bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Children's Medical and Dental Insurance Coverage by Socio demographic Characteristics, United States, 1995
Authors: Vargas Clemencia M. , Isman Robert E. , Crall James J.
Published: May 2007

Background: Insurance coverage can reduce financial barriers that constitute a significant deterrent to obtaining medical and dental care, especially for children who reside in low‐income households. We present baseline information on the codistribution of medical and dental coverage among US children according to socio demographic characteristics before the enactment of the State Children's Health Insurance Program (SCHIP). Methods: Data for 27,059 children 0–17 years old from the 1995 National Health Interview Survey (NHIS) were analyzed to examine the distribution of medical and dental insurance coverage by socio demographic characteristics. Prevalence estimates and adjusted odds ratios with 95 percent confidence intervals were calculated using SUDAAN. Results: Overall, 14.1 percent children were uninsured for medical care and 36.4 were uninsured for dental care; thus, there were 2.6 times as many children uninsured for dental than for medical care. Near‐poor and Hispanic children were most likely to be without medical or dental coverage. Near‐poor children were more likely to be uninsured for dental care than for medical care (43.8% vs 22.5%). Conclusion: Our findings, coupled with previous reports, suggest that the most serious problem concerning lack of dental insurance is among near‐poor children. SCHIP has the potential to address dental coverage among near‐poor children.
An ABCD Program to Increase Access to Dental Care for Children Enrolled in Medicaid in a Rural County
Authors: Kaakko Tarja , Skaret Erik , Getz Tracy , Hujoel Philippe , Grembowski David , Moore Carree S. , Mllgrom Peter
Published: May 2007

Objectives: The Access to Baby and Child Dentistry (ABCD) Program addresses the needs of families in obtaining dental care. In this study, the program was evaluated in rural Stevens County, Washington. Aims were to assess utilization of dental services, average dental expenditures per child, and oral health status. Methods: Medicaid‐enrolled children aged 1–4 years were randomly assigned to the ABCD program (n=216) or to regular benefits (n=221). An outreach worker contacted each ABCD family and provided an orientation. Dental care utilization and expenditures were calculated from claims. A posttest‐only design was used to evaluate oral health status. Results: An enrollment effect was seen in ABCD, but the difference between groups was not sustained. There was a doubling of utilization between groups for the youngest cohort, while the others showed no differences. In the first year the rate was higher for the entire ABCD group than for the children not in ABCD (34.0% vs 24.7%). Thirty‐three percent of ABCD children (70/212) who had visited the dentist had >1 appointment compared to 21.5 percent (47/219) for the children not in ABCD who had visited the dentist. There was no overall difference in expenditures, while expenditures for preventive services were greater for ABCD. ABCD children had fewer teeth with initial caries. The average incremental cost per child per initial lesion prevented was $31.44. Conclusion: ABCD most benefited the youngest cohort of children and improved health.
Dental Caries Experience of Female Inmates
Authors: Heng Christine K. , Morse Douglas E.
Published: May 2007

Objectives: The purpose of this study was to determine the extent of dental caries and level of unmet dental need among female offenders in a federal prison in Connecticut. Methods: All inmates admitted into the Federal Correctional Institution at Danbury, Connecticut, from May 31, 1997, to May 21, 1998, were given oral screening examinations (n=500; age range=20–65 years). The data were analyzed in terms of race/ethnicity and age groupings. DMF and D/DF scores were determined. Results: The mean DMFT and DMFS scores were 16.8 and 57.0, respectively; the scores were higher for non‐Hispanic whites and Hispanics than non‐Hispanic blacks, and increased with age. The mean DT/DFT and DS/DFS scores were 36.8 percent and 36.0 percent, respectively. These scores were higher for non‐Hispanic blacks than non‐Hispanic whites and Hispanics, and decreased with age. Conclusions: Female prisoners had high levels of dental caries and racial disparities persisted in the prison.
Provision of Care to the Underserved Populations by National Health Service Corps Alumni Dentists
Authors: Mofidi Mahyar , Konrad Thomas R. , Porterfield Deborah S. , Niska Richard , Wells Barbara
Published: May 2007

Objective: This study examined factors associated with dentists continuing to provide care to the underserved populations beyond their National Health Service Corps (NHSC) obligation period. Methods: Self‐administered questionnaires were mailed in 1998 to 404 dentists who had completed their service obligation between 1980 and 1997. The outcome variable was dentist self‐report of continuing to work with the underserved population past NHSC obligation. Results: Among 249 respondents (62% response rate), 46 percent of alumni dentists continued to work with an underserved population. Multivariate analyses found that being an African American (odds ratio [OR]=3.2), higher final salary during the NHSC assignment (OR=1.2), and higher altruistic motivation to work with the underserved populations prior to entering NHSC (OR=I.1) were significantly associated with continued service to the underserved populations. Conclusions: A small number of factors were associated with alumni NHSC dentists' decisions to continue to provide care for the underserved populations. Targeting African‐American students and students interested in caring for the underserved may improve the long‐term commitment of dentists toprovide care forthe underserved populations. Attention will also need to be given to increased salary as a potenfial to to increase the numbers of dentists who continue to serve the underserved populations.
Orofacial Pain: Racial and Sex Differences Among Older Adults
Authors: Riley Joseph L. , Gilbert Gregg H. , Heft Marc W.
Published: May 2007

