bluuebunny/crossref_metadata_2025 huggingface dataset:
Dentists' and Physicians' Attitudes on the Role of the Dental Health Care Team in a Cardiovascular Risk Factor Reduction Program
Authors: Young Sandra L. , Karp Nancy V. , Karp Warren B.
Published: May 2007

This study examines the attitudes of both dentists and physicians on the role of the dental health care team in a cardiovascular risk factor reduction program directed at a general “well” population. A questionnaire was sent to a stratified sample of primary care dentists and physicians in the Augusta, Georgia, metropolitan area. The questionnaire was divided into four parts: the demographic component and three attitude components (the affective component, the cognitive component, and the action component). Results showed that dentists tended to have a positive attitude about performing cholesterol screening, nutrition counseling, and blood pressure screening in the dental office. Physicians tended to be negative about the idea of dentists performing cholesterol screening and nutrition counseling and were undecided about this role for dentists in a cardiovascular risk factor reduction program. Both dentists and physicians had positive attitudes about the idea of dentists referring high cardiovascular risk patients to physicians, as well as about the role of dentists in blood pressure screening. Overall, although dentists and physicians expressed concerns about the role of dentists in a cardiovascular risk factor reduction program, responses of both groups demonstrated a willingness to explore this concept further.
Dental Health Personnel Planning: a Review of the Literature
Authors: Goodman Harold S. , Weyant Robert J.
Published: May 2007

Dental personnel planning is important in formulating policy in dental education, dental public health programs, and dental care delivery systems. The purpose of this literature review is to illustrate the use of dentist‐to‐population ratios, need‐based models, and demand‐based models in the determination of appropriate supply of dental personnel. A historical perspective is provided that demonstrates how political manipulation and subjectivity have characterized the use of these models by organized dentistry, the federal government, and others. The lack of pertinent data and the inability to predict economic, social, political, and epidemiologic trends weaken the applicability of each model in determining future personnel levels. Considering the long‐term consequences of the use of each model in personnel planning, caution is urged in using any of the presently available models.
Measuring the Impact of P.L. 99‐252: an Economist's View
Authors: Caswell Robert J.
Published: May 2007

This paper examines ways in which standard economic analysis may be used to predict and evaluate the impact of P.L 99‐252, the Comprehensive Smokeless Tobacco Health Education Act of 1986. Simple supply and demand models are used to illustrate the range of possible effects of the act. Analysis indicates that the act should reduce demand, though the magnitude of the impact can only be determined empirically. Given that the act affects only one of the principal determinants of demand, consumer preferences, the impact may be rather limited in magnitude. The impact on supply is more ambiguous, but it is possible that restrictions on advertising might lower the smokeless tobacco producers' costs in ways that would lead to an increase in supply. Several suggestions for empirical measurement of impact are made. Three other issues are identified and discussed: potential negative consequences of the act's required health warnings (as a liability defense for firms); the importance of point of view in dealing with the costs of smokeless tobacco use; and a comparison of the act to alternative strategies to reduce smokeless tobacco use, such as taxation.
P.L. 99‐252–Implications for Dentists and Their Clinical Practice
Authors: Schroeder Kathleen L.
Published: May 2007

This paper is one of a series attempting to determine the impact of Public Law 99‐252, the Comprehensive Smokeless Tobacco Health Education Act of 1986, on decreasing smokeless tobacco use. Potential indicators are discussed that could be used by the dental profession to determine the efficacy of the profession's involvement in existing and future prevention and cessation efforts relative to this law. In this review, six major areas are considered for measuring declines in smokeless tobacco use relative to the role of the dental health practitioner. These areas encompass the following: (1) the dental profession's knowledge of smokeless tobacco health hazards, (2) dental practitioners' involvement in measuring changes in use patterns, (3) the influence dentists have with their patients and community in decreasing smokeless tobacco use, (4) the general attitude and intention to quit on the part of dental patients, (5) active governmental involvement efforts, and (6) health effects of smokeless tobacco that might be used for identifying decreasing smokeless tobacco use. Within each of these six broad categories, more specific indicators for measuring the impact of P.L. 99‐252 relative to the dental profession were considered.
Psychosocial Factors in the Use of Smokeless Tobacco and Their Implications for P.L. 99‐252
Authors: Severson Herbert H.
Published: May 2007

This article briefly reviews the prevalence of smokeless tobacco use by males in the United States, the relationship of smokeless tobacco use to cigarette use, and patterns of use that include dosage, topography, products, and function of use. The primary focus of the article is to describe the concurrent and predictive factors associated with onset, use, and cessation of smokeless tobacco. The implications of P.L. 99‐252, the Comprehensive Smokeless Tobacco Act of 1986, are discussed in the context of what is known about the psychosocial variables associated with the use of smokeless tobacco.
The Enforcement of Regulations Restricting Expanded Duties by Dental Auxiliaries: an Analysis of the Recent Disciplinary Actions of the Texas State Board of Dental Examiners
Authors: Feine Jocelyne S.
Published: May 2007

