bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sources of Fluoride Intake in Children
Authors: Levy Steven M. , Kiritsy Mary C. , Warren John J. 
Published: April 2007

AbstractWide variations in fluoride intake among children make estimating fluoride intake difficult. This paper discusses the various sources of fluoride intake among children, beginning with a review of the fluoride concentrations of water and other beverages, foods, and therapeutic fluoride products. A review of previous studies' estimates of fluoride intake from diet, dentifrice, fluoride supplements, fluoride mouthrinses, and gels, as well as total fluoride intake also is presented. Then, estimates of fluoride intake among young children of different age groups are summarized, and examples demonstrating the high level of variability of fluoride intake, both from individual sources and in total, are presented. Lastly, this paper discusses the implications of our current level of knowledge of children's fluoride intake, and presents recommendations for the use of fluoride for children in light of this current knowledge. The major recommendations are that: (1) the fluoride content of foods and beverages, particularly infant formulas and water used in their reconstitution, should continue to be monitored closely in an effort to limit excessive fluoride intake; (2) ingestion of fluoride from dentifrice by young children should be controlled, and the use of only small quantities of dentifrice by young children should be emphasized; and (3) dietary fluoride supplements should be considered a targeted preventive regimen only for those children at higher risk for dental caries and with low levels of ingested fluoride from other sources.
Fluoride and Bone Health
Authors: Phipps Kathy 
Published: April 2007

AbstractThis paper reviews some of the studies related to the effect of fluoride on the skeletal system of humans and outlines the knowns and unknowns of fluoride and bone health. Current research indicates that, in large enough doses, fluoride stimulates bone formation by osteoblastic stimulation, increases bone formation earlier and to a larger extent in trabecular bone compared to cortical bone, and increases spinal bone density. There is controversy, however, concerning the efficacy of fluoride as a therapeutic agent in the treatment of osteoporosis. Some clinical studies have found a reduction in vertebral fracture rates while others have not. To date, only ecologic studies have been conducted on the association between water fluoridation and hip fractures. The inability of ecologic studies to control for confounding variables makes their interpretation difficult. Based on the literature presented, it is concluded that there are more unknowns than knowns in terms of fluoride's effect on bone, osteoporosis, and fractures. One of the major unknowns in the relationship between fluoride and bone health is dose and duration. Two studies are underway that attempt to describe the dose‐response relationship between waterborne fluoride and osteoporosis. These studies will be completed in the near future and their results, while providing new insight into fluoride's effects on bone, will by no means answer all the questions raised on this issue.
Three‐year Root Caries Incidence and Risk Modeling in Older Adults in North Carolina
Authors: Lawrence Herenia P. , Hunt Ronald J. , Beck James D. 
Published: April 2007

Abstract
Objectives: The purposes of this study were to describe the incidence of root caries and to identify its risk factors in a representative sample of older adults. Methods: Root caries incidence was estimated and multivariate risk assessment models were developed to identify predictors for root caries in a three‐year follow‐up study of 234 black and 218 white noninstitutionalized adults aged 65 and older residing in North Carolina. Results: During the observation period, 29 percent of blacks developed root caries, compared to 39 percent of whites (P<.05). The mean net DFS increment per person was 0.55±0.13 root surfaces for blacks vs 0.80±0.21 for whites (P>.32). Multivariate logistic regression analysis indicated that blacks wearing a partial denture, having some root fragments, having an average gingival recession ≥2 mm, and being free of P. intermedia were at greater risk for developing new root caries. The model for whites showed that retired people with their most severe gingival recession ≥4 mm, an average probing pocket depth ≥2 mm, and taking antihistamines were more likely to develop new lesions. Conclusions: These findings suggest that older blacks had less risk of root caries than whites, and in both groups indicators of poor periodontal status increased the risk of root caries.
Oral Cavity and Pharyngeal Cancer among Department of Veterans Affairs Hospital Discharges
Authors: Fedele Denise J. , Adelson Richard , Niessen Linda C. , Harrison Kathleen 
Published: April 2007

Abstract Objectives: The purpose of this study is to determine the number of oral cavity and pharyngeal cancers among hospital discharges at Department of Veterans Affairs (VA) medical centers in one 12‐month period. Methods: A SAS file was created from the patient treatment file (PTF) with all discharges during fiscal 1990 having ICD‐9‐CM codes for oral cavity and pharyngeal cancer. Up to 10 discharge diagnoses from the most recent discharge summary were included in the data set. ICD‐9‐CM codes for alcohol dependence syndrome, drug dependence, and nondependent abuse of drugs also were included. ICD‐9‐CM codes for salivary and nasopharyngeal cancers were excluded. Results: There were 3,733 unique individuals discharged with a diagnosis of oral cavity and pharyngeal cancer. The majority of cases (62%) were found in the oral cavity. The age distribution of oral cavity and pharyngeal cancer did not parallel the age distribution of veterans discharged during this year. Race and ethnicity of those discharged with the disease does not differ from that of all VA hospital discharges for 1990. Conclusions: VA data provide descriptive statistics of oral cavity and pharyngeal cancer among VA hospital discharges. VA data sets such as the PTF may offer the opportunity to examine hospital management issues, length of stay, and co‐morbid diagnoses associated with oral cavity and pharyngeal cancer.
Longitudinal Evaluation of Sealing Molars with and without Incipient Dental Caries in a Public Health Program
Authors: Heller Keith E. , Reed Susan G. , Bruner Fred W. , Eklund Stephen A. , Burt Brian A. 
Published: April 2007

Abstract Objectives: This study undertook a retrospective evaluation of the effect of sealants on the caries experience of initially sound and incipient permanent first molar pit and fissure surfaces. Methods: Records of children with complete five‐year records were obtained from a school‐based dental sealant program in a fluoridated community. Sealants were placed on 677 tooth surfaces in 96 children; 120 tooth surfaces in 17 children who received baseline examinations were not sealed because of lack of caregiver consent. Tooth surfaces were initially diagnosed as being sound or having incipient lesions, and evaluated for caries status after five years. Results: For initially incipient surfaces the five‐year decay rate was 10.8 percent (41 of 380 surfaces) for sealed surfaces and 51.8 percent (29 of 56 surfaces) for nonsealed surfaces with an odds ratio of 8.88 (95% Cl=4.56, 17.35). Initially sound surfaces had a decay rate of 8.1 percent (24 of 297 surfaces) for sealed surfaces and 12.5 percent (8 of 64 surfaces) for nonsealed surfaces with an odds ratio of 1.63 (95% Cl=0.63, 4.08). The two odds ratios were significantly different. Conclusions: Initially sound tooth surfaces were unlikely to become decayed in five years, and did not benefit greatly from the application of sealants. Within the limitations of this study, there were clear efficiencies in sealing incipient, but not sound, surfaces. The targeting of teeth with incipient caries for sealants is therefore recommended.
Risk Factors for Dental Fluorosis in Pediatric Dental Patients
Authors: Skotowski Mary Catherine , Hunt Ronald J. , Levy Steven M. 
Published: April 2007

Abstract Objectives: Concerns have been raised recently about whether a substantial amount of dental fluorosis is resulting from the increased use of fluoride from various sources. The purposes of this study were to determine the prevalence and severity of dental fluorosis in a sample of pediatric patients seeking dental treatment in a university pediatric dental clinic and to evaluate sources of fluoride as risk factors for dental fluorosis. Methods: A convenience sample of 157 children aged 8 to 17 years were examined for dental fluorosis using the Tooth Surface Index of Fluorosis (TSIF). Fluoride history questionnaires assessing previous exposure to fluoride during the first eight years of life were completed by the children's parents. Fluoride exposures were compared among 54 cases and 54 matched controls using a case‐control retrospective design. Results: Fluorosis was found in 72 percent of the children, but was generally quite mild. The risk of fluorosis was significantly greater for children who had greater exposure to fluoridated water and who used larger amounts of fluoridated toothpaste up to age eight. Conclusions: This study provided evidence that increased use of fluoride toothpaste may be a risk factor for dental fluorosis. The results suggest prudent use of dentifrice by young children to minimize the risk of fluorosis.
Enamel Opacities and Dental Esthetics
Authors: Ellwood Roger Philip , O'Mullane Denis 
Published: April 2007

