Database: MEDLINE <: biomedical, nursing & dental literature, 1966 - Sep 2000.> Search Strategy (You Saved Citations 1-151 From Set 74): ----------------------------------------------------------------------------- 1 exp Poverty/ 7653 2 poverty.mp. 8523 3 exp Social class/ 11645 4 exp Socioeconomic factors/ 122078 5 SES.mp. 1193 6 exp Minority groups/ 3365 7 exp Ethnic groups/ 49004 8 income:.mp. 17466 9 (socioeconomic adj3 status:).mp. 5517 10 (education: adj3 (level: or status:)).mp. 8503 11 (occupation: adj3 status:).mp. 1187 12 "HEAD START".mp. 306 13 "WIC".mp. 290 14 exp Public assistance/ 17247 15 exp Social welfare/ 27301 16 (public adj assistance).mp. 255 17 (welfare adj3 assistance:).mp. 41 18 (welfare adj3 dependenc:).mp. 33 19 (welfare adj3 status:).mp. 77 20 (welfare adj3 recipient:).mp. 84 21 (women adj infant adj2 children).mp. 9 22 medicaid.mp. 6293 23 employment.mp. 21251 24 unemployment.mp. 3405 25 downsiz:.mp. 331 26 down-siz:.mp. 62 27 education/ 5985 28 or/1-27 225135 29 exp Tooth demineralization/ 22604 30 demineralization.mp. 1614 31 caries.mp. 15267 32 caires.mp. 1 33 craies.mp. 0 34 careis.mp. 4 35 carise.mp. 0 36 (teeth adj3 cavit:).mp. 422 37 (tooth adj3 cavit:).mp. 217 38 (dental adj3 cavit:).mp. 276 39 (dentin adj3 cavit:).mp. 254 40 (enamel adj3 cavit:).mp. 182 41 (teeth adj3 decay:).mp. 374 42 (tooth adj3 decay:).mp. 321 43 (dental adj3 decay:).mp. 249 44 (dentin adj3 decay:).mp. 12 45 (enamel adj3 decay:).mp. 20 46 (active adj decay).mp. 9 47 (rampant adj3 decay:).mp. 14 48 (recurrent adj3 decay:).mp. 30 49 (white adj spot:).mp. 507 50 carious.mp. 2073 51 cariology.ti,ab. 56 52 (non-cavitated adj3 lesion:).mp. 15 53 (noncavitated adj3 lesion:).mp. 2 54 Tooth remineralization/ 472 55 (dental adj3 fissure:).mp. 98 56 (tooth adj3 fissure:).mp. 50 57 (teeth adj3 fissure:).mp. 97 58 caries-free.mp. 602 59 cariesfree.mp. 17 60 Cariogenic agents/ 728 61 precavit:.mp. 8 62 (filled adj3 teeth).mp. 510 63 (filled adj3 tooth).mp. 116 64 (oral adj fissure:).mp. 6 65 (tooth adj3 remineraliz:).mp. 28 66 (teeth adj3 remineraliz:).mp. 24 67 dft.mp. 411 68 dfs.mp. 1246 69 dmf:.mp. 6389 70 cariogeni:.mp. 1783 71 or/29-70 32194 72 28 and 71 1663 73 limit 72 to (human and english language and yr=1990-2000) 740 74 limit 73 to ("aged < 65 and over >" or "aged, < 80 and over 151 >") 75 from 74 keep 1-151 151 *************************** <1> UI - 20316555 AU - Kawamura M AU - Iwamoto Y IN - Department of Preventive Dentistry, Hiroshima University School of Dentistry, Japan. TI - Present state of dental health knowledge, attitudes/behaviour and perceived oral health of Japanese employees. SO - International Dental Journal 1999 Jun;49(3):173-81 AB - The aim of this survey was to assess the present state of dental health knowledge, attitudes/behaviour and perceived oral health of Japanese employees. A 60-item questionnaire was used in a dental health project in the work place. The subjects comprised 77,845 employees, 76 per cent of whom reported delaying a dental visit until they had toothache, with about 60 per cent delaying even when they discovered a decayed tooth. The majority did not regard decayed teeth as a disease and only a minority reported regular dental visits. About three quarters reported bleeding gums on brushing, although more than half had never been taught professionally how to clean their teeth and less than 5 per cent flossed daily. More than half believed that false teeth were inevitable in old age, and that their teeth were getting worse despite daily brushing. About 70 per cent of the employees thought that it was impossible to prevent gum disease with toothbrushing alone, and nearly half believed a toothpaste with fluoride was effective in preventing periodontal disease. Reorientation of oral health care in Japan, therefore, is urgently needed and dental services have to be provided for the implementation of systematic oral health promotion for employees in the workplace. <2> UI - 20317625 AU - Chikte U AU - Brand AA IN - Department of Community Dentistry, University of Stellenbosch. TI - Attitudes to water fluoridation in South Africa 1998. Part I. Analysis by age, sex, population and province. SO - SADJ 1999 Nov;54(11):537-43 AB - The successful implementation of water fluoridation (WF) depends upon support from the public. A survey was conducted in 1998 by the Human Sciences Research Council to assess attitudes of the South African population towards WF. A representative sample of 2,220 persons over the age of 18 years was interviewed. Questions relating to current knowledge, sources of information, the purpose of water fluoridation and its desirability as a public health measure were put to respondents. Only 25% of the population had heard or read of WF. The major sources of information were the electronic and printed media (40% and 27% respectively), while 2.5% heard about it from dentists. Just over a third of the sample (35.5%) identified the purpose of WF as protecting teeth from decay; 28% said it was to purify water and 28.5% were uncertain of, or did not know its purpose. Nearly two-thirds (61.9%) indicated that fluoride should be added to drinking water if it can reduce tooth decay, while 9% were not in favour and 29% were uncertain. The results suggest that most people do not know what WF is or does, though most were in agreement that it should be implemented to reduce tooth decay. <3> UI - 20305626 AU - Brennan DS AU - Spencer AJ AU - Slade GD IN - Australian Institute of Health and Welfare Dental Statistics and Research Unit, University of Adelaide. TI - Caries experience among publicly-funded dental patients in Australia, 1995-96: type of care and geographic location. SO - Australian Dental Journal 2000 Mar;45(1):37-45 AB - Health card holders are a financially disadvantaged group and are the target population eligible for publicly-funded dental care. While their health status is generally worse compared with other Australians, there is also considerable variation among card holders. The aims of this study were to describe the oral health status of publicly-funded dental patients by type of care, geographic location and age, and to compare trends over time against other Australian studies. Patients were sampled randomly, based on date of birth, by State/Territory dental services in 1995-96. Dentists recorded oral health measures at the initial visit of a course of care using written instructions, but there was no formal calibration. The 6109 patients sampled were weighted in proportion to the numbers of publicly-funded dental patients for each State/Territory. Multiple linear regression analysis indicated that caries experience measured by the DMFT index increased across older age groups (p < 0.05). For rural compared with urban patients, mean numbers of decayed and filled teeth tended to be higher. For emergency compared with non-emergency care, mean numbers of decayed and missing teeth were higher, and filled teeth lower. The findings of this monitoring survey document high levels of previous disease and treatment and indicate variation between subgroups of users of publicly-funded dental care. This included an uneven geographic distribution of oral health and disease, and variation in unmet treatment needs by type of course of care. Temporal comparisons indicate publicly-funded patients have experienced the population trend towards lower levels of tooth loss over time but have higher levels of untreated decayed teeth compared with the general population. <4> UI - 20285595 AU - Newton JT AU - Gibbons DE AU - Gelbier S IN - Division of Dental Public Health and Oral Health Services Research, Guy's Hospital, Guy's King's and St. Thomas' Dental Institute, King's College London. david.gibbons@kcl.ac.uk TI - The oral health of older people from minority ethnic communities in south east England. SO - Gerodontology 1999 Dec;16(2):103-9 AB - OBJECTIVES: To describe the clinical health status and subjective oral health status of older adults from minority ethnic communities resident in South East England. DESIGN: Cross sectional survey incorporating a clinical examination and a questionnaire assessment of subjective oral health status. SETTING: Community groups working with individuals from minority ethnic communities. SUBJECTS: A total of 540 individuals from 7 minority ethnic communities. MEASURES: Clinical assessment of oral health status using BASCD criteria. Assessment of oral symptoms and impact experienced together with satisfaction with oral status, by structured questionnaire. RESULTS: On all measures of clinical health status the participants were healthier than a comparison group based on data from the Adult Dental Health Survey. The participants expressed high levels of subjective oral symptoms. Levels of satisfaction were lower than those found in the Adult Dental Health Survey. There was evidence of some variation across minority ethnic communities in clinical and subjective oral health status. CONCLUSIONS: Approximately 20% of the 540 adults from minority ethnic communities resident in the South East of England surveyed were relatively fit orally. They experienced a great many oral symptoms, and in approximately 30% of individuals these were sufficient to interfere with their quality of life. ETHICAL APPROVAL: The research described in this paper was approved by the Ethics committee of King's College London. <5> UI - 20228705 AU - Calabrese JM AU - Friedman PK AU - Rose LM AU - Jones JA IN - Boston University Goldman School of Dental Medicine, MA, USA. TI - Using the GOHAI to assess oral health status of frail homebound elders: reliability, sensitivity, and specificity. SO - Special Care in Dentistry 1999 Sep-Oct;19(5):214-9 AB - A pilot study assessed the clinically determined and self-reported oral health status of 50 randomly selected homebound patients served by Boston's Home Medical Service. The sample was largely female, low-income, and edentulous. The median age of the patients was 81 years (range, 64-101). While 76% deemed themselves to be in good to excellent oral health, 80% of the patients had not seen a dentist within the last two years, and 80% were found to be in need of routine dental care. To assess whether the Geriatric Oral Health Assessment Index (Atchison and Dolan, 1990) could be used by non-dental health professionals to determine the need for requesting dental consultation, the study physician repeated the administration of the GOHAI for 23 of the 50 subjects within eight weeks of the initial examination. For the 23 subjects having both dentist- and physician-administered GOHAI scores, the intraclass correlation coefficient was r = 0.61 (p = 0.002), indicating good agreement between the dentist's and physician's administrations of the GOHAI. However, given the high prevalence of need for care, the GOHAI appears to be of less value than an examination for identifying persons who need dental care in this population. Future research is needed to examine the GOHAI's sensitivity and specificity in populations with low to moderate prevalence of treatment need. <6> UI - 20191321 AU - Mattila KJ AU - Asikainen S AU - Wolf J AU - Jousimies-Somer H AU - Valtonen V AU - Nieminen M IN - Dept of Medicine, Helsinki University Central Hospital, Finland. kimmo.mattila.km@bayer.fi TI - Age, dental infections, and coronary heart disease. SO - Journal of Dental Research 2000 Feb;79(2):756-60 AB - Epidemiological and intervention studies have suggested that infections are risk factors for coronary heart disease (CHD). Dental infections have appeared as cardiovascular risk factors in cross-sectional and in follow-up studies, and the association has been independent of the "classic" coronary risk factors. This case-control study aimed at detailed assessment of the dental pathology found in various CHD categories (including elderly patients). Altogether, 85 patients with proven coronary heart disease and 53 random controls, matched for sex, age, geographic area, and socio-economic status, were compared with regard to dental status, assessed blindly with four separate scores, and to the "classic" coronary risk factors (seven of the controls had CHD, and they were not included in the analyses). The dental indices were higher among CHD patients than in the controls, but, contrary to previous studies, the differences were not significant (between the CHD patients and their matched controls or among the different CHD categories). This result could not be explained by potential confounding factors. The participants in the present study were older and had more often undergone recent dental treatment in comparison with subjects in our earlier studies. Age correlated with the severity of dental infections only in the random controls but not in the coronary patients who, although young, already had high dental scores. We believe that the higher age of the participants in the present study is the most likely reason for the results. Other possible explanations include an age-related selection bias among older CHD patients, and the fact that those participating in studies like this may have better general health and thus also less severe dental infections. Thus, the role of dental infections as a coronary risk factor varies according to the characteristics of the population studied. <7> UI - 20151850 AU - Roberts-Thomson KF AU - Spencer AJ IN - Department of Dentistry, The University of Adelaide. TI - Public knowledge of the prevention of dental decay and gum diseases. SO - Australian Dental Journal 1999 Dec;44(4):253-8 AB - In 1992, a mail survey was conducted among South Australians aged 10 years and older to assess the knowledge of prevention of dental caries and gum diseases and to explore its variation by sociodemographic factors. The survey provided 838 completed questionnaires. Questions were asked on perceptions of importance of a number of preventive measures, the main purpose of water fluoridation and sources of information. Respondents rated four myths for preventing dental caries as the most important: 97 per cent rated regular tooth brushing; 87 per cent rated regular dental visits; 85 per cent rated calcium in the diet; and 