Objectives: This study investigated racial differences in orofacial pain symptoms in a sample of older adults. Orofacial pain prevalence, persistence, severity, and behavioral impact were assessed. We also tested whether sex and race interact, such that racial differences are only observed for a single sex, or whether sex differences only occur within a single racial group. Methods: Telephone interviews were conducted with a stratified random sample of 1,636 community‐dwelling older (age 65+ years) north Floridians. Results: Racial differences were not found for 12‐month prevalence or pain ratings for any painful oral symptom, or in the total number of symptoms. The most consistent racial differences were in behavioral impact associated with pain. Blacks reported greater behavioral impact as defined by pain having reduced their daily activities or motivating them to take some action in response to pain. For toothache pain, that action was more likely to have been some form of self‐medication. These relationships persisted after controlling for socioeconomic status, approach to health care, and pain intensity in multivariable models. Conclusion: Although pain prevalence is an important public health variable, this study suggests that other pain‐related variables, such as behavioral impacts, are useful when describing disparities associated with orofacial pain.
Racial and Socioeconomic Disparities in Oral Disadvantage, a Measure of Oral Health‐related Quality of Life: 24‐month Incidence
Authors: Chavers L. Scott , Gilbert Gregg H. , Shelton Brent J.
Published: May 2007

Objectives: This paper estimates the incidence of oral disadvantage based on the subject's approach to dental care, sex, race, and financial status; identifies demographic and socioeconomic characteristics that were associated with oral disadvantage; and determines if these characteristics were differentially associated with the three domains of oral disadvantage. Methods: The Florida Dental Care Study was a longitudinal study of oral health in diverse groups of persons who at baseline had at least one tooth, were 45 years or older, and were either African American or non‐Hispanic white. Incidence rates, odds ratios, and 95 percent confidence intervals were used to describe oral disadvantage and its relation to race, income, and other key sociodemographic characteristics. Results: The strongest independent predictors of oral disadvantage were approach to dental care (problem‐oriented attenders or regular), and situation if faced with an unexpected $500 dental bill. Demographic and socioeconomic characteristics were differentially associated with each disadvantage domain. Conclusions: African Americans, females, rural residents, individuals who did not graduate from high school, individuals with limited financial resources, and problem‐oriented dental attenders had significantly higher occurrences of oral disadvantage. Racial and sex disparities in oral disadvantage were largely explained by differences in approach to dental care and financial resources between these groups.
Influence of Patient, Visit, and Oral Health Factors on Dental Service Provision
Authors: Brennan David S. , Spencer A. John
Published: May 2007

Objectives: Service provision should reflect the oral health of the patient. However, patient and visit factors may influence service patterns and the appropriateness of care delivered. The aim of this study was to examine factors associated with variation in dental services and to assess whether variation by patient and visit characteristics persisted after controlling for oral health status. Methods: A random sample of Australian dentists was surveyed during 1997–98 (response rate=60.3%). Private general practitioners (n=345) provided data on service provision, as well as patient, visit and oral health variables from a log of a typical clinical day (n=4,115 patients). Multivariate Poisson regression models were run for eight service areas (e.g., diagnostic, preventive, and restorative). Results: Significant effects (P<.05) were observed for oral health factors in all eight models, visit factors in all eight models, patient demographics in four models, dental knowledge/behavior in one model, and area‐based socioeconomic status in one model. Conclusions: After controlling for oral health, visit characteristics persisted as significant predictors of services, with nonemergency visits, insurance, and capital city location associated with more favorable service mix patterns. Higher socioeconomic status areas and payment scale ratings also were associated with a better service pattern in particular service areas. These findings show that a wide range of factors, in addition to oral health, contribute to variation in service provision.
The Epidemiology of Self‐reported TMJ Sounds and Pain in Young Adults in Israel
Authors: Katz Joseph
Published: May 2007

Objectives: We investigated the prevalence of self‐reported temporomandibular joint sounds (TMJS), masticatory muscle pain (MMP), and their interrelation in a young adult population. Methods: A large sample (n=20,869) of young soldiers aged 18–21 years who attended dental clinics were asked about their experience of TMJ sounds and pain. Results: The overall prevalence of TMJS was 8.4 percent (8.9% in females and 8.2% in males) and for masticatory pain was 4.0 percent for both males and females (P<.001 under chi‐square test). Twenty‐five percent of patients reporting positive TMJS also reported positive MMP compared to 2 percent in the negative TMJS group (P<.001). Fifty‐three percent of patients reporting positive MMP also reported positive TMJS, compared to 6.5 percent in the negative MMP group (P<.001). Conclusions: The low prevalence of TMJ sounds and pain found in these study might be attributed to the different cultural and social environment, as well as to the uniformity in age of the study group.
Fluoridation and Social Equity
Authors: Burt Brian A.
Published: May 2007

