bluuebunny/crossref_metadata_2025_split huggingface dataset:
Temporal Changes in Dental Caries Levels and Patterns in a Native American Preschool Population
Authors: Douglass Joanna M. , O'Sullivan David M. , Tinanoff Norman 
Published: April 2007

Abstract Objectives: The purposes of this study were to assess current dental caries experience and levels of mutans streptococci in Apache children in 1993 and to determine how caries levels and patterns were different from 15 years before. Methods: Four‐year‐old Head Start children (n=127) were examined for dental caries and sampled for salivary mutans streptococci in 1993. Dental caries information on 113 4‐year‐old children from the same location was obtained from a chart audit of the 1978–79 Head Start dental examinations. Results: Neither the caries prevalence (95%) nor the prevalence of caries patterns differed between the 1978–79 and 1993 cohorts. However, the level of treatment received in 1993 was greater than that in 1978–79. Children with nursing caries (64%) had a greater severity of fissure caries and a greater prevalence of posterior proximal caries compared with caries‐positive children without nursing caries. The mean dmfs and dmft of the children categorized in the high mutans streptococci range were greater than those of children categorized in the moderate range. Conclusion: The caries prevalence found in these preschool Native Americans is among the highest reported for this age group and does not differ from that found at this location 15 years before. It appears that children with nursing caries in this population are at greater risk for posterior caries patterns.
Consequences of Success: Do More Teeth Translate into More Disease and Utilization?
Authors: Joshi Anil , Douglass Chester W. , Feldman Henry , Mitchell Paul , Jette Alan 
Published: April 2007

Abstract Objectives: Increased tooth retention coupled with increased numbers of older adults means that the actual number of teeth at risk to dental disease will increase sharply. Whether this increase in the number of teeth will translate into more disease and utilization in unknown. The purpose of this study was to test this “more teeth, therefore more dental disease” theory using cross‐sectional data. Methods: In‐home personal interview and oral examination data were obtained on a probability sample of elders aged 70 years and older living in the six New England states using the Medicare beneficiary list as a sampling frame. Data on dental utilization, number of teeth, dental caries, and periodontal disease were included in the current analysis. Results: Analysis of variance on subjects with 1–10 (Group 1), 11–24 (Group 2), and 25–32 (Group 3) teeth show that the extent of bleeding on probing, pocket depth, and loss of attachment all increase as numbers of teeth increase. Similarly, a greater number of restored coronal and root surfaces were found in Group 3 relative to the other two groups. Mean numbers of decayed and filled coronal surfaces were 8.4 in Group 1,33.0 in Group 2, and 50.3 in Group 3. In contrast, unrestored coronal and root surfaces were significantly higher in Group 1 (mean root DS=1.3) than Group 3 (mean root DS=0.3). Utilization patterns of those with successful aging dentitions (Group 3) show that they are visiting dentists more frequently than the compromised group (Group 1). Conclusion: These cross‐sectional data obtained from a probability sample of New England elders show that subjects who retained higher numbers of teeth have more periodontal disease and dental caries experience, and visit the dentist more frequently.
Relationship Between Dental and General Health Behaviors in a Canadian Population
Authors: Payne Barbara J. , Locker David 
Published: April 2007

Abstract Objectives: Because the promotion of healthier life styles has become a public health issue of increasing interest, a survey was conducted to compare levels of preventive oral and general health behaviors. Methods: A randomly selected population of voters aged 19 years and older living in a multicultural suburb of metropolitan Toronto, Canada, participated in a mail survey. Results: Dentate respondents (n=976) reported high optimal levels for at least daily toothbrushing (96%); moderate levels of preventive yearly dental examination (69%); and low levels for flossing (22%), using an interdental device (25%), not snacking between meals (12%), and consuming fewer than two cariogenic foods on the previous day (26%). For the general health behaviors, the majority did not smoke (75%), had low alcohol intake (89%), used seat belts (69%), and exercised three times weekly (50%). Additive indices for the oral and general health behaviors were significantly, although weakly, correlated (r=.13; P<.001) and few respondents (31.3%) scored high on both indices. OLS regression on a combined index of oral and general health behaviors found that females, older respondents, and those with higher incomes were more likely to engage in a higher level of health behaviors. Conclusion: These results indicate the need to develop health promotion life style programs that incorporate both dental and general health components and to target these programs to younger age groups, males, and those with low incomes.
A Taxonomy for Lay Risk Perceptions of Dentistry
Authors: Deahl S. Thomas , Kromer Megan E. 
Published: April 2007

