The authors conducted a study to examine oral cancer prevention and early detection practice patterns in a population-based random sample of practicing oral health care professionals in New York state.
The authors surveyed a population-based, self-weighting, stratified random sample of dentists (n = 1,025) and dental hygienists (n = 1,025) in New York state. They assessed the subjects’ readiness to offer tobacco-use cessation and alcohol-abuse counseling and oral cancer examinations.
The effective response rates were 55 and 66 percent for dentists and dental hygienists, respectively. In terms of readiness to perform oral cancer examinations for patients aged 40 years and older, the large majority (82 percent of dentists and 72 percent of dental hygienists) were in the maintenance stage of behavior, indicating that oral cancer examinations were a routine part of their practice. In terms of readiness to offer tobacco-use cessation counseling, only 12 percent of dentists and 21 percent of dental hygienists were in the maintenance stage, and only 2 percent of dentists and 4 percent of dental hygienists were in the maintenance stage of offering alcohol-abuse counseling.
Oral cancer examinations seem to have been adopted as a standard of practice by most oral health care providers in New York state, but cancer prevention services, such as counseling regarding cessation of tobacco use and alcohol abuse, are lacking.
Oral health care providers should be trained in oral cancer prevention services such as tobacco-use cessation and alcohol-abuse counseling and encouraged to include these services, along with continued provision of oral cancer examinations, as a standard aspect of care.
Oral cancer; tobacco use; alcohol abuse; cancer prevention; counseling; smoking; oral health
Evaluation of a customer-designed dental service network across the service sectors for geriatric patients.
The lack in accessibility of dental services and the non-awareness of possible dental causes to medical problems by clinicians often prevents the geriatric patient from receiving the dental care needed. In cooperation with the Dental Board a geriatric dentist was appointed, multi-professional rounds, training in oral hygiene organized and a documentation system for cross-references to other medical conditions and the nutritional status implemented.
The scientific evaluation of >280 geriatric dental patients from 2008 to 2009 (22 with original teeth, 260 with dentures, 88 with denture problems, 32 with other affections).
Upon admission patients are screened for dental problems. Possible problems are seen by the specially trained geriatric dentist. The patient’s dental problems are photo-documented and than cross-referenced to his overall medical condition in a common documentation sheet for an overview of possible dental causes, the nutritional situation or other conditions.
Conclusion and discussion
The integration of a special geriatric dental service, using competence from across the sectors of medical care lead to an improved level of dental care and oral hygiene in the geriatric patients and better inter-professional understanding.
dental care; care for the elderly
Alcohol and tobacco abuse are detrimental to general and oral health. Though the effects of these harmful habits on oral mucosa had been demonstrated, their independent and combined effect on the dental caries experience is unknown and worthy of investigation.
Materials and Methods:
We compared 268 alcohol-only abusers with 2426 alcohol and tobacco abusers in chewing and smoking forms to test the hypothesis that various components of their dental caries experience are significantly different due to plausible sociobiological explanations. Clinical examination, Decay, Missing, Filled Teeth (DMFT) Index and Oral Hygiene Index - Simplified were measured in a predetermined format. Descriptive statistics, Chi-square test and one-way ANOVA analysis were done using SPSS Version 16.0.
The mean DMFT were 3.31, 3.24, 4.09, 2.89 for alcohol-only abusers, alcohol and chewing tobacco abusers, smoking tobacco and alcohol abusers, and those who abused tobacco in smoke and smokeless forms respectively. There was no significant difference between the oral hygiene care measures between the study groups. Presence of attrition among chewers and those with extrinsic stains experienced less caries than others.
Discussion and conclusion:
The entire study population exhibited a higher incidence of caries experience. Use of tobacco in any form appears to substantially increase the risk for dental caries. Attrition with use of chewing tobacco and presence of extrinsic stains with tobacco use appear to provide a protective effect from caries. The changes in oral micro-flora owing to tobacco use and alcohol may play a critical role in the initiation and progression of dental caries.
Dental caries; India; tobacco; alcohol
Little is known about how different types of substances affect oral health. Our objective was to examine the respective effects of alcohol, stimulants, opioids, and marijuana on oral health in substance-dependent persons. Using self-reported data from 563 substance-dependent individuals, we found that most reported unsatisfactory oral health, with their most recent dental visit more than 1 year ago. In multivariable logistic regressions, none of the substance types were significantly associated with oral health status. However, opioid use was significantly related to a worse overall oral health rating compared to 1 year ago. These findings highlight the poor oral health of individuals with substance dependence and the need to address declining oral health among opioid users. General health and specialty addiction care providers should be aware of oral health problems among these patients. In addition, engagement into addiction and medical care may be facilitated by addressing oral health concerns.
