bluuebunny/crossref_metadata_2025 huggingface dataset:
Atraumatic Restorative Treatment (ART): a Three‐year Community Field Trial in Thailand—Survival of One‐surface Restorations in the Permanent Dentition
Authors: Phantumvanit Prathip , Songpaisan Yupin , Pilot Taco , Frencken Jo E.
Published: April 2007

This study compares the Atraumatic Restorative Treatment (ART) technique to conventional amalgam restorations in the management of dental caries. The present report is limited to the results for one‐surface restorations in the permanent dentition over a three‐year period. A community field trial was carried out in rural villages in northeastern Thailand. Dental caries was treated using the ART technique in one village where 144 persons were treated with 241 restorations. In a second village, 205 conventional amalgam restorations were provided to 138 persons using mobile dental equipment. Both ART and amalgam restorations were performed by one dentist and two dental nurses without administering local anesthesia. Clinical evaluation was carried out one, two, and three years after placement. The longevity of the restorations was determined by computing the estimated cumulative survival rates according to the life table method. The survival rates of ART restorations (93%, 83%, 71% in years one, two, and three, respectively) were close to those for amalgam restorations (98%, 94%, 85%); however, differences were statistically significant. No statistically significant differences were observed between ART restorations in children and adults, or between those placed by the dentist and dental nurses. Survival rates were lower for occlusal surface restorations compared to those in other surfaces. ART is a feasible approach for the management of dental caries, especially for one‐surface lesions in the permanent dentition. Because of its simplicity as a minimal intervention technique, ART can make the control of dental caries available to all people irrespective of their economic and living conditions.
Dental Caries under Glass Ionomer Restorations
Authors: van Amerongen Willem E.
Published: April 2007

The Atraumatic Restorative Treatment (ART) technique has two potential limitations. Because only hand instruments are used, dental caries can be left during cavity preparation. Beyond this limitation, the glass ionomer filling material currently used has some unfavorable mechanical properties with respect to its strength, wear resistance, and shrinkage during setting. The purpose of this paper is to provide an overview of changes that can be expected in carious dentin when a glass ionomer restoration is placed. Restriction of the substrate supply and the release of different components from the glass ionomer have an inhibiting effect on cariogenic microorganisms. Whether this influence is sufficient to completely arrest the caries process is doubtful. The influence of glass ionomers on the remineralization of carious dentin needs further research.
Validity of a Self‐reported Periodontal Disease Measure
Authors: Joshipura Kaumudi J. , Douglass Chester W. , Garcia Raul I. , Valachovic Richard , Willett Walter C.
Published: April 2007

Objectives: The purpose of this study was to determine the validity of a self‐reported periodontal disease measure for use in the Health Professionals Follow‐up Study. Methods: Participating dentists responded to the question “Have you had periodontal disease with bone loss?” Radiographs obtained from 140 participants were evaluated for bone loss at 32 posterior sites and used as the standard. A site was positive if it had bone loss >2 mm and/or complete loss of crestal lamina dura. To avoid falsely classifying participants as positive, three blinded examiners independently evaluated each participant's radiographs. An a priori decision rule was used to classify a participant positive if all examiners independently assessed the same two or more sites positive. Results: The validity of the self‐reported measure was good among dentists, with positive and negative predictive values of 0.76 and 0.74, respectively. Among nondentists, the self‐reported measure showed discriminatory power by confirming associations with known risk factors such as age and smoking. Conclusion: Dentists have a good perception of their periodontal status, and there is reasonable consensus among dentists regarding the threshold for defining periodontal disease. Self‐reported measures might have potential for use in studies of other populations with substantial cost reduction, and deserve further evaluation.
Status and Strategic Plans for Fluoridation: Centers for Disease Control and Prevention Perspective
Authors: Reeves Thomas G.
Published: April 2007

This paper summarizes the current status of water fluoridation in the United States and discusses the strategic plan developed by the Division of Oral Health (DOH), Centers for Disease Control and Prevention (CDC) to meet the Healthy People 2000 fluoridation objective. This objective proposes to: “Increase to a least 75 percent the proportion of people served by community water systems providing optimal levels of fluoride (baseline: 62% in 1989).” The CDC strategic plan defines the nature of the problem with attainment of this objective, sets CDC priorities, and establishes six major components for future action: (1) assessment, evaluation and surveillance; (2) consultation; (3) state and regional efforts; (4) professional education and involvement; (5) public education; and (6) quality assurance. Actions in each of the components of the plan to help in the attainment of priorities are detailed. Finally, the broader picture of the federal role in a national fluoride plan is discussed.
The Effectiveness of Community Water Fluoridation in the United States
Authors: Horowitz Herschel S.
Published: April 2007