The issue of delegation of dental procedures (expanded duties) to auxiliaries continues to be controversial. Although it has been shown that these practices are usually beneficial to the public, many states continue to maintain laws prohibiting expanded duties. In Texas, auxiliaries are not allowed to perform many simple functions, and dentists who supervise these acts are tried and sentenced by the Texas State Board of Dental Examiners. Although one might expect that more serious categories of offenses would be treated in a harsher manner, this study indicates that this is not the case in Texas. The disciplinary actions of the Texas State Board of Dental Examiners were analyzed, and the rate of conviction and severity of penalty for three types of offenses: supervising auxiliaries in the performance of unauthorized expanded duties, malpractice/negligence, and drug offenses were compared. The results revealed that dentists who were convicted for unauthorized auxiliary expanded duty use were assigned harsher penalties than those given to dentists convicted for other classes of offenses (P=.02, Fisher's exact test). This study indicates that, at least for the dentists of Texas, the punishment may not always fit the crime.
Caries Prevalence, Treatment Level, and Sealant Use Related to School Lunch Program Participation
Authors: Ripa Louis W. , Leske Gary S. , Kaufman MPH Hershall W.
Published: May 2007

A total of 2,753 schoolchildren (8‐11 years old) from two school districts received visual‐tactile examinations for caries. The school districts were approximately 15 miles apart and located in fluoride‐deficient (F<0.3 ppm) Long Island, New York. The higher socioeconomic community (HSES) had 9.2 percent of its students enrolled in the free or reduced‐payment school lunch program; the lower socioeconomic community (LSES) had 50.3 percent enrolled. The LSES community had a higher caries prevalence, more untreated lesions, fewer caries‐free children, and fewer children treated with sealants. School lunch programs provide an index to identify communities for dental programs.
Time to Adoption of an Innovation by Dentists in Private Practice: Sealant Utilization
Authors: Chapko Michael K.
Published: May 2007

Dentists can be divided into five adoption categories based upon their time of adoption of pit and fissure sealants: innovators, early adopters, early majority, late majority, and laggards. The differences among dentists in the five adoption categories were examined for four classes of variables: practice characteristics, dentist characteristics, communication of information, and practice environment. Questionnaires were mailed in September 1984 to a random sample (N=521) of Washington State dentists in general practices. A total of 376 completed questionnaires were returned, for a response rate of 72 percent. Adoption of sealants proceeded as follows: 5 percent of dentists through 1973, 24 percent through 1979, 50 percent through 1982, and 75 percent through 1984. Adoption category was related to percent of assistants who were certified, delegation to assistants and hygienists, magnitude of the fees charged by the practice, number of staff meetings per month, the dentist having been an officer in a dental organization, year the dentist adopted other new technologies, dentist's self‐rating of willingness to try new things, percent of patients who are children, and percent of the dentist's colleagues who used sealants. These data lend some support to the two‐stage or opinion‐leader model of diffusion and suggest that new technologies can be promoted by first influencing dentists who consistently adopt early.
Legislation and Reality in Public Dental Services in Norway: Dental Health Services for Children and Adolescents in 1975 and 1985
Authors: Rossow Ingeborg , Hoist Dorthe
Published: May 2007

The act relating to dental health services implied a reorganization of the public dental health services in Norway in 1984. The act intended to extend the target group of public dental health services and to achieve social and geographic equality in the distribution of dental health services among children and adolescents. The purpose of this study was to assess the degree to which these intentions had been fulfilled. The material comprised two nationwide, stratified, and randomly selected samples of 3,356 and 2,970 children and adolescents in the age group zero to 18 years. Data were collected in 1975 and 1985. Both the theoretical and the empirical models applied structural and individual resources to explain individual variation in use of dental health services. The results showed that the proportion of zero‐ to 18‐year‐olds who had seen a dentist within the past 12 months was higher in 1985 than in 1975 (81.7% and 75.8%, respectively). Bivariate and trivariate table analyses showed that statistically significant associations between structural resources and use of dental health services disappeared when controlling for a third variable. Use of dental health services among children and adolescents in Norway was not systematically influenced by the same factors, as was the use of dental health services in the adult population. Thus, the Public Dental Health Service in Norway seems to have had the capability of compensating for most of the discriminating effects that individual and structural factors may have on the use of dental health services both before and after the reorganization of the public dental health service.
Changes in Dental Caries Prevalence in Upstate New York Schoolchildren
Authors: Kumar Jayanth , Green Elmer , Wallace William , Bustard Robert
Published: May 2007