Oral health; Substance dependence; Dental care
To quantify racial and socioeconomic status (SES) disparities in oral health, as measured by tooth loss, and to determine the role of dental care use and other factors in explaining disparities.
Data Sources/Study Setting
The Florida Dental Care Study, comprising African Americans (AAs) and non-Hispanic whites 45 years old or older who had at least one tooth.
We used a prospective cohort design. Relevant population characteristics were grouped by predisposing, enabling, and need variables. The key outcome was tooth loss, a leading measure of a population's oral health, looked at before and after entering the dental care system. Tooth-specific data were used to increase inferential power by relating the loss of individual teeth to the disease level on those teeth.
Data Collection Methods
In-person interviews and clinical examinations were done at baseline, 24, and 48 months, with telephone interviews every 6 months.
African Americans and persons of lower SES reported more new dental symptoms, but were less likely to obtain dental care. When they did receive care, they were more likely to experience tooth loss and less likely to report that dentists had discussed alternative treatments with them. At the first stage of analysis, differences in disease severity and new symptoms explained tooth loss disparities. Racial and SES differences in attitudes toward tooth loss and dental care were not contributory. Because almost all tooth loss occurs by means of dental extraction, the total effects of race and SES on tooth loss were artificially minimized unless disparities in dental care use were taken into account.
Race and SES are strong determinants of tooth loss. African Americans and lower SES persons had fewer teeth at baseline and still lost more teeth after baseline. Tooth-specific case-mix adjustment appears, statistically, to explain social disparity variation in tooth loss. However, when social disparities in dental care use are taken into account, social disparities in tooth loss that are not directly due to clinical circumstance become evident. This is because AAs and lower SES persons are more likely to receive a dental extraction once they enter the dental care system, given the same disease extent and severity. This phenomenon underscores the importance of understanding how disparities in health care use, dental insurance coverage, and service receipt contribute to disparities in health. Absent such understanding, the total effects of race and SES on health can be underestimated.
Tooth loss; health disparities; race; socioeconomic status
Oral health has a significant impact on the quality of life, appearance, and self-esteem of the people. Preventive dental visits help in the early detection and treatment of oral diseases. Dental care utilization can be defined as the percentage of the population who access dental services over a specified period of time. There are reports that dental patients only visit the dentist when in pain and never bother to return for follow-up in most cases. To improve oral health outcomes an adequate knowledge of the way the individuals use health services and the factors predictive of this behavior is essential. The interest in developing models explaining the utilization of dental services has increased; issues like dental anxiety, price, income, the distance a person had to travel to get care, and preference for preservation of teeth are treated as barriers in regular dental care. Published materials which pertain to the use of dental services by Indian population have been reviewed and analyzed in depth in the present study. Dental surgeons and dental health workers have to play an adequate role in facilitating public enlightenment that people may appreciate the need for regular dental care and make adequate and proper use of the available dental care facilities.
Access; awareness; dental care; India; utilization
Objectives: to obtain a biomedical oral profile of a community of adult drug addicts in treatment by analysing their dental health, with a view to determining whether the state of their oral health could be attributed primarily to their lifestyle and the direct consequences of drug abuse on their overall condition, rather than to the effects of the drugs used.
Experimental Design: the study was conducted under the terms of an agreement between the Complutense University of Madrid’s (UCM) Odontology Faculty and the City of Madrid’s Substance Abuse Institute. Seventy drug addicts and 34 control group subjects were examined. The study assessed oral hygiene habits, systemic pathology, type of drugs used and the duration of use, oral pathology, oral health indices, risk of caries based on saliva tests, oral candidiasis and periodontal microbiology.
Results: statistically significant differences (p<0.05) were found between the test and control groups for practically all the variables analysed. In the drug users group, dental hygiene was wanting, systemic and oral pathology prevailed and the decayed/missing/filled teeth or surface (DMFT/S) indices denoted very poor buccodental health. The saliva tests showed a substantial risk of caries and candidiasis rates were high. By contrast, with a single exception, the microbiological studies detected no statistically significant difference between drug users and control groups periodontal flora.