Grand Rapids, the first city in the world to implement controlled water fluoridation, has served as a model for thousands of other communities. Fluoridation is one of the greatest public health and disease‐preventive measures of all time. Its advantages include effectiveness for all, ease of delivery, safety, equity, and low cost. Today, nearly 56 percent of the US population lives in fluoridated communities (62% of those on central water supplies). Previously observed caries reductions of one‐half to two‐thirds are no longer attainable in the United States because other fluoride methods and products have reduced the caries prevalence in all areas, thus diluting the measurement of effectiveness, and because benefits of fluoridation are dispersed in many ways to persons in nonfluoridated areas. Water fluoridation itself, however, remains as effective as it ever was among groups at high risk to dental caries. Contrary to early beliefs that stressed the importance of preeruptive fluoride exposure, fluoridation also provides an important source of topical fluoride and facilitates remineralization. Although data on effectiveness and safety are compelling, future progress of water fluoridation will be affected by economic, political, and public perception factors.
From the Art of Filling Teeth to the Science of Dental Caries Prevention: a Personal Review
Authors: Krasse Bo
Published: April 2007

The journey from the art of filling teeth to the science of prevention is reviewed. First, a private winding road is described that produced some new methods of value in risk assessment, treatment of the causes of dental caries, and prevention of the disease. The description illustrates the importance of monitoring the effects of different measures. Next, the new knowledge and methods that form the primary basis of prevention on a large scale are reviewed. They represent a golden era in caries research and form a solid ground for the prevention of dental caries and for the treatment of the causes of disease. The prevalence and incidence of dental caries has fallen not only among schoolchildren, but also among adults in developed countries. Improvement in dental health is due to the successful application of new knowledge—it has not happened by chance. New or improved opportunities for prevention could lead to a further reduction in dental caries. The problem is to find ways to stimulate both dentists and patients to use them. Finally, the next part of the journey is discussed. In some countries the journey probably will be an uphill struggle; in others, it could be fairly undulating, eventually leading to further declines in dental caries.
The Need for Health Promotion in Oral Cancer Prevention and Early Detection
Authors: Horowitz Alice M. , Goodman Harold S. , Yellowitz Janet A. , Nourjah Parivash A.
Published: April 2007

Objectives: This review paper provides a rationale for using health promotion to help reduce morbidity and mortality due to oral cancers by identifying barriers to prevention and early detection of these cancers and discussing strategies for change. Methods: A literature review of the following areas was conducted: epidemiology of and risk factors for oral cancers; knowledge, opinions, and practices of health care providers and the public regarding prevention, early detection, and control of oral cancers; and policies and regulations that either enhance or act as barriers to the prevention and early detection of oral cancers. Results: Overall, the public is ill‐informed about risk factors for and signs and symptoms of oral cancers and relatively few US adults have had an oral cancer examination. Further, health care providers are remiss in providing oral cancer examinations and detecting early oral cancers. Conclusion: To achieve the 13 oral cancer objectives contained in “Healthy People 2000,” health care providers and the public must know the risk factors for these cancers as well as their signs and symptoms. Further, health care providers need to provide oral cancer examinations routinely and competently. Equally important, the public needs to know that an examination for oral cancer is available and that they can request one routinely. Thus, a vigorous agenda that includes education, policy, and research initiatives is needed to enhance oral cancer prevention and early detection.
Comparison of Access and Costs of Medicaid Dental Services in a Hospital Clinic and Community Practices
Authors: Marcus Marvin , Coulter Ian , Mann Joyce , Leibowitz Arleen , Buchanan Joan
Published: April 2007

Objectives: This paper reports the results of a three‐year evaluation of access to dental care and its associated costs for Aid to Families with Dependent Children (AFDC) beneficiaries enrolled in a hospital‐based health maintenance organization (HMO) or a fee‐for‐service (FFS) option. Methods: Medicaid enrollees (n=3,655) having a year of eligibility were assigned to either the hospital HMO or FFS care, and their use of dental care and its costs compared. Results: A higher percent of those beneficiaries enrolled in the FFS option used dental care than those in the HMO plan. FFS enrollees also had more annual visits per person than those in the randomly assigned HMO group. FFS dental patients treated in the hospital had the highest costs of any payment‐provider combination studied. Conclusions: To understand the mix of utilization rates, visits, and costs, one must take into account the way in which the HMO hospital plan is reimbursed, the way in which the dental department is reimbursed, and the way in which the dental provider is reimbursed.
Factors Influencing the Appropriateness of Restorative Dental Treatment: an Epidemiologic Perspective
Authors: Grembowski David , Fiset Louis , Milgrom Peter , Forrester Kathleen , Spadafora Agnes
Published: April 2007

Objectives: An epidemiologic analysis was performed to identify patient and dentist factors influencing over‐ and undertreatment of restorative services in a sample of insured adults. Methods: At baseline, 681 Washington State employees and their spouses, aged 20 to 34 years and residing in the Olympia or Pullman areas, were interviewed by telephone. Oral assessments were conducted to measure personal characteristics, oral disease, and restoration quality. Adults were followed for two years to measure use of restorative services from dental insurance claims. Each adult's baseline and claims data were linked with provider and practice variables collected from the dentist who provided treatment. Results: For overtreatment, 39 percent of adults received one or more replacement restorations in nondecayed teeth with satisfactory fillings at baseline, while 18 percent of adults had one or more restorations placed in teeth with no decay and fillings. An adult's probability of overtreatment was higher if the adult had more fillings at baseline, or if an adult's dentist was younger, had a busy practice, advertised, charged higher fees, had less continuing education, or had a solo practice. For undertreatment, about 16 percent of adults either received no replacement restorations in teeth with unsatisfactory fillings at baseline, or had decayed teeth at baseline that were not filled or crowned. An adult's probability of undertreatment was higher if an adult had less decayed or more missing surfaces at baseline, or if an adult's dentist believed in sharing information with patients, had a busy practice, or reported not placing fillings when radiographic evidence of new caries was present. Conclusion: A minority of adults aged 20 to 34 experienced potential over‐ or undertreatment of restorative services, which are influenced by both patient and dentist factors.
Factors Related to Loss of Root Canal Filled Teeth
Authors: Caplan Daniel J. , Weintraub Jane A.
Published: April 2007

