bluuebunny/crossref_metadata_2025 huggingface dataset:
REVIEWS
Authors: Brooks Stephanie , Miller John K. , Cole Patricia M. , Cummins Emery J. , Olson Michael
Published: May 2007

Green, S., & Flemons, D. (2004). Quickies: The handbook of brief sex therapy.

Lilienfield, S. O., Lynn, S. J., & Lohr, J. M. (Ed.). (2003). Science and pseudoscience in clinical psychology.

Rastogi, M., & Wieling, E. (Eds). (2005). Voices of color: First‐person accounts of ethnic minority therapists.

Sue, D. (2003). Overcoming our racism: The journey to liberation.

Cozolino, L. J. (2002). The neuroscience of psychotherapy: Building and rebuilding the human brain.
SUPERVISOR MULTICULTURAL COMPETENCE AND ITS RELATION TO SUPERVISORY PROCESS AND OUTCOME
Authors: Inman Arpana G.
Published: May 2007

This study investigated the direct and indirect effects of marriage and family therapy trainees' perceptions of their supervisors' multicultural competence in supervision on the supervisory working alliance, trainees' multicultural competence (case conceptualization abilities in etiology and treatment), and perceived supervision satisfaction. Path analyses revealed supervisor multicultural competence to be positively associated with supervisory working alliance and perceived supervision satisfaction. In addition, supervisor multicultural competence seemed to have a negative effect on trainee etiology conceptualization abilities. Finally, results suggested supervisory working alliance to be a significant mediator in the relationship between supervisor multicultural competence and supervision satisfaction. Findings are discussed within the context of theoretical, empirical, and practical implications for multicultural supervision.
GIVING ADVICE ON ADVICE‐GIVING: A CONVERSATION ANALYSIS OF KARL TOMM's PRACTICE
Authors: Couture Shari J.
Published: May 2007

In this article we challenge a common definition of therapeutic advice as a linear, one‐way accomplishment, enacted by therapists toward clients. We also offer a novel conception of advice as a dialogical “performance, ” to which both therapists and clients contribute. We discuss the results of a conversation analysis of a family therapy session by Karl Tomm, showing sequential practices employed by a family therapist and a family as they jointly work out common ground to set the stage for the therapist's eventual offering of advice. We discuss the results of this study in light of the literature on advice provision in various contexts.
THE THERAPY ALLIANCE: A MODERATOR IN THERAPY OUTCOME FOR FAMILIES DEALING WITH CHILD ABUSE AND NEGLECT
Authors: Johnson Lee N. , Ketring Scott A.
Published: May 2007

The role of the therapy alliance in therapy outcome for families dealing with child abuse and neglect was examined using the family as the unit of analysis. The alliance was tested as a moderator in relationship to posttreatment levels of symptom distress and physical violence. Results show that the bonds, goals, and tasks subscale scores are significantly related to posttreatment levels of symptom distress and that the goals subscale score is significantly related to posttreatment level of violence. There is an interaction between bonds and level of violence at intake, suggesting that the greater the level of violence at intake, the more important the bonds domain.
SOCIALLY SENSITIVE DENTISTS FOR A CHANGING SOCIETY; THE APPROACH OF ONE DENTAL SCHOOL
Authors: Sanders Edith R.
Published: May 2007

“Pockets of Poverty”; their characteristics and the teaching of dental students to understand them.
DRAFTING THE POLICY AND PROCEDURES FOR THE NATIONAL CHILDREN'S DENTAL HEALTH PROGRAM*
Authors: Johnson Harry S.
Published: May 2007

For those dentists in the practice of dental public health who wonder how the Children's Bureau now operates, Dr. Johnson provides the answer.
THE PROJECTED FINANCIAL SAVINGS IN DENTAL RESTORATIVE TREATMENT; THE RESULT OF CONSUMING FLUORIDATED WATER
Authors: Cuzacq Genevieve , Glass Robert L.
Published: May 2007

The writers of this report provide readers with an interesting estimate of the savings that might accrue in a national dental health program when universal fluoridation of drinking water maintains.
DENTAL UTILIZATION OF A NEIGHBORHOOD HEALTH CENTER*
Authors: Sarda Olda , Stallard Richard E. , Goldberg Hyman J. V.
Published: May 2007

These three investigators have demonstrated the problem ahead of a neighborhood health center in its attempt to gain better utilization of continued dental supervision for the patients concerned.
AN APPRAISAL OF THE REPORT OF THE TASK FORCE ON NATIONAL HEALTH PROGRAMS*
Authors: Pollack Burton R.
Published: May 2007

After a last‐minute change in assignment, Dr. Pollack and his Committee, because of the urgency initiated by the publication of the report by the American Dental Association's Task Force, prepared a recommendation for vigorous action by the American Association of Public Health Dentists.
DENTAL PUBLIC HEALTH ADMINISTRATION AND PROGRAMMING*
Authors: Henry Hoffmann J.
Published: May 2007

