A day at the office (an advertorial).

This issue of General Dentistry highlights how tobacco products affect oral health. The following articles are presented to help general dentists with their efforts to champion cessation and to educate their patients. Please also note the guest editorial from Dr. Robert Mecklenburg. This first article by Dr. Stephen B. Corbin is an introduction to the topic at large and provides the reader with a suggested script for use in helping patients quit the smoking habit. We hope you find these articles useful and look forward to hearing your response. Please fax (312/440-4261) or e-mail (AGDJournal@agd.org) your thoughts on these articles. We hope these articles succeed in helping you help your patients beat the tobacco habit.

Early childhood caries: a positive beginning.

Early childhood caries (ECC) is among the most prevalent health problems of low-income infants and toddlers, yet little attention and few resources have been allocated to understanding this disease. Since dental caries in infants and toddlers cannot be exclusively ascribed to feeding practices, other concepts regarding its etiology and prevention need to be examined. Furthermore, the establishment of evidence-based policies regarding this basic health problem is critical for the dissemination of consistent standards of care to health care providers and government agencies. To accomplish these objectives, the scientific community, organizations concerned with children's health and the political process need to be energized to find resources and energy to solve this public health challenge.

Public knowledge of prevention of dental disease.

The authors present data describing the level and extent of the general public's knowledge of oral diseases and their prevention. They discuss data from the 1990 National Health Interview Survey's Health Promotion and Disease Prevention Supplement in the context of national oral health objectives. They focus on demographic and socioeconomic differences seen in the public's knowledge of the preventive purposes of fluorides and dental sealants for dental caries and of symptoms of gum disease. Reported low levels of knowledge regarding oral disease symptoms and their prevention show the continuing trend reported during the past decade. Racial and ethnic minorities and groups with low levels of formal education demonstrate the least knowledge of prevention of oral diseases. For example, 76 percent of those with more than 12 years of schooling know the preventive purpose of water fluoridation, compared with 61 percent of those with 12 years, and 36 percent of those with less than 12 years of school. Efforts to increase levels of knowledge about oral disease prevention are required to achieve national objectives for oral health.

The benefits and risks of dental amalgam: current findings reviewed.

In response to recent concern and research findings about dental amalgam, the U.S. Public Health Service conducted a comprehensive scientific review of its benefits and risks. This review would serve as a basis for re-examining federal policy on the use of dental amalgam as a restorative material. This article summarizes the principal findings, conclusions and recommendations from that review.

Concepts of modern risk assessment and management.

An emerging and increasingly complex array of environmental health concerns face dental practitioners in both the private and public sectors. These concerns are challenging and possibly threatening the traditionally inviolable dentist-patient relationship. Regulatory bodies, health risk experts, attorneys, and enthusiastic media are inserting themselves into the process. Essential assets for "successful" dental practitioners include enhanced expertise in basic science and technology, including the area of risk assessment, and development of broadened perspectives and skills for communicating with patients and the public.

Oral disease prevention technologies for community use.

Dentistry is perhaps the most prevention oriented of the many disciplines in health care. This article examines technologies for the prevention of caries (including the use of fluoride, oral hygiene and prophylaxis, sealants, and dietary modifications), periodontal disease, and soft-tissue lesions that can be used in community-oriented programs.

National health care: whither goeth dentistry?

National health insurance is reemerging as an important issue on the national health policy scene. The continuing escalation of health care costs in the US and increasing numbers of individuals without access to health services are stimulating a variety of proposals to redesign the structure and financing of the American health care system. Some change in the current system toward a more national approach to health care is inevitable in the years ahead. While dental care is subject to pressures similar to other health care services, little attention is being accorded dental services in the various national health care proposals that are being advanced. This may be due largely to organized dentistry's reluctance to define a role for itself. If dentistry is to be included in such a plan, it is essential that concerted efforts start soon and that the various public and private sectors of dentistry work collaboratively to develop the dental component to such a plan. The future oral health of the public and the future health of dentistry as a profession depend on it.

Patterns of sealant delivery under variable third party requirements.

