bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medication and Dry Mouth: Findings from a Cohort Study of Older People
Authors: Thomson W. Murray , Chalmers Jane M. , Spencer A. John , Slade Gary D. 
Published: May 2007

Abstract Objective: The aim of this study was to examine the association between medication exposure and (1) unstimulated whole‐salivary flow rate and (2) the severity of xerostomia among older people while adjusting for multiple medication use. Methods: Data were obtained from participants remaining at the five‐year follow‐up phase of a cohort study of community‐dwelling older South Australians. Medication exposure information was available at baseline and at five years, enabling examination of the effects on dry mouth of long‐term exposure to medications. At the five‐year follow‐up, unstimulated salivary flow was estimated using the spit method, and xerostomia severity was estimated using the 11‐item Xerostomia Inventory. Because of the potential difficulties posed by polypharmacy, a two‐stage analytical approach was employed: (1) Classification and Regression Tree (CART) analysis was used as an exploratory device to elucidate the relationships among the dependent and independent variables, and (2) linear regression analysis was used as a complementary procedure. Results: Unstimulated flow rate was lower among individuals who were female or taking antide‐pressants at both baseline and five years, and higher among smokers or people who were taking hypolipidemic drugs. Xerostomia severity was higher among females, or individuals taking: (1) an anginal at baseline and five years, (2) an anginal without a concomitant betablocker at five years, (3) thyroxine and a diuretic at five years, or (4) antidepressants or antiasthma drugs at both baseline and at five years. Conclusions: These results suggest that polypharmacy can be accounted for to a certain extent by using CART analysis in conjunction with more conventional approaches; and that the relationship between medications and dry mouth is a complex one, and differs according to which aspect of dry mouth is being examined.
Professionally Applied Topical Fluoride and Restorative Care in Insured Children
Authors: Eklund Stephen A. , Pittman James L. , Heller Keith E. 
Published: May 2007

Abstract Objective: This study evaluates the association between use of professionally applied topical fluoride and use of interproximal restorations in primary and permanent teeth of children. Methods: Insurance claims from 15,190 children, for treatment provided by 1,556 different dentists, were analyzed to look for associations between frequency of use of professionally applied topical fluoride and use of interproximal restorations. The average follow‐up period for the children included in the analysis was 5.3 years, with the range from 3.0 to 7.9 years. Results: Both tabular and regression results failed to demonstrate an association between frequency of use of professionally applied topical fluoride and use of interproximal restorations in either the primary or permanent dentition. The most powerful predictor of restorative care for these children was the overall propensity of the dentist to place restorations in children. Conclusions: In this group of insured children, we were unable to find an association between the frequency of use of professionally applied topical fluoride and restorative care. Further, despite numerous recommendations that professionally applied topical fluorides should be used only in moderate‐ and high‐caries children, approximately two‐thirds of these children received topical fluoride at every recall visit, nearly two times per year.
Factors Related to Decisions to Extract or Retain At‐risk Teeth
Authors: Warren John J. , Hand Jed S. , Levy Steven M. , Kirchner H. Lester 
Published: May 2007

Abstract Objective: Decisions to extract a tooth may be among the most critical in dentistry. The aim of this study was to prospectivety investigate both clinical and nonclinical factors related to decisions to extract or retain teeth in private general dental practice. Methods: A convenience sample of 196 Iowa dentists in private general dental practice reported on 549 cases where decisions were made to extract or retain teeth as they occurred in their practices during a one‐month period in May 1997. Bivariate and multivariate analyses were used to identify factors that differentiated between cases where a tooth (or teeth) was extracted and cases where an at‐risk tooth was retained. Results: Of the 549 cases, 67 percent involved extraction, while the remainder involved alternatives to extraction. In comparing extraction cases to alternative treatment cases, we excluded 150 extraction cases because dentists reported that no alternative to extraction was available. Using Generalized Estimating Equations (GEE), we identified cost of treatment, presence of tooth mobility, poor prognosis of alternative treatment, and presence of gross caries as significant factors associated with extraction, while previous treatment of the tooth and concerns with patients' health were significantly associated with alternatives to extraction. Conclusions: For teeth at risk for extraction, cost, substantial periodontal disease, and several clinical factors were predictive of extraction.
The Availability and Distribution of Dentists in Rural ZIP Codes and Primary Care Health Professional Shortage Areas (PC‐HPSA) ZIP Codes: Comparison with Primary Care Providers
Authors: Knapp Katherine K. , Hardwick Kevin 
Published: May 2007