After a period of teaching dental sociology at the University of Detroit's School of Dentistry, Dr. Hoffmann migarated to Santa Fe as the dental director of New Mexico. With an abundant supply of sociological notions and experience to guide him, he now reports his notions of dental programming and dental administration in action.
BOOK REVIEWS
Authors: Miller S. L. , Heietz S.B.
Published: May 2007

Book reviewed in this article:

Schroeder, O.C., ed. Dental jurisprudence

American Dental Association, Council on Dental Therapeutics, Accepted dental therapeutics.
A Symposium on the Future of Dentistry Report: Implications for the Public Sector: Impact on Dental Hygiene
Authors: Fales Martha H.
Published: May 2007

This paper reviews the six recommendations as approved by the House of Delegates of the American Dental Association in 1983. Each recommendation is reviewed in relation to public health and preventive dentistry as well as the established goal of dental hygiene: “To improve the public's total health by increasing the awareness of and access to quality oral health care and to position the dental hygienist as the preventive oral health professional.”

To reach this goal it is recommended that dental hygienists seek out opportunities in the public sector where there is more job satisfaction, their professional roles have higher acceptance with both coworkers and patients, and there is a high level of interaction with other health‐care professionals.
Public Health Officials' Perceptions of Dental Caries Preventive Methods*
Authors: Hastreiter Richard J. , Lambo Alice M. , Anderson Henry A.
Published: May 2007

The Wisconsin Division of Health has traditionally promoted the implementation of cost‐effective dental public health caries prevention programs through the cooperation of communities, schools, and local health agencies. Because of the opportunities created by the division's goal to enhance the capabilities of local public health agencies and the difficult program‐priority decisions produced by diminishing federal funding, an evaluation of the state's dental public health promotional efforts appeared appropriate. In 1982, as part of this evaluation process, an opinion survey of dental caries prevention methods was distributed to local public health officials. The survey instrument consisted of seven questions that ranked caries‐prevention measures. The questionnaire return rate was 85 percent, or 104 responses. Data were arrayed by frequency of rank, composite‐rank score, and overall rank. The Kolmogorov‐Smirnov test was used to determine the significance of composite‐score data.

The results of the survey indicated that 1) local public health officials perceive consumer‐passive and school‐based caries‐preventive methods as the most effective and cost‐beneficial means of preventing tooth decay in school‐age children, 2) this knowledge could permit them to act as informed dental public health advocates, and 3) this knowledge may account for the implementation and maintenance of cost‐effective public health caries‐prevention programs throughout Wisconsin.
A Symposium on Building a Coalition To Improve the Public's Oral Health: Reaction Paper
Authors: Striffler David F.
Published: May 2007

The dental research community has a social and civic responsibility to participate actively in promoting the public's oral health, but participation should be carefully orchestrated with other groups. The ADHA “Hearing on Needs” has stimulated a coalescing of groups and individuals to contribute to the welfare of society's oral health. Dental organizations—especially dental public health organizations—need to work more cooper‐ atively together to work, in turn, with other organizations. “In union, there is strength.”
The Results after 20 Months of a Study Testing the Efficacy Of a Weekly Fluoride Mouthrinsing Program
Authors: Clark D. Christopher , Robert Guy , Tessier Charles , Frechette Nicole , Le Blanc Guylaine , Boucher Louise , Maheux Sylvie , Le Blanc Denis
Published: May 2007

The purpose of this study was to determine the efficacy of weekly mouthrinsing with a 0.2 percent NaF solution in first‐grade children living in a non‐ fluoridated community. Children in the control group were also participants in a randomized clinical trial to evaluate the efficacy of semiannual fluoride varnish treatments. Children allocated to the mouthrinse group attended school at three of the 17 area schools where the varnish study was occurring. Random allocation of children into the treatment group was considered impractical because of potential problems of teacher cooperation and compliance. The same two standardized examiners examined all participants, and were blind to group assignment for all children.

After two academic years, or approximately 72 weeks of rinsing, 178 and 247 children remained in the treatment and control groups, respectively. The control group experienced a mean caries rate of 2.02 surfaces over 20 months, while the treatment group demonstrated an increment of only 1.33 surfaces, representing a savings of about 0.34 surfaces per year or a reduction in DMFS of 34.2 percent. Surface‐specific incremental reductions after 20 months were 0.35, 0.19, and 0.14 for the occlusal, buccal, and lingual surfaces, respectively. The proximal increment was too small to draw any meaningful conclusions. In the primary dentition, the treatment and control dfs increments were 0.74 and 1.74, respectively. This reduction represents a savings of one‐half surface increment per year, or a education of 57.5 percent.
Dental Hygienists' Knowledge, Opinions, and Use of Pit and Fissure Sealants: a Comparison of Two States
Authors: Duffy M. Bridget , Bernet Julia K. , Chovanec Gale K. , Majerus Georgia J. , Frazier P. Jean , Newell Kathleen J.
Published: May 2007