The overall reduction in caries prevalence and severity in the United States over recent decades is largely due to widespread exposure to fluoride, most notably from the fluoridation of drinking waters. Despite this overall reduction, however, caries distribution today remains skewed, with the poor and deprived carrying a disproportionate share of the disease burden. Dental caries, like many other diseases, is directly related to low socioeconomic status (SES). In some communities, however, caries experience has now diminished to the point where the need for continuing water fluoridation is being questioned. This paper argues that water fluoridation is still needed because it is the most effective and practical method of reducing the SES‐based disparities in the burden of dental caries. There is no practical alternative to water fluoridation for reducing these disparities in the United States. For example, a school dental service, like those in many other high‐income countries, would require the allocation of substantial public resources, and as such is not likely to occur soon. But studies in the United States, Britain, Australia, and New Zealand have demonstrated that fluoridation not only reduces the overall prevalence and severity of caries, but also reduces the disparities between SES groups. Water fluoridation has been named as one of the 10 major public health achievements of the 20th century by the Centers for Disease Control and Prevention, and promoting it is a Healthy People objective for the year 2010. Within the social context of the United States, water fluoridation is probably the most significant step we can take toward reducing the disparities in dental caries. It therefore should remain as a public health priority.
Predictors of Chewing Difficulty Onset Among Dentate Adults: 24‐month Incidence
Authors: Peek Chuck W. , Gilbert Gregg H. , Duncan R. Paul
Published: May 2007

Objectives: Chewing ability is an important measure of health‐related quality of life, yet few studies have examined predictors of chewing difficulty in community‐based samples. This study describes longitudinal patterns of chewing difficulty and identifies predictors of chewing difficulty onset. Methods: The Florida Dental Care Study (FDCS) was a longitudinal study of oral health and related behaviors. Interviews and a clinical exam were conducted with a sample that included persons who had at least one tooth and were aged 45 years or older (n=873). The five‐item chewing index of Leake (1990), with minor revision, was the outcome of interest. Results: Approximately 21 percent of baseline participants reported chewing difficulty and about 34 percent reported difficulty during the study. Having infected or sore gums, loose tooth, loose crown or bridge, toothache pain, lower numbers of opposing pairs of teeth, dry mouth, and being female were significant predictors of incident chewing difficulty. Conclusions: Self‐reported oral disease and tissue damage and toothache pain were strong predictors of decline in chewing ability. Additionally, women were identified as a high‐risk group for incident chewing difficulty. Future research should elaborate further the pathways through which these factors affect oral function.
Relative Effects of Pre‐ and Posteruption Water Fluoride on Caries Experience of Permanent First Molars
Authors: Singh K. A. , Spencer A. John , Armfield J. M.
Published: May 2007

Objectives: Previous studies have attributed the caries‐preventive effects of preeruption (PRE) and posteruption (POST) exposure to fluoridated water based on data collected before and after the commencement or discontinuation of water fluoridation. This study aims to determine the relative pre‐ and posteruption exposure effects of fluoridated water on caries experience of 6‐15‐year‐old Australian children based on individual residential histories. Methods: Parental questionnaires covering residential history of participants were linked to their oral examinations conducted between June 1991 and May 1992 by the School Dental Services of South Australia and Queensland. Percentage of lifetime exposed to optimally fluoridated water PRE and POST was calculated with respect to the eruption age for first permanent molars. Combined pre‐ and posteruption categories were created to test PRE against POST exposure: PRE & POST=0, PREPOST, and PRE & POST≥90 percent lifetime exposure. These categories were used as indicator variables with PRE and POST=0 as reference in an analysis of first permanent molar DMFS scores. The linear regression model controlled for important potential confounders. Results: Participation rates were 69.7 percent in South Australia and 55.6 percent in Queensland with 9,690 and 10,195 participants, respectively. Pre‐ and posteruption exposures were strongly correlated (r=. 74; P<.01). Compared to the reference, the categories PRE>POST, PRE=POST in the range 0‐90 percent, and PRE and POST≥90 percent showed significantly lower caries levels. Conclusions: The findings indicated that preeruption exposure was required for a caries‐preventive effect and that exposure after eruption alone did not lower caries levels significantly. However, the maximum caries‐preventive effects of fluoridated water were achieved by high pre‐ and posteruption exposure.
A National Survey of the Oral Health Status of Homeless Veterans
Authors: Gibson Gretchen , Rosenheck Robert , Tullner John B. , Grimes Rebecca M. , Seibyl Catherine L. , Rivera‐Torres Angel , Goodman Harold S. , Nunn Martha E.
Published: May 2007

Objectives: This study reports results from a survey designed to (1) assess the oral health needs of a national sample of homeless veterans and (2) compare the dental needs of homeless veterans participating in VA‐sponsored rehabilitation programs with domiciled veterans in VA substance addiction programs.