Conclusions: drug-dependent patients had poor oral health and a significant increase in oral pathology, essentially caries and periodontal disease. Their risk of caries was high and the presence of candidiasis was representative of their poor general and oral health. Drug users’ poor buccodental condition was more closely related to lifestyle than to drug abuse itself.
Key words:Buccal, dental, drug addicts.
According to World Oral Health report 2003, the prevalence of periodontitis is 86% in India. Dental care can sometimes be a forgotten part of a healthy life style. While its importance is often underestimated, the need for regular dental care cannot be overstated. Oral health has been neglected for long in India. The scarce literature on dental health awareness, attitude, oral health-related habits and behavior among the adult population in Rajasthan prompted us to assess the preventive oral health awareness and oral hygiene practices in patients attending outpatient department of Vyas Dental College and Hospital (VDCH), Jodhpur through this study.
Materials and Methods:
A total of 500 patients in the age group 15–50 years were selected using random sampling technique. A self-administered structured questionnaire including 16 multiple choice questions was given to them. The results were analyzed using percentage.
The result of this study shows an acute lack of oral hygiene awareness and limited knowledge of oral hygiene practices. In Jodhpur, few people use tooth brush.
Hence, there is an urgent need for comprehensive educational programs to promote good oral health and impart education about correct oral hygiene practices.
Motivation; oral hygiene practices; oral hygiene awareness
Access to oral health care for people living with HIV/AIDS is a severe problem. This article describes the design and impact of an Innovations in Oral Health Care Initiative program, funded through the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance (SPNS) program, that expanded oral health-care services for these individuals in rural Oregon. From April 2007 to August 2010, 473 patients received dental care (exceeding the target goal of 410 patients) and 153 dental hygiene students were trained to deliver oral health care to HIV-positive patients. The proportion of patients receiving oral health care increased from 10% to 65%, while the no-show rate declined from 40% to 10%. Key implementation components were leveraging SPNS funding and services to create an integrated delivery system, collaborations that resulted in improved service delivery systems, using dental hygiene students to deliver oral health care, enhanced care coordination through the services of a dental case manager, and program capacity to adjust to unanticipated needs.
This study examined the prevalence and correlates of substance abuse service use among uninsured young adults aged 18 to 34 years (N=24,282).
Data were drawn from the 1999 National Household Survey on Drug Abuse. Logistic regression was used to identify correlates of substance abuse service use among persons who met DSM-IV criteria for dependence.
Among uninsured young adults (N=5,067), 66 percent lacked any health care coverage for at least one year. In this uninsured group, 72 percent were past-year users of alcohol or drugs (N=2,335). Among past-year alcohol users (N=2,273), 12 percent met criteria for alcohol dependence; among past-year drug users (N=864), 21 percent met dependence criteria. Eighty-seven percent of the uninsured young adults with alcohol or drug dependence did not receive any substance abuse treatment services in the previous year. In the uninsured substance-dependent group, women, blacks, and His-panics were less likely than men and whites to use substance abuse services. Among those with substance dependence, uninsured persons were more likely than privately insured persons to receive substance abuse services from the self-help or human service (nonmedical) sector.
Racial, ethnic, and gender disparities in the use of substance abuse services are notable among young adults who lack health insurance.
This qualitative study explored the impact on oral health-care knowledge, attitudes, and practices among 39 people living with HIV/AIDS (PLWHA) participating in a national initiative aimed at increasing access to oral health care. Personal values and childhood dental experiences, beliefs about the importance of oral health in relation to HIV health, and concerns for appearance and self-esteem were found to be determinants of oral health knowledge and practice. Program participation resulted in better hygiene practices, improved self-esteem and appearance, relief of pain, and better physical and emotional health. In-depth exploration of the causes for these changes revealed a desire to continue with dental care due to the dental staff and environmental setting, and a desire to maintain overall HIV health, including oral health. Our findings emphasize the importance of addressing both personal values and contextual factors in providing oral health-care services to PLWHA.