78 per cent rated eating fibrous foods as definitely or probably important. Only 56 per cent of respondents rated drinking water with fluoride as definitely or probably important for preventing dental caries, and only half (50.2 per cent) identified the main purpose of water fluoridation as the prevention of decay. Respondents rated regular tooth brushing (96 per cent) and regular dental visits (87 per cent) as important for the prevention of gum diseases. However, the myth of massaging the gums was rated as important by 67 per cent. Higher percentages of females, older adults and those with lower educational attainment rated the myths for preventing caries as important. Younger people were less able to specify the main purpose for fluoridation of water supplies. The persistence of myths and the low rating of the importance of scientifically efficacious measures are major challenges for oral health promotion. <8> UI - 20146529 AU - Huntington NL AU - Krall EA AU - Garcia RI AU - Spiro A 3rd IN - Veterans Administration Normative Aging Study, Boston VA Outpatient Clinic, Massachusetts, USA. nlhuntin@bu.edu TI - SES and oral health status in an elderly population. SO - Annals of the New York Academy of Sciences 1999;896:451-4 <9> UI - 99440280 AU - Kinjo Y AU - Beral V AU - Akiba S AU - Key T AU - Mizuno S AU - Appleby P AU - Yamaguchi N AU - Watanabe S AU - Doll R IN - Cancer Information and Epidemiology Division, National Cancer Center Research Institute, Tokyo, Japan. TI - Possible protective effect of milk, meat and fish for cerebrovascular disease mortality in Japan. SO - Journal of Epidemiology 1999 Aug;9(4):268-74 AB - Cerebrovascular disease was a leading cause of death from 1955 to 1980 in Japan. The mortality rate from this disease has decreased sharply in recent decades. This downward trend seems to correspond to the dietary habits of Japanese. Data from a large prospective cohort study were analyzed to examine the association between dietary habits and cerebrovascular disease mortality in Japan. The subjects for this analysis were 223,170 men and women aged 40 to 69 at baseline in December 1965. There were 6,168 deaths in men and 4,862 deaths in women due to cerebrovascular disease (ICD7: 330-334) during the follow-up period from January 1966 to December 1981. Rate ratio (RR) and 95% confidence interval (95% CI) adjusted for sex, attained age, follow-up period, prefecture, cigarette smoking, alcohol drinking and occupation was used for comparison. In this study, the risk of mortality from cerebrovascular disease was inversely associated with dairy milk, meat and fish consumption. Therefore the joint effect of dairy milk, meat and fish (DMF) as animal fat and protein was of interest. In the binary analysis, DMF (D, M, F) means the combination of dairy milk (1-3 times/week or more), meat (1-3 times/week or more) and fish (4 times/week or more). Thus DMF (d, m, f) was the reference group having dairy milk (less than 1 time/week), meat (less than 1 time/week) and fish (less than 4 times/week). For the disease, the RR of DMF (D, M, F) was 0.68 with 95% CI of 0.63 to 0.74, relative to the reference group. Furthermore the joint effect of DMF was more strongly associated with cerebral haemorrhage (ICD7: 331, DMF (D, M, F); RR: 0.63, 95% CI: 0.55-0.70) than with cerebral embolism and thrombosis (ICD7: 332, DMF (D, M, F); RR: 0.79, 95% CI: 0.70-0.89). These findings suggest that the increasing intake of animal fat and/or protein may have played a key role in reducing cerebrovascular disease in Japan. <10> UI - 99391681 AU - Powell LV AU - Persson RE AU - Kiyak HA AU - Hujoel PP IN - Department of Restorative Dentistry, University of Washington, Seattle, Wash. 98195, USA. lvpowell@u.washington.edu TI - Caries prevention in a community-dwelling older population. SO - Caries Research 1999 Sep-Oct;33(5):333-9 AB - A clinical trial was conducted to compare the effect of different caries-preventive strategies on caries progression in lower-income, ethnically diverse persons 60 years of age and older. Two hundred and ninety-seven subjects were randomized into one of five experimental groups. Group 1 received usual care from a public health department or a private practitioner. Group 2 received an educational program of 2 h duration implemented twice a year. Group 3 received the educational program plus a 0.12% chlorhexidine rinse weekly. Group 4 received the education and chlorhexidine interventions and a fluoride varnish application twice a year. Group 5 received all the above interventions as well as scaling and root planing every 6 months throughout the 3-year study. A carious event was defined as the onset of a carious lesion, a filling, or an extraction on a surface which was sound at baseline. Two hundred and one subjects remained in the study for the 3-year period. Groups that received usual intraoral procedures (groups 3, 4, and 5) had a 27% reduction for coronal caries events (p = 0.09) and 23% for root caries events (p = 0.15), when compared to the groups that received no intraoral procedures (groups 1 and 2). Routine preventive treatments may have had only a small-to-moderate effect upon caries development. <11> UI - 99372532 AU - Ahlberg J AU - Murtomaa H AU - Meurman JH IN - Institute of Dentistry, University of Helsinki, Finland. jari.ahlberg@yle.fi TI - Subsidized dental care associated with lower mutans streptococci count in male industrial workers. SO - Acta Odontologica Scandinavica 1999 Apr;57(2):83-6 AB - Salivary mutans streptococci count, dental status, and related factors were studied in male industrial workers (age 38-65 years) with or without access to subsidized dental care. Altogether 315 subsidized workers and 168 controls without subsidy were compared. A prior questionnaire survey had shown that the two study groups were similar in age, oral self-care habits, and socio-environmental factors. In the present study, the mean number of carious teeth was significantly lower in the subsidized group (0.4, SD 1.2) than in the control group (1.7, SD 3.2) (P< 0.001). Otherwise the study groups had similar dental status. A total of 92% subsidized employees had visited a dentist within the past 2 years, while 82% in the control group had done so (P< 0.01). According to the trend test, men in the subsidized group tended to have a lower mutans streptococci count than the control employees (P< 0.01). The logistic regression showed that the probability of having one or more carious tooth was significantly negatively associated with subsidized care and positively associated with high mutans streptococci count. It is concluded that subsidized dental care leading to a smaller number of untreated carious teeth might result in decreased levels of mutans streptococci. <12> UI - 99317465 AU - Swedberg Y IN - Department of Health and Environment, Faculty of Health Sciences, Linkoping, Sweden. TI - On the reporting of dental health, time for dental care, and the treatment panorama. SO - Swedish Dental Journal - Supplement 1999;133:1-65 AB - The thesis included five methodological studies and one caries epidemiological investigation, the general aim being to study how to measure and report dental health, time for dental care, treatment panorama, and dental care outcomes, within a Public Dental Service organization. The specific aims were to monitor dental clinic activities using a time study method, to apply time study results of a dental health-related patient group system for the 3-19 year age groups, and to compare time study results with corresponding results from computerized systems used for reporting dental care. Other specific aims were to compare longitudinal caries index data results between cohort and cross-sectional samples, to analyse caries index for extreme caries groups among adolescents leaving organized dental care, and--using time series methods--to analyse dental health development of the 15-19 year age groups. Results from the time studies portrayed the dental clinic as a working unit, showed that reported values can represent dental care only for intervention procedures, and indicated that clinic patterns were not adapted to the health situation of the patient groups. Longitudinal cohort attempts gave different values from those of the cross-sectional year classes, which should be the primary focus when presenting caries index mean values in dental health reviews. Caries-free groups from 15 to 19 years of age seem to be stable in their caries development in about 60%-80% of cases; while the 20% groups with the highest index values accounted for about 80% of all approximal lesions. In times of major economic adjustment, dental health for adolescents in Goteborg was an example of sustainable dental health development. A model system for monitoring, analysing, and reporting dental health and dental care outcomes within a dental care-giving organization calls for several conditions, for example, a dental health-related patient group system, and a rationale for the choice of dental team models. These areas could be gathered into a system where contemporary socio-economic factors and dental research results interact with performed dental care, and also with different methods for reporting and evaluating dental health, dental care costs, and the demand for dental care competence. <13> UI - 99231292 AU - Bourgeois D AU - Berger P AU - Hescot P AU - Leclercq MH AU - Doury J IN - Laboratory of Research in Oral Health EA 1885, WHO Collaborating Centre, Faculty of Dentistry, University Lyon I, France. TI - Oral health status in 65-74 years old adults in France, 1995. SO - Revue d Epidemiologie et de Sante Publique 1999 Mar;47(1):55-9 AB - BACKGROUND: A study was carried out to assess the oral health status of the non-institutionalized population aged 65-74 years and living in the Rhone-Alpes region, France, in 1995. METHODS: The representative sample was composed of 603 subjects comprised of 41.5% of men of which 24.5% lived in rural areas--i.e. less than 2,000 inhabitants--and 75.5% of urban areas. The quota sample used was stratified by socio-economic status, residence and gender. Oral health was defined by dentate status, D (Decayed), M (Missing), F (Filled) components and DMFT components. Carious lesions, fillings, missing teeth were recorded using the World Health Organization criteria. An indicator of treatment need--the ratio of decayed teeth over decayed and filled teeth--D/D+F was used. RESULTS: The DMFT index at 65-74 years for the French population was 23.3 +/- 4.0. The dental condition of the study group in the Rhones-Alpes region of France appears satisfactory considering the low percentage of untreated decayed teeth at 65-74 years old (17.4%) and the low rate of edentate people (16.3%). Gender, location and socio-economic variables in relation to the dental status were discussed. CONCLUSION: The relatively good oral health status of the senior citizens and the low rate of need for treatment of dental decay together with the level of oral care available provided a solid base for further development of a qualitative national dental care system. <14> UI - 99256663 AU - Boehmer U AU - Kressin NR AU - Spiro A 3rd IN - Center for Health Quality, Outcomes and Economic Research, Bedford, Massachusetts, USA. TI - Preventive dental behaviors and their association with oral health status in older white men. SO - Journal of Dental Research 1999 Apr;78(4):869-77 AB - While prevention practices are widely encouraged, the link between the performance of preventive behaviors and oral health status has rarely been examined. This study investigates the association between preventive dental behaviors (recent and long-term) and oral health status and compares the strength of such associations. Longitudinal data over six time points on 649 dentate white men were obtained from the VA Dental Longitudinal Study (DLS). Participants' oral health was measured through dental examinations, and preventive dental behaviors--i.e., toothbrushing, flossing, using interdental devices, seeking dental prophylaxis, and undergoing dental treatment-were assessed by self-report. Oral health status was measured in terms of (1) functioning teeth, (2) sound-equivalent teeth, (3) decayed, missing, and filled teeth, and (4) decayed and filled root surfaces. Pearson correlation and linear regression analysis revealed significant positive associations between most preventive behaviors and measures of oral health status. Dental prophylaxis emerged as the strongest predictor of oral health status. Long-term preventive dental behavior measures explained more variance in oral health status than short-term preventive behaviors measured cross-sectionally. <15> UI - 99196657 AU - Anonymous TI - Total tooth loss among persons aged > or =65 years--selected states, 1995-1997. SO - MMWR - Morbidity & Mortality Weekly Report 1999 Mar 19;48(10):206-10 AB - Loss of all natural permanent teeth (edentulism) substantially reduces quality of life, self-image, and daily functioning. Although loss of teeth results from oral diseases such as dental caries and periodontitis, it also reflects patient and dentist attitudes, availability and accessibility of dental care, and the prevailing standard of care. One of the national health objectives for 2000 is to reduce to no more than 20% the proportion of persons aged > or =65 years who have lost all their natural teeth (objective 13.4). Edentulism has been declining in the United States since the 1950s, but few state-specific data are available on adult tooth loss. To estimate the prevalence of edentulism among persons aged > or =65 years, CDC analyzed data from the 46 states that participated in the oral health module of the 1995-1997 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the findings from this analysis, which indicate a large state-specific variation in edentulism and that many states have not yet achieved the national health objective for preventing total tooth loss. <16> UI - 99160133 AU - Albandar JM AU - Kingman A IN - National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA. Jasim.Albandar@odont.uib.no TI - Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. SO - Journal of Periodontology 1999 Jan;70(1):30-43 AB - BACKGROUND: The aim of this study was to assess the prevalence and extent of gingival recession, gingival bleeding, and dental calculus in United States adults, using data collected in the third National Health and Nutrition Examination Survey (NHANES III). METHODS: The study group consisted of 9,689 persons 30 to 90 years of age obtained by a stratified, multi-stage probability sampling method in 1988 to 1994. The weighted sample is representative of U.S. adults 30 years or older and represents approximately 105.8 million civilian, non-institutionalized Americans. Gingival recession, gingival bleeding, and dental calculus were assessed at the mesio-buccal and mid-buccal surfaces in 2 randomly selected quadrants, one maxillary and one mandibular. Data analysis accounted for the complex sampling design used. RESULTS: We estimate that 23.8 million persons have one or more tooth surfaces with > or = 3 mm gingival recession; 53.2 million have gingival bleeding; 97.1 million have calculus; and 58.3 million have subgingival calculus; and the corresponding percentages are 22.5%, 50.3%, 91.8%, and 55.1% of persons, respectively. The prevalence, extent, and severity of gingival recession increased with age, as did the prevalence of subgingival calculus and the extent of teeth with calculus and gingival bleeding. Males had significantly more gingival recession, gingival bleeding, subgingival calculus, and more teeth with total calculus than females. Of the 3 race/ethnic groups studied, non-Hispanic blacks had the highest prevalence and extent of gingival recession and dental calculus, whereas Mexican Americans had the highest prevalence and extent of gingival bleeding. Mexican Americans had similar prevalence and extent of gingival recession compared with non-Hispanic whites. Gingival recession was much more prevalent and also more severe at the buccal than the mesial surfaces of teeth. Gingival bleeding also was more prevalent at the buccal than mesial surfaces, whereas calculus was most often present at the mesial than buccal surfaces. CONCLUSIONS: Dental calculus, gingival bleeding, and gingival recession are common in the U.S. adult population. In addition to their unfavorable effect on esthetics and self-esteem, these conditions also are associated with destructive periodontal diseases and root caries. Appropriate measures to prevent or control these conditions are desirable, and this may also be effective in improving the oral health of the U.S. adult population. <17> UI - 99156433 AU - Elter JR AU - Beck JD AU - Slade GD AU - Offenbacher S IN - Center for Oral and Systemic Diseases, Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, 27599-7450, USA. TI - Etiologic models for incident periodontal attachment loss in older adults. SO - Journal of Clinical Periodontology 1999 Feb;26(2):113-23 AB - Etiologic factors for incident periodontal attachment loss (ALOSS) have not been conclusively identified. The purpose of this study was to develop etiologic models for ALOSS in older adults. Data on 697 older blacks and whites were obtained from 5 sequential examinations over 7 years in the Piedmont 65+ dental study, a complex random sample of older adults in North Carolina. Multivariable Poisson regression models were fit for average number of ALOSS events per person or site month at risk. In models for whites, molar sites, sites with adjacent caries, sites in persons who had: Porphyromonas gingivalis (P.g.) at least 2% of total microbial count (TMC), never had a dental checkup, more depression symptoms, fewer than 12 years of education, higher BANA score, or smoked, had significantly higher rates of ALOSS. In a separate model for blacks, interproximal and molar sites, sites in blacks who had: P.g. at least 2% of TMC, higher BANA score, never had a dental checkup, lower socioeconomic status (SES), or smoked, had significantly higher rates of ALOSS. These results confirm a multifactorial etiology for ALOSS in older adults and indicate that interventions aimed at infection, smoking, and preventive dental care utilization, may be most useful. <18> UI - 99431123 AU - Gilbert GH AU - Miller MK AU - Duncan RP AU - Ringelberg ML AU - Dolan TA AU - Foerster U IN - Department of Oral & Maxillofacial Surgery & Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville 32610-0416, USA. gilbert@nersp.nerdc.ufl.edu TI - Tooth-specific and person-level predictors of 24-month tooth loss among older adults. SO - Community Dentistry & Oral Epidemiology 1999 Oct;27(5):372-85 AB - OBJECTIVES: To describe: (1) the 24-month incidence of tooth loss in a diverse sample of dentate adults; and (2) the clinical, attitudinal, behavioral, and sociodemographic correlates of tooth loss incidence. METHODS: The Florida Dental Care Study is a prospective longitudinal cohort study of persons who at baseline had at least one tooth, were 45 years or older, and who resided in north Florida. An in-person interview and clinical examination were conducted at baseline and 24-months after baseline, with 6-monthly telephone interviews between those times. A two-level hierarchical generalized linear regression (logit model) was used to quantify tooth-specific and person-level factors simultaneously. RESULTS: Of the 739 persons who attended for a 24-month examination, 24% lost one or more teeth during follow-up. Tooth loss was more common in persons with dental disease at baseline, incident dental signs or symptoms, those with negative attitudes toward dental care and dental health, those with limited financial resources, older adults, blacks, females, and problem-oriented users of dental care (as distinct from regular attenders). Although disease presence at baseline was a major factor associated with incident tooth loss, most diseased teeth were in fact still present 24 months after baseline. CONCLUSIONS: Other than periodontal attachment loss, severe tooth mobility, and dental caries, no single factor was a dominant predictor of tooth loss; instead, numerous factors made statistically significant but small contributions to variation in tooth loss. Tooth loss apparently is the result of complex interactions among dental disease, incident dental signs and symptoms, tendency to use dental care in response to specific dental problems, dental attitudes, and ability to afford non-extraction treatment alternatives. <19> UI - 99089474 AU - Boriani G AU - Frabetti L AU - Biffi M AU - Sallusti L IN - Institute of Cardiology, University of Bologna, Italy. cardio1@almadns.unibo.it TI - Clinical experience with downsized lower energy output implantable cardioverter defibrillators. Ventak Mini II Clinical Investigators. SO - International Journal of Cardiology 1998 Oct 30;66(3):261-6 AB - BACKGROUND AND STUDY OBJECTIVE: Technical improvements in cardioverter defibrillators technology has resulted in decrease in can size coupled with improved electrodes technology. A decrease in maximum energy output allows further decrease in device size. The aim of this study was to evaluate the feasibility of a single lead transvenous implant employing a downsized cardioverter-defibrillator (volume 59 cm3), with a related decrease in maximum energy output (29-31 joules as stored energy and 25-27 joules as delivered energy). METHODS AND RESULTS: Fifty-five patients with ventricular tachyarrhythmias were enrolled in 17 European institutions for implantation. At implantation step-down defibrillation threshold (DFT) was determined and the device was implanted only if a safety margin > or =10 joules was maintained between DFT and maximum programmable output. Implantation was performed in 54 of the 55 referred patients (98%) in a single electrode-device configuration. Step-down DFT testing was performed in 44 patients (43 finally implanted) and DFT was 7.77+/-4.41 joules (range 3-20). In 20 of the tested patients (45%) DFT was < or =5 joules, in 26 patients (59%) was < or =8 joules and in 34 patients (77%) it was < or =10 joules. No differences were found in DFT comparing patients with left ventricular ejection fraction < or = or >40% or patients treated or not with antiarrhythmic drugs or beta-blockers. Mean implant duration was 85+/-34 min. CONCLUSIONS: Employing a downsized cardioverter defibrillator, successful transvenous implantation can be achieved in 98% of the patients, with maintenance of adequate defibrillation safety margins despite a reduction in stored energy to 29 joules. <20> UI - 99139133 AU - al Shammery A AU - el Backly M AU - Guile EE IN - Department of Restorative Dental Sciences, King Saud University College of Dentistry, Riyadh, Saudi Arabia. TI - Permanent tooth loss among adults and children in Saudi Arabia. SO - Community Dental Health 1998 Dec;15(4):277-80 AB - OBJECTIVE: The objective of this study was to assess tooth loss among various age-groups in Saudi Arabia as a part of a national epidemiological study on oral conditions. DESIGN: Methodology was based on the WHO International Collaborative Study II. The sampling strategy covered Kingdom-wide sites in 10 regions with stratified cluster random samples. Data collection was confined to age-groups 6 to 7, 12 to 13, 15 to 19, 20 to 29, 35 to 44 and 65 to 74 years. SETTING: Children and adults from the schools and households of the ten provinces of Saudi Arabia. Clinical examinations were performed in daylight to determine oral clinical status and the prevalence of tooth loss. SUBJECTS: A total of 7,377 children and adults in the specified age-groups. OUTCOME MEASURES: Loss of permanent teeth assumed due to caries, assessed on clinical examination. Examiners reliability was calibrated using the kappa statistic. RESULTS: Tooth loss due to caries was 0.03 in the 6 to 7-year age-group; 0.12 at 12 to 13 years; 0.29 at 15 to 19 years; 1.24 at 20 to 29 years; 4.15 at 35 to 44 years; and 15.79 in the 65 to 74-year age-group. When compared by gender, a statistically significant difference was found between males and females for those aged 6 to 7, 15 to 19, 20 to 29, and 35 to 44 years. CONCLUSIONS: This study indicated that tooth loss increases with age and differs for gender and socio-economic status. No differences found based on city or rural lifestyles. <21> UI - 99086082 AU - Powell LV IN - Restorative Dentistry, University of Washington, Seattle 98126, USA. lvpowell@u.washington.edu TI - Caries prediction: a review of the literature. [Review] [48 refs] SO - Community Dentistry & Oral Epidemiology 1998 Dec;26(6):361-71 AB - For over a decade researchers have been looking for the formula that will allow caries prediction. The purpose of this summary is to review recent multifactorial prediction models for adults and children with the aim of identifying the most successful and consistent methods. Conclusions from this review include the following: Clinical variables, especially past caries experience, are confirmed as the most significant predictors of future caries development. The status of the most recently erupted/exposed surface is the most successful measure of past caries experience. Bacterial levels are included in the most accurate prediction models. Sociodemographic variables are most important to caries prediction models for young children and older adults. [References: 48] <22> UI - 99044097 AU - Sandstedt B AU - Kennergren C AU - Schaumann A AU - Herse B AU - Neuzner J IN - Division of Cardiology, Sahlgrenska University Hospital, Goteborg Sweden. TI - Short- and long-term performance of a tripolar down-sized single lead for implantable cardioverter defibrillator treatment: a randomized prospective European multicenter study. European Endotak DSP Investigator Group. SO - Pacing & Clinical Electrophysiology 1998 Nov;21(11 Pt 1):2087-94 AB - A new, thinner (10 Fr) and more flexible, single-pass transvenous endocardial ICD lead, Endotak DSP, was compared with a conventional lead, Endotak C, as a control in a prospective randomized multicenter study in combination with a nonactive can ICD. A total of 123 patients were enrolled, 55 of whom received a down-sized DSP lead. Lead-alone configuration was successfully implanted in 95% of the DSP patients vs 88% in the control group. The mean defibrillation threshold (DFT) was determined by means of a step-down protocol, and was identical in the two groups, 10.5 +/- 4.8 J in the DSP group versus 10.5 +/- 4.8 J in the control group. At implantation, the DSP mean pacing threshold was lower, 0.51 +/- 0.18 V versus 0.62 +/- 0.35 V (p < 0.05) in the control group, and the mean pacing impedance higher, 594 +/- 110 omega vs 523 +/- 135 omega (p < 0.05). During the follow-up period, the statistically significant difference in thresholds disappeared, while the difference in impedance remained. Tachyarrhythmia treatment by shock or antitachycardia pacing (ATP) was delivered in 53% and 41%, respectively, of the patients with a 100% success rate. In the DSP group, all 28 episodes of polymorphic ventricular tachycardia or ventricular fibrillation were converted by the first shock as compared to 57 of 69 episodes (83%) in the control group (p < 0.05). Monomorphic ventricular tachycardias were terminated by ATP alone in 96% versus 94%. Lead related problems were minor and observed in 5% and 7%, respectively. In summary, both leads were safe and efficacious in the detection and treatment of ventricular tachyarrhythmias. There were no differences between the DSP and control groups regarding short- or long-term lead related complications. <23> UI - 99000274 AU - Elvery MW AU - Savage NW AU - Wood WB IN - Department of Dentistry, The University of Queensland, St. Lucia, Australia. TI - Radiographic study of the broadbeach aboriginal dentition. SO - American Journal of Physical Anthropology 1998 Oct;107(2):211-9 AB - This study forms part of a larger anthropological investigation of the Ngaraangbal Aboriginal Tribe's ancestral burial ground at Broadbeach, Australia. It examines the dentition, records the associated pathology in a noninvasive manner, and relates this to the likely subsistence diet of the tribe. The Broadbeach osteological collection was returned for reburial in 1985; however, radiographic