Methods:Homeless veterans enrolled in a nationwide rehabilitation program (n=1,152) completed a survey including questions concerning patients' perceptions of their oral health, dental service needs and use, and alcohol and tobacco use. A sample of these veterans (n=281) subsequently received dental exams. A comparison group of domiciled veterans enrolled in VA substance abuse programs (n=339) completed a similar survey. A sample of these veterans (n=150) also received dental exams. Results: Sociodemographic variables, patient‐reported oral health information and risk behaviors, and findings from dental exams described two remarkably similar populations. Conclusions: As expected, the homeless veterans exhibited poor oral health, but it was not different from domiciled veterans enrolled in substance addiction programs. Lifestyle choices, such as heavy drinking and smoking, may contribute more to poor oral health than living conditions.
Oral Health Surveillance: Past, Present, and Future Challenges
Authors: Beltrán‐Aguilar Eugenio D. , Malvitz Dolores M. , Lockwood Stuart A. , Rozier R. Gary , Tomar Scott L.
Published: May 2007

We reviewed and summarized the efforts in the United States to collect data on oral diseases, conditions, and behaviors implemented at the national and state level. The main characteristics of these efforts were: (1) systematic collection of data from representative samples, mostly at the national level; (2) one‐time or sporadic experiences when data are collected at state and local levels; (3) use of visual‐tactile protocols implemented at the tooth‐surface or tooth‐site level for data collection; (4) focus mainly on dental caries and periodontal diseases; and (5) leap‐time from data collection to publication of results. Using the definition of surveillance in public health (the ongoing and systematic collection, analysis, and interpretation of outcome‐specific data for use in planning, implementing, and evaluating public health practice), we show there is an impending need to develop new techniques to build up surveillance systems for oral diseases, conditions, and behaviors at the national, state, and local levels. In the second part of this review, we presented a number of alternative techniques developed in the last 10 years to collect timely data for oral health. The main characteristics of these efforts include: (1) focusing on data collection at state and local level; (2) integration into existing and ongoing surveillance systems; (3) using visual‐only protocols to collect data on oral disease status; (4) focusing on a variety of diseases, conditions, and behaviors; and (5) analyzing the data in a timely matter. Many of these efforts have been integrated into the National Oral Health Surveillance System, which has developed eight indicators in response to national health objectives. Finally, we envision the future of visual‐tactile protocols in data collection of representative samples to monitor oral health status at the national level and as a research tool. At the state and local level, however, we envision an integrated system of data collection as a constantly evolving process as new techniques are developed in response to new demands.
The New York State Minority Health Survey: Determinants of Oral Health Care Utilization
Authors: Chattopadhyay Amit , Kumar Jayanth V. , Green Elmer L.
Published: May 2007

Objectives: To determine the factors associated with visits to a dentist and more specifically the role of dental insurance coverage and to explore the reasons for not visiting a dentist among minorities in New York State. Methods: The Minority Health Survey was a one‐time, statewide, random digit‐dialed telephone survey. We drew a directed acyclic graph (DAG) of the potential determinants of oral health care utilization for our population of interest and modeled the independent variables as determinants of oral health care utilization. The data for this study were analyzed in SUDAAN using appropriate weights and variance adjustments that accounted for the complex sampling design. Hence, this report is generalizable to the New York State adult “minority” population. Results: About 63 percent respondents had visited a dentist in the past one year. Having dental insurance (adjusted odds ratio [adj OR]=2.5), having more than high school education (adj OR=1.9), being younger (adj OR=2.3 for 18‐25 years vs age 40 years or older), being married (adj OR‐1.7), being dentate (adj OR=0.3 for edentulousness), and having higher income (adj OR=0.5 for middle vs high income) were significantly associated with having visited a dentist in the past year. Cost and awareness‐related factors were the most common reasons for not visiting a dentist. Most of the year 2000 oral health objectives measurable in this survey were not met. Conclusion: Increasing dental insurance coverage and increasing awareness about oral health care would be the two biggest factors in meeting the goals of year 2010.
Early Childhood Caries: Prevalence and Risk Factors in Seoul, Korea
Authors: Jin Bo‐Hyoung , Ma Deuk‐Sang , Moon Hyock‐Soo , Paik DaMI , Hahn Se‐Hyun , Horowitz Alice M.
Published: May 2007