A survey of second and fifth grade children was conducted in upstate New York to determine recent trends in dental caries prevalence. Clinical examinations were conducted on 960 second grade and 837 fifth grade children in 51 schools. A single examiner derived the findings on a uniform basis using a standard protocol. An examination of changes in the percent of caries‐free children and mean DMFS/dfs indices revealed that caries prevalence has continued to decline. Although the low SES group in this survey had consistently higher caries levels and a higher treatment need compared to the high SES group, the magnitude of the difference was much smaller compared to the previous survey. Because the sampling was restricted to young children in upstate New York, the trends observed should not be applied to a similar New York City population, to older children throughout New York State, or to children in other states.
The Venturi Fluoride Saturator Project
Authors: Hastreiter Richard J. , Falken Myron C. , Smith Gerald G. , Wunderlich H. Curtis , Roesch Mildred H.
Published: May 2007

This study was conducted to determine whether Venturi Fluoride Saturator (VFS) systems could be used to fluoridate small community and school water supply systems with an acceptable level of maintenance. VFS systems were installed and operated at four school and six community well sites according to state and federal regulations and recommendations. School VFS systems were unable to maintain optimum fluoride residuals even with substantial maintenance. All six community well site VFS systems performed acceptably, with only a few short lapses. VFS system maintenance was labor intensive. Recurring problems were caused by lengthy equipment delivery delays, the unavailability of timely technical assistance to support the VFS system, and the inadequate quality of VFS equipment and design. Based upon these findings, further expansion of the use of VFS systems either for community or school fluoridation cannot be recommended. Additional study of and improvements in the VFS system are indicated. Three major recommendations appear appropriate: (1) extensive laboratory testing of the VFS system concept under controlled conditions should be performed to determine the functioning parameters of this equipment under different hydrody‐namic conditions; (2) additional research and development of the VFS unit to improve the quality of operations and the quality control of manufacturing and assembly should be undertaken; and (3) a VFS equipment distribution network should be developed, with sufficient logistical and technical support to supply equipment parts and expertise for installation, monitoring, and maintenance in a timely and efficient manner.
Oral Health Knowledge and Habits of Senior Elementary School Students
Authors: Hamilton Michael E. , Coulby W. Mark
Published: May 2007

Despite improvements in children's dental health, and significant resource allocation to health education programs, few recent studies have investigated the associations of oral health knowledge, behaviors, and status. This study of 11 ‐year‐old children (N =6,329) in northeastern Ontario used a supervised self‐complete questionnaire and a clinical examination to gather baseline data on, and test associations of, caries and periodontal knowledge, self‐reported oral health behaviors and source of knowledge, and oral health status. Results show the children had poor knowledge of caries preventive measures such as waterfluoridation, dental sealants, and choice of snack foods. Periodontal knowledge was better, but children confused plaque and calculus. Respondents claimed good oral health habits, with 73 percent claiming to brush at least twice daily, 88 percent claiming to use toothpaste, 42 percent claim to floss at least twice weekly, and 84 percent claiming an annual dental visit. Children with the best knowledge claimed dentist and school as the sources. High knowledge was associated with good oral health habits (P<. 001) and low DM FT score (P<.001). Good habits were not related to DMFT score (P=. 1095). Logistic regression showed high knowledge was associated with English cultural status, urban school area, good habits, having a dental sealant, and attending a fluoride‐rinse school (P<.05). Findings suggest a need to reinforce caries preventive teaching, to investigate the effect of cultural status, dental experience, and residence status on oral health knowledge, and to further test the efficacy of different oral health education programs delivered by different sources.
The Validity of Self‐reported Oral Health Status in the Elderly
Authors: Douglass Chester W. , Berlin Jesse , Tennstedt Sharon
Published: May 2007

The validity of self‐reported number of teeth was assessed in a random sample of 50 individuals aged 70+ by comparing self‐reports in a telephone interview with results of a subsequent in‐home examination by a dentist. There were no significant differences between self‐report and examination data, nor was there any systematic under‐ or over‐counting of teeth as the actual number of teeth increased. These data support the validity of self‐reported dentition.
Health Through Oral Health; Guidelines for Planning and Monitoring for Oral Health Care: A Critical Comment on the WHO Model
Authors: Bronkhorst Ewald M. , Truin Gert‐Jan , Batchelor Paul , Sheiham Aubrey
Published: May 2007

Recently a joint working group of WHO/FDI published guidelines for planning and monitoring oral health care. In the report a model for calculations of future need for dental manpower was introduced as an effective planning tool. An analysis of whether the WHO model is appropriate to calculate the future need for manpower planning was carried out. It appears that the model has serious methodological shortcomings. The model expects the user to know the future oral care needs concerning preventive, special group, surgical, orthodontic, and periodontal care. In calculating future needs for restorative and prosthetic care, the model restricts itself to looking back in time and roughly calculating what has happened in the past, assuming this will happen again.
The Oral Health Status, Treatment Needs, and Dental Utilization Patterns of Native American Elders
Authors: Phipps Kathy R. , Reifel Nancy , Bothwell Eric
Published: May 2007

