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1.  A transition scoring system of caries increment with adjustment of reversals in longitudinal study: evaluation using primary tooth surface data 
The aim of this paper is to evaluate a new comprehensive scoring system for longitudinal studies using the International Caries Detection and Assessment System (ICDAS).
A sample of 638 children was examined in 2002–03 and again in 2007. Caries was assessed using the ICDAS criteria which assess six clinical stages of dental caries. Based on a transition matrix matching the baseline and follow-up ICDAS scores, we developed transition weights to best describe the progression, regression, or no progression nor regression of dental caries. Differential weights were assigned to transitions involved with non-cavitated, cavitated, filled, crowned, or missing lesions. This method (Transitional Scoring System (TSS)) differentiated biologically plausible reversals from those due to examiner’s misclassification. We computed and compared mean dmfs (decayed, missing, and filled tooth surfaces) increment scores including (dtmfs) or excluding the non-cavitated stage (dcmfs) from TSS and another adjustment method proposed by Beck (modified Beck’s method). The coefficients of variations (CV) of the two methods were also compared.
Mean dtmfs from TSS was slightly higher than that from modified Beck’s method. There was no difference in mean dcmfs between two methods. The ratios of CV indicated that the CV of TSS was significantly smaller than those from modified Beck’s method.
There were differences in caries increment scores between the two methods when we accounted for the transition of non-cavitated lesions. The evaluation of CV concluded that TSS was more efficient because it requires less sample size compared with the modified Beck’s method to detect a treatment effect. Both methods can be used to compute caries increments for populations with similar distribution of the dmfs scores to the sample used in this study.
PMCID: PMC2998587  PMID: 20690932
2.  Characteristics of African-American male caregivers in a study of oral health in Detroit – A brief communication 
The role of fathers among African-American men, particularly related to oral health, has received relatively little scholarly attention. This paper describes the characteristics of African-American men who self-identified as primary caregiver to an index child participating in the Detroit Dental Health Project. Of 1.021, caregiver-child pairs recruited to this oral health study, 52 were male. Data were collected at a central site in Detroit on: 1) demographics; 2) social support; 3) oral health beliefs, behaviors, and knowledge; 4) caregivers’ and child’s oral health. Participants reported good availability of social support and high perceived self-efficacy to take care of their child’s teeth, yet, they possessed limited knowledge on preventing oral health problems. Moreover, male caregivers had high levels of caries, missing teeth, and poor hygiene. Findings may inform the development of effective interventions aimed at male caregivers to improve knowledge and understanding of the caries process, particularly concerning their children.
PMCID: PMC2784282  PMID: 19192101
oral health; male caregivers; health disparities
3.  Lead levels in blood and saliva in a low-income population of Detroit, Michigan 
The relationships between blood lead (PbB) and saliva lead (PbSa) concentrations and the determinants of PbB and PbSa status in 970 low-income adults in the city of Detroit, Michigan were explored. Average PbB and PbSa values in the sample population were found to be 2.7 ± 0.1 μg/dl and 2.4 ± 0.13 μg/l (equivalent to 0.24 ± 0.13 μg/dl), respectively, and a weak but statistically significant association was found between the lead levels in the two types of body fluid samples. The average PbB level for men (4.0 ± 0.56 μg/dl) was higher than that for women (2.7 ± 0.11 μg/dl); other significant predictors of PbB included age, level of education, being employed, income level, the presence of peeling paint on the wall at home and smoking. There was no gender- or age-dependent difference in blood saliva values but statistically significant correlations were found between PbSa and level of education, employment, income level and smoking. Dental caries was severe in this population. Only 0.5% of the participants had no clinical signs of caries, over 80% had cavitated carious lesions (i.e., lesions that had progressed into dentin), and the number of lost teeth and carious lesions averaged 3.4 and 30, respectively. Weak but significant associations were found between PbB as well as PbSa and measures of dental caries in the study population. The positive associations are believed to be a reflection of the fact that the risk factors for dental caries, especially in low-income populations of the US, overlap extensively with those of lead poisoning and may not have a causal significance.
PMCID: PMC1819402  PMID: 16443391
Blood lead; Saliva lead; Dental caries; Lead exposure; Biomonitoring; Lead poisoning
4.  Assessment of the Relationship between Neighborhood Characteristics and Dental Caries Severity among Low-Income African-Americans: A Multilevel Approach 
To assess the relationship between neighborhood effects and the severity of dental caries among low-income African-Americans.