This article reports results of a study of 563 practicing Minnesota and Wisconsin dental hygienists' knowledge, opinions, and use of pit and fissure sealants. The study was carried out six months prior to the 1983 NIH Consensus Development Conference on Dental Sealants in the Prevention of Tooth Decay. It therefore provides baseline information for two states prior to the initiation of widespread public information about the positive value of sealants that occurred as a result of that conference. Such baseline information is relevant for future studies of the diffusion of adoption of this caries‐preventive technology by dental hygienists. Two independent samples were selected randomly from the populations of licensed dental hygienists residing in the two states. Data were collected using a 42‐item mailed questionnaire, with an 84 percent response. Data were analyzed for both interstate and intrastate comparisons. Respondents were generally knowledgeable and had favorable opinions about sealants, although they had low levels of training in their use. Sealants were being used in 54 percent of the offices in which respondents practiced, with the dentist placing them most often. Among hygienists who applied sealants at all, more than two‐thirds did so three or fewer times per week. Eighty‐four percent indicated they would like to apply sealants more often. The most frequent reasons given for nonuse were lack of acceptance by the dentist‐employer and nondelegation.
Hepatitis B Vaccine Usage Among Dental Practitioners in the United States: an Epidemiological Survey
Authors: Echavez Michael I. , Shaw Frederic E. , Scarlett Margaret I. , Kane Mark A.
Published: May 2007

A telephone survey of 283 nonfederally affiliated dental practitioners in the United States was completed in April 1986. The study's objectives were to determine hepatitis B vaccine usage among dentists nationwide, and to examine the epidemiologic characteristics of vaccinated and unvaccinated subjects. Forty‐four percent of the participants had received at least the first of the three doses of HB vaccine. Acceptance of the vaccine was associated with the use of gloves during dental procedures and the subject's perception of high‐risk patients in his or her dental practice. The most common reasons for not being vaccinated were concerns about vaccine safety and a lack of perceived need for the vaccine. The vaccination rate in this survey is higher than in earlier studies, indicating that acceptance of the vaccine by dental practitioners is increasing.
Incidence of Coronal and Root Caries in an Older Adult Population
Authors: Hand Jed S. , Hunt Ronald J. , Beck James D.
Published: May 2007

Incidence rates for new root caries and new coronal caries in noninstitutionalized older adults are unknown. In this study, a representative sample of 451 elderly lowans received dental examinations at the start of the study and again after 18 months. This dentate cohort had a mean of 0.87 new surfaces of coronal decay per person per year and a mean of 0.57 new surfaces of root decay per person per year. Coronal caries occurred at an annual rate of 1.4 surfaces per 100 susceptible coronal surfaces. Root caries occurred at an annual rate of 2.6 surfaces per 100 susceptible root surfaces. This study shows that both coronal and root caries were active in this older population, indicating a need for emphasis on the prevention and treatment of dental caries in older adults.
Response Trends and Nonresponse Bias in a Mail Survey of Oral and Facial Pain
Authors: Locker David , Grushka Miriam
Published: May 2007

While mail surveys offer a low‐cost method for collecting health data, they have been unpopular because of concerns about low response rates and nonresponse bias. This paper examines the response to a mail survey concerning oral and facial pain and uses regression techniques to assess the degree and direction of nonresponse bias on estimated prevalence rates. The analysis shows that early and late responders to the survey differed in terms of sociodemographic variables and responses to items concerning pain. The regression analysis suggests that the rather high prevalence rates revealed by the survey are not a product of bias induced by nonresponse and deserve further investigation.
Dentistry's Public‐Private Interface: A Federal Perspective
Authors: Mecklenburg Robert E.
Published: May 2007

Each dental public health worker is confronted with a wide variety of organizations with which a professional relation can be developed. Decisions about which relations should receive priority, and the kind of relations that may be expected, are easier to define if each possible organizational interface is placed in one of three categories: (1) professional associations; (2) the employing bureaucracy and its sister agencies; and (3) the organizations performing the same dental public health functions as the worker, but within different geographic parameters. A three‐dimensional model is developed, using as an example the organizational interfaces of the chief dental officer, US Public Health Service; with national level associations, the federal government; and with dental public health workers at the international and state levels of government. Current issues of importance to the American Association of Public Health Dentistry are identified according to the principal relations needed with other national associations, the federal government, and international and state governments.
Eruption Pattern of Permanent Molars: Implications for School‐based Dental Sealant Programs
Authors: Kuthy Raymond A. , Ashton James J.
Published: May 2007