The purpose of this study was to evaluate the oral health status, treatment needs, and dental care utilization patterns of a Native American population aged 65‐74 years. A random sample of 688 individuals was chosen and approached regarding participation in the study. Data were gathered through an interviewer‐administered questionnaire and an oral examination. A total of 204 individuals completed all aspects of the study. Only one participant had all 28 natural teeth, while 58.3 percent were totally edentulous. Of the 85 dentate participants, almost 53 percent required at least one extraction. The average number of required extractions in the dentate subjects was three. Although 94 percent of the sample stated they had a usual source of dental care, 40.7 percent had not visited a dentist within the last five years. Multiple regression analyses were used to determine the factors associated with total number of teeth present among the dentate participants. Years of education and time since last dental visit were the two significant predictors (P<.05) of number of teeth present. The higher the level of education, the greater the number of teeth in later life. The number of teeth present was inversely related to years since dental treatment. Compared to the results of the National Survey of Oral Health in US Employed Adults and Seniors, this Native American sample had a higher prevalence of edentulism and utilized dental services less often than a comparable age group in the US population as a whole.
Differences in Need for Orthodontic Treatment Between Native Americans and the General Population Based on DAI Scores
Authors: Jenny Joanna , Cons Naham C. , Kohout Frank J. , Jakobsen Jane
Published: May 2007

Clinical impressions by Indian Health Service (IHS) dentists of a greater frequency of severe dental malrelations among Native Americans than in the general US population have never been objectively confirmed. This study uses the DAI as the standard to determine whether there is a greater prevalence of severe malocclusions among Native Americans. Four hundred eighty‐five Native American students in grades 7‐12 from two remote sites–Pine Ridge, SD, and Many Farms, AZ– and one nonremote site–Lapwai, ID–were scored for the DAI. The mean scores from each reservation, as well as the mean score from the three reservations combined, were significantly higher, indicating poorer aesthetics, than the mean DAI score from a large sample of the general US population. These data confirm the clinical impressions of IHS dentists that Native Americans residing on reservations have significantly poorer dental aesthetics than the aesthetics found in the general US population; therefore, Native Americans have greater needs for orthodontic treatment.
National Health Care and the Public's Oral Health*
Authors: Schoen Max H.
Published: May 2007

This article presents an outline of a proposal for a national health program, together with a discussion of the necessity of inclusion of dentistry for optimum benefit to the public. A thorough restructuring of current principles of coverage, benefits, methods of payment, administration, and methods of protection of the public is proposed. Disease prevention and the role and responsibility of public health dentistry would be enhanced in such a scheme. Current total dental care expenditures should be sufficient to cover most of the costs. It is the author's belief that further tinkering with the existing health care system and the application of more bandaids can only exacerbate existing problems.
Factors Associated with Job and Career Satisfaction Among Dental Hygienists
Authors: Bader James D. , Sams Darlene H.
Published: May 2007

Information concerning dental hygienists' job and career satisfaction is dated and incomplete. Because satisfaction may be important in retention of dental hygienists, a survey of all active dental hygienists in private practices in North Carolina was performed to ascertain dimensions and levels of job and career satisfaction, as well as factors associated with these constructs. Of 2,099 eligible hygienists, 51 percent responded to a survey instrument containing 202 items addressing overall satisfaction, as well as satisfaction with a variety of work‐related factors. Factor analysis was used to develop scales for job and career satisfaction, and for the work‐related factors. Final reduced regression models indicated that the constructs of job and career satisfaction are separate and that each has distinct general and intrinsic dimensions. Models for general job and career satisfaction had R2 values of .45 and .27, respectively, and included a variety of work‐related factors such as supervisory style and satisfaction with salary. Models for intrinsic job and career satisfaction were not as strong, with R2 values of .06 and .09, respectively. These models also included work‐related factors such as satisfaction with hours of work, office safety arrangements, and supervisory style. These results suggest that general job and career satisfaction levels should be amenable to change through management interventions.
The Assessment of Nursing Caries and Its Relationship to High Caries in the Permanent Dentition
Authors: Kaste Linda M. , Marianos Donald , Chang Richard , Phipps Kathy R.
Published: May 2007