Objectives: This case‐control study characterized factors related to loss of root canal filled (RCF) teeth among members of the Kaiser Permanente Dental Care Program, a dental health maintenance organization based in Portland, Oregon. Methods: Individuals were identified who were enrolled continuously from January 1, 1987, through December 31, 1994, underwent initial root canal therapy on a permanent tooth (excluding third molars) in 1987 or 1988, had a clinical examination within two years after endodontic access, and were at least 21 years old at access. Patients who lost the RCF tooth by December 31, 1994, were defined as cases (n=96); those who did not were defined as controls (n=120). Computerized data, dental radiographs, and chart entries were reviewed to ascertain variables of interest, and multivariable logistic regression was used to describe differences between the groups. Results: RCF teeth of cases had fewer proximal contacts at access than RCF teeth of controls (odds ratio=2.7; 95% Cl=1.4, 5.1). Cases were older (odds ratio=1.4; 95% Cl=1.1, 1.9 per 10‐year increase) and more likely to have had a facial injury than controls (odds ratio=3.6; 95% Cl=1.2, 10.5). Cases also had more missing teeth (odds ratio=1.5; 95% Cl=1.0, 2.1) and more plaque (odds ratio=1.7; 95% Cl=1.0, 2.6). Conclusion: Conditions evident during treatment planning may help dentists assess patients' chances of losing an RCF tooth.
Aspects of Quality of Dental Hygiene Care in Supervised and Unsupervised Practices
Authors: Freed James R. , Perry Dorothy A. , Kushman John E.
Published: April 2007

Objective: The purpose of this study was to assess aspects of the quality of care provided by dental hygienists in a California demonstration project in which hygienists treated patients independent of dentists' supervision. Methods: The structure and process of care were evaluated in nine independent practices using site visits and reviews of 25 records at each practice. The findings were compared to evaluations of six general dentist practices reviewed for a government agency and insurance company during the same time period. Patient satisfaction was assessed by a questionnaire. Results: The structural aspects of the unsupervised hygienist practices were generally acceptable and surpassed the dentist practices in most areas, including infection control. For process, the hygienist practices had high percentages of acceptable care and were significantly better than the dentist practices in several areas, including follow‐up to medical findings, updating the medical history at recall, and documenting the evaluation of the periodontal status and soft tissues. Ninety‐eight percent of patients expressed satisfaction with their care in hygienist practices. Conclusion: Under the circumstances of the demonstration project and the methods used to assess the quality of care, the study showed that independent dental hygienist practice did not increase the risk to the health and safety of the public.
Acute Fluoride Toxicity from Ingesting Home‐use Dental Products in Children, Birth to 6 Years of Age
Authors: Shulman Jay D. , Wells Linda M.
Published: April 2007

Objectives: This paper analyzes reports to the American Association of Poison Control Centers (AAPCC) of suspected overingestion of fluoride by children younger than 6 years of age between 1989 and 1994, and estimates the probably toxic amounts of various home‐use fluoride products in children younger than 6 years of age. Methods: Annual incidence rates of reported fluoride exposures attributed to dietary supplements, toothpaste, and rinses were calculated. Probably toxic amounts of each product were calculated using the frequently cited dose of 5 mg/kg. Results: Children younger than 6 years of age accounted for more than 80 percent of reports of suspected overingestion. While the outcomes were generally not serious, several hundred children were treated at health care facilities each year. A 10 kg child who ingests 50 mg fluoride (10.1 g 1.1% NaF gel; 32.7 g 0.63% SnF2 gel; 33.3 g 1,500 ppm F toothpaste; 50 g 1,000 ppm F toothpaste; and 221 mL 0.05% NaF rinse) will have ingested a probably toxic dose. Conclusion: Overingestion of fluoride products in the home is preventable. Dentists and other health care providers should educate parents and child care providers about the importance of keeping fluoride products out of reach of children. Manufacturers should be encouraged by the ADA and the FDA to use child‐resistant packaging for all fluoride products intended for use in the home.
Dental Caries and Treatment Need in Schoolchildren Related to Medicaid Enrollment
Authors: Robison Valerie A. , Rozier R. Gary , Weintraub Jane A.
Published: April 2007

