bluuebunny/crossref_metadata_2025_split huggingface dataset:
National Health Care: Whither Goeth Dentistry?*
Authors: Corbin Stephen B. 
Published: May 2007

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

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

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

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

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

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

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

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

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

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

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

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

ABSTRACTEvidence is increasing that oral health has important impacts on systemic health. This paper presents data from the third National Health and Nutrition Examination Survey (NHANES III) describing the prevalence of dental caries and periodontal diseases in the older adult population. It then evaluates published reports and presents data from clinical and epidemiologic studies on relationships among oral health status, chronic oral infections (of which caries and periodontitis predominate), and certain systemic diseases, specifically focusing on type 2 diabetes and aspiration pneumonia. Both of these diseases increase in occurrence and impact in older age groups. The NHANES III data demonstrate that dental caries and periodontal diseases occur with substantial frequency and represent a burden of unmet treatment need in older adults. Our review found clinical and epidemiologic evidence to support considering periodontal infection a risk factor for poor glycemic control in type 2 diabetes; however, there is limited representation of older adults in reports of this relationship. For aspiration pneumonia, several lines of evidence support oral health status as an important etiologic factor. Additional clinical studies designed specifically to evaluate the effects of treating periodontal infection on glycemic control and improving oral health status in reducing the risk of aspiration pneumonia are warranted. Although further establishing causal relationships among a set of increasingly more frequently demonstrated associations is indicated, there is evidence to support recommending oral care regimens in protocols for managing type 2 diabetes and preventing aspiration pneumonia.
Target Outcomes for Long‐term Oral Health Care in Dementia: a Delphi Approach
Authors: Jones Judith A. , Brown Elizabeth J. , Volicer Ladislav 
Published: May 2007

ABSTRACTThis study developed a list of target outcomes for long‐term oral health care in persons with dementia. A three‐round Delphi study was used to develop a list of target outcomes. Participants included 99 staff and 171 family members associated with the Dementia Special Care Unit in Bedford, MA. In Round 1 participants were asked to list five outcomes for long‐term oral health care. Items were grouped, redundancies removed, and fed back in Round 2, when participants scored the items from 1 (least important) to 10 (most important). Round 2 responses were tabulated and the top 20 were fed back for scoring in Round 3. The top 10 target outcomes in decreasing order of importance were: patient will be free from oral pain, patient will not be at risk for aspiration, emergency dental treatment will be available when needed, prevent mouth infections, daily mouth care is as much a part of daily care as shaving or brushing hair, prevent discomfort from loose teeth or sore gums, teeth will be brushed thoroughly once a day, staff will be able to provide oral hygiene care as needed, provide dental care to prevent problems eating, and recognize oral problems early. Family and professional caregivers were remarkably consistent in their identification of the top 10 outcomes. Further work is needed to ensure broad international and interdisciplinary acceptance (including families and the long‐term care residents themselves) of target outcomes for long‐term oral health care in persons with dementia.