A multistage probability sample of African-American families living in the poorest 39 census tracts in Detroit was drawn. During 2002–03, cross-sectional data of a cohort that includes 1021 caregivers were collected in the first of three waves of interviews and examinations. Multilevel analyses focused on 27 neighborhood clusters and involved a combination of individual (Level-1) and neighborhood (Level-2) data including census and geocoded (address matching to census geographic areas) information.
There is significant variation in the severity of caries between low-income neighborhood clusters. Caries severity decreases with a higher number of churches, while it increases with a higher number of grocery stores in the clusters after accounting for individual characteristics. Only 14% of the inter-individual variability in caries was explained by classical individual risk factors for this condition.
Neighborhoods contribute something unique to caregivers’ oral health, beyond socioeconomic position and individual risk factors. Multilevel interventions are necessary to reduce disparities among African-Americans and churches may offer a promising venue from which to conduct them.
PMCID: PMC1817893  PMID: 16570748
African-American; dental caries; multilevel analysis; neighborhood effects
Caries research  2006;40(6):473-480.
The aim of this study was to examine the relationship between dietary patterns and caries experience in a representative group of low-income African-American adults. Participants were residents of Detroit, Michigan, with household incomes below 250% of the federally-established poverty level (n = 1,021). Dietary histories were obtained by trained interviewers in face-to-face interviews with the adult participants, using the Block 98.2® food frequency questionnaire developed by Block Dietary Systems, Berkeley, CA. Caries was measured by the ICDAS criteria (International Caries Detection and Assessment System). There were 200 dietary records whose data were judged to be invalid; these participants were omitted from the dietary analyses to leave n = 821. Analyses were conducted using software from SAS and SUDAAN. Factor analysis identified patterns of liquid and solid food consumption, and the resulting factor scores were used as covariates in multivariable linear regression. Caries was extensive, with 82.3% of the 1,021 participants (n=839) having at least one cavitated lesion. Nearly three-quarters of the adult participants were overweight or obese. This population has severe caries, poor oral hygiene, and diets that are high in sugars and fats and low in fruits and vegetables. Apart from tapwater, the most frequently consumed food item by adults of all ages was soft drinks; 19% of all energy from sugar came from soft drinks alone. In both the bivariate analyses and in the regression model, frequency of soft drink consumption and the presence of gingival plaque deposits were significantly associated with caries. Interventions to promote oral health are unlikely to be successful without improvements in the social and physical environment.
PMCID: PMC1626651  PMID: 17063017
diet; dietary patterns; soft drinks; sugars; fat consumption; caries; plaque deposits; oral hygiene; adults; disparities; low-income
6.  Reliability and Validity of Brief Measures of Oral Health-Related Knowledge, Fatalism, and Self-Efficacy in Mothers of African American Children 
Pediatric dentistry  2005;27(5):422-428.
Low-income African American children experience high rates of dental caries compared to the general population. Knowledgeable and efficacious caregivers can play an important role in caries prevention. This study developed and evaluated four brief measures reflecting mothers’ potentially modifiable cognitions associated with African American children’s oral health: (1) knowledge about appropriate bottle use (KBU); (2) children’s oral hygiene (KCOH); (3) oral health-related fatalism (OHF); and (4) oral health-related self-efficacy (OHSE).
Questions were selected based on reviews of the health promotion and oral health literature, with input from low income African American caregivers of young children. Reliability and validity were evaluated using survey and dental examination data from 719 low-income African American mothers and their children ages 1–5 years.
Alpha reliabilities ranged from .76 – .91. KCOH was significantly associated with mothers’ oral health perceptions and children’s caries status. OHSE was significantly positively correlated with children’s brushing frequency and with mothers’ subjective perceptions of children’s oral health, which was in turn significantly associated with children’s caries status.
Results support the reliability and validity of the new measures. If confirmed by further research, these measures can be used to develop tailored educational and cognitive-behavioral interventions to reduce oral health disparities.
PMCID: PMC1388259  PMID: 16435644
7.  Similarity of Bacterial Populations in Saliva from African-American Mother-Child Dyads▿  
Journal of Clinical Microbiology  2007;45(9):3082-3085.
Using PCR-based denaturing gradient gel electrophoresis analyses of oral bacterial samples in 20 mother-child dyads, this study demonstrated a high degree of similarity of bacterial compositions between the mothers and their children; the two may share as much as 94% of their oral bacterial spectra, including cariogenic species.
PMCID: PMC2045297  PMID: 17634300

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