Perceptions of the natural dentition in the context of multiple variables.

Perceived oral health status has been shown to be associated with a variety of single clinical and self-reported indicators of oral health and oral health-related behaviors. A behavioral model is utilized which hypothesizes that perceived condition of natural teeth is predicted by multiple factors, including individual demographic and enabling characteristics, other health perceptions and orientations, actual levels of diseases and conditions, and self-defined need for treatment. The data are from the clinical examination and adult questionnaire of Phase 1 (1988-1991) of the Third National Health and Nutrition Examination Survey, which is based on a stratified multistage probability sample to produce nationally representative data for the civilian, non-institutionalized US population. Multivariate hierarchical regressions were used to assess perceived condition of natural teeth in two groups of dentate adults (those with a dental visit during the past 12 months, and those with a less recent dental visit). Self-defined treatment need made a significant, non-trivial contribution after other variables had been controlled. In both subpopulation models, the perception of general health and epidemiological indicators of oral health status were also significant factors. Socio-economic indicators did not contribute significantly in either regression. Understanding components of overall perceptions of oral health moves us closer to understanding oral health behaviors and oral-health-related quality of life.

Oral health care in US nursing homes, 1995.

In 1993, nursing home care was a $70 billion industry. Since oral diseases are intertwined with declining health, it is important to achieve a better understanding of oral health care in nursing homes. The purpose of this paper is to present basic information regarding the nature of dental care from the 1995 US National Nursing Home Survey. Data include general availability of dental services, a description of types of dentists' and dental hygienists' services, and numbers of full-time equivalent dentists and dental hygienists. SUDAAN software was used to adjust for the complex, multistage sample design. Of the estimated 16,700 nursing homes in the contiguous US in 1995, between 14,000 and 15,000 offered some level of dental services. About 15,600 nursing homes provided assistance for oral hygiene, while some 7720 nursing homes had dental hygienists' services available. Approximately 60% of nursing homes either did not have services of dentists at all, or had them only on call or only off-site. Availability of dental services varied by characteristics of nursing homes. Examination of the nature of dental care raises questions about whether the intent of the Federal standards for dental care in Medicare and Medicaid are really being met. As more elderly remain dentate, and as the oral comorbidities of chronic diseases become more recognized, appropriate oral health services for individuals in long-term care settings likely will increase as public health issues.

Components of self-reported oral health and general health in racial and ethnic groups.

OBJECTIVE: The objective of this study is to investigate the validity of the General Oral Health Assessment Index (GOHAI), a self-reported oral health measure, when used in an all-age adult sample of Hispanics and African-Americans. METHODS: The study groups were 506 disadvantaged Hispanic and African-American adults who were recruited at low-cost medical and dental clinics. To explore the validity of the GOHAI in an all-age, ethnically diverse sample, principal component and principal factor analyses were conducted on the 12 items of the GOHAI and the 14 items constituting the MOS physical/social and mental health components. RESULTS: Four factors accounted for 40 percent of the total variance of health as measured by the MOS and GOHAI items: general health, physical/worry oral health, mental health, and social oral health. An association between socioeconomic variables and each subscale was found to be significant except for the physical/worry oral health subscale. CONCLUSIONS: This study confirms that the GOHAI is valid when used in younger and ethnically diverse samples. The findings also emphasize that oral health is distinct from general health and that the use of generic self-reported measures of health may miss important aspects of oral health that are valuable for dental health professionals.

Perceived oral health in a diverse sample.