Abstract Objectives: This paper aims to develop and organize a set of variables that can be used to: (1) test the widely held but unproven assumption that lay risk perceptions can adversely affect dental care, (2) investigate the possible influence of lay risk perceptions on dental care, and (3) permit the evaluation of risk communication strategies in dentistry. Methods: We reviewed the literature regarding risk perception and risk communication in health care and technology. We then selected a set of variables that could be measured in a study of the general public and organized these in a taxonomy to suggest likely relationships among the variables. Results: The central relationship of the proposed taxonomy is between a lay person's perception of dental risk and a set of measurable outcomes that could affect that person's dental care. The taxonomy lists three possible influences on the lay person's risk perception: attributes of the individual, attributes of the dental procedure or technology perceived as risky, and attributes of the dental practice. Conclusion: Systematic testing of the proposed variables should demonstrate whether lay risk perceptions substantially influence dental care, and if so, which factors most strongly influence risk perceptions. A model of lay risk perceptions of dentistry then could be developed and strategies could be devised to minimize the detriment, if any, to dental care from risk perception.
Cost Implications of Differences in Dentists' Restorative Treatment Decisions
Authors: Shugars Daniel A. , Bader James D. 
Published: April 2007

Abstract Objectives: This study sought to determine the effects of variation in both dentists' decisions to treat and choice of treatment on the costs of care. Methods: Each of 37 patients was examined individually by several practicing dentists (between 3–22, x=6.2). For each dentist's recommended treatment for each patient, the total cost of restorative treatment was calculated first using the least expensive treatment possible for each tooth indicated as needing treatment, and second using the costs of specific treatment selected by each dentist. Results: Considerable variation was found among dentists in each patient's cost of treatment using both methods. The mean of the median cost per patient of the specific treatment selected was three times larger than the cost per patient of basic treatment. Few dentists were found to consistently recommend higher or lower cost treatment plans. Conclusion: These findings suggest that inconsistencies in both dentists' decisions to intervene and dentists' selection of treatment can have a profound effect on cost. Further, focusing utilization review on “outlier dentists” is likely to be much less productive in containing costs and improving quality than comprehensive attempts to improve consistency across the profession.
The Fluoridation War: a Scientific Dispute or a Religious Argument?
Authors: Newbrun Ernest 
Published: April 2007

AbstractCommunal water fluoridation is not considered controversial by the vast majority of the scientific community; however, politically it has persisted as an issue that many legislators and community leaders have avoided because of an aura of dispute. it has been a battleground for vigorous opposition by a very small but outspoken minority who have fought it with the dedication of religious zealots. This paper reviews the nature of the opposition, who they are, the broad thrust of their arguments, some of the specific issues they have raised, and their techniques.
The Dental Curriculum: What Should Be New in the 21st Century?
Authors: Baum Bruce J. 
Published: April 2007