The prevalence of nursing caries has been found to be high in populations of Native American children, unlike other US population groups. Comparisons among studies are difficult because a variety of operational definitions of the syndrome have been used. This study had two goals. First, a retrospective dental record audit was conducted for a Native American population attending Head Start in 1977–78, to compare the prevalence rates of nursing caries obtained by using different nursing caries classification schemes. Second, we studied the relationship of prior nursing caries to current high caries level deter‐mined by a clinical exam in the same children approximately ten years later (N=88). As expected, different classification schemes yielded different prevalence rates. Classification of nursing caries by buccal or lingual caries in the maxillary incisors found 45 percent of the children with the disorder, vs 61 percent if measured by three or more carious maxillary incisors, or 76 percent if two or more carious maxillary incisors. Nursing caries in these Head Start children, defined by caries on the buccal or lingual surfaces of the maxillary incisors, showed noincreased risk of ≥5 DMFT at age 15. The Head Start children classified as having nursing caries by two or more, or three or more, decayed maxillary anterior teeth had relative risks (RR) of 1.6 (95% Cl 1.1, 2.4) and 1.4 (95% Cl 1.0, 1.9) for high caries (DMFT ≥5) ten years later, whereas the RR for children with a dmft ≥5 was 2.4 (95% Cl 1.4, 4.3). The classification of nursing caries by carious maxillary incisors appears to depict the overall caries experience in the primary dentition of these Native American Head Start children, rather than specifically nursing caries. The maxillary incisor classifications demonstrated a positive relationship to the presentation of high caries in the permanent dentition, which was not found when nursing caries was measured by buccal or lingual caries of the maxillary incisors.
Cost of Fluoridation: 44 Florida Communities
Authors: Ringelberg Melvin L. , Allen Susan J. , Brown L. Jackson
Published: May 2007

Previous data relating to the cost of fluoridation often do not include annualized costs or costs for labor and maintenance. The purpose of this study was to estimate accurately current costs for initiating and maintaining fluoridation and to develop a methodology that can be used to provide the cost basis for further cost‐effectiveness studies. The data were collected from 44 Florida communities that had initiated community water fluoridation between 1981 and 1989. Equipment, installation, and engineering costs were derived from copies of actual invoices for equipment and services and then adjusted to 1988 dollars. The chemical costs were calculated from operational reports listing flow rate and pounds used. The cost was then adjusted according to whether the hydrofluosilicic acid was supplied as 15‐gallon carboys, 55‐gallon drums, in bulk, or as sodium silicofluoride or sodium fluoride. The initial cost was annualized at 2 percent and 4 percent over 15 years. Calculated operational costs included chemical costs, labor costs, and maintenance and repair costs. The operational costs were then added to the annualized depreciation costs and opportunity costs for the initial investment, to produce an estimated cost per person served. The total mean cost per person for all installations was $1.14 per year at 2 percent and $1.25 per year at 4 percent. The mean cost at 4 percent for communities of fewer than 10,000 was $2.12; for communities between 10,000 and 50,000 it was $0.68; and for communities over 50,000 it was $0.31. The total mean cost per person across all installations was $0.41 at 2 percent and 0.45 at 4 percent. The average yearly cost was related to the size of the community, the number of injection points, and the method of chemical purchase and delivery.
Root Caries Prevalence in Black and White North Carolina Adults over Age 65
Authors: Graves Richard C. , Beck James D. , Disney Judith A. , Drake Claude W.
Published: May 2007

The baseline root caries prevalence of 809 dentate black and white home‐dwelling North Carolinians over age 65 was determined along with the collection of a large number of demographic and behavioral, clinical, and microbiological variables in the longitudinal Piedmont over‐age‐65 Dental Study. In comparison to other studies of older adults, the prevalence of decayed‐filled root surfaces (DFRS) was low, fewer than 2.0 DFRS in whites, and significantly fewer than that in blacks (1.3 DFRS). Although tooth loss was a substantial problem, nearly half of the white population and almost two‐thirds of the black participants exhibited no evidence of root caries history. Even though DFRS prevalence was much lower in blacks, their treatment need for decayed root surfaces (ORS) was significantly higher than for white participants. Correlates with DRS within both race groups appeared to be those that reflect lack of access to dental services or neglect of oral health—decayed coronal surfaces, higher rates of tooth extraction, high CPITN scores and worst loss of attachment ≥7 mm, and more than a year since the last dental visit. Some variables were associated significantly with one racial group, but not the other, while others, particularly root surfaces at risk and age, were not associated significantly with DRS. We concluded that although there was considerable neglect of root caries, particularly among blacks, it was not a serious problem among older North Carolinians.
A Cluster Randomized Controlled Trial Testing the Effectiveness of a School‐based Dental Health Education Program for Adolescents
Authors: Redmond Caroline A. , Blinkhorn Fiona A. , Kay Elizabeth J. , Davies Robin M. , Worthington Helen V. , Blinkhorn Anthony S.
Published: May 2007