Measures of perceived oral health represent subjective, individual perspective of one's health. One measure commonly used is the single-item perceived oral health rating: How would you rate your overall oral health? These analyses examine the associations among age, ethnicity, and perceived oral health within the context of a comprehensive battery of 21 predisposing, enabling, and need variables. The study of compares the adult data from three United States research locations of the International Collaborative Study of Oral Health Outcomes (ICS-II). Only social survey data were used for this analysis. The multiple regression model explains over 30% of the variance in perceived oral health, with R squares ranging from 0.324 for Indian Health Service sites to 0.391 for San Antonio. The most important significant predictors include ethnic group, education, perceived general health status, being edentulous or not having a partial denture, having no oral pain, fewer oral symptoms, and having one or more dental visits. The predictors of positive perceived oral health for the diverse groups highlight interesting age and ethnic differences. The only universal predictor for the middle-aged adults was having fewer oral symptoms. For the older adults, being edentulous or not having a partial denture was the only universal predictor. The findings suggest that perceived oral health may be a useful outcome measure in dentistry because of its relation to predisposing sociodemographics and dental utilization.

Conceptualizing oral health and oral health-related quality of life.

This investigation considers oral health from a health-related quality of life perspective using a multidimensional concept representing a combination of impairment, function, perceptions, and/or opportunity. A subset of dentate individuals aged 18 and older from a national probability sample of the U.S. was selected for the reported analysis with data available from personal interviews, self-administered questionnaires, and oral examinations. Impairment was represented by clinically assessed active diseases and sequelae of diseases and self-reported acute symptoms. Other domains are represented by self-reported problems with function, perception of control over oral health, satisfaction with teeth, value attributed to oral health, and opportunity to obtain dental care. Principal components analysis with varimax rotation provided a structure to interpret four factors: accumulated oral neglect, self-perceived symptoms and problems, reparable oral diseases, and oral health values and priorities. Approximately 50% of the variance was explained by these four factors. Factor-based scores, envisioned as an index or summary measure representing the combination of variables identified in each factor, were used to assess potential validity. Whites had lower levels of accumulated oral neglect, fewer symptoms, and less reparable oral disease, but similar oral health values, than non-whites. Level of formal education was associated with each of the four factor-based scores. Age was directly associated with accumulated oral neglect, but the youngest age group had significantly more reparable oral diseases. Individuals with a dental visit in the past two years had considerably less accumulated oral neglect, fewer self-perceived problems, less reparable oral disease, and higher values of oral health than those without a dental visit in the past two years. Ordinary least square regressions were performed on each of the four factor-based scores using eight sociodemographic and economic variables. All four regression models were significant, with only the education variable being significant across all models. These analyses provide no evidence for one unique factor representing oral health. Rather, a conceptual framework for oral health appears to be represented by a set of reasonably independent components, including two groups of clinically assessed oral health, which together more fully represent oral health than any one single variable. Conceptualizing and measuring oral health multidimensionally leads us closer to examining it as part of general health.

Dentist-patient interactions in treatment decision-making: a qualitative study.

The growing involvement of patients, third party payers, and government in the financing, planning, and delivery of health services has heightened the demand for knowledge about the process of rendering care. This study used a qualitative methodology to examine dentist-patient interactions in treatment decision-making. A series of focus groups was conducted with dentists and patients participating in an ongoing investigation of dental treatment planning conducted at the University of North Carolina. Study findings indicate that dentist-patient interactions play an important role in treatment decision-making and that both are predicated on a variety of non-clinical factors. Dentists' intuition and judgment seem to be used not only to select desired health outcomes and the means for achieving them, but also to depart from the ideal and/or to modify treatment plan presentation on a patient-to-patient basis. Patients' impressions of dentists' examination styles, personalities, and ability to relate to them as individuals seem to mediate both treatment acceptance and willingness to participate in the decision-making process. Results of this investigation suggest that any effort aimed at improving dental treatment decision-making needs to acknowledge the interplay of clinical and psychosocial factors.

Oral health status and related behaviours of U.S. nursing home residents, 1995.