AbstractDental education is at a critical juncture. The success of water fluoridation has reduced the caries burden of Americans and, consequently, has raised questions about the disproportionate technical emphasis on treating the sequelae of caries in US dental schools. Additionally, several powerful external factors—such as changing demographics, advances in biological science, fundamental changes in our health care delivery system, and a modest US economy—are forcing dental educators to question the appropriateness of retaining the current dental curriculum into the 21st century. The author considers these factors, suggests what type of dentist will be needed by society in approximately 20 years, and concludes that today's dental educational system is inadequate to produce such a dentist Several elements, in addition to technical excellence, are required for the dental curriculum, including major changes in pedagogy, relevant science training, practical fluency in medicine, an increased mix of stomatologic skills, and broader contact with other health care providers.
Factors Associated with Having Oral Cancer Examinations Among US Adults 40 Years of Age or Older
Authors: Horowitz Alice M. , Nourjah Parivash A. 
Published: April 2007

Abstract Objectives: This study describes factors associated with having an oral cancer examination among US aduits 40 years of age or older. Methods: Data used in this study are from the Cancer Control supplement of the 1992 National Health Interview Survey, which included questions about having had an oral cancer screening examination and knowledge of risk factors for oral cancers. The survey was administered to a national sample 18 years of age and older (n=12,035). Questions regarding beliefs and opinions about cancers in general also were asked and their associations with responses to having had an oral cancer examination studied. Analyses are limited to those respondents 40 years of age and older (n=6,538). Results: Fifteen percent of the adults reported having had an oral cancer examination. Of these, 48 percent had the exam during the past year and 31 percent had an exam one to three years ago. Respondents who were above the poverty level, white, non‐Hispanic, 40 to 64 years of age, and who had more than a high school education and a higher level of knowledge about risk factors for oral cancer were more likely to have had an oral cancer examination. Conclusion: These findings demonstrate the need for vigorous health education and health promotion interventions aimed at health care providers and the public to increase knowledge about risk factors for oral cancers and to increase oral cancer examinations.
Cancer Prevention in the Dental Practice: Oral Cancer Screening and Tobacco Cessation Advice
Authors: Martin Linda M. , Bouquot Jerry E. , Wingo Phyllis A. , Heath Clark W. 
Published: April 2007

Abstract Objectives: In this paper we describe the proportion of US adults who report receiving oral cancer screening and tobacco cessation counseling and assistance from dentists and other health professionals. Methods: Data from the 1992 National Health Interview Survey (NHIS) Cancer Control Supplement, a nationally representative sample of 12,035 adults 18 years of age and older, are analyzed. Results: In 1992, less than 10 percent of adults reported oral cancer screening by a dentist or hygienist within the past three years. White adults (10.1%; 95% Cl=9.3,10.9) reported an oral cancer screening three times more frequently than black (3.2%; 95% Cl=1.9, 4.5) or Hispanic (3.4%; 95% Cl=2.1, 4.7) adults. About half of adult current smokers had seen a dentist within 12 months, and of those only 24.1 percent (95% Cl=21.7, 26.5) had been advised to quit smoking. Heavy smokers (two or more packs a day) were more likely to have been advised to quit than light (pack or less per day) or occasional smokers. A similar proportion (24.3%; 95% Cl=17.6, 31.0) of white adult men who reported using smokeless tobacco products had been told by a dentist to quit using tobacco. Conclusions: Results from this population‐based survey indicate that cancer screening and tobacco cessation advice are underutilized in the dental practice. Increased patient awareness and implementation of screening and tobacco cessation interventions could improve oral cancer incidence and mortality and have a public health benefit for other tobacco‐related morbidity and mortality as well.
Evaluation of Bias and Logistics in a Survey of Adults at Increased Risk for Oral Health Decrements
Authors: Gilbert Gregg H. , Duncan R. Paul , Kulley Andrew M. , Coward Raymond T. , Heft Marc W. 
Published: April 2007