Objectives: This trial investigated the value of a school‐based dental health education program in terms of changes in knowledge, reported behavior, and plaque scores. Methods: A total of 2,678 pupils with a mean age of 12.1 years attending 28 schools participated in a school‐based dental health education program. The study used a cluster randomized controlled study design. The health service administrators stipulated that all participants receive the intervention; to meet this requirement, a rolling program of two six‐month periods was utilized. During the first six months, half the adolescents received the intervention program, the other half acting as controls. Throughout a further six‐month period, all participants received the intervention program. This research design allowed comparisons between participants receiving the program for six and 12 months. At baseline, six, and 12 months, a random subsample of 40 children in each participating school had their plaque scores recorded and a questionnaire was used to record their knowledge of dental health and reported dental behavior. Results: The analysis used the subjects clustered within the schools, which were the units of randomization. The intervention program produced statistically significant improvements (P<.001) in knowledge about periodontal disease and the frequency of sugar intake and dental caries in both assessment time periods. The reported frequency of brushing did not change, but the group who had received 12 months of the intervention were more likely (P<.05) to brush for over a minute. At six months the early intervention group had a statistically significant, 13 percent reduction in the mean proportion of sites with plaque compared with the late intervention group (P=.043). This difference was sustained at 12 months (P=.037). Conclusion: This cluster randomized control trial demonstrated that the intervention program resulted in an improvement in knowledge of dental disease and an increase in the reported duration of brushing. These improvements were accompanied by a significant improvement in oral hygiene and a reported reduction in gingival bleeding.
Managed Care in Dental Markets: Is the Experience of Medicine Relevant?
Authors: Hernandez John B. , Coulter Ian , Goldman Dana , Freed James , Marcus Marvin
Published: May 2007

Objective: This paper reports on factors that predict the market penetration and growth into the market of both medical and dental managed care, and the relationship between the two. Methods: Using data from the National Association of Dental Plans, the Interstudy Competitive Edge HMO Census, and the Area Resource File from 1987–95, we created an analytic data base covering the dental HMO market, the medical HMO market, dentist and physician supply, and regional market characteristics. Simple correlation analysis and multivariate linear regression using ordinary least‐squares techniques were used to predict medical HMO penetration and dental HMO penetration in each state during 1994 and 1995. Results: The results show that although the penetration of dental HMOs has been modest when compared to medicine, its growth is predictable by the same factors, and closely follows the pattern found in medical markets. Conclusions: Despite the observed relationship between medical and dental HMO penetration rates, there are potential barriers to managed care in the case of dentistry that may explain the slower growth to date, and that may ultimately decide the extent of managed care penetration into the dental market.
Dental Expenditures and Source of Payment by Race/Ethnicity and Other Sociodemographic Characteristics
Authors: Vargas Clemencia M. , Manski Richard J.
Published: May 2007

Objective: This study presents race/ethnic‐specific distributions of dental expenditures and their sources of payment by socioeconomic characteristics among US working‐age adults. Methods: Data for persons aged 19–64 years from the 1987 National Medical Expenditure Survey (NMES) (n=18,696) were used to calculate mean dental expenditures and their 95 percent confidence intervals. Results: Dental expenditures were reported by 44.5 percent of participants. Non‐Hispanic whites and persons with higher income were more likely to report dental expenditures than their counterparts. Among persons reporting expenditures, those with lower income had lower expenditures than higher‐income persons. No differences in the amount of expenditures by race/ethnicity, sex, or employment status were observed. In all race/ethnic groups almost half the expenditures were paid out‐of‐pocket and one‐third by dental insurance. Conclusion: While sociodemographic characteristics determined who had dental expenditures, they did not determine the amount or source of those expenditures.
Complex Sampling: Implications for Data Analysis
Authors: Caplan Daniel J. , Slade Gary D. , Gansky Stuart A.
Published: May 2007

Investigators in dental public health often use strategies other than simple random sampling to identify potential subjects; however, their statistical analyses do not always take into account the complex sampling mechanism. Often it is not clear whether a given strategy requires adjustment for stratification and/or cluster sampling of observations. We propose that the need for such adjustment depends on the primary study objective. As a general rule, we recommend that if the study goal is to estimate the magnitude of either a population value of interest (e.g., prevalence), or an established exposure‐outcome association, adjustment of variances to reflect complex sampling is essential because obtaining appropriate variance estimates is a priority. However, if the study goal is to establish the presence of an association, especially in a preliminary investigation of novel conditions or understudied populations, obtaining appropriate variance estimates may not be of primary importance; hence, adjustment of variances for complex sampling is not always required, but often is recommended. This paper describes several types of complex sampling designs, methods of adjusting for complex sampling strategies, examples illustrating the effect of adjustment, and alternative approaches for analysis of complex samples.
Plausibility of Periodontal Disease Estimates from NHANES III
Authors: Slade Gary D. , Beck James D.
Published: May 2007