Objectives: This study compared dental caries status and treatment need in four groups of children: those not enrolled in Medicaid, those enrolled in Medicaid who used dental services prior to a dental survey, those enrolled in Medicaid who used services after the survey, and those enrolled in Medicaid who did not use dental services. Methods: This study used data on 6,620 children 5 to 18 years of age, who were representative of North Carolina schoolchildren and who participated in a statewide oral health survey in 1986–87. Clinical results from the survey were linked with a separate data base of Medicaid claims and enrollment files from 1984 to 1992. With this link, the surveyed children were classified into the four study groups and dental status compared. Results: Medicaid‐enrolled children who used services prior to the survey had the highest caries prevalence of all groups (DMFS=1.74 at ages 6 to 11 years), and had fewer treatment needs (D/DMFS=19%) than children outside of Medicaid (DMFS=0.95, D/DMFS=33%). Enrolled children who never used dental services had a caries prevalence (DMFS=0.83) similar to children outside of Medicaid, yet had greater unmet treatment need (D/DMFS=62%). Conclusion: Caries prevalence did not differ substantially among groups; however, the level of unmet treatment did vary. Some Medicaid‐enrolled children had a significant portion of their restorative treatment needs met.
Measuring Beliefs about Orthodontic Treatment: A Questionnaire Approach
Authors: Bennett M. Elizabeth , Michaels Christine , O'Brien Kevin , Weyant Robert , Phillips Ceib , Vig Katherine Dryland
Published: April 2007

Objectives: Few studies have examined what parents and orthodontists expect from and value about orthodontic treatment. In this study, we designed and tested a questionnaire to outline what drives consumer demand for children's orthodontic care. Further, we present data from the questionnaire to illustrate how expectations and values pertaining to orthodontic treatment relate to sociodemographic variables. Methods: Subjects were 220 Pennsylvania orthodontists and 220 parents at a university orthodontic clinic who were administered a questionnaire designed to assess what parents and orthodontists value about and expect from orthodontic treatment. Items for the questionnaire were developed via a qualitative, telephone interview process. Data were analyzed using factor analysis and reliability analysis for scale development, and analysis of variance for preliminary validity assessment. Results: Through factor analysis, the questionnaire was reduced from 84 to 52 items, and eight scales were examined: expected treatment benefits, expected treatment risks (short‐ and long‐term), expected treatment inconveniences, value of treatment benefits, value of risks (short‐ and long‐term), and value of treatment inconveniences. For parents, the reliability for all scales was in the acceptable range. For orthodontists, only the “short‐term risks” scale failed to attain an acceptable reliability. Preliminary validity was assessed through examining relationships between demographic variables and subscale scores. For parents, income, father's education level, and sex of respondent were related to treatment expectations and values. For orthodontists, age, sex, and patient volume were related to treatment values. Conclusions: The questionnaire developed in the present study was found to be practical and reliable for use with providers and consumers of orthodontic care and can be used to explore factors affecting the demand for orthodontic care. Implications of possible unrealistic treatment expectations on the part of orthodontists and parents also are discussed.
Restorative Certainty and Varying Perceptions of Dental Caries Depth Among Dentists
Authors: Lewis Donald W. , Pharoah Michael J. , El‐Mowafy Omar , Ross Donald G.
Published: April 2007

Objective: The question of whether dentists who most frequently identify tooth surfaces for definite restoration perceive dental caries as significantly deeper than other dentists is assessed. Methods: One group of 20 dentists independently examined 145 unrestored approximal tooth surfaces on 16 bitewing radiographs and recorded their restorative and depth decisions. Another group of 15 dentists similarly scored 304 unrestored surfaces on 30 bitewing radiographs. Each group of dentists was later divided into four subgroups according to the number of surfaces designated for definite restoration by each dentist. Results: As the number of tooth surfaces designated for definite restoration increased, mean caries depth (P<.05 for the high vs low subgroups) and the percent of dentinally carious surfaces increased, while the percent of surfaces assessed as sound decreased. Dentists with the lower numbers of surfaces designated for definite restoration came closest to the true histologic mean caries depth of the examined tooth surfaces. Conclusions: Dentists who designated high numbers of approximal tooth surfaces for definite restoration assessed caries as deeper than other dentists, and deeper than was proven histologically.
Dental Public Health for the 21st Century: Implications for Specialty Education and Practice
Authors: Shulman Jay D. , Niessen Linda C. , Kress Gerard C. , DeSpain Becky , Duffy Rosemary
Published: April 2007

A panel of public health practitioners sponsored by the Health Resources and Services Administration met December 6–8, 1994, to examine current roles and responsibilities for dental public health workers and to recommend changes in education and training to meet challenges posed by an evolving health care system. Overall, at least the same number, if not more, dental public health personnel will be needed in the future. While some new roles were identified, the panel felt that only small numbers of personnel will be needed to fill these new roles. Not all of these roles necessarily require a dental degree. The panel felt that a need exists for more academicians for dental schools, schools of public health, dental public health residencies, and dental hygiene programs; oral epidemiologists and health services researchers; health educators; and specialists in utilization review/outcomes assessment, dental informatics, nutrition, program evaluation, and prevention. To meet these personnel needs: (1) dental public health residency programs should be structured to meet the educational needs of working public health dentists with MPH degrees through on‐the‐job residency programs; (2) the standards for advanced specialty education programs in dental public health should be made sufficiently flexible to include dentists who have advanced education and the requisite core public health courses; (3) flexible MPH degree programs must be available because of the rising debt of dental students and the decreased numbers of graduating dentists; (4) loan repayment should be available for dentists who have pursued public health training and are working in state or local health departments; and (5) standards for advanced education in dental public health should be developed for dental hygienists.
History of Federal Legislation in Health Professions Educational Assistance in Dental Public Health, 1956–97
Authors: Duffy Rosemary E. , Chen D. W. , Sampson Neil H.
Published: April 2007