Abstract Objectives: Designing research to include sufficient respondents in groups at highest risk for oral health decrements can present unique challenges. Our purpose was to evaluate bias and logistics in this survey of adults at increased risk for oral health decrements. Methods: We used a telephone survey methodology that employed both listed numbers and random digit dialing to identify dentate persons 45 years old or older and to oversample blacks, poor persons, and residents of nonmetropolitan counties. At a second stage, a subsample of the respondents to the initial telephone screening was selected for further study, which consisted of a baseline in‐person interview and a clinical examination. We assessed bias due to: (1) limiting the sample to households with telephones, (2) using predominantly listed numbers instead of random digit dialing, and (3) nonresponse at two stages of data collection. Results: While this approach apparently created some biases in the sample, they were small in magnitude. Specifically, limiting the sample to households with telephones biased the sample overall toward more females, larger households, and fewer functionally impaired persons. Using predominantly listed numbers led to a modest bias toward selection of persons more likely to be younger, healthier, female, have had a recent dental visit, and reside in smaller households. Blacks who were selected randomly at a second stage were more likely to participate in baseline data gathering than their white counterparts. Comparisons of the data obtained in this survey with those from recent national surveys suggest that this methodology for sampling high‐risk groups did not substantively bias the sample with respect to two important dental parameters, prevalence of edentulousness and dental care use, nor were conclusions about multivariate associations with dental care recency substantively affected. Conclusion: This method of sampling persons at high risk for oral health decrements resulted in only modest bias with respect to the population of interest
Do Root Lesions Tend to Develop in the Same People Who Develop Coronal Lesions?
Authors: Beck James D. , Drake Claude W. 
Published: April 2007

Abstract Objectives: The three purposes of this study are to: (1) describe the relationship between the prevalence of coronal caries and root caries; (2) describe the relationship between the three‐year incidence of coronal caries and root caries; and (3) if the two conditions are associated, develop a multiple regression model that identifies characteristics distinguishing people who had increments of both root caries and coronal caries from people who had increments of either coronal caries or root caries, or who had no new caries. Methods: Dental examinations and interviews were conducted in the homes of a randomly selected, stratified sample of people over the age of 65 years in five North Carolina counties. The relationships between coronal and root D and DF were analyzed through contingency table analyses, and ordinal logistic regression was used to identify characteristics that differentiated people who had both coronal and root D over the three years from people who had either coronal or root D and people who had no new disease. Results: Evidence of root and coronal caries in whites was much more likely to be in the form of fillings, while for blacks, it was more likely to be in the form of untreated decay. Prevalence rates of coronal and root D and DF were significantly associated for both blacks and whites. Incidence rates based on DF indicated that root and coronal caries were not associated in whites, but were associated in blacks. People more likely to experience both types of caries had more gingival recession at baseline, greater average attachment loss over the three years, and lactobacilli at baseline. In addition, the presence of Porphymonas gingivalis at three years was important for whites. Conclusion: It appears that coronal and root caries do tend to appear together in the same individuals, but fillings attenuate that relationship. The impact of dental treatment on the epidemiology of dental caries appears to be considerable and calls into question whether the F component of the caries index is related to disease as defined by epidemiologic criteria.
Dental Caries and Dental Fluorosis at Varying Water Fluoride Concentrations
Authors: Heller Keith E. , Eklund Stephen A. , Burt Brian A. 
Published: April 2007

Abstract Objectives: The purpose of this study was to investigate the relationships between caries experience and dental fluorosis at different fluoride concentrations in drinking water. The impact of other fluoride products also was assessed. Methods: This study used data from the 1986–87 National Survey of US Schoolchildren. Fluoride levels of school water were used as an indicator of the children's water fluoride exposure. The use of fluoride drops, tablets, professional fluoride treatments, and school fluoride rinses were ascertained from caregiver questionnaires. Only children with a single continuous residence (n=18,755) were included in this analysis. Results: The sharpest declines in dfs and DMFS were associated with increases in water fluoride levels between 0 and 0.7 ppm F, with little additional decline between 0.7 and 1.2 ppm F. Fluorosis prevalence was 13.5 percent, 21.7 percent, 29.9 percent, and 41.4 percent for children who consumed <0.3, 0.3 to <0.7, 0.7 to 1.2, and >1.2 ppm F water. In addition to fluoridated water, the use of fluoride supplements was associated with both lower caries and increased fluorosis. Conclusion: A suitable trade‐off between caries and fluorosis appears to occur around 0.7 ppm F. Data from this study suggest that a reconsideration of the policies concerning the most appropriate concentrations for water fluoridation might be appropriate for the United States.
Validity of Self‐reported Tooth Counts During a Telephone Screening Interview
Authors: Gilbert Gregg H. , Duncan R. Paul , Kulley Andrew M. 
Published: April 2007