Objective: This study investigated possible reasons for observed discrepancies in prevalence estimates and measures of association for periodontal disease between phases (1988–91 and 1991–94) of the third National Health and Nutrition Examination Survey (NHANES III). Methods: NHANES III data on CD‐ROM were obtained from the National Center for Health Statistics. Accompanying documentation states that each phase and combined phases constitute national probability samples of the US population. Weighted estimates of prevalence (percent of persons affected) and extent (percent of sites affected) for previously reported thresholds of gingival bleeding (GB), attachment loss (AL), and probing pocket depth (PD) were generated using data from all 15,511 persons aged 13–90 years who received periodontal examinations. Odds ratios for associations between four selected risk indicators and both PD and AL were compared between phases. Results: Phase 2 estimates of GB and PD were as much as 56 percent lower than phase 1 estimates and both were different from combined‐phase estimates. However, AL prevalence was consistent between phases. Prevalence differences between phases could be explained in part by examiner variations. Odds ratios for PD differed between phases by as much as one‐third, although the direction and precision of associations were not affected, and differences were reduced after controlling for examiner. Conclusions: Combined‐phase estimates of GB and PD prevalence and extent differ from previously published estimates derived from Phase 1, apparently because estimates in at least one phase of the NHANES III study are biased. However, associations with selected risk indicators were fairly consistent between phases.
Pediatric Oral Health Performance Measurement: Current Capabilities and Future Directions
Authors: Crall James J. , Szlyk Carrie Ingalls , Schneider Donald A.
Published: May 2007

This paper offers an overview of performance measurement in health care, provides a synopsis of the findings and recommendations of an Oral Health Expert Panel organized by the National Committee for Quality Assurance (NCQA) under contract with the Health Care Financing Administration (HCFA), and discusses challenges and possible future directions for pediatric oral health care performance measures development. Existing performance measures for pediatric oral health care are extremely limited; however, several new measures have been proposed and are in various stages of development and testing. Measures capable of being implemented in the short‐term focus on access and use of services, rely on administrative data sources, and represent refinements and enhancements of current measures. Measures proposed for future implementation focus more on the effectiveness of care, consumer assessments of care and plan performance, and the value of services provided to enrolled children. Recommendations are targeted toward high‐risk children who, for the most part, are covered by public programs (e.g., Medicaid and the Children's Health Insurance Program). Nevertheless, the entire set of recommended measures is considered to be relevant to all pediatric populations and applicable to all forms of dental care coverage, including state‐administered programs and commercial third party arrangements.
A Systematic Review of Clinical Diagnostic Criteria of Early Childhood Caries
Authors: Ismail Amid I. , Sohn Woosung
Published: May 2007

Objective: This paper reviews case definitions and clinical diagnostic criteria of early childhood caries (ECC) and severe ECC (S‐ECC) in children aged 1 to 5 years old. The acronym S‐ECC as used in this paper refers to nursing caries, baby bottle tooth decay, rampant caries, labial caries, maxillary anterior caries, and other terms used to refer to severe dental caries in preschool children. Methods: A search was carried out for articles published in peer‐reviewed journals and indexed in MEDLINE using the following terms: nursing caries, baby bottle tooth decay, early childhood caries, rampant caries in preschool children, labial caries, maxillary anterior caries, and nursing bottle caries. MEDLINE's MeSH terms “dental caries” and “deciduous teeth” were used to search for other relevant studies. Reports were selected if they included children 1 to 5 years of age and described diagnostic criteria or case definitions of S‐ECC. Three previous reviews were searched for other relevant reports. One unpublished report was included in this review and data from NHANES III were analyzed to provide information on caries patterns in preschool children in the United States. The first author read all the abstracts from the MEDLINE search and tagged relevant reports for photocopying. He also abstracted all the information from the reports. The first author calibrated the second author, who independently read all included and excluded reports. Disagreements were resolved by consensus. Results: Out of 126 studies, 32 were excluded and 94 (93 published and 1 unpublished) were included in this review. Eighty‐one of the 94 published studies were cross‐sectional surveys or clinical studies, 7 were case‐control clinical studies, 2 studies were controlled clinical trials, and 4 were cohort or field trials. About two‐thirds of the included studies did not report on calibration of examiners. Information on reliability of examiners was reported by 19 of the 94 studies. The included studies varied widely in the name used to identify S‐ECC, case definitions, and diagnostic criteria. “Cavitation” was the most common criterion used to define dental caries. Several studies measured early or noncavitated carious lesions. Twenty‐seven studies used the presence of 1 dmf maxillary incisor to classify a child with S‐ECC. Another 23 and 9 studies defined S‐ECC by the presence of 2+ or 3+ dmf maxillary incisors, respectively. Dental caries in preschool children clusters in pits and fissures and on smooth tooth surfaces of primary molars and maxillary incisors. Conclusions: This review found a wide variation in the case definitions and diagnostic criteria used to diagnose ECC or define S‐ECC. Dental caries in the maxillary incisors is one of several patterns of dental caries that may occur in primary teeth of preschool children. A consensus is needed on case definitions and diagnostic criteria that can assist researchers to test preventive interventions and study the etiology and epidemiology of ECC.
The Role of Dietary Fluoride Supplements in Caries Prevention
Authors: Horowitz Herschel S.
Published: May 2007

