bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Cluster Randomized Controlled Trial Testing the Effectiveness of a School‐based Dental Health Education Program for Adolescents
Authors: Redmond Caroline A. , Blinkhorn Fiona A. , Kay Elizabeth J. , Davies Robin M. , Worthington Helen V. , Blinkhorn Anthony S. 
Published: May 2007

Abstract Objectives: This trial investigated the value of a school‐based dental health education program in terms of changes in knowledge, reported behavior, and plaque scores. Methods: A total of 2,678 pupils with a mean age of 12.1 years attending 28 schools participated in a school‐based dental health education program. The study used a cluster randomized controlled study design. The health service administrators stipulated that all participants receive the intervention; to meet this requirement, a rolling program of two six‐month periods was utilized. During the first six months, half the adolescents received the intervention program, the other half acting as controls. Throughout a further six‐month period, all participants received the intervention program. This research design allowed comparisons between participants receiving the program for six and 12 months. At baseline, six, and 12 months, a random subsample of 40 children in each participating school had their plaque scores recorded and a questionnaire was used to record their knowledge of dental health and reported dental behavior. Results: The analysis used the subjects clustered within the schools, which were the units of randomization. The intervention program produced statistically significant improvements (P<.001) in knowledge about periodontal disease and the frequency of sugar intake and dental caries in both assessment time periods. The reported frequency of brushing did not change, but the group who had received 12 months of the intervention were more likely (P<.05) to brush for over a minute. At six months the early intervention group had a statistically significant, 13 percent reduction in the mean proportion of sites with plaque compared with the late intervention group (P=.043). This difference was sustained at 12 months (P=.037). Conclusion: This cluster randomized control trial demonstrated that the intervention program resulted in an improvement in knowledge of dental disease and an increase in the reported duration of brushing. These improvements were accompanied by a significant improvement in oral hygiene and a reported reduction in gingival bleeding.
Managed Care in Dental Markets: Is the Experience of Medicine Relevant?
Authors: Hernandez John B. , Coulter Ian , Goldman Dana , Freed James , Marcus Marvin 
Published: May 2007

Abstract Objective: This paper reports on factors that predict the market penetration and growth into the market of both medical and dental managed care, and the relationship between the two. Methods: Using data from the National Association of Dental Plans, the Interstudy Competitive Edge HMO Census, and the Area Resource File from 1987–95, we created an analytic data base covering the dental HMO market, the medical HMO market, dentist and physician supply, and regional market characteristics. Simple correlation analysis and multivariate linear regression using ordinary least‐squares techniques were used to predict medical HMO penetration and dental HMO penetration in each state during 1994 and 1995. Results: The results show that although the penetration of dental HMOs has been modest when compared to medicine, its growth is predictable by the same factors, and closely follows the pattern found in medical markets. Conclusions: Despite the observed relationship between medical and dental HMO penetration rates, there are potential barriers to managed care in the case of dentistry that may explain the slower growth to date, and that may ultimately decide the extent of managed care penetration into the dental market.
Dental Expenditures and Source of Payment by Race/Ethnicity and Other Sociodemographic Characteristics
Authors: Vargas Clemencia M. , Manski Richard J. 
Published: May 2007

Abstract Objective: This study presents race/ethnic‐specific distributions of dental expenditures and their sources of payment by socioeconomic characteristics among US working‐age adults. Methods: Data for persons aged 19–64 years from the 1987 National Medical Expenditure Survey (NMES) (n=18,696) were used to calculate mean dental expenditures and their 95 percent confidence intervals. Results: Dental expenditures were reported by 44.5 percent of participants. Non‐Hispanic whites and persons with higher income were more likely to report dental expenditures than their counterparts. Among persons reporting expenditures, those with lower income had lower expenditures than higher‐income persons. No differences in the amount of expenditures by race/ethnicity, sex, or employment status were observed. In all race/ethnic groups almost half the expenditures were paid out‐of‐pocket and one‐third by dental insurance. Conclusion: While sociodemographic characteristics determined who had dental expenditures, they did not determine the amount or source of those expenditures.
Complex Sampling: Implications for Data Analysis
Authors: Caplan Daniel J. , Slade Gary D. , Gansky Stuart A. 
Published: May 2007