and photographic records of 36 adult males were available. These form the basis of our study. The pathology noted in the study sample was compared with a representative sample (n = 38) of pre-European Aboriginal remains from throughout Queensland for verification purposes only. Rates of dental pathology and injury were calculated from the radiographic and photographic records. There was a significant rate of tooth-wear related intra-bony pathology (4.0%), moderate to severe alveolar bone loss, and heavy dental attrition, of which the mandibular posterior teeth were the most severely affected. Caries prevalence (0.8%) was low for hunter-gatherer populations. A large number of molar pulp chambers had a distinctive "cruciate" morphology resulting from the formation of secondary dentine and pulp stones. Injuries and abnormalities included upper central incisor avulsion (58.3%) and taurodontism. These results support the proposal that the Ngaraangbal tribe was a hunter-gatherer population subsisting on an abrasive diet that included marine foods. <24> UI - 99035979 AU - Eklund SA AU - Pittman JL AU - Smith RC IN - University of Michigan, School of Public Health, Department of Epidemiology, Ann Arbor, Mich. 48109-2029, USA. TI - Trends in per-patient gross income to dental practices from insured patients, 1980-1995. SO - Journal of the American Dental Association 1998 Nov;129(11):1559-65 AB - The authors discuss changes that occurred in per-patient gross income to dental practices from insured patients between 1980 and 1995. The current young-adult cohort appears to provide lower per-patient practice incomes compared with earlier young-adult cohorts. These changes may be the result of differences in the need for restorative care among young adults who benefited from the childhood caries decline of the 1970s and 1980s. If this reduced use of restorative services pattern persists as this young-adult cohort and succeeding cohorts age, the effect on dental practices could be substantial. <25> UI - 98452112 AU - Gamonal JA AU - Lopez NJ AU - Aranda W IN - School of Dentistry, University of Chile, Santiago, Chile. TI - Periodontal conditions and treatment needs, by CPITN, in the 35-44 and 65-74 year-old population in Santiago, Chile. SO - International Dental Journal 1998 Apr;48(2):96-103 AB - A CPITN survey involving Chileans aged 35-44 and 65-74 was conducted. A random, stratified sample by age, gender, socio-economic status and educational level was obtained, comprising 1150 individuals. Prevalence of chronic inflammatory periodontal disease (Codes 3 + 4) was 90.89 per cent in subjects aged 35-44, and 100 per cent in subjects aged 65-74. The total prevalence for both age cohorts was 92.19 per cent. Prevalence of periodontal disease was slightly lower in females but severity was significantly higher in males. A significant association between socio-economic status and periodontal health was found. Prevalence (Code 3 + 4) was 56.44 per cent in subjects of high, 98 per cent in subjects of middle, and 100 per cent in subjects of low socio-economic status. Also, the mean number of sextants with pockets > 6 mm (1.12) and mean number of excluded sextants (1.43) were significantly higher in subjects of low socio-economic status. An association between educational level and periodontal health was apparent. The only subjects who were periodontally healthy were in the group with university education. Prevalence of CITN (Code 3 + 4) was also significantly lower in subjects with university education. There was also a significant association between educational level and loss of teeth. Concerning missing teeth, 22 per cent were lost due to periodontal disease and 77 per cent due to caries. The prevalence of periodontal disease found in this adult representative Chilean population indicates that the entire population needs oral hygiene instruction and scaling, and that 45.70 per cent need complex periodontal treatment. <26> UI - 98410985 AU - Norhayati binti Moktar M AU - Noor Hayati MI AU - Nor Fariza N AU - Rohani AK AU - Halimah AS AU - Sharom MY AU - Zainal Abidin AH IN - Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur. hayati@medic.ukm.my TI - Health status of Orang Asli (aborigine) community in Pos Piah, Sungai Siput, Perak, Malaysia. SO - Southeast Asian Journal of Tropical Medicine & Public Health 1998 Mar;29(1):58-61 AB - A study of health status of Orang Asli population (based on physical examination findings) was conducted in 4 villages in Pos Piah, Sungai Siput Perak, Malaysia. In all 356 individuals between 4 months-72 years old (178 males and 178 females) participated in this study. Poor general health status, physical and mental handicaps were seen in 7.8%, 0.3% and 0.3% of the population, respectively. About one-fifth of the population had dental caries. Splenomegaly, hepatomegaly and hepatosplenomegaly were among the commonest abnormalities with the occurrence rates of 19.8%, 13.7% and 6.7%, respectively, being detected in the population. About one-fifth of the population showed signs suggestive of protein-energy deficiency; whilst less than 5% showed signs indicative of riboflavin, iodine and iron deficiencies. Vitamin A deficiency was the commonest nutritional deficiency identified in this community with almost 38.4% of them showing signs of the deficiency. The commonest skin infection was scabies. <27> UI - 98338252 AU - Schoenberg NE AU - Gilbert GH IN - Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington 40536-0068, USA. TI - Dietary implications of oral health decrements among African-American and white older adults. SO - Ethnicity & Health 1998 Feb-May;3(1-2):59-70 AB - OBJECTIVE: Older African-Americans are at disproportionate risk of chronic, nutritionally-related diseases. To begin to understand factors that may contribute to the disproportionate prevalence of life-threatening illnesses among African-Americans, this study investigates ethnic differences in the prevalence of oral health decrements. DESIGN: The Florida Dental Care Study (FDCS), a longitudinal study of changes in the oral health of 873 subjects age 45+, was used to explore a broad range of oral health status differences between African-Americans and White adults in the United States. The FDCS consists of clinical and self-reported measures of oral health, sociodemographic information, and other indicators of oral functional status. RESULTS: The prevalence of oral health decrements in this sample using a broad range of clinical and self-reported measures was substantial. African-American elders were at a heightened risk of poor oral health profiles, including having fewer teeth and being more likely to have a carious surface, fractured cusp or incisal edge, severely mobile teeth and severe periodontal levels than their White counterparts. Furthermore, the African-American respondents in our sample were significantly more likely to report a lower self-rated oral health and functioning than their White counterparts. These findings persist regardless of poverty status or educational level, two factors commonly thought to confound racial differences in health outcomes. CONCLUSION: Our study provides evidence that the widespread prevalence of oral health decrements and accompanying functional disability among this sample of dentate older adults impacts their daily lives. Of particular concern is the oral heath status of older African-Americans who may be nutritionally vulnerable due, in part, to these oral health decrements and disabilities. We suggest enhancing the access of health services in order to prevent those oral health decrements that presumably undermine adequate dietary intake. <28> UI - 98318868 AU - Levallois P AU - Grondin J AU - Gingras S IN - Centre de sante publique de Quebec, Beauport. patrick.levallois@msp.ulaval.ca TI - Knowledge, perception and behaviour of the general public concerning the addition of fluoride in drinking water. SO - Canadian Journal of Public Health. Revue Canadienne de Sante Publique 1998 May-Jun;89(3):162-5 AB - A telephone survey was carried out in 1994, in the Quebec City region, among 1006 people living in two municipalities where tap water is fluoridated and 1003 people living in two municipalities where there is no fluoridation. Knowledge of the main benefit associated with the use of fluoride (prevention of tooth decay) in drinking water was not different in fluorated versus non-fluoridated municipalities (20.4% vs 19.4%, p = 0.57). Knowledge of its main disadvantage (increase of dental fluorosis) was very low and similar in both groups (3.1% vs 2.0%, p = 0.11). Opposition to fluoridation was slightly higher in fluoridated areas (22.0% vs 18.3%, p = 0.04), and the use of fluoridated supplements for children was much less important in fluoridated areas (4.4% vs 12.4%, p = 0.001). No changes in the measures of association (odds ratios) were found after adjustment for the different characteristics of the participants (age, family income, education). Opposition to fluoridation was lower among those who believed their tap water was fluoridated (even if not): 19.9% vs 34.5%, p < 0.001. This study demonstrates that there is still need for public health education on the uses of fluorides. <29> UI - 98332124 AU - Ragnarsson E IN - Institute of Dental Research, University of Iceland, Reykjavik. TI - Dental fear and anxiety in an adult Icelandic population. SO - Acta Odontologica Scandinavica 1998 Apr;56(2):100-4 AB - This study was carried out on a random sample drawn from participants in a population-based survey in Reykjavik, Iceland. The sample consisted of 1548 people, men and women, born in 1914-63 (age range, 25-74 years) who lived in and around Reykjavik and a rural area in southern Iceland. The results from a single, modified Dental Anxiety Question (DAQ), designed to classify fear or anxiety into five different levels or categories, were compared with respect to age, oral status, extent of edentulousness, and education level. Of the whole sample 10% admitted to having considerable or more than considerable fear, while 5% classified their fear as extensive or more than extensive. Only 0.3%, however, said that it prevented dental visits. Fear was influenced by sex, as significantly more women experienced some level of fear (P < 0.001) and described their fear as considerable or extensive (P < 0.001). Fear was more common in the younger age groups among both sexes. A significant correlation was found between the number of decayed teeth and anxiety among the men, and patients of both sexes who admitted to fear had significantly fewer fillings. Fear was significantly more common in the rural than the urban population (P < 0.001). Edentulousness, or number of remaining teeth, did not seem to be significantly reflected in the extent of dental fear. People with higher education levels reported less dental fear. <30> UI - 98332258 AU - Powell LV AU - Leroux BG AU - Persson RE AU - Kiyak HA IN - Department of Restorative Dentistry, University of Washington, Seattle 98195, USA. lvpowell@u.washington.edu TI - Factors associated with caries incidence in an elderly population. SO - Community Dentistry & Oral Epidemiology 1998 Jun;26(3):170-6 AB - The purpose of this paper was to identify baseline factors associated with future caries development in older adults (age 60+) during a 3-year study period. Poisson regression analysis was used to determine the association between potential risk factors and disease incidence. The significant factors associated with high coronal caries incidence rates were high baseline root DMFS (P<0.001), high counts of mutans streptococci and lactobacilli (P=0.036), male gender (P=0.007), and Asian ethnicity (P=0.002). These factors had small to moderate effects on incidence rates, with relative risk values of approximately 1.2 to 2. The significant factors associated with higher disease incidence on root surfaces were baseline coronal DMFS (marginally significant, P=0.078), high bacterial counts (P=0.002), and Asian ethnicity (P=0.009). The predictive value of the models was low for both coronal and root caries. This result may be because this population had a higher than usual caries incidence rate, making discrimination among these caries-active individuals difficult. The current study affirmed the value of baseline DMFS and salivary variables to modeling caries incidence and introduced ethnicity as a variable useful for the study of dental caries in older adults. <31> UI - 98345892 AU - Persson RE AU - Persson GR AU - Kiyak HA AU - Powell LV IN - Department of Oral Medicine, University of Washington, Seattle, USA. TI - Oral health and medical status in dentate low-income older persons. SO - Special Care in Dentistry 1998 Mar-Apr;18(2):70-7 AB - Oral and medical conditions of 295 low-income dentate older persons (17% African-Americans, 14.5% Asians, 11.5% Hispanics, and 57% Caucasians) were studied. The mean age was 72 (SD +/- 6.8; range, 60-91). Oral examinations were performed, stimulated saliva was collected, and interviews were conducted regarding oral health attitudes, knowledge, and behaviors. Past history of restorative care, defined by filled coronal surfaces, differed by ethnicity, with Caucasian elders having most filled surfaces (p < 0.001). Ethnic minority elders had significantly poorer periodontal health (p < 0.001), with the worst conditions in Asians. Low salivary flow (< 0.01 mL/min) was found in 31% using medications known to cause hyposalivation. Frequent diseases were arthritis (46%), hypertension (39%), heart disease (25.2%), and diabetes (8.5%). Hypothyroidism was associated with low flow rate (F = 13.2, p < 0.0003). Seventy percent reported that they had never smoked. Smokers had deeper probing depths (chi 2 = 11.98, p < 0.05) and more gingival recession (F = 8.08, p < 0.001). Women on hormone replacement therapy (HRT) had less calculus (F = 11.33, p < 0.01) and fewer sites with probing depths > 5 mm (F = 8.99, p < 0.003). The present study found few associations between physical and oral health and ethnicity. The benefits of HRT for women's periodontal health and the effects of hypothyroidism on stimulated