Health professions education assistance in dental public health has been congressionally authorized in one form or another during the last four decades. The US Department of Health and Human Services (and its predecessor, the Department of Health, Education, and Welfare) has been a focal point for managing these federal programs. This report tracks the history of relevant national legislation, beginning in the 1950s with the Health Amendment Acts of 1956 and continuing most recently with the Health Professions Education Extension Amendments of 1992. The number of dental public health professionals trained and available to provide expertise and leadership to improve community oral health status has been tied to the presence and intensity of federal programming in this area.
Dental Public Health Postdoctoral Education: a Survey on the Status of Funding and Career Opportunities
Authors: Watson Maria Rosa , Niessen Linda C.
Published: April 2007

Objectives: This paper reports the results of a survey to determine the consequences of budget reductions on the status of dental public health postdoctoral training in the United States, and opinions of experts in education and practice regarding career opportunities in dental public health. Methods: A survey was mailed to 154 dental and public health education and service institutions. Results: Most respondents (74 of 103; 72%) agreed that training opportunities depend on funding, and 73 percent (n=75) expressed the view that more dental public health specialists are needed. Respondents reported that funding for current dental public health master's degree and residency programs is less than satisfactory. Respondents involved in training of dental public health professionals held marginally statistically significant different opinions regarding career opportunities than those who were not involved. No significant differences in opinions of respondents existed by type of institution. Conclusion: With decreased numbers of dental graduates, improved funding for dental public health programs will be critical, particularly at the specialty entry level, to ensure that adequate numbers of specialists are trained and available to meet the oral health needs of all the US population.
Academic Dental Public Health Diplomates: Their Distribution and Recommendations Concerning the Predoctoral Dental Public Health Faculty
Authors: Kaste Linda M. , Sadler Zara E. , Hayes Kathy L. , Narendran Sena , Niessen Linda C. , Weintraub Jane A.
Published: April 2007

Objectives: The purpose of this study was to assess the representation of academically based diplomates of the American Board of Dental Public Health (ABDPH) and to identify their perceptions on the training of dental public health predoctoral faculty. Methods: Data were collected by a mailed, self‐administered, 13‐item questionnaire. The population was the 48 diplomates of the ABDPH as of March 1997 associated with academic institutions. Results: Twenty of the 55 US dental schools had a diplomate of the ABDPH with a mean of 1.8 diplomates per school with a diplomate. An average of 4.5 full‐time faculty members per school were associated with teaching dental public health. A master's degree in public health (MPH) was the most frequently suggested educational requirement for dental public health faculty. Continuing education courses were training needs perceived for dental public health faculty. The lack of time, money, and incentives, along with perceived rigidity of requirements for board certification, were reported as major barriers for faculty becoming dental public health board certified. Conclusion: Numerous challenges confront the development of a strong dental public health presence in US dental schools. These challenges include, among others, insufficient numbers of academic dental public health specialists and insufficient motivations to encourage promising candidates to pursue specialty status.
Dental Caries in African Preschool Children: Social Factors as Disease Markers
Authors: Khan Mehroon N. , Cleaton‐Jones Peter E.
Published: April 2007

Objective: This study investigated the associations between dental caries prevalence and severity and social factors in 3‐ to 5‐year‐old African children. Methods: Dental caries was diagnosed in natural light using WHO criteria, mirrors, and explorers. Socioeconomic information was obtained by questionnaire. Results: The percentages of 3‐, 4‐, and 5‐year‐olds with any caries experience were 47 percent, 58 percent, and 63 percent, respectively. Mean dmfs scores (sd) were 2.2(3.6), 3.0(3.8), and 3.7(4.1), respectively. Family education was associated with caries prevalence (P=.03) and severity (P=.008) in a multivariable regression model. Conclusion: In the indigenous African group studied, family education is a disease marker to target in future caries risk evaluations.
Racial Differences in Survival of Oral and Pharyngeal Cancer Patients in North Carolina
Authors: Caplan Daniel J. , Hertz‐Picciotto Irva
Published: April 2007