Abstract Objectives: The purpose of this study was to determine the esthetic importance of different types of developmental enamel defect. Methods: In the first method used, individual subjects from three different populations with less than 0.1, 0.7, and 0.9 ppm fluoride in their drinking water, were asked about the appearance of their teeth and results compared to assessments of clinical photographs made by a single examiner. In the second method used, dentist and lay observers were asked to assess the appearance of the dentition of selected individuals who had a range of enamel defects. Results: According to the first method, both the size of demarcated opacities and the degree of enamel hypomineralization (TF index) were related to satisfaction with appearance. However, there was no difference in satisfaction with the appearance of the teeth among the three areas included in this study. In the second method, similar types of enamel defects were found to be esthetic stimuli as with the first study, but the dentists responded more strongly to the stimulus of enamel hypomineralization than the lay examiners. Conclusions: Both demarcated opacities and enamel hypomineralization may be important when assessing differences between populations. Further, esthetic ratings by dentists may not be a suitable means of assessing the esthetic importance of different types of enamel defects.
Variation in Dentists' Clinical Decisions
Authors: Bader James D. , Shugars Daniel A. 
Published: April 2007

Abstract Objectives: The first comprehensive review of the recent literature regarding variation in dentists' clinical treatment decisions is presented. Methods: Variation among dentists in the clinical decisions they make as well as the methods used for assessing this variation are examined at three levels of aggregation of clinical decisions: the dental practice (or dentist), the patient, and the individual tooth. Results: The extent to which differences in dentists' clinical decisions have been examined is limited. Studies are particularly sparse at the level of the dental practice, where the aggregate of dentists' treatment decisions is reflected. Further, the methods and measures used to assess variation tend to be different across studies, making quantification of variation difficult. Nevertheless, the available information reflects substantial variation in measures such as rates of provision of specific procedures; cost and numbers of procedures recommended for specific patients; and diagnoses, intervention decisions, and treatment selections for individual teeth. Conclusions: Even when differences in patients are controlled, variation in dentists' clinical decisions is ubiquitous. While its consequences remain undetermined, the variation in basic clinical decisions such as caries diagnosis signals the need to consider the extent to which the appropriateness of care is affected.
Dental Care Satisfaction: the Reliability and Validity of the DSQ in a Low‐income Population
Authors: Golletz Daniel , Milgrom Peter , Mancl Lloyd 
Published: April 2007

Abstract Objectives: Studies examining satisfaction with dental health care among the poor are quite rare. This study was done to confirm the internal structure and reliability of the Dental Satisfaction Questionnaire (DSQ), a measure of dental care satisfaction, among a low‐income population, and provide normative data regarding dental satisfaction among low‐income people. Methods: Subjects were 895 mothers of school‐aged children who were administered the DSQ as part of a larger study of dental utilization and dental fears in Seattle. Results: Factor analysis largely confirmed the factor structure of the DSQ. Results also suggested subjects in this sample were less satisfied with pain management than nonpoor people. Self‐reported dental health and dental appearance were associated with satisfaction with pain management, quality of care, access to care, and overall satisfaction. Race/ethnicity, education level, marital status, nation of origin, and type of insurance predicted differences in satisfaction with pain management and access. Conclusions: Barriers to dental care and quality of care among low‐income populations are discussed. Uses and research with the DSQ are suggested.
Relative Contribution of Caries and Periodontal Disease in Adult Tooth Loss for an HMO Dental Population
Authors: Phipps Kathy R. , Stevens Victor J. 
Published: April 2007