salivary flow are noteworthy. <32> UI - 98307311 AU - Suominen-Taipale L AU - Widstrom E IN - Department of Community Dental Health, Institute of Dentistry, University of Turku, Finland. liisa.suominentaipale@polaris.cc.utu.fi TI - Does dental service utilization drop during economic recession? The example of Finland, 1991-94. SO - Community Dentistry & Oral Epidemiology 1998 Apr;26(2):107-14 AB - After enjoying rapid economic growth in the 1980s, Finland suffered a deep economic recession that began in 1990. It has been claimed that recession and uneven subsidies influence the use of dental services negatively. Finnish adults born after 1956 and world war veterans are entitled to subsidized dental care either in the Public Dental Service (PDS) or in the private sector. Other adults pay their treatment costs. OBJECTIVES: The purpose of this paper is to determine whether the economic recession in Finland during the early 1990s affected the use of dental services. METHODS: The data were collected by the National Research and Development Centre for Welfare and Health using a method called CATI (Computer Assisted Telephone Interview). The target population was non-institutionalized persons aged 25-79 years. RESULTS: About one-third of those interviewed had visited a dentist during the previous 6 months and this proportion was stable during the years studied. Number of teeth, length of education, income and sex had the highest predictive values for use of dental services as analyzed by multiple logistic regression. Two-thirds had visited a private practitioner, one-third a PDS clinic and a small percentage some other dentist or denturist. CONCLUSIONS: The results showed that the dental service utilization by Finns was stable during this period of economic downturn and only minor changes occurred in the mean number of visits. The most prominent change was seen in the youngest age group, among whom dental utilization decreased by almost 10%. The study indicated that subsidies do not strongly affect dental utilization today. <33> UI - 98259893 AU - Fischer HC AU - Funk GF AU - Karnell LH AU - Arcuri MR IN - University of Iowa College of Medicine, Iowa City, USA. TI - Associations between selected demographic parameters and dental status: potential implications for orodental rehabilitation. SO - Journal of Prosthetic Dentistry 1998 May;79(5):526-31 AB - PURPOSE: This pilot study evaluated potential relationships between dental status and various sociodemographic variables in the age group segment of the United States population at greatest risk for the disruption of dental function due to treatment of an oral cavity cancer. METHODS: The Dental Health Supplement of the 1989 National Health Interview Survey was used to evaluate the self-reported status of natural dentition and prior dental rehabilitation among the population of persons 45 years or older. RESULTS: Sociodemographic variables, which showed a significant association with status of natural dentition, were level of income and occupation at lower income levels (p < 0.05). Increased levels of prior dental rehabilitation were significantly associated with lower age, female gender, increased level of income, and occupation (p < 0.05). Occupations that required social interaction had the highest levels of both status of natural dentition and prior dental rehabilitation (p < 0.05). CONCLUSIONS: Overall dental status after treatment of oral cancer may be related to the occupational status of many persons. Sociodemographic factors that influence the dental rehabilitation needs of individual patients after treatment of an oral cancer should be considered in policy decisions affecting accessibility of dental rehabilitative care. A follow-up, survey study that would further define the identified relationships between a person's demographic status and dental rehabilitation needs is recommended. <34> UI - 98193620 AU - Drum MA AU - Chen DW AU - Duffy RE IN - Division of Science, Education, and Analysis, Maternal and Child Health Bureau, Rockville, MD, USA. TI - Filling the gap: equity and access to oral health services for minorities and the underserved. SO - Family Medicine 1998 Mar;30(3):206-9 AB - BACKGROUND AND OBJECTIVES: Family physicians and other primary care providers play a pivotal role in preventing oral disease, especially among minority and underserved populations who have limited access to dental services and poorer oral health status. Oral diseases/conditions, such as caries, baby bottle tooth decay, gingivitis, periodontitis, oral pharyngeal malignancies, and orofacial trauma, are prevalent and costly, yet largely preventable. Given their role in promoting and protecting overall health and their historical role in serving minority and underserved families, family physicians occupy a unique position to assure equity, access, and improvement in oral health for all Americans. <35> UI - 98219321 AU - Lang WP AU - Borgnakke WS AU - Taylor GW AU - Woolfolk MW AU - Ronis DL AU - Nyquist LV IN - Department of Periodontics/Prevention/Geriatrics, University of Michigan, School of Dentistry, Ann Arbor 48109-1078, USA. wplang@umich.edu TI - Evaluation and use of an index of oral health status. SO - Journal of Public Health Dentistry 1997 Fall;57(4):233-42 AB - OBJECTIVES: The goals of this investigation were (1) to evaluate the Oral Health Status Index in relation to demographic characteristics, socioeconomic status, and preventive behaviors of an adult population; and (2) to understand how individual index components performed as indicators of oral health status compared to the composite index. METHODS: The Oral Health Status Index (OHSI) was used on a probability sample of adults, aged 18-93 years, living in the Detroit tricounty area. Data were collected on 509 subjects via in-home dental examinations. Bivariate and multivariate analyses were used to compare the OHSI and its components, including decayed, missing, and replaced teeth, free ends, and moderate and severe periodontal disease measures. RESULTS: The mean OHSI score for subjects was 77.3 (SE = 1.83) with a range of -8.0 to 100.0. In regression analyses, OHSI scores were positively correlated with subjects' education level, self-rated oral health scores, and frequency of dental checkups and negatively correlated with age, nonwhite race, and smoking. Of the index components, missing teeth performed well as an indicator of oral health status. Missing teeth were positively correlated with age, nonwhite race, and smoking and negatively correlated with education level, self-rated oral health, and use of Medicaid. About 53 percent of variance in OHSI scores was explained by the multivariate models, compared to 46 percent for missing teeth. CONCLUSIONS: Choosing an indicator of oral health status likely will depend upon the characteristics of the population to be studied. As a composite measure of oral health status, the OHSI performed acceptably; however, missing teeth, an index component, also worked well. Continued evaluation of the OHSI is warranted. <36> UI - 98179233 AU - Yoder KM AU - Schimmele RG IN - Oral Health Services, Indiana State Department of Health, Indianapolis, USA. TI - The oral health of Indiana's independent, disabled adults. SO - Journal Indiana Dental Association 1997 Fall;76(3):7-11 AB - This epidemiological study was conducted to measure the oral health and related variables of one of Indiana's special population groups: adults who are developmentally disabled, work in sheltered workshops and do not live in staffed residential facilities. Fifteen sheltered workshops in ten Indiana counties cooperated with this study in which 393 individuals were interviewed and received oral screening. Information was gathered regarding oral health status, history of utilization of dental services, availability of dental insurance or Medicaid and use of tobacco products. This study was conducted by the Indiana Foundation of Dentistry for the Handicapped and was funded by the Indiana State Department of Health. <37> UI - 98211162 AU - Marcus M AU - Reifel NM AU - Nakazono TT IN - Section of Public Health Dentistry, School of Dentistry, University of California, Los Angeles 90095, USA. TI - Clinical measures and treatment needs. SO - Advances in Dental Research 1997 May;11(2):263-71 AB - Clinically evaluated oral health outcome variables from the ICS-II USA data set were examined in the diverse ethnic groups, for two adult age cohorts (35-44 and 65-74 years). These measures were derived from epidemiological examinations and include the DMFT components, loss of attachment, and an indicator of treatment need--the ratio of decayed teeth over decayed and filled teeth. The ratio of decayed over decayed and filled teeth was used in multivariate analysis, since this measure represents an area where public policy could have an impact if determinants were understood. The most important independent variables were race-ethnicity, educational attainment, no fear of dental visits because of pain, and oral hygiene practices. Having a usual source of dental care and visiting the dentist within the past 12 months did not appear to be as important in predicting unmet needs as these other variables. To bridge the gap between the oral health status of majority and minority populations, health educators in minority communities need to become more accessible, have a pro-active interest in oral health, and also be cognizant of the various socio-cultural issues influencing oral health. The problems regarding Native American adults are more complex and require more careful study. <38> UI - 98211155 AU - Andersen RM AU - Davidson PL IN - Department of Health Service, University of California, Los Angeles 90095, USA. TI - Ethnicity, aging, and oral health outcomes: a conceptual framework. [Review] [68 refs] SO - Advances in Dental Research 1997 May;11(2):203-9 AB - An expanded version of Andersen's Behavioral Model of Health Services Utilization is used as the theoretical and analytical framework for the International Collaborative Study of Oral Health Outcomes (ICS-II). The conceptual framework for understanding determinants of oral health is based on a "systems" perspective. The framework posits that characteristics of the external environment, the dental care delivery system, and the personal characteristics of the population influence oral health behaviors. The expanded behavioral model conceptualizes health behaviors (oral hygiene practices and dental services utilization) as intermediate dependent variables, which in turn influence oral health outcomes (evaluated, perceived, patient satisfaction). The framework is presented with an increased focus on the effects of race-ethnicity and age cohort, the major exogenous variables used in this study for systematic assessment of the differences in the multitude of factors influencing oral health. The framework can be applied by policy analysis and health services managers to help describe, predict, and explain population-based health behaviors and health outcomes. [References: 68] <39> UI - 98120161 AU - Locker D AU - Jokovic A AU - Payne B IN - Community Dental Health Services Research Unit, Faculty of Dentistry, University of Toronto, Ontario, Canada. TI - Life circumstances, lifestyles and oral health among older Canadians. SO - Community Dental Health 1997 Dec;14(4):214-20 AB - OBJECTIVE: To examine the contribution of life circumstances and lifestyles, and the interaction between them, to the oral health status of older Canadians. DESIGN: Subjects were recruited using a telephone interview survey, based on random digit dialling and subsequently interviewed and clinically examined. PARTICIPANTS: Four hundred and ninety-eight dentate subjects aged 53 years and over living independently in Ontario, Canada. MEASURES: Subjects were classified as living in deprived, middle or privileged life circumstances based on their social and personal attributes. They were also classified as having relatively poor or relatively favourable lifestyles based on their health behaviours. The oral health status indicators used were: the number of missing teeth, the number of decayed and filled root surfaces, mean periodontal attachment loss, the number of oral symptoms in the previous four weeks, self-rated oral health, and a psycho social impact score. RESULTS: In bivariate analyses, life circumstances were significantly associated with three of these six indicators and lifestyles with five. Healthy lifestyles had an effect on the oral health status of those living in deprived and middle circumstances but not on the privileged, although no overall interaction effect was observed in multivariate analyses controlling for gender and age. CONCLUSIONS: These data suggest that, among this population, life circumstances and lifestyles are both related to oral health. They also indicate that the role of these factors varies according to the condition and health indicator in question. <40> UI - 98030656 AU - Edwards DM AU - Watt RG IN - Department of Public Health, Bedfordshire Health, Luton. TI - Oral health care in the lives of Gypsy Travellers in east Hertfordshire. SO - British Dental Journal 1997 Oct 11;183(7):252-7 AB - OBJECTIVE: To explore Gypsy Travellers' perceptions of dental health and dental service use within the context of culture, environment and the use of other services. SETTING: The author was a community dental officer and the study formed part of a MSc dissertation in dental public health. SUBJECTS AND METHODS: Information was obtained from semi-structured interviews with 43 Gypsy Travellers supplemented by a questionnaire and clinical screening of 72 Travellers. MAIN OUTCOME MEASURES: Place of residence, registration with GMP and GDP, school attendance, caries, normative and perceived barriers to care. RESULTS: The Travellers in the study had a high level of unmet need, low dental registration and very little use of preventive services. Travellers have no cultural barriers to dental care. Control of their travelling was the major factor determining access to education and health services. CONCLUSIONS: There is inequity of dental health and dental service use with more disadvantage being experienced by Travellers on unauthorized and transit sites. <41> UI - 97463608 AU - Main PA AU - Lewis DW AU - Hawkins RJ IN - Department of Community Dentistry, Faculty of Dentistry, University of Toronto. TI - A survey of general dentists in Ontario, Part II: Knowledge and use of topical fluoride and dental prophylaxis practices. SO - Journal / Canadian Dental Association. Journal de l Association Dentaire Canadienne 1997 Sep;63(8):607, 610-7 AB - A mail questionnaire was used to assess variations in the knowledge and practices of Ontario dentists with respect to topical fluoride and prophylaxis procedures. The questionnaire was answered by 1,276 general dentists. A high percentage (72 to 83 per cent) of respondents identified six months as the optimal time interval at which both procedures should be repeated for all patients under 19 years of age. Relatively few dentists (< 10 per cent) indicated that there should be no specific time interval for re-treatment (i.e. that it should be individually selected). The respondents' preventive knowledge was found to be deficient in two areas: few dentists (16 per cent) knew that it is not necessary to provide a prophylaxis prior to topical fluoride application to achieve maximum caries protection; and most dentists overestimated the speed of caries progress from outer enamel to the dentinoenamel junction (DEJ) in both primary (83 per cent) and permanent (82 per cent) approximal tooth surfaces. In bivariate analysis, three variables were found to be consistently and significantly related to optimal time intervals selected for both topical fluoride application and prophylaxis procedures: year of graduation from dental school; level of hygienist employment; and percentage of patients with private insurance. Multivariate analysis also identified three significant variables: year of graduation from dental school; level of dental hygienist employment; and practice business. Continuing education courses are suggested as a means of updating dentists' knowledge regarding preventive services. Studies are needed to determine the extent to which recent recommendations regarding the professional application of topical fluorides have been followed. <42> UI - 98014995 AU - Hawkins RJ AU - Jutai DK AU - Brothwell DJ AU - Locker D IN - Community Dental Health Services Research Unit, Faculty of Dentistry, University of Toronto, Ontario, Canada. TI - Three-year coronal caries incidence in older Canadian adults. SO - Caries Research 1997;31(6):405-10 AB - This paper describes the incidence of coronal caries in a sample of older adults. A 3-year follow-up study was conducted of 493 community-dwelling adults aged 50 years and over in Ontario, Canada. The incidence of coronal caries was 57.0%, and the mean net DFS increment was 1.9 surfaces. In bivariate analysis, several variables were significantly associated with incidence and/or mean DFS increment. These included: age, marital status, baseline coronal DFS, number of teeth at baseline, mean periodontal attachment loss of 4 mm or more, and wearing partial dentures. In logistic regression analysis only four factors had significant independent effects. These were level of education, marital status, mean periodontal attachment loss and number of teeth at baseline. The predictive ability of this model was fair: accuracy 65.7%, sensitivity 80.2%, and specificity 46.2%. When logistic analysis was repeated separately for two age groups, different predictors had significant independent effects, and sensitivity and specificity values differed substantially. These findings indicate predictive models for caries incidence should include both clinical and non-clinical variables because both types of variables may help to explain different aspects of coronal caries experience. Further research is required to identify other factors associated with coronal caries in older adults. <43> UI - 97439293 AU - Thomson WM IN - Department of Community Dental Health, School of Dentistry, University of Otago, Dunedin. TI - Predicted distribution of treatment needs for caries across three indicator age groups by the year 2031 [see comments]. CM - Comment in: N Z Dent J 1997 Jun;93(412):35 SO - New Zealand Dental Journal 1997 Jun;93(412):39-43 AB - New Zealand is undergoing a demographic transition which is resulting in fewer young people and greater numbers of elderly people. A dental transition is also occurring by which more elderly people are retaining more teeth. Projections of the caries experience of three indicator adult age groups show that the bulk of future restorative demands on the dental-care system will come from those in the middle-aged and elderly groups. Such a trend requires an increase in gerodontological input at all levels of dental education and training. <44> UI - 97380774 AU - Anonymous TI - Elderly, poor at risk for costly dental illnesses [news]. SO - CMAJ 1997 Jul 15;157(2):127 <45> UI - 97339548 AU - Heimann R AU - Ferguson D AU - Powers C AU - Suri D AU - Weichselbaum RR AU - Hellman S IN - Department of Radiation and Cellular Oncology, Pritzker School of Medicine, University of Chicago, IL 60637, USA. heimann@rover.uchicago.edu TI - Race and clinical outcome in breast cancer in a series with long-term follow-up evaluation. SO - Journal of Clinical Oncology 1997 Jun;15(6):2329-37 AB - PURPOSE: To compare the outcome of African American (AA) and Caucasian (C) breast cancer patients who had equivalent disease extent and were similarly treated. PATIENTS AND METHODS: We compared prognostic characteristics, treatment, and outcome of 1,037 C and 481 AA breast cancer patients treated with mastectomy between 1946 and 1987. The median follow-up duration was 15.6 years. RESULTS: During the study period, there was a successive increase in the percent of patients who presented with early breast cancer. Between 1980 and 1987, 35.1% AA versus 47.6% C patients had < or = 2-cm tumors and 50.0% AA versus 61.9% C patients were node-negative, while between 1946 and 1959, 27.7% AA and 31.3% C had < or = 2-cm tumors and 41.5% AA versus 40.4% C patients were node-negative. The treatments were similar during the study period. The 20-year disease-free survival (DFS) rate of AA compared with C patients with node-negative < or = 2-cm, 2.1- to 4-cm, and greater than 4-cm tumors and of patients with one to three and > or = four positive nodes was not significantly different. Equal-size tumors had similar proportion of positive axillary nodes in AA compared with C patients. The DFS for AA patients compared with C patients was similar in the periods 1946 to 1959, 1960 to 1969, and 1970 to 1979, but was lower between 1980 and 1987 (P = .02). In multivariable analysis, race was not a significant variable. CONCLUSION: In this large group of uniformly treated breast cancer patients, race was not an independent factor that influenced outcome. The racial differences seen between 1980 and 1987 are likely because of a larger percent of greater than 2-cm and node-positive tumors in AA patients. Education and access to early diagnosis should reduce or eliminate the racial differences seen. <46> UI - 97345860 AU - Gold MR AU - Khalighi K AU - Kavesh NG AU - Daly B AU - Peters RW AU - Shorofsky SR IN - Department of Medicine, University of Maryland Medical System, Baltimore 21201, USA. TI - Clinical predictors of transvenous biphasic defibrillation thresholds. SO - American Journal of Cardiology 1997 Jun 15;79(12):1623-7 AB - Transvenous lead systems have become routine for defibrillator placement. However, previous studies of clinical predictors of an adequate nonthoracotomy defibrillation threshold (DFT) evaluated monophasic waveforms or more complex lead systems, including subcutaneous patches. Accordingly, this study is a prospective evaluation of the predictors of an adequate biphasic DFT in 114 consecutive patients undergoing cardioverter-defibrillator implantation with a single transvenous lead. For each subject, 38 parameters were assessed, including standard demographic, electrocardiographic, echocardiographic, and radiographic measurements. An adequate DFT (< or =20 J) was achieved in 92% of patients. Multivariable analysis revealed 2 independent factors predictive of a high threshold: echocardiographic measurements of left ventricular dilation (odds ratio = 0.16, 95% confidence interval 0.05 to 0.53, p = 0.003) and body size (odds ratio = 0.36, 95% confidence interval 0.17 to 0.73; p = 0.005). No patient with a normal left ventricular end-diastolic dimension had a high DFT, whereas 14% (9 of 66) of those with left ventricular dilation had elevated thresholds. When the DFT cutoff was lowered to 15 J, as is necessary with some downsized pulse generators, an adequate threshold was observed in 84% of patients and the same 2 independent predictors of high thresholds were found. These results indicate that an adequate transvenous DFT can be predicted from simple clinical parameters. <47> UI - 97251137 AU - Siener K AU - Rothman D AU - Farrar J IN - Department of Pediatric Dentistry, University of the Pacific, USA. TI - Soft drink logos on baby bottles: do they influence what is fed to children?. SO - ASDC Journal of Dentistry for Children 1997 Jan-Feb;64(1):55-60 AB - Baby bottle with popular soda pop and soft drink logos are on marked shelves. A descriptive study was conducted to determine their prevalence among families and to determine whether the logos could be influencing what families put in baby bottles. A convenience sample of 314 mothers (and grandmothers if they were primary caregivers) with children using baby bottles was interviewed in three California counties. The results were analyzed for significance, using the chi-square test for independence. The ethnicities and educational levels of the sample population matched the distribution of the State. Overall, 31 percent of the children drank either soda pop or Kool-Aid from baby bottles. Forty-six percent of the respondents owned a baby bottle with a soda pop logo and 17 percent owned a bottle with a Kool-Aid logo. Families who owned bottles with popular beverage logos were four times more likely to give children the respective beverage in bottles than families with "logo bottles." Populations most likely to drink these beverages were those in the black and Hispanic ethnic groups, in the youngest age-group (15-20 years of age), and those without a high school diploma. Health professionals are concerned that the logos could cause an increase in children's consumption of sweetened beverages in baby bottles and consequently an increase in Baby Bottle Tooth Decay and nutritional problems. <48> UI - 97222159 AU - Konski AA AU - Bracy PM AU - Jurs SG AU - Weiss SJ AU - Zeidner SR IN - Department of Radiation Oncology, Flower Hospital, Sylvania, OH 43560, USA. TI - Cost minimization analysis of various treatment options for surgical stage I endometrial carcinoma. [Review] [33 refs] SO - International Journal of Radiation Oncology, Biology, Physics 1997 Jan 15;37(2):367-73 AB - PURPOSE: This study compares the payors' cost of treatment for surgical Stage I endometrial carcinoma with results of published clinical studies to determine which treatment most efficiently uses available resources. METHODS AND MATERIALS: Six options for treatment of surgical Stage I endometrial carcinoma were selected for comparison. The treatment options were observation only, low-dose-rate brachytherapy (LDRB) (nonremote afterloading), LDRB and external beam radiation (EBRT), EBRT only, high-dose-rate brachytherapy (HDRB) only (three applications), and EBRT and HDRB (three applications). The literature was reviewed to obtain disease-free survival (DFS) rates corresponding to the treatment options chosen in surgical Stages IA, IB, and IC. Metaanalysis and sensitivity testing were performed on the collected clinical data. A typical midsized city in Medicare region IV was used as our representative payor cost basis. RESULTS: Thirteen retrospective articles contained sufficient clinical information for analysis. Comparison of DFS between the observation, LDRB, and EBRT treatment groups was made for Stage IA; LDRB and EBRT for Stage IB; and LDRB, EBRT, LDRB +/- EBRT, LDRB + EBRT, and HDRB + EBRT for Stage IC. Meta-analysis failed to reveal statistically significant DFS between the respective treatment options within Stages IA, IB, or IC. The RVUs for each treatment option were LDRB, 21.7; EBRT, 117.1; EBRT + LDRB, 130.7; HDRB, 155.5; and EBRT + HDRB, 264.4. The DRG payment for LDRB is $2714.92. The calculated payor's cost for each treatment option was: LDRB, $3466.62; EBRT, $4053.03; EBRT + LDRB, $7238.55; HDRB, $5381.19; and EBRT + HDRB, $9153.14. CONCLUSION: Our analysis reveals no statistically significant differences in DFS among the treatment options considered within each surgical stage. Observation appears to result in acceptable DFS with minimal cost in Stage IA. Low-dose-rate brachytherapy was the most cost-effective treatment in Stage IB, with no statistically significant difference in DFS between LDRB and EBRT. Although LDRB had inferior DFS compared to other treatment options in surgical Stage IC, this difference failed to reach statistical significance. Our analysis implies, excluding observation, that LDRB may be a more cost-efficient treatment than the other treatment options considered. Further studies stratifying for surgical stage and grade are needed to determine the optimal cost-effective treatment for this common malignancy. [References: 33] <49> UI - 97114185 AU - Drake CW AU - Beck JD AU - Lawrence HP AU - Koch GG IN - Department of Diagnostic Sciences, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450, USA. TI - Three-year coronal caries incidence and risk factors in North Carolina elderly. SO - Caries Research 1997;31(1):1-7 AB - The data presented in this paper are from the Piedmont 65+ Dental Study (1988-1991), designed to assess the levels of coronal and root caries, periodontal disease, tooth loss, and a variety of dental health-related needs among a representative sample of 234 black and 218 white noninstitutionalized older adults in North