We examined the association of substance abuse treatment with access to liver specialty care among 231 persons coinfected with HIV and hepatitis C virus (HCV) with a history of alcohol problems who were recruited and followed up in the HIV-Longitudinal Interrelationships of Viruses and Ethanol cohort study from 2001 to 2004. Variables regarding demographics, substance use, health service use, clinical variables, and substance abuse treatment were from a standardized research questionnaire administered biannually. We defined substance abuse treatment services as any of the following in the previous 6 months: 12 weeks in a halfway house or residential facility, 12 visits to a substance abuse counselor or mental health professional, day treatment for at least 30 days, or any participation in a methadone maintenance program. Liver specialty care was defined as a visit to a liver doctor, a hepatologist, or a specialist in treating hepatitis C in the past 6 months. At study entry, most of the 231 subjects (89%, n = 205) had seen a primary care physician, 50% had been exposed to substance abuse treatment, and 50 subjects (22%) had received liver specialty care. An additional 33 subjects (14%) reported receiving liver specialty care during the follow-up period. In the multivariable model, we observed a clinically important although not statistically significant association between having been in substance abuse treatment and receiving liver specialty care (adjusted odds ratio = 1.38; 95% confidence interval = 0.9–2.11). Substance abuse treatment systems should give attention to the need of patients to receive care for prevalent treatable diseases such as HIV/HCV coinfection and facilitate its medical care to improve the quality of care for individuals with substance use disorders. The data illustrate the need for clinical care models that give explicit attention to the coordination of primary health care with addiction and hepatitis C specialty care while providing ongoing support to engage and retain these patients with complex health needs.
Substance abuse; Hepatitis C virus; Liver specialty care; Substance abuse treatment
This cross-sectional study was performed in the Dental School of Prince of Songkla University to ascertain noise exposure of dentists, dental assistants, and laboratory technicians. A noise spectral analysis was taken to illustrate the spectra of dental devices.
A noise evaluation was performed to measure the noise level at dental clinics and one dental laboratory from May to December 2010. Noise spectral data of dental devices were taken during dental practices at the dental services clinic and at the dental laboratory. A noise dosimeter was set following the Occupational Safety and Health Administration criteria and then attached to the subjects' collar to record personal noise dose exposure during working periods.
The peaks of the noise spectrum of dental instruments were at 1,000, 4,000, and 8,000 Hz which depended on the type of instrument. The differences in working areas and job positions had an influence on the level of noise exposure (p < 0.01). Noise measurement in the personal hearing zone found that the laboratory technicians were exposed to the highest impulsive noise levels (137.1 dBC). The dentists and dental assistants who worked at a pedodontic clinic had the highest percent noise dose (4.60 ± 3.59%). In the working areas, the 8-hour time-weighted average of noise levels ranged between 49.7-58.1 dBA while the noisiest working area was the dental laboratory.
Dental personnel are exposed to noise intensities lower than occupational exposure limits. Therefore, these dental personnel may not experience a noise-induced hearing loss.
Noise-induced hearing loss; Noise; Dental practice; Dental school; Dental instruments
The dental health status of 4,006 residents of Louisiana was analyzed, based on data in the 1968-70 Ten-State Nutrition Survey funded by the U.S. Government. These data were based on examinations of census districts in which the average per capita income was in the lowest quartile for the nation. A considerable variation in the prevalence of dental diseases was found among the Louisiana residents according to age. The females examined had a slightly higher DMF (decayed, missing, and filled permanent teeth) score, a lower OHI (oral hygiene index) score, and a slightly lower PI (periodontal index) score than did the males. The dental caries attack rate did not vary much by race, but the whites examined had received a much greater amount of dental care than had their black counterparts. The OHI scores of the blacks were higher than those for the whites in both the debris and calculus components. The PI scores were higher for the blacks than for the whites. More white persons than blacks were edentulous; this result, however, tends to confirm the observation of increased dental care in white persons. The percentages of persons with periodontal disease and periodontal pockets were considerably higher among persons with incomes below the poverty level, and a greater percentage of blacks had incomes below that level. The data thus apparently indicate that the major determinants of dental health status in Lousiana are age and level of income; race appears to be the major determinant of the amount of dental care received.