Abstract
Objectives: This study examined the reasons for tooth loss in an adult population with dental insurance. Methods: Computerized records were used to identify Kaiser Permanente Dental Care patients aged 40–69 years who had an extraction during 1992 (n=1,877). A random sample of 839 dental charts were reviewed. Results: Slightly more than 51 percent of the teeth were extracted for periodontal disease, 35.4 percent for caries, 9.5 percent for a combination of the two, and 3.5 percent for other reasons. When considering patients as the unit of analysis, 58.4 percent of the patients had an extraction for caries, 39.9 percent for periodontal disease, 5.0 percent for both, and 2.6 percent for other reasons. Conclusions: In this population both caries and periodontal disease play a role in tooth loss. For this reason, prevention programs focusing on the prevention of both disease processes should be developed for adults.
Frustrating Patient Visits
Authors: Milgrom Peter , Cullen Tom , Whitney Coralyn , Fiset Louis , Conrad Douglas , Getz Tracy 
Published: April 2007

Abstract Objectives: This study, part of a national mail survey of dentist malpractice liability claims, reports the reliability and validity of a new 22‐item instrument measuring frustrating patient visits. Methods: The items were subjected to factor analysis and subscales constructed. Reliability was assessed using Cronbach's alpha. Validity was assessed by comparing subscale scores to self‐reports of satisfaction and liability claims. Results: Factor analysis revealed four subscales representing unpleasant feelings, lack of communication, compliance, and practice organization (alpha=0.60–0.86). Compliance was the most important factor, Subscale scores were related to satisfaction with practice and the proportion of patient visits in the practice that were frustrating to the dentist. Dentists who reported frustrating patient visits as quite typical of their practices were more likely to have had a malpractice liability claim within the last five years. Conclusion: This instrument may be of value in detecting patient‐dentist communication difficulties that are the precursor to liability claims.
The Use of Dental Sealants by Ohio Dentists
Authors: Siegal Mark D. , Garcia A. Isabel , Kandray Diane P. , Giljahn Lynn K. 
Published: April 2007

Abstract Objectives: To assess the extent to which Ohio dentists report using pit and fissure sealants and factors associated with sealant use. Methods: A mail survey of a random sample of Ohio dentists was conducted in 1989 and repeated in 1992 with a newly drawn sample. Only responses from general dentists were analyzed using univariate analyses and multiple regression. Results: Dentists who reported using sealants increased from 79.4 percent in 1989 to 91.8 percent in 1992. In 1992, 42.9 percent were low‐level users (<15% of school‐aged patients), 41.7 percent were moderate‐level users (15–39%), and 15.3 percent were high‐level users (>39%). Over three‐fourths of sealant‐using dentists expressed some degree of willingness to seal incipient caries. The level of sealant use was associated with dentists' knowledge about sealants, conservative management of dental caries, number of children seen in the practice, and influence of insurance coverage for sealants. The regression model explained 22.0 percent of the variance. Clinical factors associated with the level of use were: dentists' willingness to seal premolars; caries‐free teeth; teeth with deep, narrow pits and fissures; teeth with small, frank occlusal caries; and patients 18 years of age or older. This regression model explained only 15.1 percent of the variance. Conclusion: The great majority of Ohio dentists report using sealants. The percent of reported sealant users increased between 1989 and 1992. Ohio dentists are not consistent with regard to the percent of their child patients for whom they apply sealants or their willingness to seal incipient caries. Dentists continue to identify lack of insurance coverage for sealant application as a major barrier to patients receiving the service.
The Risk of Fluorosis in Students Exposed to a Higher than Optimal Concentration of Fluoride in Well Water
Authors: Ismail Amid I. , Messer James G. 
Published: April 2007