Abstract Objective: This paper maps dentists, primary care physicians, physician assistants, nurse practitioners, and nurse midwives in rural areas and rural areas meeting criteria as underserved for primary health care. Methods: Computer‐based mapping was used to localize health care provider groups by five‐digit ZIP code. For each rural and each rural primary care health professional shortage area (PC‐HPSA) ZIP code, the number of providers in each group was determined. The different combinations of providers were determined. Results: All providers in rural areas were present at levels substantially lower than national averages, particularly in PC‐HPSA areas. Dentists were approximately equal in number to primary care physicians in rural areas and the largest group in PC‐HPSAs. Approximately 75 percent of rural residents lived in ZIP code areas with dentists available. Over 5.8 million rural residents and over 50 percent of rural PC‐HPSA residents had no providers available in their ZIP code areas. Conclusions: Rural areas continue to have a short supply of primary care providers and dentists. Dentists were present in many areas where primary care provider presence was absent or very low. These data, including those relating to provider co‐presence, can be used to develop strategies to overcome health care access problems due to provider shortages.
The Prevalence of Dental Caries and Fluorosis in Japanese Communities with Up to 1.4 ppm of Naturally Occurring Fluoride
Authors: Tsutsui Akihito , Yagi Mlnoru , Horowitz Alice M. 
Published: May 2007

Abstract Objective: The purpose of this study was to determine the relationship between the concentration of fluoride in drinking water and the prevalence of dental caries and fluorosis in seven Japanese communities with different concentrations of fluoride occurring naturally in the drinking water. Methods: A total of 1,060 10‐ to 12‐year‐old lifetime residents were examined to determine the prevalence of dental caries and fluorosis in communities with trace amounts to 1.4 ppm fluoride in the drinking water in 1987. Systemic fluorides (drops or tablets) have never been available in Japan and the market share of fluoride‐containing toothpaste was 12 percent at the time of the study. Results: The prevalence of dental caries was inversely related and the prevalence of fluorosis was directly related to the concentration of fluoride in the drinking water. The mean DMFS in the communities with 0.8 to 1.4 ppm fluoride was 53.9 percent to 62.4 percent lower than that in communities with negligible amounts of fluoride. Multivariate analysis showed that water fluoride level was the strongest factor influencing DMFS scores. The prevalence of fluorosis ranged from 1.7 percent to 15.4 percent, and the increase in fluorosis with increasing fluoride exposure was limited entirely to the milder forms. Conclusions: The findings of this study conducted in 1987 in Japan parallel those reported by Dean et al. in the early 1940s.
How Do Routines of Daily Activities and Flexibility of Daily Activities Affect Tooth‐cleaning Behavior?
Authors: Abegg Claides , Croucher Ray , Marcenes Wagner S. , Sheiham Aubrey 
Published: May 2007