Carolina. Of the 452 subjects followed for 3 years, 45% of blacks and 59% of the whites developed new coronal caries when caries was defined as decayed and filled surfaces, decayed root fragments, and crowned surface (p = 0.022). The annualized rate of caries increment for blacks and whites was 0.8 and 1.6 surfaces per 100 at risk (p < 0.001), respectively. The mean 3-year net increment per subject, excluding newly crowned surfaces, was 1.6 and 2.1 (p = 0.025), respectively. Whites had more newly filled and crowned surfaces, whereas blacks had more newly decayed surfaces and more decayed root fragments. Logistic regression models using baseline explanatory variables showed factors related to coronal caries differed between blacks and whites. For blacks, having more teeth, higher concentration of lactobacilli in stimulated saliva, more decayed and filled root surfaces, and smoking were related to the development of new coronal DFS (mostly D). For whites, having more coronal surfaces at risk and having more physical health problems but not seeking medical care in the past 6 months were related to the development of new coronal DFS (mostly F). The study showed the caries attack rate to be higher for whites than blacks, mainly as a result of more crown restorations, whereas blacks appeared to be at greater risk for incident lesions. Thus, in order to obtain more realistic figures for caries risk groups, coronal caries increment can and should be presented including and excluding crowns, since the utilization of dental services is likely to differ between groups of older adults. <50> UI - 99459730 AU - Stabholz A AU - Babayof I AU - Mersel A AU - Mann J IN - Department of Community Dentistry, Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel. TI - The reasons for tooth loss in geriatric patients attending two surgical clinics in Jerusalem, Israel. SO - Gerodontology 1997;14(2):83-8 AB - OBJECTIVES: Numerous studies around the world have been conducted in order to understand the reasons for tooth extractions in various age groups. Most studies have dealt with the general adult population but little attention has been paid to the elderly population. In Israel, as in most of the western countries, the elderly population is growing rapidly and thus demands for its dental needs are also increasing. In order to meet the dental requirements of the geriatric population, data on the main reasons of tooth mortality have been collected. DESIGN: Retrospective analysis of reasons for extraction divided into three categories: caries, periodontal disease and "other". SUBJECTS: The files of 302 consecutive elderly patients aged 65-95 years attending for extraction. The cause for tooth extraction was gathered from the written diagnosis described by the operator as well as from radiographs. Setting Two surgical clinics in Jerusalem serving low income residents. Results Results indicated that 30% of the extractions were due to caries, 65% were due to periodontal disease and only 6.4% related to "other" reasons. In both, males and females, periodontal disease was the major cause for tooth loss yet, females exhibited more extractions due to caries than males (35% vs 23% respectively). A relatively high incidence of tooth loss was documented for the 85+ age group. Of the teeth that were extracted, incisors and molars were equally the most frequent (29%) followed by premolars (26%) and canines (17%). Premolars were the teeth most frequently extracted out of the teeth removed due to caries (32%) whereas incisors were the most frequently removed within the group of teeth extracted due to periodontal disease (31%). CONCLUSIONS: The results of this study point to the importance of prevention and treatment of dental diseases, particularly periodontal disease, in adults aged 0 years and above in order to prevent tooth loss in their later years. <51> UI - 99459728 AU - Steele JG AU - Walls AW AU - Murray JJ IN - Department of Restorative Dentistry, Dental School, Newcastle upon Tyne, UK. TI - Partial dentures as an independent indicator of root caries risk in a group of older adults. SO - Gerodontology 1997;14(2):67-74 AB - OBJECTIVES: To estimate the independent association between the wearing of removable partial dentures (RPD) and the presence of root caries in a population of older adults. DESIGN: Multivariate logistic regression modeling of root caries prevalence using different measures of root caries as dependent variables. The model included measures of disease history as indicators of historical risk. SETTING: Data collected in the field from three areas of England. SUBJECTS: Random sample of adults aged 60 years and over, drawn from lists of patients registered with general medical practitioners. INTERVENTION: Field measurements of a range of oral health variables including oral disease, disease history, oral status and various social and demographic measures. MAIN OUTCOME MEASURES: The presence of root caries, unsound and sound root restorations. RESULTS: Of the five different models of root caries prevalence which were used, RPDs featured as an independent risk indicator for root surface caries in the three which were related to the presence of untreated disease. The odds ratios for the contribution made by RPDs were all over 1.6, and when considered alone was in excess of 2 in one model. These models were generally well fitting. RPDs did not feature as a risk indicator in the two models which related only to the presence of root surface restorations. CONCLUSIONS: In this study, where RPDs were present, the odds of untreated disease being present increased substantially. <52> UI - 98114699 AU - Kiyak HA IN - University of Washington, Seattle, USA. TI - Measuring psychosocial variables that predict older persons' oral health behaviour. SO - Gerodontology 1996 Dec;13(2):69-75 AB - The importance of recognising psychosocial characteristics of older people that influence their oral health behaviours and the potential success of dental procedures is discussed. Three variables and instruments developed and tested by the author and colleagues are presented. A measure of perceived importance of oral health behaviours has been found to be a significant predictor of dental service utilization in three studies. Self-efficacy regarding oral health has been found to be lower than self-efficacy regarding general health and medication use among older adults, especially among non-Western ethnic minorities. The significance of self-efficacy for predicting changes in caries and periodontal disease is described. Finally, a measure of expectations regarding specific dental procedures has been used with older people undergoing implant therapy. Studies with this instrument reveal that patients have concerns about the procedure far different than those focused on by dental providers. All three instruments can be used in clinical practice as a means of understanding patients' values, perceived oral health abilities, and expectations from dental care. These instruments can enhance dentist-patient rapport and improve the chances of successful dental outcomes for older patients. <53> UI - 96430382 AU - Alvarez-Arenal A AU - Alvarez-Riesgo JA AU - Pena Lopez JM AU - Fernandez Vazquez JP AU - Villa Vigil MA IN - Department of Prosthodontics, School of Dentistry, University of Oviedo, Spain. TI - DMFT and treatment needs in adult population of Oviedo, Spain. SO - Community Dentistry & Oral Epidemiology 1996 Feb;24(1):17-20 AB - An epidemiological survey was carried out in 1992 researching dental caries and treatment needs in an adult population in Oviedo, Spain. A representative sample of 261 subjects, randomly obtained and stratified by age, was examined. Results show a dental decay prevalence of 99.6%; 12.5 DMFT index with 2.9, 7.5 and 2.1 mean values for D, M and F components. Women and the lower social class showed the highest DMFT index. Treatment needs reach a mean value of 12.1 teeth per person. Pontics are the most needed treatment, the mean value increases with age while the differences among age groups and social classes are statistically significant. The next most needed dental treatment is filling of one surface which decreases with age, is the same for men and women and higher among the middle social class; the differences are statistically significant among the social classes. <54> UI - 96429983 AU - Gilbert GH AU - Antonson DE AU - Mjor IA AU - Ringelberg ML AU - Dolan TA AU - Foerster U AU - Legler DW AU - Heft MW AU - Duncan RP IN - Claude D. Pepper Center for Research of Oral Health in Aging, University of Florida, Gainesville, USA. TI - Coronal caries, root fragments, and restoration and cusp fractures in US adults. SO - Caries Research 1996;30(2):101-11 AB - The Florida Dental Care Study is a longitudinal study of changes in oral health that included at baseline 873 subjects (Ss) who had at least 1 tooth, were 45 years or older, and participated for an interview and examination. Forty-five percent of Ss had active coronal caries; 94% of the coronal carious surfaces were primary decay, and only 6% were secondary/recurrent. Ten percent of Ss had 1 or more root fragments, 16% of Ss had 1 or more teeth with restoration fractures, and 14% of Ss had 1 or more teeth with cusp fractures. Blacks, poor persons, and irregular attenders had more caries, root fragments, and cusp fractures, even though they had significantly fewer teeth. Blacks, poor persons, and irregular attenders were not at increased risk for restoration fractures, probably because fractures were associated with dental care use. These findings regarding caries and restorative treatment needs are consistent with a substantial burden in adult high-risk groups, and are relevant for dental primary health care policy. <55> UI - 97058912 AU - Chen MS AU - Hunter P IN - Center for Health Administration Studies, School of Social Service Administration, University of Chicago, IL 60637, USA. TI - Oral health and quality of life in New Zealand: a social perspective. SO - Social Science & Medicine 1996 Oct;43(8):1213-22 AB - This study addresses the social dimensions of oral health by relating oral quality of life (i.e. dental symptoms, perceived oral well-being and oral functioning) to oral health status. We propose a conceptual model which postulates that socioeconomic status, oral health behavior and oral health status each influence oral quality of life. Using data from the New Zealand National Oral Health Survey, we describe and analyze oral health status and oral quality of life among children aged 12-13 and adults aged 35-44 and 65-74. The study demonstrates the impact of oral health problems on the oral quality of life of children, middle-aged adults and older adults in New Zealand. The majority have experienced at least one dental symptom in the past year. Some of them perceive poor oral health and also dislike the way their teeth/dentures look. Various aspects of their social and physical functioning are adversely affected by oral health problems. The results of multiple regression analyses of oral quality of life demonstrate that perceived general health is a consistent predictor of quality of life. Furthermore, the adults' oral quality of life is positively related to asymptomatic dental visits and negatively related by symptomatic dental visits. Children's oral quality of life is positively related to more frequent brushing and flossing. Oral health status is closely associated with oral quality of life for both adults and children. Analyzing the New Zealand oral quality of life data and reviewing previous research findings using a conceptual model provide the possibility for a more comprehensive and integrated understanding of oral quality of life issues. <56> UI - 97112538 AU - Lawrence HP AU - Beck JD AU - Hunt RJ AU - Koch GG IN - Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450, USA. TI - Adjustment of the M-component of the DMFS index for prevalence studies of older adults. SO - Community Dentistry & Oral Epidemiology 1996 Oct;24(5):322-31 AB - Cross-sectional studies of caries in older adults report a substantial number of missing teeth, making it difficult to estimate caries experience accurately. The goal of this study was to improve the method of estimating caries experience as expressed by the DMFS index in population groups with missing teeth. The adjustment was demonstrated with reference to the Piedmont 65+ Dental Study conducted on a random sample of 363 community-dwelling older adults in North Carolina who were followed for 5 years. These older dentate adults had a mean (+/-SE) of 11.7 +/- 0.5 teeth missing at baseline, 56.1 +/- 2.5 missing surfaces and a DMFS of 86.7 +/- 2.0. A predicted caries prevalence was determined from the DFS at 5 yrs plus the 5-yr DFS incidence and the baseline DFS of teeth lost during the study period. Then a formula was developed that would estimate the predicted caries prevalence as a function of the observed 5-yr DMFS. This formula provided a good estimation of caries prevalence at 5 yrs (DMFSadj) when compared with the predicted prevalence (paired t-test, p > 0.05), while prevalence was underestimated by the DFS and greatly overestimated by the traditional DMFS index. Subgroup analyses by race, sex, and periodontal status also indicated that the DMFSadj resulted in patterns of estimates similar to the predicted prevalence, while the DFS and the DMFS were likely to result in different findings. The DMFS from the time of tooth eruption also was adjusted using this formula. The resulting analyses of subgroup differences in caries were not different from the previous estimates based on the 5-yr historical data, indicating that the adjustment of all M surfaces avoids the biases inherent in the traditional DMFS and DFS indices. This study showed that predicted caries prevalence could be estimated by adjusting the M component of the DMFS. It appears that this adjustment formula can be used without obvious bias, but additional studies are needed to provide adjustment figures for populations with different caries prevalences. <57> UI - 97013190 AU - Lawrence HP AU - Hunt RJ AU - Beck JD AU - Davies