Dental caries remains a prevalent, chronic disease of childhood. The preponderance of dental caries is located on the pit and fissure surfaces of teeth, an area where dental sealants are most effective in preventing this malady. In the school year 1987‐88, 4,879 Ohio schoolchildren participated in an assessment of dental health. Grades chosen for this assessment included 1, 2, 3, 6, 7, 8, and 11. This study focuses on eruption of first and second permanent molars in development of a timing strategy for placement of occlusal sealants in a school‐based program. An eruption score was developed for the determination of the first or second molar eruption status for each child. The data were analyzed for grade, sex, race, locale, fluoridation status, and percent of children on free or reduced‐cost lunch programs. Analyses were performed on 2,215 children in grades 1‐3 and 1,840 children in grades 6–8. Fifty‐seven percent of first graders had all first permanent molars sufficiently erupted for sealant placement on the occlusal surface. Likewise, 23.6 percent of sixth graders had sufficient occlusal exposure on the second molar. Females showed an earlier eruption pattern than males for both first (P<.05) and second (P<.001) molars. Black children preceded white children only in the eruption of the second molar (P<.001). This study provides dental public health decision makers with state‐specific information on the earliest time to initiate a school‐based occlusal sealant program. Information on caries experience is warranted to determine whether or not there can be a delay in performing this service so that more individual teeth can have dental sealants placed.
Causes of Tooth Loss in a Veteran Population
Authors: Niessen Linda C. , Weyant Robert J.
Published: May 2007

Tooth loss in adults over age 35 usually is attributed t to periodontal diseases. However, certain adult populations are known to have high caries rates. It is not clear to what extent caries contributes to tooth loss in adults. This pilot study examined the causes of tooth loss in a veteran population residing in an 800‐bed, primarily long‐term care facility. The study retrospectively reviewed 572 patients' dental records and documented causes for dental extractions. Of the sample population, 168 teeth were extracted in 51 patients who c had 860 teeth present before treatment. Mean age of the patients undergoing extractions was 57.7 years, lower than the sample population of 60.1 years. Of the 168 teeth extracted, 105 (63%) were attributed to caries and 33 (20%) were documented as root tips, suggesting the presence of root caries. Fifty‐five (33%) were extracted due to periodontal disease and six (4%) were extracted for prosthodontic reasons. Of the maxillary teeth, 67 percent were extracted for caries and 25 percent of periodontal reasons. Caries accounted for 57 percent and periodontal disease accounted for 42 percent of the mandibular teeth extracted. The order in which teeth were most frequently extracted was maxillary anteriors, mandibular anteriors, maxillary and a mandibular premolars, and maxillary and mandibular molars. This study supports the recent work of authors who have found caries contributing significantly to tooth loss in adult populations.
How Effective is Oral Hygiene Instruction? Results after 6 and 24 Weeks
Authors: Weinstein Philip , Milgrom Peter , Melnick Sandra , Beach Barbara , Spadafora Agnes
Published: May 2007

We studied the clinical effectiveness of oral hygiene instruction given to 71 “high” plaque patients in 19 Washington State dental practices to determine the extent of plaque reduction. Patients were examined prior to instruction and prophylaxis. Therapist instructions were tape‐recorded and content analyzed, and therapists' expectations were scored. Patients were surveyed as to oral health behaviors and general health habit characteristics. Only 20 of 71 (28%) initially “high” plaque patients had reduced mean plaque scores to 1.0 or less at six weeks. An additional 13 percent had deteriorated plaque levels at 24 weeks. We concluded that therapists did not consistently follow principles of effective instruction and often overestimated their effectiveness. Determinants of relapse involve the educational process, the patients' oral status, and patients' life situations.
Oral Health Knowledge and Sources of Information Among Elementary Schoolchildren
Authors: Woolfolk Marilyn W. , Lang W. Paul , Faja Barbara Wirth
Published: May 2007

The dental health knowledge and sources of health information of 848 elementary schoolchildren (aged 9–12) in southwestern Michigan were assessed. Demographic parameters (education level, percent below poverty level, median income level) of the area were similar to state and national averages. The children were found to have some knowledge of caries and periodontal disease prevention, yet basic misconceptions were evident. More than one‐third of the children thought that plaque should only be removed by a dentist. While 75 percent of the subjects knew that fluoride protected teeth from decay, only 4 percent of the children identified fluoridated water as the best source of this preventive agent. Knowledge of pit and fissure sealants was limited. Extent of correct dental knowledge was not related to age, sex, or mean DMFS scores. Children who answered the most questions correctly named parents and family as their source of information; dentist's office was the second most frequently mentioned source. Findings suggest a need to correct basic misinformation about dental health and to inform children about current efficacious preventive agents.
Assessment of a Dental Disease Prevention Program after Three Years
Authors: Malvitz Dolores M. , Broderick Eric B.
Published: May 2007

This assessment compared routine data on selected clinical services provided within the Oklahoma City Area of the Indian Health Service during the first six months of fiscal year 1984, prior to implementation of a program emphasizing oral health promotion and disease prevention, to comparable data from 1987. The assessment revealed: similar absolute numbers of routine examinations and completed treatment among children; a 10 percent increase in total visits for persons of all ages, accomplished with comparable numbers of dental personnel; and an increase in the percent of services that were preventive, as well as a concomitant decrease in basic restorative services. The ratio of pit and fissure sealants to one‐surface amalgam restorations was reversed dramatically. Although counts of services rendered do not measure oral health status directly, some conclusions are warranted. Clinical dental personnel can be reoriented to devote an increased proportion of available patient care time to primary preventive services, accomplishing a substantial increase in these services. That increase is associated with a corresponding decrease in the proportion of basic restorative services.
Examiner Agreement Between Hygienists and Dentists for Caries Prevalence Examinations
Authors: Mauriello Sally M. , Bader James D. , Disney Judith A. , Graves Richard C.
Published: May 2007