Abstract Objective: The aims of this study were: (1) to investigate the level of routines and flexibility of people's daily activity and to identify how tooth cleaning fits into these activities; and (2) to evaluate the impact of different levels of routines and flexibility in daily living on pattern (frequency of tooth cleaning), structure (range of items used in tooth cleaning), performance (relative effectiveness of tooth cleaning) and the outcome of performance (gingival bleeding on probing) in tooth cleaning. Methods: A convenience sample of 471 Brazilians aged 24 to 44 years was selected from factories, offices, banks, shops, and hospitals. Behavioral, socioeconomic, and clinical data were collected through structured interviews. Dental plaque and gingival bleeding were assessed by clinical examination. Data were analyzed by means of logistic regression. Results: A highly significant relationship was observed between routines of daily activities and tooth‐cleaning pattern (OR=2.3; 95% CI=1.34, 3.92) after adjusting for age, sex, marital status, and socioeconomic status. No significant associations were observed between routines of daily activities and gingival bleeding. A significant association was observed between tooth‐cleaning frequency (OR=1.6; 95% CI=1.07, 2.49), performance (OR=2.7; 95% CI=1.77, 4.14), outcome (OR=2.3; 95% 01=1.31, 3.18), and flexibility of daily activities. Those who had more flexibility of daily activities had lower gingival bleeding scores. Conclusion: People who have a less routinized and more flexible day have higher tooth‐cleaning frequency than those who have a less flexible and more routinized day. In this study, those with a more flexible day also cleaned their teeth more effectively than those who had a less flexible day, and had reduced gingival bleeding.
Rampant Early Childhood Dental Decay: an Example from Italy
Authors: Petti Stefano , Cairella Giulia , Tarsitanl Gianfranco 
Published: May 2007

Abstract Objective: This study sought to estimate the prevalence and related prediction factors for dental caries in 3‐to 5‐year‐old children in Rome, Italy. Methods: From a sample of 2,025 children, 1,494 (73.8%) were included in the analysis. Children with at least two primary maxillary incisors showing evidence of caries experience were considered affected by rampant early childhood dental decay (RECDD). Behavioral and socioeconomic variables, mutans streptococci counts, diet, and nutritional status were investigated for their association with RECDD using regression analysis. Results: The prevalence of any caries was 27.3 percent, and was 7.6 percent for RECDD. Among all children, mean dft and dt scores per person were 1.1 (SD=2.4) and 0.9 (SD=2.3), respectively; among those classified as having RECDD, scores were 6.9 (SD=4.2) and 6.7 (SD=4.3), respectively. Children with RECDD had 56 percent of all the decayed teeth in the sample. Low and medium social classes, use of a baby bottle filled with sweetened beverages, high salivary mutans streptococcal levels, and malnutrition were directly associated with RECDD; milk and yogurt consumption and low Plaque Index scores were inversely associated with the condition. Conclusions: The high prevalence of RECDD suggests that the implementation of preventive programs should be a priority for dental public health. Because of its high prevalence among children as young as 3 years of age, preventive measures targeted toward pregnant women and toddlers should be developed and tested, while kindergarten students could be used for monitoring RECDD prevalence and for detection of communities at risk.
Low Birth Weight and Dental Fluorosis: Is There an Association?
Authors: Kumar Jayanth V. , Swango Philip A. 
Published: May 2007

Abstract Objective: The association between low birth weight and dental fluorosis was explored in a cross‐sectional study to explain the higher prevalence of dental fluorosis among African‐American children. Methods: Birth weight data on 960 children were obtained from the New York State Birth Registry. Data on race, fluoride exposure, sociodemographic characteristics, and dental fluorosis were available from a cross‐sectional study conducted in Newburgh and Kingston. Associations among birth weight, race, and fluoride exposure from fluoridated water, regular use of supplements, brushing before the age of 2 years, and subject‐level dental fluorosis were explored using logistic regression procedures. Results: The regression coefficients for the main effects and the two‐way interaction effects associated with low birth weight, race, and fluoride exposure were not statistically significant. Even after controlling for low birth weight and fluoride exposure, African‐American children had a statistically significant higher odds ratio (OR=2.0). An analysis of the data limited to mandibular permanent first molars showed similar effects, except for evidence of effect modification in low birth weight children exposed to fluoride supplements. Conclusions: Lower birth weight did not explain the higher prevalence of dental fluorosis observed among African‐American children.
Caries Risk Assessment and Prevention: Strategies for Head Start, Early Head Start, and WIC
Authors: Kaneilis Michael J. 
Published: May 2007