Objective: The purpose of this study was to determine the prevalence of early childhood caries (ECC), including noncavitated lesions (d1), in children 6‐59 months of age in relation to socioeconomic factors, feeding practices, and oral health behaviors in Seoul, Korea. Methods: The children attended child care facilities and were selected from 32 primary sampling units. Two dentists examined 470 children. Parents of 383 of the subjects were interviewed by phone regarding caries risk factors. Results: For children 6‐59 months of age, the prevalence of ECC and severe ECC were 56.5 percent and 47.0 percent respectively. In bivariate analysis, the children whose nursing bottle contained sweetened solution had higher severe ECC prevalence (P=.035), and children whose parents reported a lower frequency of between‐meal snacks showed lower ECC prevalence (P=.046). By logistic regression analysis, age and frequency of between‐meal snacks were associated with the prevalence of ECC (P<.05). Conclusion: This study demonstrates that the prevalence of ECC was high among children in Seoul. Early educational intervention programs for pregnant women and mothers of young children should be developed based on the risk factors identified in this study.
Statistical Model for Assessing the Impact of Targeted, School‐based Dental Sealant Programs on Sealant Prevalence Among Third Graders in Ohio
Authors: Kim Sunny , Lehman Amy M. , Siegal Mark D. , Lemeshow Stanley
Published: May 2007

Objectives:Since Ohio school‐based dental sealant programs target economically disadvantaged groups, simple comparison of sealant prevalence between schools with sealant programs and those without is problematic due to underlying disparities between the two in sealant prevalence. The goal of our analysis was to estimate the impact of sealant programs on sealant prevalence among third graders in Ohio by applying a statistical model to data from a 1998‐99 Ohio oral health screening survey of schoolchildren to control for differences in background characteristics. Methods: Included in the analysis were 9,747 third graders at randomly selected schools in Ohio. Chi‐square statistics and survey logistic regression were used to analyze the association of sealant presence with school sealant program participation, dental care payment method, sex, race, and school lunch program eligibility. Results: The unadjusted odds ratio for dental sealant presence was 3.4 (95% confidence interval [CI]=2.6, 4.4; P<.01). Adjusting for race and income, the odds of having dental sealants among children in schools with dental sealant programs increased to 4.8 (95% CI=3.5,8.5;P<.01).Conclusions: Not controlling for confounders can result in underestimation of the impact of targeted school sealant programs.
Patterns of Fluoride Intake from 36 to 72 Months of Age
Authors: Levy Steven M. , Warren John J. , Broffitt Barbara
Published: May 2007

Objectives: This paper reports on estimated daily fluoride intake from water by itself, beverages, selected foods, dentifrice, and dietary supplements, both individually and combined (mg and mg F/kg bw), among 785 children in the Iowa Fluoride Study from 36 to 72 months of age. Methods: Children were recruited in 1992‐95, with questionnaires sent at four‐ to six‐month intervals. Dietary fluoride intake estimates used community and individual water fluoride levels and average fluoride levels of beverages and foods prepared with water. Descriptive statistics and generalized linear models (GLM) assessed levels and associations with demographic factors. Results: There was substantial variation in fluoride intake, with some individuals' intakes greatly exceeding the means. Daily water fluoride intake estimates (in mg) increased with age, fluoride intake from other beverages and dentifrice both decreased slightly, and combined intake was quite consistent. For combined intake per unit body weight (mg F/kg bw), there was a steady decline with age. Therefore, the percentages with estimated intake exceeding possible thresholds for dental fluorosis also declined with age. Conclusions: Daily mean fluoride intakes from single and combined sources are relatively stable from 36‐72 months of age among these children. [J Public Health Dent2003;63(4):211‐20]
Oral Health of Bangladeshi Women Tobacco‐with‐paan Users and Self‐reported Oral Pain Following Tobacco Cessation
Authors: Croucher Ray , Pau Allan K. H. , Jerreat Matt , Begum Shamsia , Marcenes Wagner
Published: May 2007

Objectives: The study objectives were to assess the oral health status of a sample of UK resident Bangladeshi women tobacco‐in‐paan users and its relationship to participant age and number of daily paan, to determine the prevalence of oral pain at baseline and at the one‐week postcessation follow‐up, and to explore the relationship between oral health status and changes in self‐reported oral pain at baseline and at the one‐week postcessation follow‐up. Methods: Interviews were conducted in Sylheti using fully structured questionnaires and an oral examination was carried out. A quit date was set and nicotine replacement therapy patches (Nicorette(r) 15 mg, Pfizer) were supplied. Age, number of daily paan, and oral pain characteristics, including intensity, frequency, any provoking factors, and associated symptoms were recorded. Oral mucosal lesions (OMLs) and numbers of teeth decayed, missing, filled, and those with recession, abrasion, loss of attachment (LOA), and tooth wear were charted. Results: Fifty‐two women took part. The mean age was 42.8 years and number of daily paan with tobacco was 13. Compared to those aged 18‐39 years, those aged 40 years and older had poorer oral health. Older adults were significantly more likely to have higher numbers of teeth with recession, abrasion, and LOA greater than 3.5 mm. They were significantly more likely to have an OML at baseline. The prevalence of self‐reported oral pain was 26.9 percent at baseline and 51.9 percent at one‐week follow‐up. Presence of an OML at baseline was a significant predictor of reports of oral pain at the one‐week follow‐up. Results of stepwise multiple regression analysis confirmed this finding (OR=3.66; 95% CI‐1.06, 12.621; P=.04). Conclusions: Reports of oral pain at follow‐up during a tobacco cessation program correlate with the presence of OMLs at baseline. Further investigation of this relationship is needed. Access to appropriate dental care, as an aid to successful tobacco cessation, is indicated.
Implementing a Community‐based Oral Health Care Program: Lessons Learned
Authors: Diamond Richard , Litwak Eugene , Marshall Stephen , Diamond Alexis
Published: May 2007