Objectives. Dental caries is the most common chronic childhood disease, with numerous identified risk factors. Risk factor differences could indicate the need to target caregiver/patient education/preventive care intervention strategies based on population and/or individual characteristics. The purpose of this study was to evaluate caries risk factors differences by race/ethnicity, income, and education. Methods. We enrolled 396 caregiver-toddler pairs and administered a 105-item questionnaire addressing demographics, access to care, oral bacteria transmission, caregiver's/toddler's dental and medical health practices, caregiver's dental beliefs, and caregiver's/toddler's snacking/drinking habits. Logistic regressions and ANOVAs were used to evaluate the associations of questionnaire responses with caregiver's race/ethnicity, income, and education. Results. Caregivers self-identified as Non-Hispanic African-American (44%), Non-Hispanic White (36%), Hispanic (19%), and “other” (1%). Differences related to race/ethnicity, income, and education were found in all risk factor categories. Conclusions. Planning of caregiver/patient education/preventive care intervention strategies should be undertaken with these caries risk factor differences kept in mind.
To analyse the effects of socioeconomic disadvantage on access to dental care services and on oral health.
Design, setting and outcomes
Cross‐sectional data from the Swedish National Surveys of Public Health 2004 and 2005. Outcomes were poor oral health (self‐rated oral health and symptoms of periodontal disease) and lack of access to dental care services. A socioeconomic disadvantage index (SDI) was developed, consisting of social welfare beneficiary, being unemployed, financial crisis and lack of cash reserves.
Swedish population‐based sample of 17 362 men and 20 037 women.
Every instance of increasing levels of socioeconomic disadvantage was associated with worsened oral health but, simultaneously, with decreased utilisation of dental care services. After adjusting for age, men with a mild SDI compared with those with no SDI had 2.7 (95% confidence interval (CI) 2.5 to 3.0) times the odds for self‐rated poor oral health, whereas odds related to severe SDI were 6.8 (95% CI 6.2 to 7.5). The corresponding values among women were 2.3 (95% CI 2.1 to 2.5) and 6.8 (95% CI 6.3 to 7.5). Nevertheless, people with severe socioeconomic disparities were 7–9 times as likely to refrain from seeking the required dental treatment. These associations persisted even after controlling for living alone, education, occupational status and lifestyle factors. Lifestyle factors explained only 29% of the socioeconomic differences in poor oral health among men and women, whereas lack of access to dental care services explained about 60%. The results of the multilevel regression analysis indicated no additional effect of the administrative boundaries of counties or of municipalities in Sweden.
Results call for urgent public health interventions to increase equitable access to dental care services.
Pediatric dental caries is the most common chronic disease among children. Above 40% of the U.S. children aged 2–11 years have dental caries; more than 50% of them come from low-income families. Under dental services of the Medicaid program, children enrolled in Medicaid must receive preventive dental services. However, only 1/5 of them utilize preventive dental services. The purpose of this overview is to measure the impact of Medicaid dental benefits on reducing oral health disparities among Medicaid-eligible children. This paper explains the importance of preventive dental care, children at high risk of dental caries, Medicaid dental benefits, utilization of dental preventive services by Medicaid-eligible children, dental utilization influencing factors, and outcome evaluation of Medicaid in preventing dental caries among children. In conclusion, despite the recent increase of children enrolled in Medicaid, utilizing preventive dental care is still a real challenge that faces Medicaid.
There is limited evidence of the influence of psychosocial factors and health beliefs on public dental patient's patterns of service use in Australia. The research aims were to examine associations between dental attitudes and beliefs of public dental service users and dental visiting intention and behaviour using the Theory of Planned Behaviour.
517 randomly selected adult public dental patients completed a questionnaire assessing dental attitudes and beliefs which was matched with electronic records for past and future dental service use. A questionnaire measured intentions, attitudes, subjective norms and perceptions of behavioural control and self-efficacy in relation to visiting public dentists. A measure of dental attendance at public dental clinics was obtained retrospectively (over 3 1/2 years) and prospectively (over a one year period following the return of the questionnaire) by accessing electronic patient clinical records.
Participants had positive attitudes, subjective norms and self-efficacy beliefs towards dental visiting but perceived a lack of control over visiting the dentist. Attitudes, subjective norms, self-efficacy and perceived control were significant predictors of intention (P < 0.05). Intentions, self-efficacy and past dental attendance were significant predictors of actual dental attendance (P < 0.05).
Public dental patients held favourable attitudes and beliefs but perceived a lack of control towards dental visiting. Reducing structural barriers may therefore improve access to public dental services.
HIV infected patients should be expected in the Sudanese dental health care services with an increasing frequency. Dental care utilization in the context of the HIV epidemic is generally poorly understood. Focusing on Sudanese dental patients with reported unknown HIV status, this study assessed the extent to which Andersen's model in terms of predisposing (socio-demographics), enabling (knowledge, attitudes and perceived risk related to HIV) and need related factors (oral health status) predict dental care utilization. It was hypothesized that enabling factors would add to the explanation of dental care utilization beyond that of predisposing and need related factors.