Abstract Objective: This review updates the evidence regarding caries risk assessment for infants, toddlers, and preschool children and formulates recommendations for preventive strategies for WIC, Head Start, and Early Head Start. Methods: Literature on caries risk assessment and preventive strategies for infants, toddlers, and preschool children were reviewed and synthesized. Recommendations for WIC, Head Start, and Early Head Start were made based on the review. Results: Individual caries risk for children in WIC, Head Start, and Early Head Start should be based on: (1) previous caries experience, (2) precavity lesions, (3) visible plaque, and (4) perceived risk by examiners. Recommended preventive strategies for WIC and Head Start populations include: (1) daily toothbrushing in Head Start centers using fluoridated toothpaste; (2) fluoride varnish application to children enrolled in WIC, Head Start, and Early Head Start; (3) use of chlorhexidine gets and varnishes (following FDA approval); and (4) increased use of sealants on children with precavity pit and fissure lesions. Conclusions: Early screening, risk assessment, and preventive programs in WIC, Head Start, and Early Head Start populations hold a great deal of promise for preventing dental decay in high‐risk children.
Successful Aging: Implications for Oral Health
Authors: Kiyak H. Asuman 
Published: May 2007

ABSTRACTThe past few years have seen a growing emphasis in gerontology on the concept of “successful” or “robust” aging. This represents a major paradigm shift in the field from a focus on declines in physical and social functioning, assumptions of the aging process as a downward spiral, and studies on how to manage these declines. Leading the way toward this new perspective on aging, the MacArthur Studies of Successful Aging asked the fundamental question: “What genetic, biomedical, behavioral, and social factors are crucial to maintaining health and functional capacities in the later years?” These studies examined longitudinally a large cohort of independent elders on several physical, cognitive, emotional, and social parameters. Other researchers have focused on the theme of robust aging; however, common predictors have emerged, such as remaining active physically and cognitively, maintaining social contacts, and avoiding disease. This research is timely, given the expanding population of the oldest old, and with successive cohorts demonstrating the “compression of morbidity” phenomenon. Such a paradigm shift is critical in geriatric dentistry as well, where successful aging is evident in the growing number of older adults who have retained their natural dentition into advanced old age. This presentation draws parallels between successful aging at the systemic and oral health levels, with illustrations from epidemiologic studies that demonstrate trends in improved health and quality of life among newer cohorts of older adults.
Demonstrating Successful Aging Using the International Collaborative Study for Oral Health Outcomes
Authors: Atchison Kathryn A. , Andersen Ronald M. 
Published: May 2007

AbstractAs the lifespan increases and people are faced with 15 to 20 years of “old age,” we ask what one considers successful aging with respect to oral health. We propose a comprehensive combination of outcome variables, maintenance of teeth, manageable periodontal condition, positive perceived oral health, satisfaction with their access to and receipt of dental services, and minimal functional problems, that together comprise a definition of successful aging. The International Collaborative Study for Oral Health Outcomes provides a data set for exploring the oral health of a diverse sample of older adults in US and international sites using the modified Andersen Behavioral Model. The percent of adults who report no natural teeth ranged from 16 percent in San Antonio to 59 percent in New Zealand. Seventy percent or more of the adults from each site rated their oral health as good/fair or better except in Poland. The current cohort of older adults is faring better on some indicators than others; nevertheless, ethnic minorities and poorer countries still demonstrate inequities. Dentistry must attempt to educate individuals early in their lifespan that a combination of personal oral health practices and current dental techniques offers the potential for successful oral health throughout one's lifetime.
Successful Aging—the Case for Prosthetic Therapy
Authors: Budtz‐Jørgensen EJvlnd , Chung Jean‐Pierre , Mojon Philippe 
Published: May 2007

AbstractReduced chewing ability in community‐dwelling older people is linked to the presence of removable dentures and having fewer than 20 natural teeth present. Compensation is provided by chewing longer and swallowing larger food particles. Replacement of posterior tooth loss by fixed or removable prostheses increases the activity of the masticatory muscles, and reduces chewing time and the number of chewing strokes until swallowing. In residents of nursing homes and long‐term care facilities undernutrition is prevalent because of general medical problems, reduced appetite, and poor quality of life. Poor oral health and xerostomia are often present and may have a negative effect on masticatory function and nutrition, precipitating avoidance of difficult‐to‐chew foods. There is no evidence that the provision of prosthetic therapies can markedly improve dietary intakes; however, it might improve oral comfort and quality of life and avoid enteral alimentation.
The Delivery of Oral Care Services to Elderly People Living in a Noninstitutionalized Setting
Authors: Fiske Janice 
Published: May 2007