SETTING: The 1995 U.S. National Nursing Home Survey. AIMS: A descriptive overview of reported oral health status and related behaviours for residents. DESIGN: Cross-sectional survey. SUBJECTS: 8,056 residents. INTERVENTION: Interviews by knowledgeable staff, examination of charts and/or personal knowledge. MAIN OUTCOME MEASURES: Information on the overall condition of oral health, edentulous status, presence/absence of dentures, difficulty chewing or biting, dental care received in past month, and method of payment for dental services in addition to personal characteristics and medical information. RESULTS: Fifteen percent of the residents were described as having excellent or very good oral health. Forty-one percent of the residents had difficulty chewing and biting. Almost one half of nursing home residents (47%) were totally edentulous. Twenty-six percent of residents had dental services paid for during the past month. Nursing home residents have multiple known barriers to oral health: ability to pay, extended periods of time without direct access to the dental care delivery system, and serious chronic medical conditions. CONCLUSIONS: There are serious deficiencies in achieving one of the US national health objectives: ensuring adequate oral health care for institutionalized individuals.

Prevalence of incisor trauma in persons 6-50 years of age: United States, 1988-1991.

Traumatic injuries to the teeth are among the most serious of dental conditions, yet little is known about the prevalence of tooth or dental trauma at the national level. The National Institute of Dental Research (NIDR) modified existing indices for specific use in national epidemiologic studies of tooth trauma among both children and adults. The NIDR index was developed not only to track the status of the tooth from sound (no evidence of trauma) through missing due to trauma, but also to reflect selected sequelae of trauma. The index is based on clinical, non-radiographic evidence of tooth inujury and treatment received in the eight permanent incisors, including a positive history of injury obtained from the subject. The trauma assessment index was applied immediately following the caries examination for dentate participants ages 6-50 years old (n=7,707) in Phase 1 of the NHANES III oral examination. This article reports the first national overall and age-specific population-based prevalence of dental trauma among gender, racial, and ethnic groups. There is a higher prevalence of incisal trauma, of both maxillary and mandibular incisors, in males than females, in both the younger and older age groups. The prevalence of incisal trauma of both maxillary and mandibular incisors in whites and blacks in both younger and older age categories is similar. The study found that half of the individuals with trauma had only one incisor tooth classified as having trauma. Males and older age groups showed larger numbers of traumatized teeth. Further study and examination of methodological issues are desirable for additional understanding of incisal trauma in the general population .

The state of the nation's oral health: mid-decade assessment of Healthy People 2000.

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.

Use of mouthguards and headgear in organized sports by school-aged children.

Sports-related orofacial trauma is a serious problem that can be prevented by wearing protective mouthguards and headgear. While this equipment is available, few studies have been done of wearing practices. This study assesses the wearing practices using data from the Child Health Supplement of the 1991 National Health Interview Survey. Results indicate that football was the only sport in which the majority of children used mouthguards and headgear. While statistically significant differences (p<.05) were found in use of the equipment in all sports by grade level, gender, parent's education, ethnicity, and by region of the the country, these differences were not consistent across sports. Healthy People 2000 calls for extending requirements for use of orofacial protective devices to all organizations sponsoring sports that pose risk to injury. Given the complex nature of the findings, multifaceted initiatives that include the promulgation of rules must be developed and tested to determine what approaches are effective in ensuring consistent use.

Oral health, health, and health-related quality of life.

Health-related quality of life is a multidimensional concept with five broad domains: opportunity/resilience, health perception, functional states, impairments/diseases, and duration of life. It addresses the tradeoff between how long and how well people live. The health-related quality of life approach has provided greater opportunity for investigation of the interrelations among oral health, health, and related outcomes. The inclusion of patient-driven measures, such as perceptions and functional status, is critical. Oral health-related quality of life measures are being developed and used in research on aging populations. Clinical measures of oral health, perceptions of general and oral well-being, and reported physical, social, and psychological functioning are independent, but correlated, components of overall oral health-related quality of life. An oral health-related quality of life approach benefits 1) clinical practitioners in selecting treatments and monitoring patient outcomes; 2) researchers in identifying determinants of health, tracking levels of health risk factors, and determining use of services in populations; and 3) policy-makers establishing program and institutional priorities, policies, and funding decisions. This overview indicates substantial value in pursuing several recommendations. A theoretical framework from which concepts, measures, and models can be derived must be developed to address oral health, oral health-related quality of life, health, and health-related quality of life. Oral health outcomes or states must be identified and classified along some continuum of impairment, function, disability, and opportunity. Indicators of appropriate concepts and domains must be adapted or established. Extended analyses on the relations among oral health, oral health-related quality of life, health, and health-related quality of life should be conducted with use of the Boston VA Normative Aging Study and other appropriate data sets.