GM IN - Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, USA. TI - Five-year incidence rates and intraoral distribution of root caries among community-dwelling older adults. SO - Caries Research 1996;30(3):169-79 AB - The 5-year incidence and intraoral distribution of decayed and filled root surfaces were evaluated in 379 black and 323 white residents of North Carolina aged 65 and older. During the period of study, approximately 39% of blacks developed at least one root DFS compared with 52% for whites (Wald X(2) test, p = 0.062). When the results were calculated using the net root DFS increment, blacks did not have significantly higher rates than whites over the 5-year study period (0.52 surfaces/person versus 0.42 surfaces/person, Survey Regression, n = 363, p = 0.708). However, for blacks, the 5-year incidence density rate of root DFS was 0.26 per 60 surface-months at risk, and for whites the rate was 0.19 new root DFS per 60 surface-months (incidence density ratio = 1.33, 95% CI = 1.01-1.76, p = 0.047). Intraoral distribution patterns for root caries incidence revealed that the approximal surfaces of the anterior teeth were involved most frequently, particularly in the mandible and maxilla in whites, followed in decreasing order by the buccal surfaces of the lower anteriors and the mesial surfaces of the upper anteriors in blacks. Although root caries incidence rates were obviously low, there were significant differences in the occurrence of caries between blacks and whites. The pattern of occurrence was similar for both races with root surface disease being concentrated in the approximal surfaces of the anterior teeth in a small proportion of affected individuals, with whites presenting more filled root increments than blacks. These findings suggest a need for more caries treatment in blacks and increased monitoring of this population since they are at a higher risk for root caries. <58> UI - 97084246 AU - Hede B IN - Department for Community Dentistry, Faculty of Health Sciences, University of Copenhagen, Denmark. TI - Determinants of oral health in a group of Danish alcoholics. SO - European Journal of Oral Sciences 1996 Aug;104(4 ( Pt 1)):403-8 AB - The purposes of this survey were to describe dental health in a group of alcoholics and to analyze the influence of social background, dental health behavior and alcohol-related variables on dental health among alcoholics. The dental health in a group of consecutively admitted alcoholics (n = 195) was described with respect to number of teeth present, DMFS, DS and the prevalence of dental erosion, removable dentures, edentulousness, and untreated dental decay. No major differences were found with respect to number of teeth and dental caries (DMFS), when compared to reference figures of the general population. As to untreated decay, however, 3-5 x more actual decayed surfaces were found among the alcoholics. In the multivariate analyses, neither DMFS, nor untreated decay were found to be associated with alcohol-related indicators. These variables were, however, related to variables of social background and dental health behavior. As to number of teeth present, an association was found with duration of alcoholism, but this relationship was eliminated, when the analysis was controlled with respect to social situation. In contrast, dental erosion was related to duration of alcoholism irrespective of confounding control of dental health behavior and social situation. Hence, the study indicates that oral health in alcoholics can be explained mainly by social situation and dental health behavior and not by variables associated directly with alcohol consumption. An exception was the presence of dental erosion, which was associated with the exposure to alcohol. <59> UI - 97041592 AU - Blinkhorn AS AU - Davies RM IN - Department of Oral Health and Development, University of Manchester Dental Hospital, UK. TI - Caries prevention. A continued need worldwide. SO - International Dental Journal 1996 Jun;46(3):119-25 AB - This paper provides a global perspective of the changing prevalence, severity, distribution and pattern of dental caries. The prevalence of caries in children and adolescents has declined in most developed countries and it is now a minority of young people who experience most of the disease. All forms of caries have reduced in prevalence but pits and fissures are the surfaces most frequently involved. The caries experience and levels of edentulousness in the adult populations of developed countries have also declined. The prevalence of caries in adults is remarkably constant with age but in older subjects root caries is becoming more prevalent. However, in many developing countries the prevalence of caries in young children is high and is increasing in those populations who are adopting a cariogenic diet. In countries such as Kenya and China, caries is the major cause of tooth loss but levels of edentulousness are low. There are considerable variations in disease levels between and within countries and it is evident that lower socio-economic and certain racial groups exhibit high levels of dental caries. It is essential to sustain the benefit of fluoride to those already receiving it and encourage the use of appropriate and effective strategies and products by those who are not. Water and salt fluoridation should be implemented where deemed feasible and the use of a clinically proven and affordable fluoride toothpaste should be encouraged. <60> UI - 97062965 AU - Payne BJ AU - Locker D IN - Department of Sociology, University of Manitoba, Winnipeg, Canada. bpayne@bldgarts.lanl.umanitoba.ca TI - Relationship between dental and general health behaviors in a Canadian population. SO - Journal of Public Health Dentistry 1996 Summer;56(4):198-204 AB - 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. CONCLUSIONS: 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. <61> UI - 97016666 AU - Gift HC AU - Drury TF AU - Nowjack-Raymer RE AU - Selwitz RH IN - Disease Prevention and Health Promotion Branch, National Institute of Dental Research, National Institutes of Health, Bethesda, MD 20892, USA. gifth@de45.nidr.nih.goy TI - The state of the nation's oral health: mid-decade assessment of Healthy People 2000. SO - Journal of Public Health Dentistry 1996 Spring;56(2):84-91 AB - OBJECTIVES: This communication reviews the history and process of establishing and assessing national health objectives, presents the status of oral health objectives in Healthy People 2000, and summarizes major issues related to the outlook for the nation's oral health from the perspectives of participants in a July 1995 briefing session with the US Assistant Secretary for Health. METHODS: Data obtained from sources such as the third National Health and Nutrition Examination Survey-Phase 1, the 1991 Indian Health Service Survey, and 1989-92 National Health Interview Surveys were examined in relation to specific indicators and populations defined at baseline using mid-1980s data. RESULTS: Examination of baseline measures and progress data shows that the indicators for objectives are, for the most part, stable or improving slightly. Deaths due to oral cancer have decreased. Edentulousness is declining. Placement of dental sealants on children's teeth is increasing. Adult dental visits are on the expected course. Little change has been observed in water fluoridation. Apparent declines in dental visits and increases in untreated dental decay for young children are potential concerns. Four objectives have no data for progress evaluation. CONCLUSIONS: The persistent and often dramatic race-ethnicity and socioeconomic differences on many objectives, in combination with possible alterations in the public health infrastructure, indicate that concentrated and collaborative efforts are needed to achieve Healthy People 2000 targets. <62> UI - 97024808 AU - Ahlberg J AU - Tuominen R AU - Murtomaa H IN - Department of Dental Public Health University of Helsinki, Finland. TI - Subsidized dental care improves caries status in male industrial workers. SO - Community Dentistry & Oral Epidemiology 1996 Aug;24(4):249-52 AB - The association between an employer-provided dental benefit scheme and dental status was studied in male industrial workers in southern Finland in 1994. A total of 325 workers (age 38-65 yrs) with access to subsidized dental care and 174 controls completed a multiple-choice questionnaire followed by clinical examinations. One or more carious teeth was registered in 19% of the subsidized group and 50% of the controls (P < 0.001). For subjects with retained roots the proportions were 2% and 15%, respectively (P < 0.001). Among those with caries the mean number of carious teeth was 2.1 (SD 2.0) in the subsidized group, and 3.2 (SD 3.8) in the control group (P < 0.05). The groups did not differ significantly in numbers of teeth or filled teeth. The probability of having one or more carious teeth was negatively associated with access to subsidized dental care, with a recall or check-up as the reason for the last dental visit, and with having had the last dental visit within the past two years. The results showed that the dental benefit scheme resulted in less untreated caries. <63> UI - 97024810 AU - Bjorkman L AU - Pedersen NL AU - Lichtenstein P IN - Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. TI - Physical and mental health related to dental amalgam fillings in Swedish twins. SO - Community Dentistry & Oral Epidemiology 1996 Aug;24(4):260-7 AB - In the past years increasing attention has been paid to possible adverse health effects of mercury exposure from dental amalgam fillings. To evaluate possible health effects from amalgam fillings, dental status registered by specially trained nurses was obtained from 587 subjects included in the ongoing Swedish Adoption/Twin Study of Aging (SATSA). Data on physical and mental health were collected and memory function tested. Mean age was 66 years (SD 9, range 46-89). In the entire material, 25% of the individuals had no own teeth and in the group with own teeth the median number of teeth surfaces filled with dental amalgam was 15 (range 0-65). Analyses of associations between number of surfaces filled with dental amalgam and a number of scales estimating somatic and mental health and memory functions were performed both for the entire group and for individuals having at least 12 teeth. Regardless of the sample, no negative effects on physical or mental health were found from amount of dental amalgam, even after controlling for age, gender, education and number of remaining teeth. When using a co-twin control design with twin pairs discordant for amalgam exposure, no negative health effects associated with dental amalgam were detected. This study does not indicate any negative effects from dental amalgam on physical or mental health or memory functions in the general population over 50 years of age. <64> UI - 96407052 AU - Honkala E AU - Kolmakow S AU - Sainio P AU - Olshevsky VA AU - Hurskainen K IN - University of Helsinki, Finland. TI - Caries experience and treatment need among adults responding to an invitation for dental examination and treatment in two Karelian communities in Russia. SO - Acta Odontologica Scandinavica 1996 Jun;54(3):171-5 AB - This study was planned and conducted by the Health Authorities of Karelia in the Russian Federation and the Faculty of Dentistry, University of Kuopio, Finland. The aim of the study was to analyze caries experience and treatment need among adults who responded to an invitation for dental examination and offered free dental treatment in two communities in Karelia. A total of 227 adults aged 30-72 years from 2 rural communities were examined clinically in accordance with WHO criteria by a team of Finnish dental specialists. The participants represented two major ethnic groups (Fenno-Ugrians, 68%; Slavs, 32%). The mean DMFT and DMFS were 15.8 and 58.8, respectively. Among dentate subjects (n = 225) 88% had at least one carious tooth and 80% had one or more filled or crowned teeth. Altogether, 34% of the subjects needed extraction(s), and 83% needed restorative treatment. The main finding of the study was that with regard to caries experience, oral health was quite good compared with that found in Finland and the UK. <65> UI - 97030654 AU - Slade GD AU - Spencer AJ AU - Locker D AU - Hunt RJ AU - Strauss RP AU - Beck JD IN - Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450, USA. TI - Variations in the social impact of oral conditions among older adults in South Australia, Ontario, and North Carolina. SO - Journal of Dental Research 1996 Jul;75(7):1439-50 AB - Previous studies among older adults have demonstrated that oral disease frequently leads to dysfunction, discomfort, and disability. This study aimed to assess variations in the social impact of oral conditions among six strata of people aged 65 years and older: residents of metropolitan Adelaide and rural Mt Gambier, South Australia; residents of metropolitan Toronto-North York and non-metropolitan Simcoe-Sudbury counties, Ontario, Canada; and blacks and whites in the Piedmont region of North Carolina (NC), United States. Subjects were participants in three oral epidemiological studies of random samples of the elderly populations in the six strata. Some 1,642 participants completed a 49-item Oral Health Impact Profile (OHIP) questionnaire which asked about impacts caused by problems with the teeth, mouth, or dentures during the previous 12 months. The percentage of dentate people reporting impacts fairly often or very often was greatest among NC blacks for 41 of the OHIP items. Two summary variables of social impact were used as dependent variables in bivariate and multivariate least-squares regression analyses. Among dentate people, mean levels of social impact were greatest for NC blacks and lowest for NC whites, while people from South Australia and Ontario had intermediate levels of social impact (P < 0.01). Missing teeth, retained root fragments, root-surface decay, periodontal pockets, and problem-motivated dental visits were associated with higher levels of social impact (P < 0.05),