ABSTRACTAdvances in medical science are enabling people to survive more illness and disability. As people live longer, their mobility and/or ability for self‐care often are reduced by physical or mental disability and other chronic diseases. It may become unreasonable or impractical for them to access mainstream dental services. Increasing numbers of dentate elderly people with expectations of oral health higher than earlier cohorts of elderly people are likely to bring increasing demands to the dental profession for their continuing care. Thus, the oral care for disabled elderly people in noninstitutionalized settings may pose a challenge. The oral care options available to this group of people include the dental surgery/operatory, a mobile dental service, home‐based or domiciliary dental care, a mix‐and‐match combination of surgery‐based and domiciliary care, and cyberspace. Noninstitutionalized, disabled elderly people may have to rely on domiciliary care services for their oral health care. This paper explores the training implications, the necessary knowledge and skills base, the benefits and limitations to both the service provider and user, the equipment a vailable, and the cost/funding of domiciliary dentistry. Domiciliary dental care services need to be developed by improving pre‐and postdoctoral training programs and by establishing realistic remuneration for dental teams providing this care so that noninstitutionalized, disabled elderly people can access oral health care.
Oral Care for Successful Aging in Long‐term Care
Authors: MacEntee Michael I. 
Published: May 2007

ABSTRACTThe oral health of frail elders residing in long‐term care facilities is very poor, probably because access to dental services is limited and help with daily mouth care is almost nonexistent. Recent concerns and interest have been raised through the cooperation of administrators, nursing staff, and dental personnel to address this apparent neglect. Moreover, evidence shows that caries and periodontal disorders can be managed successfully in geriatric populations. Consequently, there is a basis on which to develop a practical strategy for mouth care that should reduce the morbidity and early mortality in long‐term care and to assist an increasingly frail and dependent population to age successfully.
A Comparison of Unmet Needs for Dental and Medical Care Among Persons with HIV Infection Receiving Care in the United States
Authors: Heslin Kevin C. , Cunningham William E. , Marcus Marvin , Coulter Ian , Freed James , Der‐Martirosian Claudia , Bozzette Samuel A. , Shapiro Martin F. , Morton Sally C. , Andersen Ronald M. 
Published: May 2007

AbstractObjective: Oral health conditions associated with HIV disease are frequently more severe than those of the general population, making access to both dental and medical care important. Using the domains specified in the Behavioral Model of Health Services Use, this paper examines the correlates of unmet needs for dental and medical care in a nationally representative sample of patients with HIV. Methods: This investigation is a cross‐sectional study using baseline data from the HIV Cost and Services Utilization Study (HCSUS), the first nationally representative study of persons in care for HIV. Using probability‐based techniques, 4,042 people were randomly selected in January 1996, and 2,864 (71%) completed a structured interview that included questions on unmet needs for dental and medical care. Regression analysis was used to identify variables associated with having unmet needs for dental care only, medical care only, and both medical and dental care. Results: Of the estimated 230,900 people in treatment for HIV in the United States, approximately 58,000 had unmet medical or dental needs based on self‐reported data. Unmet dental needs were more than twice as prevalent as unmet medical needs (32,900 vs 14,300), and 11,600 people were estimated to have both types of unmet needs. Multinomial logit regression showed that persons with low income had increased odds of reporting unmet needs for both dental and medical care. The uninsured and those insured by Medicaid without dental benefits had more than three times the odds of having unmet needs for both types of care than did the privately insured. Conclusions: To serve both the dental and medical needs of diverse populations affected by HIV disease, greater coordination of services is needed. In addition, state insurance programs for people with HIV should consider the feasibility of expanding their benefit structure to include dental care benefits.