Inappropriate infant bottle feeding. Status of the Healthy People 2000 objective.

OBJECTIVE: To provide information on baby bottle use in the United States because of the important consequences, including early childhood caries, associated with inappropriate feeding practices. METHODS: Data from the child supplement to the 1991 National Health Interview Survey were examined. Information was collected on one randomly selected child from each family with children in the survey; data were weighted to represent the corresponding US population. Questions about the "ever use" and "still use" of baby bottles, and selected sociodemographic and health behavior variables were assessed. RESULTS: About 95% of children 6 months to 5 years old have ever used a baby bottle. Nearly one fifth of the children in this age range were put to bed with a bottle that had contents other than water. More than 8% of children 2 to 5 years old still use the bottle. Bivariate and multivariate analyses showed differences in bottle practices by education level of the adult caretaker, dental visits, Hispanic background, race, and geographic region. CONCLUSION: The high prevalence of feeding with a baby bottle requires pediatricians and other health care professionals to help reduce the risks to health.

Sealant use and dental utilization in U.S. children.

The use of dental sealants has remained relatively low in the U.S. in comparison with other proven oral disease preventive therapies, and particularly among black children. Dental visits have also been consistently lower among black children. This paper describes the reported use of dental sealants and dental visits in U.S. children ages 6-17 using data from the 1989 National Health Interview Survey (NHIS). Family income and education interact with race in explaining the use of dental sealants and dental visits. Racial differences in sealant use and dental visits are more apparent in middle and upper socioeconomic levels, than lower socioeconomic level children. Overall, 15 percent of children ages 6-17 have dental sealants and 73 percent had a dental visit in the past twelve months. More white children whose parents had higher income levels and at least one year of undergraduate education (24 percent) had sealants than similar socioeconomic status (SES) black children (11 percent). Additionally, black children whose parents had a college education (68 percent) were less likely to have dental visits during the past 12 months than white children of similar SES (86 percent). These results provide an opportunity to evaluate factors and conditions that could form a basis of targeting programs to improve behaviors, attitudes, as well as access to preventive dental services.

The measurement of mandibular cortical bone height in osteoporotic vs. non-osteoporotic postmenopausal women.

The asymptomatic progression of osteoporosis, in conjunction with the possibility of catastrophic disability, makes this disorder a major public health priority. Various body sites, including the mandible, have shown susceptibility to decreasing bone density. In 1986, Benson et al. proposed a radiomorphometric technique called the Panoramic Mandibular Index (PMI) as an inexpensive noninvasive dental technique for osteoporosis screening, although no osteoporotic subjects were included in their study. The purpose of our study was to determine whether osteoporotic postmenopausal women would show a decrease in mandibular cortical bone height, as measured by the PMI index, when compared with nonosteoporotic postmenopausal women. Seventy-two Caucasian females (33 cases/39 controls), aged 54-71 years old, were selected through records and screening via a dual-energy x-ray absorptiometry scan (LUNAR-DEXA). ANOVA analysis indicated no differences in the mean PMI between case and control groups (0.37 +/- 0.15 and 0.38 +/- 0.13, respectively; p = 0.69). Other techniques, such as computer digitized radiography should be explored to test the validity of the PMI.

U.S. adult knowledge of risk factors and signs of oral cancers: 1990.

A sample of U.S. adults were asked questions to assess their knowledge of oral cancer as part of the 1990 Health Promotion and Disease Prevention Supplement of the National Health Interview Survey. Tobacco use was the only risk factor most adults identified correctly. Only 25 percent of those surveyed could identify one sign of oral cancer. Overall, there is extensive misinformation and a general lack of knowledge.

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.