Abstract Objectives: In December 1991 the residents of the community of Rigolet, Labrador, Canada, discovered that they were exposed to higher than 2.0 ppm fluoride in the drinking water from the new town well, which became operational in December 1983. In 1993 an investigation of the occurrence of fluorosis in children exposed to the high‐fluoride water during different ages of life was carried out. Methods: A dental examination for fluorosis was conducted using Pendrys' Fluorosis Risk Index. Out of 84 students in Rigolet, 74 were examined and the parents of 60 students agreed to be interviewed. Out of the 60 students, 48 lived all of their first six years of life in Rigolet. Results: Of the 48 children with life‐long residence, the odds ratio of fluorosis on enamel zones that began forming during the first year of life was 8.31 (95% Cl= 1.84, 38.59) for children exposed since birth or during the first year of life relative to those exposed after 1 year of age. The odds that a child had a maxillary central incisor with fluorosis were 5.69 (95% Cl=1.34, 24.15) times higher if exposure occurred during the first year of life compared with exposure after 1 year of age. Only those exposed to the high‐fluoride water during the first year of life developed fluorosis on the mandibular central incisors. Conclusion: Within the limitations of this small population study, age relative to the date when the new water well became operational was a significant risk factor in development of fluorosis. The first year of life was a significant period for developing fluorosis on the mandibular and maxillary central incisors.
Etiology of Nursing Caries: a Microbiologic Perspective
Authors: Berkowitz Robert 
Published: April 2007

AbstractA compelling body of scientific evidence supports the concept that nursing caries is an infectious and transmissible disease. This evidence makes a strong case to support the tenet that infants who are colonized by mutans streptococcl, and who have feeding habits characterized by frequent and prolonged oral exposure to cariogenic substrates, are likely to have a drastic increase in their oral mutans streptococci populations. Such an increase is associated with a high risk for rampant dental caries. This evidence strongly suggests that the first step in the etiology of nursing caries is primary infection by mutans streptococci; the second step is accumulation of these organisms to pathogenic levels as a consequence of frequent and prolonged oral exposure to cariogenic substrates; and the third step is rapid demineralization and cavitation of enamel resulting in rampant dental caries. This three‐step model might provide an important framework for the design of clinical trials targeted at prevention of nursing caries.
The Association Between Developmental Enamel Defects and Caries in Populations with and without Fluoride in Their Drinking Water
Authors: Ellwood Roger Philip , O'Mullane Denis 
Published: April 2007

Abstract Objectives: The purpose of this study was to consider the association between developmental enamel defects and dental caries in children from areas with different levels of fluoride in their drinking water. Methods: children (mean age= 14.1±0.3 years) were examined from areas with less than 0.1 ppm (n=267) and 0.7 ppm (n=196) in their drinking water. These areas were chosen to contain subjects with a similar social profile. Two types of enamel defect were considered: those consistent with the diagnostic criteria of the Thylstrup Fejerskov (TF) index and demarcated opacities. Dental caries was recorded for surfaces at the level of the dentinal lesion. Results: Subjects with one or more demarcated opacities had more dental caries than those without these opacities present. Children with enamel defects scored with the TF index tended to have less dental caries than those without these defects present. However, the difference was only statistically significant in the area without fluoride in the drinking water. Conclusion: Developmental enamel defects may be useful markers of caries susceptibility, which should be considered in the risk‐benefit assessment for use of fluoride. Further studies are required to clarify the relationship between developmental enamel opacities and dental caries and the reasons for any associations.
Atraumatic Restorative Treatment (ART): Rationale, Technique, and Development
Authors: Frencken Jo E. , Pilot Taco , Songpaisan Yupin , Phantumvanit Prathip 
Published: April 2007

AbstractDespite long‐term efforts to use appropriate dental equipment for treating dental caries in economically less developed countries, the predominant treatment remains extraction. The reasons for this failure to save teeth are given in this paper. Supported by results of research undertaken in economically developed countries, a 15‐step treatment module for dental caries is presented. This technique, which is called Atraumatic Restorative Treatment (ART), is based on removing decalcified tooth tissue using only hand instruments and restoring the cavity with an adhesive filling material. The technique does not require electricity. The advantages and limitations of the technique are discussed and its use in a school oral health program in Zimbabwe presented. We conclude that ART can make restorative oral care more available to a larger part of the world population than it is today.