AbstractInvestigators in dental public health often use strategies other than simple random sampling to identify potential subjects; however, their statistical analyses do not always take into account the complex sampling mechanism. Often it is not clear whether a given strategy requires adjustment for stratification and/or cluster sampling of observations. We propose that the need for such adjustment depends on the primary study objective. As a general rule, we recommend that if the study goal is to estimate the magnitude of either a population value of interest (e.g., prevalence), or an established exposure‐outcome association, adjustment of variances to reflect complex sampling is essential because obtaining appropriate variance estimates is a priority. However, if the study goal is to establish the presence of an association, especially in a preliminary investigation of novel conditions or understudied populations, obtaining appropriate variance estimates may not be of primary importance; hence, adjustment of variances for complex sampling is not always required, but often is recommended. This paper describes several types of complex sampling designs, methods of adjusting for complex sampling strategies, examples illustrating the effect of adjustment, and alternative approaches for analysis of complex samples.
Plausibility of Periodontal Disease Estimates from NHANES III
Authors: Slade Gary D. , Beck James D. 
Published: May 2007

Abstract Objective: This study investigated possible reasons for observed discrepancies in prevalence estimates and measures of association for periodontal disease between phases (1988–91 and 1991–94) of the third National Health and Nutrition Examination Survey (NHANES III). Methods: NHANES III data on CD‐ROM were obtained from the National Center for Health Statistics. Accompanying documentation states that each phase and combined phases constitute national probability samples of the US population. Weighted estimates of prevalence (percent of persons affected) and extent (percent of sites affected) for previously reported thresholds of gingival bleeding (GB), attachment loss (AL), and probing pocket depth (PD) were generated using data from all 15,511 persons aged 13–90 years who received periodontal examinations. Odds ratios for associations between four selected risk indicators and both PD and AL were compared between phases. Results: Phase 2 estimates of GB and PD were as much as 56 percent lower than phase 1 estimates and both were different from combined‐phase estimates. However, AL prevalence was consistent between phases. Prevalence differences between phases could be explained in part by examiner variations. Odds ratios for PD differed between phases by as much as one‐third, although the direction and precision of associations were not affected, and differences were reduced after controlling for examiner. Conclusions: Combined‐phase estimates of GB and PD prevalence and extent differ from previously published estimates derived from Phase 1, apparently because estimates in at least one phase of the NHANES III study are biased. However, associations with selected risk indicators were fairly consistent between phases.
Pediatric Oral Health Performance Measurement: Current Capabilities and Future Directions
Authors: Crall James J. , Szlyk Carrie Ingalls , Schneider Donald A. 
Published: May 2007

AbstractThis paper offers an overview of performance measurement in health care, provides a synopsis of the findings and recommendations of an Oral Health Expert Panel organized by the National Committee for Quality Assurance (NCQA) under contract with the Health Care Financing Administration (HCFA), and discusses challenges and possible future directions for pediatric oral health care performance measures development. Existing performance measures for pediatric oral health care are extremely limited; however, several new measures have been proposed and are in various stages of development and testing. Measures capable of being implemented in the short‐term focus on access and use of services, rely on administrative data sources, and represent refinements and enhancements of current measures. Measures proposed for future implementation focus more on the effectiveness of care, consumer assessments of care and plan performance, and the value of services provided to enrolled children. Recommendations are targeted toward high‐risk children who, for the most part, are covered by public programs (e.g., Medicaid and the Children's Health Insurance Program). Nevertheless, the entire set of recommended measures is considered to be relevant to all pediatric populations and applicable to all forms of dental care coverage, including state‐administered programs and commercial third party arrangements.
A Systematic Review of Clinical Diagnostic Criteria of Early Childhood Caries
Authors: Ismail Amid I. , Sohn Woosung 
Published: May 2007

