, consequences the disclosure had on access to dental care. Methods: Patients in a dedicated AIDS medical clinic (n=84) responded to questions in a telephone survey. The sample was predominantly gay, white males with symptomatic HIV infection, from randomly chosen clinic appointments. Results: The study found that 67.6 percent of respondents who had seen a dentist since their HIV diagnosis chose mainstreamed dental facilities. The majority of study participants (70%) disclosed their HIV status. Of those subjects who chose disclosure, discrimination was minimal (2.7%). Conclusion: Results suggest support for public policy encouraging people with HIV to go to any dentist with whom they feel most comfortable and with whom they will receive the best possible care, regardless of whether the dentist practices in a dedicated or mainstreamed facility.
Drinking Water Fluoride Levels, Dental Fluorosis, and Caries Experience in Brazil
Authors: Cortes Denise Fonseca , Ellwood Roger Phillip , O'Mullane Dennis M. , de Magalhaes Bastos Jose Roberto
Published: April 2007

Objectives: The main aim of this study was to consider the association between water fluoride levels and caries prevalence in three Brazilian populations. Methods: A total of 457 6–12‐year‐old lifetime residents from three economically deprived groups with 2–3, 0.7, and less than 0.01 ppm F in their water supplies were examined. Dental caries was recorded on permanent upper central incisors and first molars and all primary teeth (dmft). Results: There was a significant trend (P<.01) for the mean dmft to decrease with increasing levels of fluoride in the drinking water. Caries experience in the six permanent teeth was significantly lower (P<.01) in the area with 0.7 ppm F than in the other two groups. For the 2–3 ppm F group significantly more caries was found in subjects with higher TF scores (P<.05). Conclusion: Optimization of fluoride levels in the drinking water remains a valuable dental public health measure in Brazil.
The Dawn of a New Era
Authors: Scott David B.
Published: April 2007

This paper reviews the scientific events culminating in the fluoridation of communal water supplies. Dental and medical studies completed by 1942 had established the safety and benefits of exposure to drinking water naturally containing fluoride. Researchers and public health workers concluded that it was possible to test the hypothesis that the dental benefits attained where fluoride levels around 1 ppm occurred naturally in drinking water could be safely replicated in low‐fluoride areas by raising the level to this optimal concentration. Grand Rapids became the first test site and by the time the demonstration ended in 1959, around 40 million people in about 2,000 communities already were drinking water with fluoride levels that had been adjusted to optimal. The success of fluoridation brought the dawn of the era of caries control and created great opportunities for research and public health.
Fluoridation and the Private Practice of Dentistry
Authors: Stevens Ray E.
Published: April 2007

Water fluoridation holds an important place in the history of Grand Rapids. This paper recounts the firsthand professional experiences of a dentist before and after he joined his father's established dental practice in Grand Rapids, only two years after fluoridation of the city's water supply began. The benefits of water fluoridation are documented through a review of office records. The prevalence of dental caries in patients who were born in Grand Rapids after water fluoridation began is low, and no case of a missing first permanent molar was found. Quadrant dentistry is no longer practiced. Children of parents born in Grand Rapids after the start of water fluoridation experience less decay than their parents, suggesting that factors in addition to water fluoridation have played a role in the downward trends in caries. The complete destruction of mouths of patients seen in this practice 50 years ago no longer happens, providing evidence of the benefits of water fluoridation, the most important advance ever in dentistry.
The Results of Water Fluoridation in Ireland
Authors: O'Mullane Denis , Whelton Helen P. , Costelloe Pat , McDermott Stephen , McLoughlin Jacinta
Published: April 2007