Dentists have been used as examiners in caries prevalence examinations almost exclusively. Only rarely have dental hygienists been reported as examiners in these types of studies. This article describes the degree of agreement for prevalence data (DMFT, dmft) and specific caries prediction information collected by hygienist‐screeners and dentist‐examiners. A total of 5,233 first‐ and fifth‐grade children were screened by hygienist‐screeners using a tongue blade only and then examined by dentist‐examiners using an explorer and mirror. Agreement was analyzed in terms of percent agreement and the kappa statistic. The values for screener‐hygienist dentist‐examiner agreement were compared to interexaminer and interscreener reliability values. Means were also calculated for the caries indices. The results indicated good agreement for the caries indices between the screener‐hygienist and dentist‐examiner. Agreement for the prediction indices tended to be lower. The results suggest that hygienists can be used as examiners in caries prevalence studies.
An Epilogue to Evaluating the Impact of P.L. 99‐252 on Decreasing Smokeless Tobacco Use
Authors: Chen Moon S. , Schroeder Kathleen L.
Published: May 2007

In a previous paper, “Evaluating the Impact of P.L. 99‐252 on Decreasing Smokeless Tobacco Use,” the context of this law and the theoretical framework for an evaluation plan for measuring its impact were described. In this paper, the methodology and selected findings from this project as well as their implications are discussed. This discussion includes the identification of the six indicators considered to be the most relevant, valid, reliable, accessible, and practical for measuring the impact of this law on decreasing smokeless tobacco use, as well as a report on the feasibility analysis of three of these indicators. Pilot data on two indicators–pounds of smokeless tobacco sold and incidence rates of tobacco‐induced leukoplakia–are presented and analyzed.
Dental Fluorosis Following Downward Adjustment of Fluoride in Drinking Water
Authors: Evans R. Wendell , Stamm John W.
Published: May 2007

The drinking water fluoride concentration in Hong Kong was reduced by about 0.2 ppm in June 1978. This study was undertaken to determine whether the prevailing level of dental fluorosis was affected by such a minor change. Cohorts of children (N= 1,062) aged seven to 12 years, who were born both before and after the fluoride reduction, were examined clinically using Deans fluorosis index. Based on upper right central incisors, dental fluorosis prevalence decreased from 64 to 47 percent and the community fluorosis index decreased from 1.01 to 0.75 (P<.01). Thus, dental fluorosis was reduced, although the reduction in water fluoride concentration was not sufficient to achieve the minimal fluorosis level that Dean associated with a fluoride concentration optimal for caries prevention. Variation in dental fluorosis has been reported previously to result from marked sudden changes, during tooth formative years, to drinking water fluoride concentration. This study confirms preliminary findings that variation in dental fluorosis arising from minor changes to the fluoride level in drinking water is also measurable.
National Health Care: Whither Goeth Dentistry?*
Authors: Corbin Stephen B.
Published: May 2007

National health insurance is reemerging as an important issue on the national health policy scene. The continuing escalation of health care costs in the US and increasing numbers of individuals without access to health services are stimulating a variety of proposals to redesign the structure and financing of the American health care system. Some change in the current system toward a more national approach to health care is inevitable in the years ahead. While dental care is subject to pressures similar to other health care services, little attention is being accorded dental services in the various national health care proposals that are being advanced. This may be due largely to organized dentistry's reluctance to define a role for itself. If dentistry is to be included in such a plan, it is essential that concerted efforts start soon and that the various public and private sectors of dentistry work collaboratively to develop the dental component to such a plan. The future oral health of the public and the future health of dentistry as a profession depend on it.
An Oral Health Survey of Head Start Children in Alaska: Oral Health Status, Treatment Needs, and Cost of Treatment
Authors: Jones David B. , Schlife Candace M. , Phipps Kathy R.
Published: May 2007

The purpose of this study was to obtain information on the oral health status, treatment needs, and cost of treatment for Head Start children in Alaska. Twenty communities, representing five regions within the state, were selected for participation. The study consisted of three distinct parts: a caries status exam, a sociodemographic questionnaire, and a treatment needs examination. A total of 544 children between three and five years old were examined. The mean dmft and dmfs scores were 3.91 and 8.73, respectively. When stratified by race, the Alaska Native children had significantly higher mean dmft and dmfs scores. When stratified by community of residence, those children residing in the rural communities had higher rates of dental caries than the urban children. Forty‐five percent of the total sample was in need of dental restorative treatment, excluding examinations, radiographs, and preventive services. The proportion of rural children needing care was much higher than the urban children (59% vs 27%). On average, each urban child needed treatment on 0.7 teeth, while each rural child needed treatment on 2.8 teeth. When all treatment factors including sedation and transportation costs are considered, the potential cost of treatment for the 1,475 children enrolled in the Alaska Head Start programs was $601,624.
Water Consumption in the United States in 1994–96 and Implications for Water Fluoridation Policy
Authors: Heller Keith E. , Sohn Woosung , Burt Brian A. , Eklund Stephen A.
Published: May 2007