Objective: This study seeks to determine whether lower survival of black versus white oral and pharyngeal cancer patients is due to, or differs by, stage at diagnosis. Methods: Subjects identified through the North Carolina Central Cancer Registry included all black and white North Carolina residents diagnosed from 1987 to 1990 with malignant squamous cell carcinoma of the oral cavity or pharynx. Proportional hazards regression models were used to calculate hazard ratios for all‐cause mortality during the first 18 months after diagnosis, adjusting for age, reported histologic grade, site, and several time‐dependent interactions. Results: Within the first two months after diagnosis, the black/white hazard ratio for mortality among those with localized disease was 11.8 (95% Cl=3.7, 37.5), compared to 6.4 (95% Cl=2.6, 15.8) for those with advanced disease. During months 3 to 18 after diagnosis, black/white hazard ratios were 2.07 (95% Cl=1.03, 4.18) among those with localized disease and 1.12 (95% Cl=0.85, 1.47) for those with advanced disease. Conclusion: In the first 18 months after diagnosis, blacks with oral and pharyngeal cancer have higher all‐cause mortality than whites diagnosed at the same stage of disease. Racial differences are greater among those with localized disease than for those with more advanced conditions.
National Survey of Korean Dentists' Knowledge and Opinions: Dental Caries Etiology and Prevention
Authors: Moon Hyock‐soo , Paik Dai‐il , Horowitz Alice M. , Kim Johng‐bai
Published: April 2007

Objectives: Dentists have the potential to influence what their patients know and do regarding dental caries prevention. The practices of dentists and what they tell their patients are influenced, in part, by their own knowledge and opinions. The purposes of this study were to determine the level of knowledge and opinions about caries etiology and prevention among Korean dentists and to describe related factors. Methods: A pretested, 27‐item questionnaire was mailed to 2,047 dentists, selected by a stratified random sampling allocated proportionately. A postcard reminder was sent to all dentists after one week. Nonrespondents were sent additional complete mailings after three, seven, and nine weeks. The response rate was 83 percent (n=1,700 dentists). Results: Analysis of six factors thought to be related to knowledge about caries etiology and prevention showed that recent graduates and dentists who worked in public health centers were likely to be more knowledgeable about caries etiology and prevention than their counterparts (P<.05). In regression analysis of perceived effectiveness of caries‐preventive procedures for children, recent graduates, males, and dentists who worked in public health centers tended to rate caries‐preventive procedures more effective than other dentists (P<.05). Dentists who had experience with school‐based preventive programs and dentists in rural areas were likely to rate caries‐preventive procedures for adults more effective than other dentists (P<.05). Conclusion: Overall, results of this study suggest that the majority of dentists do not know current information concerning etiology and prevention of dental caries, mechanisms of action of fluoride, and effectiveness of preventive procedures for children and adults. Efforts to enhance the level of knowledge and practices of Korean dentists about caries prevention should focus on strategies to educate older graduates and female dentists, especially those in private practice.
Adult Dental Visits in California: Successes and Challenges
Authors: Tomar Scott L. , Azevedo Andréa B. , Lawson Roberta
Published: April 2007

Objectives: This study sought to estimate and characterize the proportion of California adults who visited a dentist in the preceding year and to identify reasons for not going. Methods: In 1995, 4,029 adults were interviewed by telephone as part of the California Behavioral Risk Factor Surveillance System. Items included recentness of a dental visit, dental insurance status, and number of teeth lost due to disease. Persons who had not seen a dentist within the preceding year were asked the main reason they had not gone. Results: In 1995, 65.9% of adults reported visiting a dentist in the preceding twelve months. Use of dental services was greater among persons aged 35 years or older (70.4%) than among those aged 18–34 years (58.4%) and among those with dental insurance (74.9%) than those without (54.4%). Dental visits were less likely among adults living at or below 200 percent of the federal poverty level, those with less than a high school education, and the edentulous. Reasons most commonly cited for not seeing a dentist were no perceived reason to go (37.2%), cost (30.7%), and fear (9.2%). Conclusion: Substantial variation in use of dental services exists among California's adults. Achieving equity in access and opportunity for disease prevention in this state may require expanded dental insurance coverage and serious efforts in oral health promotion.
Maryland Adults' Knowledge of Oral Cancer and Having Oral Cancer Examinations
Authors: Horowitz Alice M. , Moon Hyock‐soo , Goodman Harold S. , Yellowitz Janet A.
Published: April 2007

Objectives: This study sought to determine (1) knowledge of risk factors for oral cancer, (2) knowledge of signs and symptoms of oral cancers, and (3) factors associated with having had an oral cancer examination among 916 Maryland adults 18 years of age and older. Methods: A statewide, random‐digit dial, computer‐assisted telephone survey was conducted. The pretested instrument consisted of 32 questions that required 12 minutes to complete. Results: Overall, level of knowledge about risk factors for and signs and symptoms of oral cancers was low; misinformation was high. Although 85 percent reported hearing about oral or mouth cancer, only 28 percent of the respondents reported having had an oral cancer examination. Of these, 20 percent had the exam during the past year—the recommended frequency for persons 40 years of age or older. In logistic regression analysis, adults more likely to have had an oral cancer examination included those who thought personal behavior causes more cancer than environ‐mental factors; had more knowledge about risk factors for oral cancer; and were 40–64 years of age, white, and better educated than their counterparts (P<.05). The primary reasons for not having an exam were “no reason/didn't know I should” and “doctor/dentist didn't recommend.”Conclusion: These results demonstrate a need for interventions designed to increase knowledge levels of risk factors for, signs, and symptoms of oral cancers and the need for oral cancer examinations; and to increase oral cancer examinations.
Prevalence of HIV‐associated Periodontitis and Chronic Periodontitis in a Southeastern US Study Group
Authors: McKaig Rosemary G. , Thomas James C. , Patton Lauren L. , Strauss Ronald P. , Slade Gary D. , Beck James D.
Published: April 2007