Nearly all dental researchers and public health authorities agree that fluoride supplements are highly effective in reducing dental caries in primary and permanent teeth, that benefits to all teeth are greater when administration begins at 2 years of age or younger, that both preemptive and posteruptive exposure is important in imparting cariostatic benefits, that effectiveness is neither enhanced nor reduced by their being combined with vitamins, and that benefits to the offspring of pregnant women who take supplements are uncertain. Several studies show that fluoride supplements delivered in school‐based programs effectively reduce dental caries, and benefits are greater to teeth that receive preemptive exposure in addition to posteruptive exposure. Many parents who, for a variety of reasons, did not administer fluoride supplements at home will enroll their children in school‐based fluoride tablet programs. Effectiveness of fluoride supplements today is undoubtedly smaller than observed previously because of dilution and diffusion effects from other fluoride sources; nevertheless, they still have the same potential efficacy. It is apparent that the current ADA dosage schedule is too high and requires modification; however, the availability of this known‐to‐be‐effective regimen should not be eliminated or restricted.
Total Fluoride Intake and Implications for Dietary Fluoride Supplementation
Authors: Levy Steven M. , Guha‐Chowdhury Nupur
Published: May 2007

This paper reviews the history and validity of recommended “optimal” levels of systemic fluoride intake and the available information on levels of fluoride intake in young children from foods and beverages (including water), dentifrices, dietary fluoride supplements, mouthrinses, and gels. Most of the studies emphasize the substantial variation in ingestion among individuals. Often, a substantial proportion of individuals received fluoride well beyond the mean exposure reported in the study. Limitations in the existing data make it difficult to determine the total distribution of fluoride intake from all sources. Therefore, hypothetical combinations of possible daily fluoride intake from the three main sources (diet, dentifrices, and supplements) are presented for those aged 6, 12, 24, and 36 months, with associated mean intake per kg body weight. Findings suggest that some children exceed the “optimal” level of fluoride intake from single sources alone, while others can from a combination of sources. Moreover, if current recommended “optimal” levels, which have been derived on an empirical basis, are actually lower than what has been quoted in the literature, then more children could be ingesting excessive amounts of fluoride, which could increase their risk of developing objectionable dental fluorosis. The variation and complexity of fluoride ingestion from all sources should be considered in the evaluation of recommendations for use of dietary fluoride supplements.
Fluoride Intake by Infants
Authors: Fomon Samuel J. , Ekstrand Jan
Published: May 2007

Many infants are fully or partially breast fed during the early months of life; however, the percentage of such infants decreases to about 30 percent by 4 months of age. The majority of US infants are fed formulas for most of the first 10 months of life. Although fluoride (F) intakes by fully breast‐fed infants are low, F intakes by partially breast‐fed infants and by formula‐fed infants are highly variable, depending primarily on the F content of the water used to dilute concentrated liquid or powdered infant formula products. In communities with F content of the drinking water less than 0.3 ppm, F consumption by many infants will be 30 to 40 μg·kg‐1· d1. The addition of a F supplement of 0.25 mg/d for a 4 kg infant would increase the F intake by 63 μg·kg‐1· d1, resulting in a total intake of about 100 μg·kg‐1·d1, an intake in the range believed to be associated with development of fluorosis of the permanent teeth. However, for the US infant population generally, many fewer infants are exposed to high F intakes from formula plus a supplement (recommended only for communities with water providing less than 0.3 ppm F) than from formula alone in communities with F content of 1 ppm in the drinking water. In assessing the possible effects of F intake during infancy on development of fluorosis, it is important to recognize that infant feeding practices have changed greatly during the past 30 years. In the 1960s, most infants over 4 months of age were fed fresh cow's milk and intakes of F were therefore low. By the mid 1970s a trend toward more extended feeding of formula was evident and this trend has continued into the 1990s. Prolonged exposure to high intakes of fluoride during infancy is much more common now than in the past.
Mechanism and Timing of Fluoride Effects on Developing Enamel
Authors: Den Besten Pamela K.
Published: May 2007

Fluoride appears to specifically interact with mineralizing tissues, causing an alteration of the mineralization process. In enamel, fluorosis results in a subsurface hypomineralization. This hypomineralized enamel appears to be directly related to a delay in the removal of amelogenins at the early‐maturation stage of enamel formation. The specific cause for this delay is not known, although existing evidence points to reduced proteolytic activity of proteinases that hydrolyze amelogenin. This delay in hydrolysis of amelogenins could be due to a direct effect of fluoride on proteinase secretion or proteolytic activity, or to a reduced effectiveness of the proteinase due to other changes in the protein or mineral of the fluorosed enamel matrix. The formation of dental fluorosis is highly dependent on the dose, duration, and timing of fluoride exposure. The early‐maturation stage of enamel formation appears to be particularly sensitive to the effects of fluoride on enamel formation. Although the risk of enamel fluorosis is minimal with exposure only during the secretory stage, this risk is greatest when exposure occurs in both secretory and maturation stages of enamel formation. The risk of fluorosis appears to be best related to the total cumulative fluoride exposure to the developing dentition.