The visit of Dr. Trendley Dean to Dublin in the mid‐1950s helped accelerate the decision to introduce water fluoridation as a public health measure in the prevention of caries in the Republic of Ireland. A challenge to the constitutional validity of the Health (Fluoridation of Water Supplies) Act 1960 failed and in 1964 the water supplies of Dublin city were fluoridated. Over the next seven to eight years all the major urban communities in the Republic of Ireland were fluoridated. Currently, 67 percent of the 3.5 million people in the country reside in fluoridated communities. Studies conducted over the last 20 years show that residents of fluoridated communities have better dental health than those in nonfluoridated communities—the mean dmft is lower in children and the number of natural teeth present in adults is higher.
Water Fluoridation Results in Basel since 1962: Health and Political Implications
Authors: Marthaler Thomas M.
Published: April 2007

The population of the canton Basel‐City has been provided with fluoridated water since May 1962. This paper presents a summary of basic findings from evaluations of this public health intervention. Standard methods were used for assessing dental caries, enamel fluorosis, urinary fluoride, and other data. Caries prevalence of schoolchildren declined until 1977 because of water fluoridation, after which it continued to decline until the late 1980s due to reasons other than water fluoridation. Caries prevalence in Basel was at least as low as in those other parts of Switzerland where either school‐based dental health education programs or comprehensive salt fluoridation programs had been implemented for many years. Enamel fluorosis was seen in 38 percent of the children, similar to regions with comprehensive salt fluoridation, but higher than in low‐fluoride regions. Overlap of salt and water fluoridation in families consuming both fluoridated water and fluoridated salt has occurred, but has not resulted in problems. Fluoride concentrations (close to, but mostly below 1.0 ppm) and excretions (0.45–0.80 mg Fper day in children, around 1 mg in adults) corresponded to expected levels. Statistics from both the School Dental Service and the Public Dental Clinic indicate a dramatic reduction in the amount of conservation dentistry being done and, in adults, prosthetic services. Political steps to remove water fluoridation were taken in 1976, 1982, 1989, and 1993, but have not been successful. Water fluoridation has resulted in the expected benefit and continues to exist beside salt fluoridation used in the other cantons of Switzerland.
And the Next 50 Years? The Future of Recombinant DNA Technology in Oral Medicine
Authors: Slavkin Harold C.
Published: April 2007

As we celebrate this spectacular 50th anniversary, fluoridation continues to be the most effective public health strategy to reduce the disease burden of dental caries. Curiously, while H. Trendley Dean and his colleagues at the National Institutes of Health were investigating the effects of fluoride on tooth enamel in the mid‐1930s, two young boys, one in London and the other in Chicago, were growing up to become the catalysts for another “biological revolution.” These two very talented individuals, James Watson and Francis Crick, would later meet by accident at Cambridge and produce their seminal discovery published in April 1953 as a letter in Nature, a one‐page article provoking an international scientific adventure to understand living organisms in terms of the structure and function of deoxyribonucleic acid (DNA), a universal genetic code and a rationale for the applications of recombinant DNA technology (rDNA) in fields as diverse as agriculture, energy, industry, and health. As we now reflect upon the triumphs from fluoridation and ponder the next 50 years and the complexities of craniofacial, oral, and dental diseases, it becomes increasingly evident that recombinant DNA technology coupled with health promotion, disease prevention, and public education offers the promise for remarkable advances in prevention, diagnosis, and therapeutics in oral medicine.
A Pragmatic Primer… Lessons from Natural Science for the Profession of Dentistry
Authors: Nash David A.
Published: April 2007

Artificially supplementing our community water supplies with optimal amounts of fluoride to gain the benefits of a significant reduction in dental caries is a lesson we have learned from natural science, a lesson from nature we have appropriated for culture—and a very pragmatic lesson. Today, we have discovered through science additional principles of nature that can be instructive and that can be appropriated for the profession of dentistry's benefit. This paper reviews five principles of natural science and derives lessons for the profession from these principles. The principles include natural selection, environmental change, form follows function, symbiosis, and entropy. Lessons derived from these principles of natural science are, respectively: survival and thriving of the profession are dependent upon the environment; the status quo will not be maintained—the profession must acknowledge, encourage, and celebrate change; the form the profession assumes must be consistent with its function of serving society; the profession must acknowledge the interdependence and reciprocity existing in its relationship with society; and the profession must continuously, energetically, and creatively reconstruct and renew itself. The challenge before us is to transform dentistry into a profession that continuously anticipates environmental changes by energetically creating new forms or structures that will result in more effective fulfillment of our function: gaining the benefits of oral health for society.
Cancers of the Oral Cavity and Pharynx in the United States: An Epidemiologic Overview
Authors: Swango Philip A.
Published: April 2007

Objectives: This paper reviews and summarizes recent epidemiologic data on the incidence, mortality, and survival of cancers of the oral cavity and pharynx. It identifies gaps in the science base, discusses emerging trends, and points out opportunities through which the epidemiology of these cancers can be understood better. Methods: Primary data sources were SEER incidence and survival data from 1973–92 and NCHS mortality data from the same period. Results: In general, the incidence, mortality, and survival rates for oral and pharyngeal cancers are well documented by existing national data; however, gaps in coverage still exist with respect to geographic, racial, and ethnic information. Overall, trends in the occurrence of these cancer types since 1973 have revealed modest improvements in incidence, more substantial improvements in mortality, and little change in survival. However, these trends varied by race, sex, and anatomic subsites. Conclusion: Demographic changes will greatly influence the epidemiology of oral and pharyngeal cancer in coming decades. For older Americans, these cancer types are likely to remain a serious and perhaps increasing problem. Understanding of these cancers can be furthered by continued analysis of existing databases and the creation of new data sources for the future.
New Assumptions Concerning IP As and Cost of Dental Care
Authors: Hazelkorn Herbert M. , Jovanovic Borko D. , Macek Mark D. , Chouinard Joanne
Published: April 2007

Objectives: Previous studies suggest that fee‐for‐service (FFS) patients receive more treatment and at a greater cost than capitation patients. In this study treatment plans of dentists who are members of an independent practice association (IPA), a preferred provider organization (PPO), or who are paid their usual fee for service are compared. Methods: A carefully selected and trained professional actor, with actual dental disease and recent radiographs, was sent to the offices of general practice dentists for an examination and treatment plan. To one group of dentists (n=21) the patient said he was a member of a PPO plan served by that dentist, to a second group (n=15) he said he was a member of an IPA plan served by that dentist, and to the third group (n=19) he said he would pay by the traditional FFS method. Results: IPA dentists recommended more restorations (mean=9.60) than those in the PPO program (mean=5.95) or those paid by the traditional FFS method (mean=5.58). The anticipated mean cost to the patient was higher for the IPA dentists ($1,815.20) compared to the other two types (PPO=$1,186.24, FFS=$1,470.42). Conclusion: The IPA models studied in this investigation permitted dentists to charge copayments for most treatments beyond basic services. This type of IPA might be similar to a fee‐for‐service model that provides practitioners with an incentive to do more rather than less treatment.
Racial Differences in Stage at Diagnosis of Screenable Oral Cancers in North Carolina
Authors: Arbes Samuel J. , Slade Gary D.
Published: April 2007

Objective: This study examined differences between blacks and whites in stage at diagnosis of screenable oral cancers. Methods: Data for 1,137 North Carolina residents with first primary tumors of the oral cavity (excluding the lip and salivary glands) or oropharynx diagnosed from 1990–92 were obtained from the North Carolina Central Cancer Registry. The outcome variable was stage at diagnosis dichotomized as localized and advanced. The explanatory variables were race, sex, age, year diagnosed, tumor site, and county‐level socioeconomic and health care resource factors. Bivariate, stratified, and multiple regression analyses were conducted. Results: In the regression analysis, the odds of advanced stage was 2.1 (95% Cl=1.5, 2.9) times greater for blacks than whites. Other multivariable effects were sex [males compared to females: OR=1.5 (95% Cl=1.2, 2.0)] and tumor site [oropharynx compared to palate: OR=4.2 (95% Cl=2.5, 7.0)]. Conclusion: Among black and white residents of North Carolina diagnosed with cancer of the oral cavity or oropharynx, blacks had a greater odds of diagnosis at advanced stage.
Prevalence and Distribution of Dental Restorative Materials in US Air Force Veterans
Authors: Albertini Tullio F. , Kingman Albert , Brown L. Jackson
Published: April 2007