Dental patients were recruited from Khartoum Dental Teaching Hospital (KDTH) and University of Science and Technology (UST) during March-July 2008. A total of 1262 patients (mean age 30.7, 56.5% females and 61% from KDTH) were examined clinically (DMFT) and participated in an interview.
A total of 53.9% confirmed having attended a dental clinic for treatment at least once in the past 2 years. Logistic regression analysis revealed that predisposing factors; travelling inside Sudan (OR = 0.5) were associated with lower odds and females were associated with higher odds (OR = 2.0) for dental service utilization. Enabling factors; higher knowledge of HIV transmission (OR = 0.6) and higher HIV related experience (OR = 0.7) were associated with lower odds, whereas positive attitudes towards infected people and high perceived risk of contagion (OR = 1.3) were associated with higher odds for dental care utilization. Among need related factors dental caries experience was strongly associated with dental care utilization (OR = 4.8).
Disparity in the history of dental care utilization goes beyond socio-demographic position and need for dental care. Public awareness of HIV infection control and confidence on the competence of dentists should be improved to minimize avoidance behaviour and help establish dental health care patterns in Sudan.
To investigate the influence of family socioeconomic trajectories from childhood to adolescence on dental caries and associated behaviours.
Population‐based birth cohort.
Representative sample of the population of subjects born in 1982 in Pelotas, Brazil.
Adolescents (n = 888) aged 15 years old were dentally examined and interviewed.
Main outcome measures
Dental caries index (DMFT), care index (F/DMFT), tooth brushing, flossing and pattern of dental services use.
Adolescents who were always poor showed, in general, a worse pattern of dental caries, whereas adolescents who never were poor had a better pattern of dental caries. Adolescents who had moved from poverty in childhood to non‐poverty in adolescence and those who had moved from non‐poverty in childhood to poverty in adolescence had similar dental pattern to those who were always poor except for the pattern of dental services use, which was higher in the first group. In all groups girls had fewer carious teeth, better oral hygiene habits and higher dental services use than boys.
Poverty in at least one stage of the lifespan has a harmful effect on dental caries, oral behaviours and dental services use. Belonging to upwardly mobile families between childhood and adolescence only contributed to improved dental care.
The objective of this study was to examine the public health relevance of the prevalence of dental fear in Kuwait and the resultant barrier that it creates regarding access to dental care. The study analysis demonstrated a high prevalence of dental fear and anxiety in the Kuwaiti population and a perceived need for anesthesia services by dental care providers. The telephone survey of the general population showed nearly 35% of respondents reported being somewhat nervous, very nervous, or terrified about going to the dentist. In addition, about 36% of the population postponed their dental treatment because of fear. Respondents showed a preference to receive sedation and anesthesia services as a means of anxiety relief, and they were willing to go to the dentist more often when such services were available. People with high fear and anxiety preferred to receive some type of medication to relieve their anxiety. In conclusion, the significance and importance of the need for anesthesia services to enhance the public health of dental patients in Kuwait has been demonstrated, and improvements are needed in anesthesia and sedation training of Kuwaiti dental care providers.
Needs assessment; Sedation; Kuwait; Dental anesthesia; Anxiety
Despite wide recognition that children with disability often have poor oral health, few high quality, controlled results are available.
Twenty-four objective and subjective criteria covering feeding, autonomy, access to dental care, oral hygiene, oral disease, general health and behavior were evaluated in a observational cross-sectional study of 2,487 children with disability (DC group), 4,772 adolescents with disability (DA group) and 1,641 children without disability (NDC group). Five algorithms ranked the subjects according to clinical criteria in three original oral health indices: the Clinical Oral Health Index (COHI), indicating the level of oral health problems, the Clinical Oral Care Needs Index (COCNI) giving dental care need levels, and the Clinical Oral Prevention Index (COPI) determining possible needs in terms of dental education initiatives.