Abstract Objective: This paper reviews case definitions and clinical diagnostic criteria of early childhood caries (ECC) and severe ECC (S‐ECC) in children aged 1 to 5 years old. The acronym S‐ECC as used in this paper refers to nursing caries, baby bottle tooth decay, rampant caries, labial caries, maxillary anterior caries, and other terms used to refer to severe dental caries in preschool children. Methods: A search was carried out for articles published in peer‐reviewed journals and indexed in MEDLINE using the following terms: nursing caries, baby bottle tooth decay, early childhood caries, rampant caries in preschool children, labial caries, maxillary anterior caries, and nursing bottle caries. MEDLINE's MeSH terms “dental caries” and “deciduous teeth” were used to search for other relevant studies. Reports were selected if they included children 1 to 5 years of age and described diagnostic criteria or case definitions of S‐ECC. Three previous reviews were searched for other relevant reports. One unpublished report was included in this review and data from NHANES III were analyzed to provide information on caries patterns in preschool children in the United States. The first author read all the abstracts from the MEDLINE search and tagged relevant reports for photocopying. He also abstracted all the information from the reports. The first author calibrated the second author, who independently read all included and excluded reports. Disagreements were resolved by consensus. Results: Out of 126 studies, 32 were excluded and 94 (93 published and 1 unpublished) were included in this review. Eighty‐one of the 94 published studies were cross‐sectional surveys or clinical studies, 7 were case‐control clinical studies, 2 studies were controlled clinical trials, and 4 were cohort or field trials. About two‐thirds of the included studies did not report on calibration of examiners. Information on reliability of examiners was reported by 19 of the 94 studies. The included studies varied widely in the name used to identify S‐ECC, case definitions, and diagnostic criteria. “Cavitation” was the most common criterion used to define dental caries. Several studies measured early or noncavitated carious lesions. Twenty‐seven studies used the presence of 1 dmf maxillary incisor to classify a child with S‐ECC. Another 23 and 9 studies defined S‐ECC by the presence of 2+ or 3+ dmf maxillary incisors, respectively. Dental caries in preschool children clusters in pits and fissures and on smooth tooth surfaces of primary molars and maxillary incisors. Conclusions: This review found a wide variation in the case definitions and diagnostic criteria used to diagnose ECC or define S‐ECC. Dental caries in the maxillary incisors is one of several patterns of dental caries that may occur in primary teeth of preschool children. A consensus is needed on case definitions and diagnostic criteria that can assist researchers to test preventive interventions and study the etiology and epidemiology of ECC.
The Role of Dietary Fluoride Supplements in Caries Prevention
Authors: Horowitz Herschel S. 
Published: May 2007

AbstractNearly all dental researchers and public health authorities agree that fluoride supplements are highly effective in reducing dental caries in primary and permanent teeth, that benefits to all teeth are greater when administration begins at 2 years of age or younger, that both preemptive and posteruptive exposure is important in imparting cariostatic benefits, that effectiveness is neither enhanced nor reduced by their being combined with vitamins, and that benefits to the offspring of pregnant women who take supplements are uncertain. Several studies show that fluoride supplements delivered in school‐based programs effectively reduce dental caries, and benefits are greater to teeth that receive preemptive exposure in addition to posteruptive exposure. Many parents who, for a variety of reasons, did not administer fluoride supplements at home will enroll their children in school‐based fluoride tablet programs. Effectiveness of fluoride supplements today is undoubtedly smaller than observed previously because of dilution and diffusion effects from other fluoride sources; nevertheless, they still have the same potential efficacy. It is apparent that the current ADA dosage schedule is too high and requires modification; however, the availability of this known‐to‐be‐effective regimen should not be eliminated or restricted.
Total Fluoride Intake and Implications for Dietary Fluoride Supplementation
Authors: Levy Steven M. , Guha‐Chowdhury Nupur 
Published: May 2007

AbstractThis paper reviews the history and validity of recommended “optimal” levels of systemic fluoride intake and the available information on levels of fluoride intake in young children from foods and beverages (including water), dentifrices, dietary fluoride supplements, mouthrinses, and gels. Most of the studies emphasize the substantial variation in ingestion among individuals. Often, a substantial proportion of individuals received fluoride well beyond the mean exposure reported in the study. Limitations in the existing data make it difficult to determine the total distribution of fluoride intake from all sources. Therefore, hypothetical combinations of possible daily fluoride intake from the three main sources (diet, dentifrices, and supplements) are presented for those aged 6, 12, 24, and 36 months, with associated mean intake per kg body weight. Findings suggest that some children exceed the “optimal” level of fluoride intake from single sources alone, while others can from a combination of sources. Moreover, if current recommended “optimal” levels, which have been derived on an empirical basis, are actually lower than what has been quoted in the literature, then more children could be ingesting excessive amounts of fluoride, which could increase their risk of developing objectionable dental fluorosis. The variation and complexity of fluoride ingestion from all sources should be considered in the evaluation of recommendations for use of dietary fluoride supplements.
Fluoride Intake by Infants
Authors: Fomon Samuel J. , Ekstrand Jan 
Published: May 2007