Objectives: This study estimates factors associated with the prevalence of HIV‐associated periodontal diseases (HIV‐P) and the severity and extent of periodontitis in HIV‐infected adults from North Carolina (NC). Methods: Data are derived from a cross‐sectional study of HIV‐infected adults (total n=326, dentate n=316) treated at the University of North Carolina Hospitals. Outcomes were a diagnosis of HIV‐P and measures of probing pocket depth (PPD), recession (REC), and clinical attachment level (CAL). Immunosuppression was measured by peripheral blood CD4+ cells/mm3. Results: In addition to persons with HIV (non‐AIDS), this study included 10 percent of the AIDS cases in North Carolina. Median age was 37 years (range=19–67); 78 percent were male and 60 percent were black. Sixty‐two percent of persons had a probing pocket depth ≥5 mm; 46% had recession ≥3 mm, and 66 percent had attachment level ≥5 mm in one or more sites. Cases of HIV‐P (n=15) were rare. Persons taking HIV‐antiretroviral medication were one‐fifth (OR=0.20; 95% Cl=0.07, 0.63) as likely to have HIV‐P as those not taking those medications, controlling for CD4+ cell counts. Conclusion: HIV‐infected persons in this study group from North Carolina exhibited severe and extensive measures of adult periodontitis. A small proportion experienced a severe form of HIV‐P, which was attenuated by antiretroviral therapy.
Cell type‐specific relationships between spiking and [Ca2+]i in neurons of the Xenopus tadpole olfactory bulb
Authors: Lin Bei‐Jung , Chen Tsai‐Wen , Schild Detlev
Published: April 2007

Multi‐neuronal recordings with Ca2+ indicator dyes usually relate [Ca2+]i to action potentials (APs) assuming a stereotypical dependency between the two. However, [Ca2+]i affects and is affected by numerous complex mechanisms that differ from cell type to cell type, from cell compartment to cell compartment. Moreover, [Ca2+]i depends on the specific way a cell is activated. Here we investigate, by combining calcium imaging and on‐cell patch clamp recordings, the relationship between APs (spiking) and somatic [Ca2+]i in mitral and granule cells of the olfactory bulb in Xenopus laevis tadpoles. Both cell types exhibit ongoing and odour‐modulated [Ca2+]i dynamics. In mitral cells, the occurrence of APs in both spontaneous and odour‐evoked situations correlates tightly to step‐like [Ca2+]i increases. Moreover, odorant‐induced suppression of spontaneous firing couples to a decrease in [Ca2+]i. In contrast, granule cells show a substantial number of uncorrelated events such as increases in [Ca2+]i without APs occurring or APs without any effect upon [Ca2+]i. The correlation between spiking and [Ca2+]i is low, possibly due to somatic NMDAR‐mediated and subthreshold voltage‐activated Ca2+ entries, and thus does not allow a reliable prediction of APs based on calcium imaging. Taken together, our results demonstrate that the relationship between somatic [Ca2+]i and APs can be cell type specific. Taking [Ca2+]i dynamics as an indicator for spiking activity is thus only reliable if the correlation has been established in the system of interest. When [Ca2+]i and APs are precisely correlated, fast calcium imaging is an extremely valuable tool for determining spatiotemporal patterns of APs in neuronal population.
Ageing and leg postjunctional α‐adrenergic vasoconstrictor responsiveness in healthy men
Authors: Smith Erica G. , Voyles Wyatt F. , Kirby Brett S. , Markwald Rachel R. , Dinenno Frank A.
Published: April 2007

Muscle sympathetic vasoconstrictor nerve activity increases with advancing age, but does not result in elevated forearm vasoconstrictor tone because of a selective reduction in α1‐adrenoceptor responsiveness. In contrast, the leg circulation of older adults is under greater tonic sympathetic vasoconstriction, but it is unclear whether α‐adrenoceptor responsiveness is altered with age. In the present study, we tested the hypothesis that postjunctional α‐adrenergic vasoconstrictor responsiveness is reduced in the leg circulation with age. We measured femoral blood flow (Doppler ultrasound) and calculated the femoral vascular conductance (FVC) responses to α‐adrenoceptor stimulation during local blockade of β‐adrenoceptors in 12 young (24 ± 1 year) and seven healthy older men (62 ± 2 year). Whole‐leg vasoconstrictor responses to local intrafemoral artery infusions of tyramine (evokes noradrenaline (NA) release), phenylephrine (α1‐agonist) and dexmedetomidine (α2‐agonist) were assessed. Consistent with previous data, resting femoral blood flow and FVC were ∼30% lower in older compared with young men (P < 0.05). Maximal vasoconstrictor responses to tyramine (−30 ± 3 versus−41 ± 3%), phenylephrine (−25 ± 4 versus−45 ± 5%), and dexmedetomidine (−22 ± 4 versus−44 ± 3%) were all significantly lower in older compared with young men (all P < 0.05). Our results indicate that human ageing is associated with a reduction in leg postjunctional α‐adrenoceptor responsiveness to endogenous NA release, and this reduction is evident for both α1‐ and α2‐adrenoceptors. However, given that basal leg vascular conductance is reduced with age and is primarily mediated by sympathetic vasoconstriction, impaired α‐adrenoceptor responsiveness does not negate the ability of the sympathetic nervous system to evoke greater tonic vasoconstriction in the leg vasculature of older men.
Presynaptic inhibition differentially shapes transmission in distinct circuits in the mouse retina
Authors: Eggers Erika D. , McCall Maureen A. , Lukasiewicz Peter D.
Published: April 2007