Objectives: The objective of this paper is to report key findings of a process evaluation that may be useful to other institutions seeking to implement a community‐based oral health care program primarily targeting children in dentally underserved communities. By partnering with community‐based organizations, public schools, and community health care providers, the Columbia University School of Oral and Dental Surgery (SDOS) established the Community DentCare Network (DentCare) in the Harlem and Washington Heights/lnwood neighborhoods of northern Manhattan. These low‐income neighborhoods are characterized by poor oral health and have been designated by the federal government as health professions shortage areas. Methods: The method used in the process evaluation was open‐ended qualitative interviewing by a sociologist with extensive experience in this methodology aided by a participant‐observer within the DentCare program. Results: The heterogeneity of the two communities required different strategies and resources to gain trust and acceptance. Fundamental changes were required of SDOS over a 10‐year period, beginning with prioritizing community service into a primary mission. Collaborating with medical clinics facilitated the implementation of the network when the partners shared the same philosophical goals. Faculty and staff with different skills were needed during the start‐up and the sustained development phases of the program.
Associations Between Occupational Health Behaviors and Occupational Dental Erosion
Authors: Kim Hyun‐duck , Douglass Chester W.
Published: May 2007

Objective: The aim of this study was to evaluate the associations between occupational health behaviors and occupational dental erosion. Methods: Using data for 943 workers among 34 factories, selected by three‐stage stratified cluster sampling from 888 factories using acids, two sets of modified case‐control studies were performed. The cases were 242 workers with any dental erosion (G1‐5) and 78 with severe dental erosion (G3‐5); the controls were 701 workers with no erosion (GO) and 864 workers with no or mild erosion grades, GO‐2, respectively. The main explanatory variables were behaviors such as wearing a respiratory mask and gargling at work. The results were adjusted for employment, age, sex, knowledge, and opinion about occupational health, attrition, and abrasion. Bivari‐ate and multivariate logistic regression analyses were conducted. Results: The odds of overall occupational dental erosion (G1‐5) was 0.63 (95% Cl=0.42, 0.94) for respiratory mask wearers compared to nonwearers; the odds of severe occupational dental erosion (G3‐5) was not significantly less in respiratory mask wearers (OR=0.94; 95% Cl=0.53, 1.67).‐ Gargling did not show a significant association with occupational dental erosion in this study. Conclusions: Among occupational health behaviors, wearing personal protective respiratory masks in work was significantly associated with less overall occupational dental erosion.
Evaluation of a Dental Health Education Program for Midwives
Authors: Öcek Zeliha Asli , Eden Ece , Soyer Meral Türk , Cliçeklioglu Meltem
Published: May 2007

Objective: The aim of the present study was to evaluate the effect of a dental health program for the midwives in primary health care services in Izmir, Turkey. Methods: One hundred sixty‐four midwives participated in the pilot project. The program was evaluated by quantitative and qualitative methods. The quantitative method assessed the improvement of the dental knowledge level, whereas the qualitative method was conducted to determine the assessments of the participants. Results: The percentages of correct responses given to knowledge items were higher after the program. The midwives defined their role as an important first step for dental services. Education atmosphere was the best characteristic of the program, whereas lack of a written document was an important limitation. Conclusion: Despite some limitations, the program was an effective way of improving the oral health knowledge of the midwives and their motivation for dental services.
Report of Recommendations from the National Dental Public Health Workshop, February 10‐12,2002, Bethesda, MD
Authors: Weyant Robert J.
Published: May 2007

A two‐and‐a‐half day workshop was held beginning February 10, 2002, to review the current state of dental public health training in the United States with the aim of creating recommendations that would address identified problems and lead to improvements in the quality of dental public health training. This workshop, held in Bethesda, Maryland, was sponsored by the Health Resources and Services Administration (HRSA) through a contract with the American Association of Public Health Dentistry (AAPHD). Workshop invitees included the program directors of all accredited dental public health residency programs in the United States and Canada, selected dental public health residents, and additional consultants invited based on their expertise in dental public health education. The recommendations have been placed into three categories: training, financing, and workforce development. Along with background and process summaries, these recommendations are reported here.
Disparity in Orthodontic Utilization and Treatment Need Among High School Students
Authors: Nelson Suchitra , Armogan Vidya , Abei Yumi , Broadbent B. Holly , Hans Mark
Published: May 2007