Objectives: Millions of restorative procedures are performed annually in the United States, yet very little is known about their distribution in the general population. With increasing concern about potential adverse health effects of some restorative materials, a better understanding of the extent of exposure to these materials in the population is important. The purpose of this study is to report the prevalence, patterns, and distribution of dental restorative materials in a population of male veterans. Methods: This collaborative study with the US Air Force examined 1,166 male veterans to assess exposure to dental amalgam and other restorative materials. An inventory of dental materials in the study population was obtained through oral examinations. Dental materials were classified into five categories: (1) amalgam; (2) resin; (3) porcelain, cement, or temporary, including ionomer (PCT); (4) cast gold alloys/direct filling gold; and (5) other metals (OM). The mean age of the study participants was 52.9 years. Over 94 percent of the study participants were dentate. Results: The study participants averaged 45.8 restored/replaced surfaces. Restored/replaced surfaces increased with age while the number of teeth decreased with age. The most frequently used restorative material was amalgam, averaging 19.89 surfaces per subject, followed by PCT (9.38), resins (8.99), OM (5.52), and gold (4.91). The distributions of restorative materials varied by age, arch type, and location in the mouth. Conclusion: The study population experienced substantial exposure to dental materials.
Restorative Treatments Received by Children Covered by a Universal, Publicly Financed, Dental Insurance Plan
Authors: Ismail Amid , Brodeur Jean‐Marc , Gagnon Pierre , Payette Martin , Picard Daniel , Hamalian Talia , Olivier Marie
Published: April 2007

Objectives: This study sought to identify risk markers associated with the provision of new restorations in children and to investigate whether the carious status of a tooth surface is associated with the restorative decisions of dentists. Methods: A total of 911 schoolchildren in grades one, two, and three were randomly selected from the island of Montreal, Quebec, Canada. Dental examinations were carried out in 1990, 1991, and 1992. Tooth surfaces of first permanent molars were classified as sound, noncavitated, and cavitated. The carious status of a tooth was matched with restorative decisions reported to the insurance board. Results: The presence of a carious cavity was a strong risk marker for placement of new restorations (odds ratios ≥4.11). After one year, less than 2 percent of sound tooth surfaces of first permanent molars were restored and about 21 percent of noncavitated tooth surfaces were restored. When new class I restorations placed in maxillary first permanent molars within 3–6 months after the baseline examination were evaluated, we found that between 73 percent and 86 percent of these new restorations were placed in sound or noncavitated tooth surfaces. A similar trend also was observed in mandibular first permanent molars. Poor agreement between epidemiologic diagnosis and restorative decisions was found. The restorative profile of dentists was a significant risk marker for placement of new restorations. Conclusion: The majority of new restorations in first permanent molars were placed in sound and noncavitated tooth surfaces because of the ubiquitous prevalence of these tooth surfaces and the validity problems of current caries diagnosis methods.
Dissatisfaction with Oral Health Status in an Older Adult Population
Authors: Jokovic Aleksandra , Locker David
Published: April 2007

Objectives: The aim of this study was to assess dissatisfaction with oral health in an older adult population and to identify factors associated with dissatisfaction. Methods: Data were obtained from 907 community‐dwelling older adults aged 50 years and older using personal interviews and clinical examinations. Bivariate and multivariate analyses examined the relationships among dissatisfaction with oral health and a variety of sociodemographic variables, clinical oral health measures, and measures of the functional and psychosocial impact of oral disorders. Results: Overall, 14.3 percent of respondents were dissatisfied with their ability to chew, 21.6 percent with their dental appearance, and 5.6 percent with their ability to speak clearly. Almost one‐third (30.8%) were dissatisfied with at least one of these dimensions of oral health. Edentulous subjects were more likely to be dissatisfied than dentate subjects. The multivariate regression model for dentate subjects contained seven variables that explained 31 percent of the variance in dissatisfaction scores. For the edentulous, the model contained three variables that accounted for 53 percent of the variance. Conclusions: These results suggest that demographic, clinical, and psychosocial impact variables are associated with dissatisfaction with oral health. However, psychosocial impact variables had by far the strongest independent effect.
Nonresponse Bias in a Survey of Ontario Dentists' Infection Control and Attitudes Concerning HIV
Authors: McCarthy Gillian M. , Koval John J. , MacDonald John K.
Published: April 2007