Despite evidence indicating dental sealants to be effective in preventing caries on the pit and fissure surfaces of teeth, only 8 percent of school-aged US children had received sealants as of 1986-87. While many rationales have been suggested and scientifically answered for this low level of utilization, issues of cost and cost effectiveness remain considerable barriers to many insurers and public programs. This study reports dentist behavior when sealants were added with few restrictions as a new benefit to an existing third party system of care. Results are compared to another third party program with stricter reimbursement policies. Overall, sealants were provided in a reasonable fashion to both groups of patients, relative to teeth selected for sealing and costs. Only a small proportion of patients receiving sealants were under age six or above age 19. Even under the most liberal program, sealants were predominantly targeted to teeth at highest risk to decay. Still, for both groups, a significant proportion of the sealants were placed in teeth at points in time quite distant from expected eruption patterns and, thus, their periods of highest risk to decay. Overall, dentists appeared to use sealants only minimally in their practices. These data suggest that sealants can be added to third party dental programs with little overall risk of inappropriate use or abuse. They also suggest that specific efforts are merited to educate providers as to the most effective times at which to provide sealants for preventing the maximum amount of decay in a population.

National oral health objectives for the year 2000.

The recent Institute of Medicine report on the future of public health is stimulating widespread discussion of the appropriate scope, direction, and means of ensuring the nation's health through public health efforts. Concurrently, the nation is in the process of establishing national disease prevention and health promotion objectives for the year 2000. This is a natural progression from the broad health promotion and disease prevention activities of the past, the 1990 Health Objectives for the Nation, and the Model Standards for Community Preventive Health Services. It is timely for North Carolina, as it celebrates past accomplishments of the state dental public health program, to consider alternative approaches to planning for the public's oral health. The year 2000 process, a national grass-roots initiative, may be a useful model for individual states to adopt. Beyond identifying specific oral health concerns, the year 2000 process offers a number of functional values: the opportunity to educate a wide audience, prioritization of state oral health concerns, identification of gaps in current programs and surveillance, and the opportunity to create an effective constituency among those individuals and institutions in the best position to bring about change.

Daughters of divorce: report from a ten-year follow-up.

A ten-year longitudinal study of 63 girls from divorced middle-class families examines patterns of adjustment and family relationships over time. Course of adjustment and outcomes are linked to age, the mother-daughter relationship, and household organization. Delayed effects are observed among young adult women forming their own relationships, influenced by issues of identification with their mothers.

Progress in infection control in dental education.

While guidelines on proper infection control practices for dentistry have been available for over a decade, evidence suggests that recommended infection control practices are not universally employed in dentistry or dental education. A self-administered written survey was mailed to all U.S. dental schools in spring 1986 to assess the status of infection control curricula, standards, and practices. From the 47 schools that responded it is evident that, while progress is occurring in dental education relative to improved infection control standards and practice, much remains to be accomplished.

Use of a compliance index for community fluoridation.

Fluoridation of public water supplies is the best method of preventing dental caries. Yet, many water systems do not maintain the optimal concentration of fluoride. The Community Fluoridation Compliance Index was developed to provide retrospective and prospective information on water systems in complying with local and State standards. This index permits flexibility in the amounts of optimal fluoride concentration and the frequency of fluoride sample testing. In addition, the index can be modified to address the size of the population served by the water system. The index's components are reviewed, and its use is demonstrated on 50 water systems from Illinois and 50 from Ohio. Annual data from these two States show how this information can be used for targeting corrective action so that the population receives the greatest benefit from fluoridation. These findings suggest that the Community Fluoridation Compliance Index can be a useful administrative instrument for comparing relative compliance results. Further studies to determine its acceptance at the State and local levels are warranted.

Findings from the Dental Care Supplement of the National Health Interview Survey, 1983.

This report describes the prevalence of edentulism, problems associated with use of dentures, and reported use of fluoride products in the civilian noninstitutionalized population of the United States. The statistics reported are based on a sample of 105,182 people about whom information was collected using the 1983 Dental Care Supplement to the National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics.