bluuebunny/crossref_metadata_2025_split huggingface dataset:
Caries Experience of Urban and Rural Children in Saudi Arabia
Authors: Al‐Shammery Abdullah R. 
Published: May 2007

Abstract Objective: Caries experience and restorative treatment needs often are reported to be higher in urban than rural areas in developing countries. The purpose of this study was to compare caries experience in 12‐and 13‐year‐old children in urban and rural areas of Saudi Arabia, a young, oil‐rich, developing country. Methods: A random sample of 1,873 schoolchildren aged 12–13 years from urban and adjoining rural areas of 10 administrative regions in the Kingdom of Saudi Arabia were examined for dental caries. Questionnaires also were administered to elicit information on the frequency of snacking as well as consumption of sweets and soft drinks. Results: No statistically significant differences were found between urban and rural children in caries experience in permanent teeth (mean DMFT=2.69 in urban areas; 2.65 in rural areas), frequency of snacking, or frequency of consumption of sweets and soft drinks. The percentage of DMFT found to be D was equally high (>89%) in both urban and rural areas, indicating a high level of restorative treatment need. Conclusion: In Saudi Arabia, an economically prosperous developing country, exposure to cariogenic diet in urban and rural areas does not differ. Also, a difference in caries experience in urban and rural areas often reported for developing countries does not apply to Saudi Arabia.
Periodontal Disease Estimates in NHANES III: Clinical Measurement and Complex Sample Design Issues
Authors: Winn Deborah M. , Johnson Clifford L. , Kingman Albert 
Published: May 2007

Abstract Objective: This paper evaluates the possibility that examiner bias or other factors contributed to an observed decline in pocket depth and gingivitis between the two three‐year sequential periods of time (or phases) covered by the Third National Health and Nutrition Examination Survey (NHANES III). Methods: Prevalences of periodontal conditions were analyzed using data from two sets of repeat oral health examinations by examining dentists of NHANES III sample persons. The first set includes sample persons who were examined twice by the same examining dentist at an interval of one to six weeks. The second set includes sample persons who were assessed on the same day by both an examining dentist and a reference dentist. Other possible sources of error also were evaluated. Results: Overall kappa statistics measuring agreement between or within dental examiners were within the range observed for other periodontal disease surveys. While differences were found among dentists in the prevalence of pocket depth of 4 mm or more, for each group of sample persons assessed by a reference examiner‐examining dentist pair, the reference examiner's periodontal measurements closely corresponded to measurements made by the examining dentists. Conclusions: Differences between dental examiners in prevalences of periodontal conditions may be due in pan to the fact that examinees were not randomly assigned to examiners. As a result, the sample persons examined by each dentist may not have been alike in characteristics thought to affect periodontal disease status. These findings suggest that the observed declines in periodontal health status between phases is not due to examiner bias. This unexplained decline may be the result of sampling variation. It is recommended that combined six‐year survey results be presented whenever possible.
A Primer on Outcomes in Dentistry
Authors: Bader James D. , Ismail Amid I. 
Published: May 2007

AbstractExpectations for evidence of “value” on the part of dental care purchasers and growth in the evidence‐based dentistry movement are beginning to demonstrate the narrow and incomplete nature of dentistry's knowledge of the outcomes of dental conditions and treatment. In this paper a classification scheme for dental outcomes is described that illustrates the broad range of outcomes information important to patients, health care providers, purchasers, and society. The uses for outcomes information are discussed and suggestions are offered for improving dentistry's knowledge of outcomes through the cooperative involvement of dental research, dental education, and dental practice.
Evaluation of Audit‐based Performance Measures for Dental Care Plans
Authors: Bader James D. , Shugars Daniel A. , White B. Alex , Rindal D. Brad 
Published: May 2007

Abstract Objective: Although a set of clinical performance measures, i.e., a report card for dental plans, has been designed for use with administrative data, most plans do not have administrative data systems containing the data needed to calculate the measures. Therefore, we evaluated the use of a set of proxy clinical performance measures calculated from data obtained through chart audits. Methods: Chart audits were conducted in seven dental programs—three public health clinics, two dental health maintenance organizations (DHMO), and two preferred provider organizations (PPO). In all instances audits were completed by clinical staff who had been trained using telephone consultation and a self‐instructional audit manual. The performance measures were calculated for the seven programs, audit reliability was assessed in four programs, and for one program the audit‐based proxy measures were compared to the measures calculated using administrative data. Results: The audit‐based measures were sensitive to known differences in program performance. The chart audit procedures yielded reasonably reliable data. However, missing data in patient charts rendered the calculation of some measures problematic—namely, caries and periodontal disease assessment and experience. Agreement between administrative and audit‐based measures was good for most, butnotall, measures in one program. Conclusions: The audit‐based proxy measures represent a complex but feasible approach to the calculation of performance measures for those programs lacking robust administrative data systems. However, until charts contain more complete diagnostic information (i.e., periodontal charting and diagnostic codes or reason‐for‐treatment codes), accurate determination of these aspects of clinical performance will be difficult.
Dentist Reliability in Classifying Disease Risk and Reason for Treatment
Authors: Bader James D. , White B. Alex , Olsen Oralee , Shugars Daniel A. 
Published: May 2007

Abstract Objective: The reliability of practicing dentists' classifications of patients' caries risk and periodontal disease risk and reason for treatment for individual teeth were determined. The risk classification protocols had been in use in a group practice for more than a year, and the reason‐for‐treatment protocol had been introduced six months previously. Methods: Eight dentists' classifications for caries (n=66) and periodontal disease risk (n=66), and six dentists' classifications for reason for treatment (n=73) were compared to those of a nominal standard examiner. Reliability was expressed as percent agreement and kappa values. Results: Percent agreement was 76 percent, 83 percent, and 74 percent for caries, periodontal disease, and reason for treatment, respectively, with kappa values of 0.56, 0.70, and 0.69. Conclusions: Dentists can attain reasonable levels of reliability using simple classification protocols with little formal training, although misclassification may be problematic for specific administrative or research‐related purposes.
A System of Diagnostic Codes for Dental Health Care
Authors: Leake James L. , Main Patricia A. , Sabbah Wael 
Published: May 2007

Abstract Objective: We set out to develop and implement a system of diagnostic codes for use in the computerized management information system of the Community Dental Services of the North York Public Health Department, Methods: We received staff input on common diagnoses, reviewed other diagnostic systems and established criteria for an ideal coding system. The codes are consistent with the format of other classification systems used in dental management information in Canada. They were implemented in 1997–98. Results: We developed a system of four‐digit, numeric codes for dental diagnoses. The diagnostic codes are specific at the level of the patient, consistent with current evidence on the natural history and classification of diseases, consistent with conventional measures of oral conditions, and fit the paradigm of the Canadian system of treatment codes. In the first year, 91 percent of 6,740 patients had at least one diagnosis, with a mean of 2.5 per patient. The five most common diagnoses were smooth surface caries, pit and fissure caries, calculus, teeth with deep fissures, and gingivitis. Conclusions: We have developed a coding system for dental diagnoses that has achieved high use and provided more accessible information on the conditions seen by staff dentists.
Fluoride Metabolism and Excretion in Children
Authors: Whitford Gary M. 
Published: May 2007

AbstractThis paper compares fluoride pharmacokinetics (plasma, renal, and extrarenal clearances) and metabolic balances in healthy infants or children with those in young or middle‐aged adults. Regardless of age, the removal of fluoride from the intra‐and extracellular body fluids occurs almost exclusively by uptake in calcified tissues and excretion in the urine. While there can be considerable differences among individuals, the rates at which fluoride is cleared from plasma by calcified tissues and the kidneys in adults are approximately equal. The calcified tissue clearance of fluoride from plasma in children is substantially higher than that by the kidneys. This is due to the greater surface area of the loosely organized crystallites in the developing calcified tissues during growth. Thus, the balance of fluoride (total intake minus total excretion) is typically higher in children than in adults, but it can be positive or negative at any age. Positive balance occurs when chronic fluoride intake is sufficient to prevent plasma concentrations from declining. When positive, the fluoride content of the calcified tissues, which contain more than 99 percent of the body's fluoride, tends to gradually increase. Negative balance, which indicates net mobilization of fluoride from calcified tissues, can occur when plasma concentrations decline due to a reduction in the level of fluoride intake.
The Differential Diagnosis of Fluorosis
Authors: Pendrys David G. 
Published: May 2007

AbstractFollowing the introduction of the first fluorosis index by Dean, a series of fluorosis indexes were introduced. While they may differ in the specific way fluorosis is categorized, they all nevertheless use the same underlying diagnostic signs—originally described by Dean, Black, and McKay—that were causally linked to the development of enamel in areas with above‐optimum fluoride in the drinking water. Underlying the various fluorosis indexes is the belief that specific clinical diagnostic criteria, based upon established clinical signs, can be utilized to differentiate fluorotic from nonfluorctic enamel opacities. These criteria repeatedly have been substantiated in studies in which the presence of enamel fluorosis, identified by clinical differential diagnosis, has been associated with fluoride exposure history. Further, to whatever extent nonfluorotic opacities have been misdiagnosed as fluorosis, observed estimates of association derived from analytical studies will have been underestimated.
The Prevalence and Severity of Enamel Fluorosis in North American Children
Authors: Rozier R. Gary 
Published: May 2007

AbstractThe question considered in this review is the extent to which changes in the prevalence or severity of enamel fluorosis have occurred over the last half‐century. Emphasis is given to a review of those studies in which subjects are drinking water that is fluoride deficient and those in which subjects are drinking optimally fluoridated water, either adjusted or natural. Trends in fluorosis were examined using two definitions of fluorosis (definite and any signs) and three types of comparisons—comparisons of pooled estimates from all available studies that include data from different communities and time periods, comparisons of estimates from the same communities at different times, and comparisons of estimates from selected studies in the early years of fluorosis research with results of the US National Fluorosis Survey done by the National Institute of Dental Research. A clear increase in fluorosis among populations drinking community water that contains less than 0.3 ppm fluoride was found. Results of the comparisons using studies with Dean's Index pooled at different time points, comparisons in the same communities over time, and comparisons of prevalence found in selected communities before fluoride was widely available with the National Fluorosis Survey all support this conclusion. An increase in the prevalence of fluorosis in those drinking optimally fluoridated water likely has occurred as well; however, evidence for such a trend is not as clear as for fluoride deficient communities because of mixed results depending on the type of comparison. The majority of fluorosis cases continue to be mild and seem of little esthetic consequence for most of the public or dental profession. But a few cases of more severe fluorosis can be found now in some communities. Because the prevalence of fluorosis is now higher than 50 years ago, we can conclude that fluoride availability to the developing enamel during critical periods when enamel is at risk of fluorosis has increased in North American children.
Overview of the History and Current Status of Fluoride Supplementation Schedules
Authors: Adair Steven M. 
Published: May 2007

AbstractClinical trials of dietary fluoride supplements began in the 1940s in an effort to bring the benefits of fluoride to those who did not receive it through their drinking water. Following the early success of these trials, the Council on Dental Therapeutics of the American Dental Association (ADA) published its first recommendations for fluoride supplementation in 1958. The American Academy of Pediatrics (AAP) followed with its own recommendations in 1972. During the 1970s a variety of alternative schedules appeared in the literature, most in reaction to the findings of unexpectedly high levels of enamel fluorosis in children being supplemented with the AAP schedule. In 1979 the ADA and AAP agreed on essentially identical schedules. During the 1980s, however, the prevalence of enamel fluorosis continued to increase, and fluoride supplements were found in some studies to be a risk factor for fluorosis. This finding prompted another round of dosage schedule recommendations in the early 1990s. This paper presents a history of fluoride dosage recommendations and reviews the recent proposals for reducing supplement dosage.
The Case for Reducing the Current Council on Dental Therapeutics Fluoride Supplementation Schedule
Authors: Newbrun Ernest 
Published: May 2007

AbstractThe milder forms of dental fluorosis have increased in prevalence since the original epidemiologic surveys of the 1930s. Most studies of fluorosis have identified the use of supplements as a major risk factor. Fluorosis could be prevented, in part, by stopping the improper prescription of fluoride supplements in optimally fluoridated areas and by lowering the dosage currently recommended by the Council on Dental Therapeutics supplemental fluoride schedule. At a 1991 workshop at the University of North Carolina, five alternatives to the present ADA Council on Dental Therapeutics schedule were suggested; however, no consensus on dosage was reached. Recently, the Federation Dentaire International adopted a dosage schedule of 0.25 mg F from birth to 3 years of age, 0.5 mg F from 3 to 5 years, and 1 mg F thereafter. At a 1992 Canadian workshop it was proposed that supplements should not be started until age 3, should be given only to those “at high risk” of caries, and only 0.25 mg F should be prescribed from 3 to 5 years of age. Similarly, in some European countries supplements are not recommended until 3 years, at which time 0.5 mg F is prescribed, but only “for children at risk.” Australia is considering a dosage schedule starting with 0.25 mg Fat 6 months, again only for those “particularly at risk of caries.” Serious problems exist in limiting fluoride supplementation only to high‐caries‐risk children because they are not easily identifiable at a young age. Ideally, a dosage schedule should be based on body surface area or weight rather than simply age, and supplements should be in the form of lozenges for children over 2 years of age. A reduced fluoride supplement dosage schedule is proposed.
Oral Cancer Educational Materials for the General Public:1998
Authors: Chung Vicki , Horowitz Alice M. , Canto Maria T. , Siriphant Piya 
Published: May 2007

Abstract Objective: Previous studies have shown that US adults are not well informed about oral cancers and only 15 percent ever have had an oral cancer examination. This study sought to determine the quantity and adequacy of educational materials designed to inform or educate US adults about risks for, and signs and symptoms of, oral cancer and the need for an oral cancer examination. Methods: Letters requesting copies of oral cancer educational materials produced by the organization or agency—leaflets, fact sheets, pamphlets, videos, posters—were sent to 172 national and state organizations or agencies. To determine the adequacy of the items, a previously developed, tested, and used form based on current science was adapted for this study. In addition, the SMOG index was used to determine readability for printed items. Results: Seventy‐seven percent or 132 of the selected organizations responded to queries. A total of 59 items were received that focused on or included the topic of oral cancer. Twenty of these 59 items focused specifically on oral cancer; the balance, on other topics, but mentioned oral cancer. The readability ranged from sixth to 13th grade. Conclusions: This study demonstrates a dearth of educational materials about oral and pharyngeal cancers; most are written at too high a grade level for the general public. These findings may help to explain why the public is so uninformed about these neoplasms.
A Comparison of Sealant Placement Techniques and 12‐month Retention Rates
Authors: Kanellis Michael J. , Warren John J. , Levy Steven M. 
Published: May 2007

Abstract Objective: This study compared time required and 12‐month retention for two methods of sealant placement: traditional acid‐etch technique and air‐abrasion technique without acid etch. Methods: Sealants were placed on the permanent first molars of 84 children in grades 1–4 who were randomly assigned to treatment groups. All sealants were placed in a school setting by the same clinician. Chair time required for sealant placement was recorded, and retention rates were determined for each technique 12 months after placement. Results: Mean chair time for placement of sealants on four first molars using the air‐abrasion technique was significantly less than for the acid‐etch technique (7:36 minutes vs 10:56 minutes). Fifty‐eight children were available at 12‐month follow‐up; an examiner not involved in sealant placement and masked as to the technique used determined retention. Rates of complete retention for occlusal surfaces were not significantly different for the two techniques, although the rate for acid etch was higher than that for air abrasion (95% vs 87%). The complete retention rates for the acid‐etch technique were significantly higher than air abrasion for buccal and distolingual surfaces. These rates were 65 percent and 58 percent, respectively, for acid etch and 6 percent and 28 percent, respectively, for air abrasion. Conclusion: Although more research is needed to improve air‐abrasion applications, it does not appear that air abrasion without acid etching offers a significant advantage over traditional sealant placement methods and, in fact, appears to be inferior to the acid‐etch technique for use in public health settings.
Dean's Fluorosis Index: an Assessment of Examiner Reliability
Authors: Kumar Jayanth V. , Swango Philip A. , Opima Pandy N. , Green Elmer L. 
Published: May 2007

Abstract Objective: This report describes the interexaminer reliability achieved using Dean's Index in a study of dental fluorosis, and shows the effect on kappa values of assigning different weights to the various components of Dean's Index. Methods: Three dentists conducted replicate fluorosis examinations on 202 children in Newburgh and Kingston, NY. Examiner reliability was assessed by computing percent agreement and weighted and unweighted kappa statistics. Results: Agreement on the presence or absence of fluorosis using Dean's definition of fluorosis ranged from 92 to 97 percent and the respective kappa values ranged from 0.75 to 0.94. A comparison of subject‐level severity scores for Dean's Index resulted in percent agreement ranging from 79.6 percent to 86.8 percent and kappa values ranging from 0.67 to 0.76. Weighting the kappa statistics improved agreement and reduced the differences. Conclusions: Examiners showed good to excellent agreement beyond chance in the use of the index. Subject level kappa scores were higher than tooth‐level scores.
Identification of Adult Populations at High Risk for Dental Caries Using a Computerized Database and Patient Records: A Pilot Project
Authors: Powell Virginia , Leroux Brian G. , Martin Jean A. , White B. Alexander 
Published: May 2007

Abstract Objective: The purpose of this study is to test the usefulness of dental insurance claims history, supplemented with radiographic caries diagnoses, as a means of identifying caries‐active and caries‐inactive working adults, as determined by bacterial levels. Computerized identification of at‐risk groups may facilitate subject selection for clinical trials designed to test caries‐preventive strategies. Methods: Two groups of subjects were initially selected from an insurance database based upon their dental service utilization during a one‐year period: a “low restorative” group of individuals defined as persons who had received no restorative treatment, and a “high restorative” group comprised of individuals who had received at least three multisurfaced restorations. A chart review confirmed a diagnosis of caries in the high restorative group and an absence of caries in the low restorative group. Subjects were then approached for saliva collection. The low and high restorative groups were compared for salivary mutans streptococci and lactobacilli levels, stimulated flow rate, and buffer capacity (n=48). Results: The high and low restorative groups differed in mutans streptococci levels, but not on other measures. Conclusions: A group of subjects who had recently received multisurfaced restorations that were placed for reasons of caries had significantly higher levels of mutans streptococci and potential for continued caries activity when compared to a group of subjects who had received no restorations and were caries free. [J Public Health 2000;60(2):82–84]