Objective: This study investigated late response and nonresponse bias in an HIV‐related survey of dentists. Methods: Questionnaires with ID numbers were mailed to all dentists in Ontario (N=5,997) with additional mailings four and seven weeks later. Results: Proportionately more respondents who returned questionnaires less than four weeks after the first mailing reported that they knowingly treated (P<.05) or were willing to treat HIV‐infected patients (P<.05); that they had an accurate perception of risk of HIV infection after a needlestick injury (P<.01), and preferred not to refer HIV‐infected patients (P<.01). Linear extrapolation of cumulative percent responses indicated nonresponse bias in terms of attitude and knowledge items; however, the magnitude was low. Conclusion: The effects of late response and nonresponse bias on the results of this study were small. However, these results cannot be generalized beyond the study population, and obtaining high response rates and testing for nonresponse bias in surveys of attitudes related to HIV are recommended.
Characteristics of Patients Seeking Care from Independent Dental Hygienist Practices
Authors: Perry Dorothy A. , Freed James R. , Kushman John E.
Published: April 2007

Objectives: This study determined demographic characteristics, satisfaction with care, and likelihood of follow‐up dentist visits for patients seen in office‐based, independent, dental hygienist practices. Methods: New patients were surveyed after their initial visits to independent hygienist practices to assess their demographic characteristics and satisfaction with care at both the beginning of practice operations and 18 months after the start of these practices. Follow‐up surveys were sent to patients 12 and 24 months after their initial visits to the independently practicing dental hygienists to determine if patients had visited a dentist. Results: Most respondents were white, female, had attended some college, and reported high family incomes. Ninety‐eight percent of respondents were satisfied with their dental hygiene care. Follow‐up questionnaires revealed that over 80 percent of respondents visited the dentist within 12 months of receiving dental hygiene care in independent settings. This level of follow‐up care with dentists was found both for respondents who reported having a regular dentist at their initial visits with the hygienists and for those who reported not having a regular dentist. Conclusion: Independent practice by dental hygienists provided access to dental hygiene care and encouraged visits to the dentist.
The Influence of Various Fluoride Exposures on the Prevalence of Esthetic Problems Resulting from Dental Fluorosis
Authors: Clark D. Christopher , Berkowitz Jonathan
Published: April 2007

Objectives: This study sought to determine the prevalence of esthetic problems due to dental fluorosis, and determine the relationship of different fluoride exposure histories to the occurrence of these problems. Methods: In 1993–94 2,715 children in grades 2 and 3 and 3,297 adolescents in grades 8 and 9 were examined by four dentists. Questionnaires detailing exposures to various fluoride technologies were collected from 3,022 of these study participants. Esthetic ratings of the participants' maxillary anterior teeth were made by the examiners, the participants themselves, and their parents using questionnaires designed for this purpose. Results: Data indicate that 46 percent of the participants had dental fluorosis. Only 40 percent had fluorosis on anterior maxillary teeth. The prevalence of esthetic problems ranged from about 1 percent to 4 percent, depending on how an esthetic problem was defined. Esthetic problems as defined by the participant were more prevalent for the “over 11′’age group. Logistic regression results demonstrated significant associations between several of the classifications of esthetic problems and the use of fluoride supplements and dentifrices, and exposure to fluoridated water during the third year of life. Conclusion: Results suggest that the prevalence of esthetic problems is low in the communities surveyed, and that exposure to any number of fluoride technologies in the third year of life can increase a child's risk for this problem.