Diverse retinal outputs are mediated by ganglion cells that receive excitatory input from distinct classes of bipolar cells (BCs). These classes of BCs separate visual signals into rod, ON and OFF cone pathways. Although BC signalling is a major determinant of the ganglion cell‐mediated retinal output, it is not fully understood how light‐evoked, presynaptic inhibition from amacrine cell inputs shapes BC outputs. To determine whether differences in presynaptic inhibition uniquely modulate BC synaptic output to specific ganglion cells, we assessed the inhibitory contributions of GABAA, GABAC and glycine receptors across the BC pathways. Here we show that different proportions of GABAA and GABAC receptor‐mediated inhibition determined the kinetics of GABAergic presynaptic inhibition across different BC classes. Large, slow GABAC and small, fast GABAA receptor‐mediated inputs to rod BCs prolonged light‐evoked inhibitory postsynaptic currents (L‐IPSCs), while smaller GABAC and larger GABAA receptor‐mediated contributions produced briefer L‐IPSCs in ON and OFF cone BCs. Glycinergic inhibition also varied across BC class. In the rod‐dominant conditions studied here, slow glycinergic inputs dominated L‐IPSCs in OFF cone BCs, attributable to inputs from the rod pathway via AII amacrine cells, while rod and ON cone BCs received little and no glycinergic input, respectively. As these large glycinergic inputs come from rod signalling pathways, in cone‐dominant conditions L‐IPSCs in OFF cone bipolar cells will probably be dominated by GABAA receptor‐mediated input. Thus, unique presynaptic receptor combinations mediate distinct forms of inhibition to selectively modulate BC outputs, enhancing the distinctions among parallel retinal signals.
TrkB is necessary for pruning at the climbing fibre–Purkinje cell synapse in the developing murine cerebellum
Authors: Johnson Erin M. , Craig Ethan T. , Yeh Hermes H.
Published: April 2007

TrkB, the cognate receptor for brain‐derived neurotrophic factor and neurotrophin‐4, has been implicated in regulating synapse formation in the central nervous system. Here we asked whether TrkB plays a role in the maturation of the climbing fibre–Purkinje cell (CF–PC) synapse. In rodent cerebellum, Purkinje cells are initially innervated by multiple climbing fibres that are subsequently culled to assume the mature mono‐innervated state, and whose contacts translocate from the soma to the dendrites. By employing transgenic mice hypomorphic or null for TrkB expression, our results indicated that perturbation of TrkB in the immature cerebellum resulted in ataxia, that Purkinje cells remained multiply innervated by climbing fibres beyond the normal developmental time frame, and that synaptic transmission at the parallel fibre–Purkinje cell synapse remained functionally unaltered. Mechanistically, we present evidence that attributes the persistence of multiple climbing fibre innervation to an obscured discrimination of relative strengths among competing climbing fibres. Soma‐to‐dendrite translocation of climbing fibre terminals was unaffected. Thus, TrkB regulates pruning but not translocation of nascent CF–PC synaptic contacts.
Neural regulation of rhythmic arm and leg movement is conserved across human locomotor tasks
Authors: Zehr E. Paul , Balter Jaclyn E. , Ferris Daniel P. , Hundza Sandra R. , Loadman Pamela M. , Stoloff Rebecca H.
Published: April 2007

It has been proposed that different forms of rhythmic human limb movement have a common central neural control (‘common core hypothesis’), just as in other animals. We compared the modulation patterns of background EMG and cutaneous reflexes during walking, arm and leg cycling, and arm‐assisted recumbent stepping. We hypothesized that patterns of EMG and reflex modulation during cycling and stepping (deduced from mathematical principal components analysis) would be comparable to those during walking because they rely on similar neural substrates. Differences between the tasks were assessed by evoking cutaneous reflexes via stimulation of nerves in the foot and hand in separate trials. The EMG was recorded from flexor and extensor muscles of the arms and legs. Angular positions of the hip, knee and elbow joints were also recorded. Factor analysis revealed that across the three tasks, four principal components explained more than 93% of the variance in the background EMG and middle‐latency reflex amplitude. Phase modulation of reflex amplitude was observed in most muscles across all tasks, suggesting activity in similar control networks. Significant correlations between EMG level and reflex amplitude were frequently observed only during static voluntary muscle activation and not during rhythmic movement. Results from a control experiment showed that strong correlation between EMG and reflex amplitudes was observed during discrete, voluntary leg extension but not during walking. There were task‐dependent differences in reflex modulation between the three tasks which probably arise owing to specific constraints during each task. Overall, the results show strong correlation across tasks and support common neural patterning as the regulator of arm and leg movement during various rhythmic human movements.