Abstract Objectives: Telephone screening has become a common method used in health services research to identify efficiently persons in specific populations of interest. In this research, we used a large‐scale telephone screening survey to assess: (1) the effectiveness of the telephone method in gathering tooth count information by measuring response rate (cooperation) to specific questions and (2) the validity of subjects' reports of the number of remaining natural teeth. Methods: We used a telephone screening methodology to identify dentate persons (at least one natural tooth remaining) who were 45 years old or older and resided in one of four counties of north Florida. At a second stage, a sample of the telephone screening participants was selected for further study, which consisted of a baseline in‐person interview and a clinical examination. We compared the number of remaining teeth reported during the telephone interview with the number determined at baseline examination. Results: The telephone method was effective at gathering tooth count information, although response rates varied with the level of specificity required. Almost all subjects reported the number of teeth at least at the nominal and ordinal levels, but fewer than three‐fourths reported the number at the interval level. When the unit of analysis was the overall sample, self‐reported number of teeth was a valid measure of the true number. When the unit of analysis was the individual subject, validity was associated with certain clinical and sociodemographic factors. Conclusion: When the unit of analysis is the overall sample, these results suggest that self‐reported tooth counts during a telephone interview are sufficiently valid to meet all but the most stringent data requirements. When the unit of analysis is the individual subject, these tooth counts may not be valid, depending upon the degree of specificity required and subject characteristics.
Validity of Two Methods for Assessing Oral Health Status of Populations
Authors: Beltrán Eugenio D. , Malvitz Dolores M. , Eklund Stephen A. 
Published: April 2007

Abstract Objective: This investigation assessed two methods for estimating epidemiologic indicators of oral health status among children: (1) a visual‐only screening, performed independently by a dental hygienist and a registered nurse; and (2) a parent‐ or guardian‐completed questionnaire. The indicators included dichotomous variables measuring dental caries and treatment needs, presence of sealants, injuries to the anterior teeth, and dental fluorosis. Methods: Following training and calibration, data were collected over an eight‐day period in April 1994 among 632 elementary schoolchildren (aged 5 to 12 years) in Monticello, Georgia. Both screening and questionnaire findings were compared pairwise with results from visual‐tactile examinations done by a dentist. Validity, represented by sensitivity, specificity, and predictive values, was assessed for screening results from the dental hygienist, the nurse, and the parent‐completed questionnaire. Results: Validity was high for screening for caries and treatment needs (>90% for sensitivity, specificity, and predictive values in a sample having 30% to 40% prevalence). Less valid data — mainly an effect of false negatives — were obtained for fluorosis, injuries, and presence of sealants. No significant difference in validity was observed between the nurse and the dental hygienist. One‐third of respondents to the questionnaire did not know if their children needed fillings (a proxy for untreated decay) or had received sealants; only knowledge of restorations was comparable to results from screening. Intraexaminer reliability for the two screeners ranged from 85 to 100 for percent agreement and 0.70 to 0.93 for kappa scores. Conclusions: Screening by dental hygienists or nurses can provide valid data for surveillance of dental caries and treatment needs. Training for visual assessment of fluorosis and injuries must be improved to diminish the proportion of false negatives. A parent‐completed questionnaire is less effective than visual screening for evaluating oral health status in children.