DC-group children presented poorer oral health and had greater needs in both treatment and preventive oral health actions than NDC-group children (OR = 3.97, 95% CI = 3.25–4.86 for COHI; OR = 2.01, 95% CI = 1.77–2.28 for COCNI; OR = 5.25, 95% CI = 4.55–6.02 for COPI). These conditions were worse again in the DA group comparing to the DC group (OR = 3.52, 95% CI = 2.7–4.6 for COHI; OR = 1.52, 95% CI = 1.38–1.69 for COCNI; OR = 1.53, 95% CI = 1.39–1.69 for COPI).
Clinical indices generated by algorithmic association of various clinical indicators allow sensitive clinical measurement, and in this study demonstrated inequalities in oral health for children with disabilities schooling in institutions. Questions need now to be addressed as to the measures that could be taken to compensate for this situation.
Background and aims
Change in the resting whole-mouth salivary flow rate (SFR) plays a significant role in patho-genesis of various oral conditions. Factors such as smoking may affect SFR as well as the oral and dental health. The primary purpose of this study was to determine the effect of smoking on SFR, and oral and dental health.
Materials and methods
One-hundred smokers and 100 non-tobacco users were selected as case and control groups, respectively. A questionnaire was used to collect the demographic data and smoking habits. A previously used questionnaire about dry mouth was also employed. Then, after a careful oral examination, subjects’ whole saliva was collected in the resting condition. Data was analyzed by chi-square test using SPSS 15.
The mean (±SD) salivary flow rate were 0.38 (± 0.13) ml/min in smokers and 0.56 (± 0.16) ml/min in non-smokers. The difference was statistically significant (P=0.00001). Also, 39% of smokers and 12% of non-smokers reported experiencing at least one xerostomia symptom, with statistically significant difference between groups (p=0.0001). Oral lesions including cervical caries, gingivitis, tooth mobility, calculus and halitosis were significantly higher in smokers.
Our findings indicated that long-term smoking would significantly reduce SFR and increase oral and dental disorders associated with dry mouth, especially cervical caries, gingivitis, tooth mobility, calculus, and halitosis.
Oral health; saliva; smoking; tobacco; xerostomia
Oral health is an essential component of general health and well-being, yet dental access barriers and unmet needs are pronounced, particularly in rural areas. Despite associations with systemic health, few studies have assessed unmet dental needs across the lifespan as they present in primary care. This study describes the prevalence of oral health conditions and unmet dental needs among patients presenting for routine care in a rural Oregon family medicine practice.
Eight primary care clinicians were trained to conduct basic oral health screenings for seven dental conditions associated with ICD-9-CM codes. During the 6-week study period patients over 12 months in age who presented to the practice for a regularly scheduled appointment received the screening and completed a brief dental access survey.
Of 1655 eligible patients, 40.7% (n = 674) received the screening and 66.9% (n = 1108) completed the survey. Half of the patients screened (46.0%, n = 310) had oral health conditions detected, including: partial edentulism (24.5%), dental caries (12.9%), complete edentulism (9.9%), and cracked teeth (8.9%). Twenty eight percent of the patients reported experiencing unmet dental needs. Patients with dental insurance were significantly more likely to report better oral and general health outcomes as compared to those with no insurance or health insurance only.
Oral health disease and unmet dental needs are substantial as they present in one rural primary care practice across the lifespan. Primary care settings may present opportune environments for reaching patients who are unable to obtain regular dental care.
We examined factors associated with dental anxiety among a sample of HIV primary care patients and investigated the independent association of dental anxiety with oral health care.
Cross-sectional data were collected in 2010 from 444 patients attending two HIV primary care clinics in Miami-Dade County, Florida. Corah Dental Anxiety Scores and use of oral health-care services were obtained from all HIV-positive patients in the survey.
The prevalence of moderate to severe dental anxiety in this sample was 37.8%, while 7.9% of the sample was characterized with severe dental anxiety. The adjusted odds of having severe dental anxiety were 3.962 times greater for females than for males (95% confidence interval [CI] 1.688, 9.130). After controlling for age, ethnicity, gender, education, access to dental care, and HIV primary clinic experience, participants with severe dental anxiety had 69.3% lower adjusted odds of using oral health-care services within the past 12 months (vs. longer than 12 months ago) compared with participants with less-than-severe dental anxiety (adjusted odds ratio = 0.307, 95% CI 0.127, 0.742).
A sizable number of patients living with HIV have anxiety associated with obtaining needed dental care. Routine screening for dental anxiety and counseling to reduce dental anxiety are supported by this study as a means of addressing the impact of dental anxiety on the use of oral health services among HIV-positive individuals.