AbstractMany infants are fully or partially breast fed during the early months of life; however, the percentage of such infants decreases to about 30 percent by 4 months of age. The majority of US infants are fed formulas for most of the first 10 months of life. Although fluoride (F) intakes by fully breast‐fed infants are low, F intakes by partially breast‐fed infants and by formula‐fed infants are highly variable, depending primarily on the F content of the water used to dilute concentrated liquid or powdered infant formula products. In communities with F content of the drinking water less than 0.3 ppm, F consumption by many infants will be 30 to 40 μg·kg‐1· d1. The addition of a F supplement of 0.25 mg/d for a 4 kg infant would increase the F intake by 63 μg·kg‐1· d1, resulting in a total intake of about 100 μg·kg‐1·d1, an intake in the range believed to be associated with development of fluorosis of the permanent teeth. However, for the US infant population generally, many fewer infants are exposed to high F intakes from formula plus a supplement (recommended only for communities with water providing less than 0.3 ppm F) than from formula alone in communities with F content of 1 ppm in the drinking water. In assessing the possible effects of F intake during infancy on development of fluorosis, it is important to recognize that infant feeding practices have changed greatly during the past 30 years. In the 1960s, most infants over 4 months of age were fed fresh cow's milk and intakes of F were therefore low. By the mid 1970s a trend toward more extended feeding of formula was evident and this trend has continued into the 1990s. Prolonged exposure to high intakes of fluoride during infancy is much more common now than in the past.
Mechanism and Timing of Fluoride Effects on Developing Enamel
Authors: Den Besten Pamela K. 
Published: May 2007

AbstractFluoride appears to specifically interact with mineralizing tissues, causing an alteration of the mineralization process. In enamel, fluorosis results in a subsurface hypomineralization. This hypomineralized enamel appears to be directly related to a delay in the removal of amelogenins at the early‐maturation stage of enamel formation. The specific cause for this delay is not known, although existing evidence points to reduced proteolytic activity of proteinases that hydrolyze amelogenin. This delay in hydrolysis of amelogenins could be due to a direct effect of fluoride on proteinase secretion or proteolytic activity, or to a reduced effectiveness of the proteinase due to other changes in the protein or mineral of the fluorosed enamel matrix. The formation of dental fluorosis is highly dependent on the dose, duration, and timing of fluoride exposure. The early‐maturation stage of enamel formation appears to be particularly sensitive to the effects of fluoride on enamel formation. Although the risk of enamel fluorosis is minimal with exposure only during the secretory stage, this risk is greatest when exposure occurs in both secretory and maturation stages of enamel formation. The risk of fluorosis appears to be best related to the total cumulative fluoride exposure to the developing dentition.
The Case for Eliminating the Use of Dietary Fluoride Supplements for Young Children
Authors: Burt Brian A. 
Published: May 2007

AbstractFluoride supplements have been used for years to prevent dental caries; nevertheless, there are three reasons why their use is inappropriate today among infants and young children in the United States. Evidence for the efficacy of fluoride supplements when used from birth or soon after is weak, supplements are a risk factor for dental fluorosis, and fluoride has little preemptive effect in caries prevention. While there are many reports on the caries‐preventive efficacy of supplements, few meet standards for acceptability as clinical trials, and those that do have tested chewable tablets or lozenges under supervision in school‐aged children. North American children today are exposed to fluoride from many sources—drinking water, toothpaste, gels, rinses, and in processed foods and beverages. The additional cariostatic benefits that accrue from using supplements are marginal at best, while there is strong risk of fluorosis when young children use supplements. Available evidence suggests that the public is more aware of the milder forms of fluorosis than was previously thought; thus, it is prudent for caries‐preventive policies to aim at maximizing caries reductions while minimizing the risk of fluorosis. It is therefore concluded that the risks of using supplements in infants and young children outweigh the benefits. Because alternative forms of fluoride for high‐risk individuals exist, fluoride supplements should no longer be used for young children in North America.
An Exploratory Qualitative Study Examining the Social and Psychological Processes Involved in Regular Dental Attendance
Authors: Gibson Barry J. , Drennan Jackie , Hanna Sarah , Freeman R. 
Published: May 2007

Abstract Objective: This study aimed to provide a description of the psychosocial process involved in regular dental attendance. Methods: The study design was a qualitative cross‐sectional study using unstructured and semistructured interviews and observations of regular dental visits. The study participants included 12 men and 18 women attending general dental practices and six men and four women attending an emergency dental service. The data were systematically recorded and subjected to line‐by‐line grounded theory coding around the main concerns of those attending the dentist. Results: The main concern of those attending for a regular dental visit was checking their oral health. The six‐month recall was conceptualized as a checking cycle in six phases: recalling, responding, inducing (i), waiting, inducing (ii), and telling. The possible outcomes of the cycle were maintaining oral health, sustaining oral health, and a further checking cycle. Variations in checking cycles resulted from reordering and normalizing pressures within participants' lifestyles. Conclusions: The findings of this study suggest that people's patterns of dental attendance are similar to those of other chronic illnesses. An understanding of the dynamic psychosocial processes involved in frequent dental attendance may be achieved when further research into this phenomenon is conducted.