Objectives: The aim of this cross‐sectional study was to assess the disparity in utilization of orthodontic services among high school students and to measure and characterize the extent of unmet treatment needs among untreated students at the time of examination. Methods: The sample consisted of 2,808 tenth grade students enrolled in different public and private high schools. All subjects completed a dental survey that included questions on demographic, dental health, and orthodontic services, and assessment of smile using the visual analog scale. A subsample of dental study casts that were available for 561 untreated subjects were scored using the Dental Aesthetic Index (DAI) to estimate unmet treatment need. Results: The orthodontic utilization rate was 37 percent. The odds of being orthodontically treated were 8.7 times greater among those with dental visits within the past year than among those without, and three times greater among Caucasians than among other ethnic groups. The DAI indicated that the unmet treatment need was 29 percent, with ethnic minority groups having 2.6 greater odds of needing treatment than Caucasians. Conclusion: Minority groups and infrequent dental attenders may experience disparities in unmet orthodontic treatment need.
An Examination of the Dental Utilization Practices of Adult Survivors of Childhood Cancer: a Report from the Childhood Cancer Survivor Study
Authors: Yeazel Mark W. , Gurney James G. , Oeffinger Kevin C. , Mitby Pauline A. , Mertens Ann C. , Hudson Melissa M. , Robison Leslie L.
Published: May 2007

Objectives: This study characterized the self‐reported dental utilization practice of long‐term survivors of childhood cancer, a group at increased risk for treatment‐induced dental abnormalities. Methods: 9,434 survivors and a comparison group of 3,858 siblings completed a 289‐item survey that included a question on when their last dental visit occurred. Results: Within the last year 60.4 percent of survivors reported a dental visit. The groups less likely to report a recent dental visit include minority subjects, subjects with low levels of educational attainment, subjects with annual household incomes <$20,000, and those without health insurance. No significant differences between survivors and siblings were seen. Male survivors exposed to cranial radiation were slightly more likely than other male survivors to report a recent dental visit (OR/1.27, 95% CI/1.12, 1.44). Conclusions: The dental utilization practices among survivors of childhood cancer are below recommended levels, even among those at highest risk for dental abnormalities.
The Effects of the Women, Infants, and Children's Supplemental Food Program on Dentally Related Medicaid Expenditures
Authors: Lee Jessica Y. , Rozier R. Gary , Norton Edward C. , Kotch Jonathan B. , Vann William F.
Published: May 2007

Objective: This study estimates the effects of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on dentally related Medicaid expenditures for young children. Methods: We used a five‐year cohort study design to compare dentally related Medicaid expenditures for children enrolled in WIC versus those not enrolled for each year of life up to age 5 years. There were 49,795 children born in North Carolina in 1992 who met the inclusion criteria for the study. Their birth records were linked to Medicaid enrollment and claims files, WIC master files, and the Area Resource File. Our analysis strategy included a logit and OLS two‐part model with CPI dollar adjustments. Results: Children who participated in WIC at ages 1 and 2 years had significantly less dentally related expenditures than those who did not participate. WIC participation at age 3 years did not have a significant effect. Fewer WIC children received dental care under general anesthesia than non‐WIC children. Conclusions: The WIC program has the potential for decreasing dentally related costs to the Medicaid program, while increasing use of dental services.
Financing of Dental Services in Turkey: Opinions and Expectations of Dentists, Residents, and Patients
Authors: Hayran Osman , Mumcu Gonca , Sur Haydar , Yildirim Celal , Söylemez Didem , Atli Hakki
Published: May 2007

Objectives: This study investigates the attitudes of dentists, residents, and patients on the financing of dental services in Turkey. Methods: In this descriptive study, randomly selected groups of 860 dentists, 641 patients, and 866 residents from 9 provinces of Turkey were interviewed. Their agreement on various statements on financing issues of dental services were recorded and analyzed. Results: Eighty‐two percent of the dentists, 83.8 percent of the patients, and 76.4 percent of the residents agreed that “governments should finance all dental services.” The majority of the dentists (83.6%), patients (74.7%), and residents (84.4%) stated that patients should pay a copayment for their dental treatment. Conclusion: Survey results indicate that the current financing system of dental services in Turkey is not satisfactory either for the providers or for the users.
Caries Prevalence in a Rural Chilean Community after Cessation of a Powdered Milk Fluoridation Program
Authors: Mariño Rodrigo J. , Villa Alberto E. , Weitz Andrea , Guerrero Sonia
Published: May 2007

Objective: The milk fluoridation scheme established in Codegua, Chile, between 1994 and 1999 demonstrated the effectiveness of powdered milk as a community‐based vehicle for fluoride to prevent dental caries. The present study aimed to compare caries prevalence in both the Codeguan control and test communities, three years after ending fluoride distribution through the powdered milk fluoridation scheme, to assess whether the benefits of such milk fluoridation were still present in the test community. Methods: Children 3–6 years old living in Codegua (test community) and La Punta (control community) were examined for dental caries at their educational facilities by three trained and calibrated examiners using natural light, dental mirrors, and sickle probes. Differences in caries prevalence (dmfs) by year of the study were tested for statistically significant differences using the Mann‐Whitney U test. Results: Findings from Codegua (1999–2002) indicate that the dental caries experience increased in all age groups following the termination of powdered milk fluoridation. These differences reached levels of statistical significance in the 3‐, 4‐, and 5‐ year old group (P<.03). Comparing results from Codegua and La Punta (2002), no statistically significant differences were found. Conclusions: Termination of the powdered milk fluoridation scheme resulted in a deterioration of the dental health of children. After three years, dental caries prevalence was higher than that reached at the end of the scheme and equivalent to that of the control community without fluoride exposure. These results emphasize the need to establish and maintain an alternative mechanism of community‐based fluoridation of proven effectiveness for the prevention of dental caries in communities where water fluoridation is not available.
A Comparison of the Costs and Patient Acceptability of Professionally Applied Topical Fluoride Foam and Varnish
Authors: Hawkins Robert , Noble James , Locker David , Wiebe David , Murray Heather , Wiebe Peter , Frosina Carolyn , Clarke Martha
Published: May 2007

Objectives: In Canada and the United States, professionally applied topical fluorides (PATF) are usually applied as a gel or foam. However, fluoride varnish has also been found to be effective for caries prevention and may be a preferred method because less time is required and fluoride exposure can be better controlled. The goal of this study was to compare the costs and patient acceptability of two methods of PATF (foam and varnish). Methods: The study population was a convenience sample of high‐risk children from the York Region and the city of Hamilton, Ontario, Canada, who had been identified as requiring fluoride therapy (n=256). Children received from dental hygienists either fluoride foam applied in trays or fluoride varnish painted on tooth surfaces. An observer recorded the time to perform each procedure, adverse outcomes, and the satisfaction of children with treatment. Results: The varnish technique took significantly less time compared to foam (5.81 vs 7.86 minutes; P<.0001). Significant differences between procedure times were found in all age groups, but the largest difference was for children aged 3–6 years (5.22 vs 8.61 minutes; P<.0001). Signs of gagging were observed in a lower proportion of participants who received varnish (3.8% vs 15.1 % P<.01), and this difference was largest for children aged 3–6 years (2.6% vs 29.7% P<.01). The cost per varnish application, for children aged 3–6 years, was substantially less after labor costs were considered ($3.43 vs $4.43, CDN). Conclusions: Varnish applications were found to take less time and resulted in fewer signs of discomfort. These results support the use of fluoride varnish in caries prevention programs, especially for younger children.
Oral Health in the Pediatric Practice Setting: a Survey of Washington State Pediatricians
Authors: Lewis Charlotte W. , Cantrell Diana C. , Domoto Peter K.
Published: May 2007

Background: Pediatric health care providers may be the only source of preventive oral health education for families of young children who lack access to professional dental care. Objective: We surveyed Washington State pediatricians in order to characterize their oral health‐related educational needs and anticipatory guidance practices. Methods: A 38‐question survey was mailed to all 606 general pediatricians in Washington State. Topics included anticipatory practices and confidence in oral health‐related activities. Results: Of 483 eligible participants, 271 returned completed surveys (response rate: 57%). A median of 30 percent of the well‐child visit was devoted to providing anticipatory guidance. A majority (83.7%) of respondents reported providing anticipatory guidance on oral health. Conclusion: Washington State pediatricians are already involved in providing oral health anticipatory guidance. Certain factors are identified that should be addressed to allow pediatricians to promote oral health more effectively.
Acceptability of Powered Toothbrushes for Elderly Individuals
Authors: Verma Suchita , Bhat K. Mahalinga
Published: May 2007

Objectives: This study evaluated the usefulness of powered toothbrushes in elderly individuals for removing supragingival plaque and improving gingival health and comparing this to the use of regular manual toothbrushes. Methods: Fourteen persons aged 68–85 years having moderate gingivitis were included in the study. A crossover clinical trial consisting of two phases of three months' duration each was carried out. All the participants were given an oral prophylaxis, following which they were instructed to use the manual toothbrush for three months. Again, for the same subjects, an oral prophylaxis was given and they were asked to use the powered toothbrush for the next three months. Plaque Index and Gingival Index scores were recorded one, two, and three months after the use of each toothbrush. Oral hygiene instruction was reinforced only at baseline. Results: The powered toothbrush was more effective than a regular manual toothbrush in removing plaque and controlling gingivitis. Conclusion: The powered toothbrush may prove to be a good alternative to the manual toothbrush for this segment of the population, as it does not require any special dexterity to use.