Objective: The purpose of this project was to describe current water consumption patterns and to compare them to findings from earlier studies. Current water consumption data also were used to reevaluate the association between water consumption and climate. These findings are of importance in estimating fluoride intake from fluoridated water. Methods: Findings from the 1994–96 Continuing Survey of Food Intakes by Individuals (CSFII) were compared to those from two earlier dietary studies, the 1977–78 Nationwide Food Consumption Survey (NFCS) and the pioneering research of Galagan and colleagues in the 1950s. Food consumption data were analyzed for 14,619 persons with food and beverage intake data for two 24‐hour periods in the CSFII. Results: Increased consumption of infant formulas and decreased consumption of tap water and cow's milk were seen in the CSFII for infants compared to the NFCS. Older children and adults showed increased consumption of carbonated beverages and juices. While Galagan and colleagues found about a 60 percent increase in water consumption between the coldest (55°F) and warmest (85°F) conditions, only a 20 percent difference was seen between the winter and summer months in certain regions in the CSFII. Conclusions: No obvious strong or consistent association between water intake and month or season was apparent in these recent data. These findings are preliminary, and suggest that water fluoridation policy requires further research regarding water consumption and climate.
Development of Effectiveness of Care and Use of Services Measures for Dental Care Plans
Authors: Bader James D. , Shugars Daniel A. , White B. Alex , Rindal D. Brad
Published: May 2007

Objective: Standardized measures to assess clinical aspects of the performance of managed dental care plans are not available. This project sought to develop and evaluate measures for effectiveness of care and use of services that could be calculated using a plan's administrative data. Methods: Two panels of stake holders representing dental plans, purchasers, and dental providers participated in a modified Delphi process to refine initial sets of effectiveness of care and use of services measures modeled after HEDIS® measures for medical care. The refined measures were then pilot tested in two dental health maintenance organizations. Results: The development process resulted in specification of seven effectiveness of care measures assessing disease activity classification, and prevention and outcomes for caries, periodontal disease, and tooth loss. Six use of services measures focusing on prophylaxes, third molar surgery, preventive, restorative, prosthetic, surgical, and endodontic care also were specified. Pilot testing of the measures indicated reasonable reliability and sensitivity, but also demonstrated the need for supervision or auditing of the process. Conclusions: These standardized measures for dental care plan performance are available for immediate use. However, because the measures depend on diagnostic information (periodontal probing data and diagnoses associated with restorative treatments) in the administrative data set, their adoption will require changes in most plans' data systems and data collection policies.
An Evaluation of NHANES III Estimates of Early Childhood Caries
Authors: Kaste Linda M. , Drury Thomas F. , Horowitz Alice M. , Beltran Eugenio
Published: May 2007

Objective: The purposes of this study were to estimate and evaluate the prevalence for the United States of early childhood caries (ECC) among children 12 to 23 months of age. Methods: The 1988–94 National Health and Nutrition Examination Survey (NHANES III) public‐use data set was analyzed using SUDAAN. Two ECC case definitions were used. Definition #1 was restricted to the caries score called by the examiner. Definition #2 liberally included children identified by definition #1 and those possibly having questionable caries scores. Results: The NHANES III six‐year prevalence estimates of caries in the maxillary anterior incisors of children 12 to 23 months of age were 1.0 percent for definition #1 and 1.7 percent for definition #2. Mexican‐American and economically disadvantaged children were disproportionally represented with ECC. Conclusions: The prevalence of ECC among children 12 to 23 months of age is barely detectable at the national level. Alternative study designs and improved case definitions are needed for further advances in ECC.
The Case for Retaining the Current Supplementation Schedule
Authors: Moss Stephen J.
Published: May 2007

Following ingestion of dietary fluoride, microquantities of fluoride return to the mouth in saliva, but in quantities large enough to facilitate the maintenance and reparative functions of enamel. Dietary fluoride supplements alone are unlikely to be the cause of the reported increase in fluorosis. Compliance continues to be extremely poor and few children use supplements for more than a year and a half. The amount of background fluoride resulting from dietary fluoride supplements appears to be very small. Considering the almost ubiquitous presence of fluoride dentifrice and the strong possibility of additional unintentional fluoride ingestion from many sources, the present fluorosis data is too amorphous to use as a basis for making reasonable risk/benefit evaluations. Very mild and mild fluorosis is not a serious problem for either the clinician or the patient. By altering the present recommended dosage we may deprive children from receiving a proven effective dose. One cannot make a risk/benefit decision concerning an esthetic problem without involving the patient's perception as well as the caries score. The apparent severity of the milder forms of fluorosis lessens with age and a community fluorosis index should be used only on populations who are older than 15 years.
Challenges of and Strategies for Changing Prescribing Practices of Health Care Providers
Authors: Horowitz Alice M.
Published: May 2007

Problems related to inappropriate prescribing practices of physicians in general are well recognized. Dietary fluoride supplements have been implicated as one of the contributing factors in an increase in dental fluorosis. Inappropriate prescribing practices of providers have been cited as a major factor in this implication. Numerous studies of physicians and dentists have documented a lack of knowledge and inappropriate prescribing practices regarding fluoride supplements. The purpose of this paper is to identify barriers to changing fluoride‐prescribing practices of health care providers and to suggest strategies for implementing change. To increase optimal and appropriate use of fluoride supplements, educational interventions are necessary for all user groups—detail men and women, physicians, dentists, pharmacists, nurse practitioners, dental hygienists, and the public. In addition, environmental supports for the educational activities in the form of policy, regulation, standards of care, and guidelines are recommended for consideration.
Dental Services, Costs, and Factors Associated with Hospitalization for Medicaid‐eligible Children, Louisiana 1996–97
Authors: Griffin Susan O. , Gooch Barbara F. , Beltrán Eugenio , Sutherland James N. , Barsley Robert
Published: May 2007

Objective: This study compared types and costs of dental services rendered to children who had received care in a hospital operating room (H) with children who had not (NH). Methods: The study population consisted of all children aged 1–5 years who received a dental service reimbursed by the Louisiana Medicaid EPSDT program from October 1996 through September 1997. Claim files were provided by the Louisiana Bureau of Health Services Financing. A treatment intensity index [TII=3*(# extractions) + 2*(# pulpotomies +# crowns) +# simple restorations] was calculated for H children (n=2,142) and NH children (n=38,423). Using logistic regression, a dichotomous hospitalization variable (H vs NH) was regressed against treatment intensity and selected personal and parish (county) characteristics for each of the five age groups. Total and average reimbursement per child were calculated for both groups of children, by age. Results: The mean treatment intensity scores for Hand NH children were 24.02 (SD=11.82) and 2.16 (SD=4.78), respectively. For all age groups, children with treatment intensity scores greater than 8 were at least 132 times more likely to be hospitalized than were children with scores less than or equal to 8. The mean cost for care provided to H children was $1,508 compared with $104 for NH. Total costs for dental care rendered to H children (5% of the study population) were $3,229,851 (45% of total dental costs for the study population). Conclusion: Reducing severe caries through early interventions could provide substantial cost savings.
Response and Nonresponse Bias in Oral Health Surveys
Authors: Locker David
Published: May 2007

Oral health surveys are undertaken to provide estimates of the dental health and behaviors of populations or population subgroups. However, the integrity of the data from sample surveys may be compromised by one or more sources of sampling and nonsampling error. An important source of nonsampling error is the failure to collect data from some of the individuals comprising the sample. Consequently, the response to a sample survey, and the direction and magnitude of bias induced by nonresponse, need to be taken into account when using estimates derived from sample surveys. Although the response rate to a survey is usually used as an indicator of the quality of the data it provides, nonresponse error is a function of nonresponse and the extent of differences in the characteristics of responders and nonresponders. Nonresponse may be managed in two ways. The first is to reduce nonresponse to a minimum using response‐enhancement strategies. The second is the post‐survey adjustment of data using weighting or imputation techniques to produce estimates that correct for nonresponse. This paper discusses issues concerning response and nonresponse bias in oral health surveys and provides guidelines on the management and reporting of nonresponse. It describes response‐enhancement strategies to reduce noncontacts and refusals, sources of data to facilitate the comparison of responders and nonresponders, methods of assessing the degree of bias induced by nonresponse, techniques for producing adjusted survey estimates, and the assumptions on which these procedures and processes are based.
Fluoride Intake and Prevalence of Dental Fluorosis: Trends in Fluoride Intake with Special Attention to Infants: REVIEW & COMMENTARY
Authors: Fomon Samuel J. , Ekstrand Jan , Ziegler Ekhard E.
Published: May 2007

Background

: Although the predominant beneficial effect of fluoride occurs locally in the mouth, the adverse effect, dental fluorosis, occurs by the systemic route. The caries attack rate in industrialized countries, including the United States and Canada, has decreased dramatically over the past 40 years. However, the prevalence of dental fluorosis in the United States has increased during the last 30 years both in communities with fluoridated water and in communities with nonfluoridated water. Dental fluorosis is closely associated with fluoride intake during the period of tooth development. Methods: We reviewed the major changes in infant feeding practices that have occurred since 1930 and the changes in fluoride intakes by infants and young children associated with changes in feeding practices. Results and Conclusions: Based on this review, we conclude that fluoride intakes of infants and children have shown a rather steady increase since 1930, are likely to continue to increase, and will be associated with further increase in the prevalence of enamel fluorosis unless intervention measures are instituted. Recommendations: We believe the most important measures that should be undertaken are (1) use, when feasible, of water low in fluoride for dilution of infant formulas; (2) adult supervision of toothbrushing by children younger than 5 years of age; and (3) changes in recommendations for administration of fluoride supplements so that such supplements are not given to infants and more stringent criteria are applied for administration to children.
Dietary Determinants of Dental Caries and Dietary Recommendations for Preschool Children
Authors: Tinanoff Norman , Palmer Carol A.
Published: May 2007

Objective: The purpose of this review, commissioned by the Administration for Children and Families, the Health Resources and Services Administration, the Health Care Financing Administration, and the Department of Agriculture's Food and Nutrition Service, was to update the evidence of the dietary factors that affect dental caries, and subsequently formulate dietary recommendations for preschool children based on principles of cariology. Methods: Literature on the dental caries process, dietary factors affecting dental caries initiation and progression, and nutrition education and counseling were reviewed and synthesized. Dietary guidelines for children at various ages were then constructed based on the review. Results: Dental caries in preschool children is due to a combination of factors, including colonization of teeth with cariogenic bacteria, type of foods and frequency of exposure of these foods to the cariogenic bacteria, and susceptible teeth. Caries risk is greatest if sugars are consumed at high frequency and are in a form that is retained in the mouth for long periods. Sucrose is the most cariogenic sugar because it can form glucan that enables firm bacterial adhesion to teeth and limits diffusion of acid and buffers in the plaque. There is emerging interest in the effects of tooth development and its role in the future dental caries risk of the child. Conclusions: Nutrition education and counseling for the purposes of reducing caries in children is aimed at teaching parents the importance of reducing high frequency exposures to obvious and hidden sugars. Guidelines include: avoiding frequent consumption of juice or other sugar‐containing drinks in the bottle or sippy cup, discouraging the behavior of a child sleeping with a bottle, promoting noncariogenic foods for snacks, fostering eating patterns consistent with the Food Guide Pyramid, limiting cariogenic foods to mealtimes, rapidly clearing cariogenic foods from the child's oral cavity either by toothbrushing or by consumption of protective foods, and restricting sugar‐containing snacks that are slowly eaten (e.g., candy, cough drops, lollipops, suckers). Along with nutritional factors, a comprehensive approach to preventing dental caries in preschool children must include improved general dietary habits, good oral hygiene, appropriate use of fluorides, and access to preventive and restorative dental care.
Sensory and Motor Deficits in the Elderly: Impact on Oral Health
Authors: Chávez Elisa M. , Ship Jonathan A.
Published: May 2007

Hearing, vision, orthopedic, and speech disorders are the most common impairments in the elderly. Older adults experience other sensory impairments such as olfactory and gustatory dysfunction, as well as oral motor problems including difficulty with mastication, speech, and swallowing. These disorders can directly affect oral health and can impair dental treatment. Therefore, it is imperative that dental health practitioners be cognizant of these conditions and aware of the impact these conditions and their treatments can have on oral health and function. Dental professionals may need to use different communication techniques for patients with vision or hearing losses. Accommodations in the dental office and by dental professionals will help older patients who have sensory and/or motor impairments to preserve their oral health and function and receive dental treatments in a safe and efficacious manner. This paper reviews the most common causes of sensory and motor impairments and their implications for oral health care with treatment modification guidelines for the older patient.
Impact of Oral Diseases on Systemic Health in the Elderly: Diabetes Mellitus and Aspiration Pneumonia
Authors: Taylor George W. , Loesche Walter J. , Terpenning Margaret S.
Published: May 2007

Evidence is increasing that oral health has important impacts on systemic health. This paper presents data from the third National Health and Nutrition Examination Survey (NHANES III) describing the prevalence of dental caries and periodontal diseases in the older adult population. It then evaluates published reports and presents data from clinical and epidemiologic studies on relationships among oral health status, chronic oral infections (of which caries and periodontitis predominate), and certain systemic diseases, specifically focusing on type 2 diabetes and aspiration pneumonia. Both of these diseases increase in occurrence and impact in older age groups. The NHANES III data demonstrate that dental caries and periodontal diseases occur with substantial frequency and represent a burden of unmet treatment need in older adults. Our review found clinical and epidemiologic evidence to support considering periodontal infection a risk factor for poor glycemic control in type 2 diabetes; however, there is limited representation of older adults in reports of this relationship. For aspiration pneumonia, several lines of evidence support oral health status as an important etiologic factor. Additional clinical studies designed specifically to evaluate the effects of treating periodontal infection on glycemic control and improving oral health status in reducing the risk of aspiration pneumonia are warranted. Although further establishing causal relationships among a set of increasingly more frequently demonstrated associations is indicated, there is evidence to support recommending oral care regimens in protocols for managing type 2 diabetes and preventing aspiration pneumonia.