Determining dental checkup frequency.

BACKGROUND: The authors assessed the dental checkup frequency of adults living in the Detroit tricounty area and identified demographic, access and subjective factors associated with visits to a dentist made not because of a dental problem. METHODS: Data are from a 1994 probability-based sample of adults who were interviewed and received an in-home oral examination. The authors used the variables of age, sex, education level, income level, dental insurance status, usual place for care, objective measures of oral health, and subjective assessments of health, pain and dental anxiety to predict the frequency of dental checkups. RESULTS: The authors found that differences in dental checkup behavior were related to demographics, access to dental care, subjective ratings of oral and general health and other self-assessments, and clinical parameters of oral health. In multiple logistic regression analysis considering all variables simultaneously, sex, income, having a usual place for care and level of dental care anxiety were found to be associated with having dental checkups. The authors determined the statistical significance level at P < .05. CONCLUSIONS: A total of 69.7 percent of the study population reported having had a dental checkup at least once a year in the past five years. The authors found that four factors associated with infrequent dental checkups: being male, having lower income levels, not having a usual place for care and being anxious about receiving dental care. PRACTICE IMPLICATIONS: Dental health professionals should consider the correlates of dental checkup frequency identified in this study and the usefulness of proposed strategies to increase and sustain regular preventive visitation patterns in their own patient populations.

Evaluation and use of an index of oral health status.

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.

Factors associated with fissure sealant delegation: dentist characteristics and office staffing patterns.

The purpose of this research was to identify dentist characteristics and dental office staffing patterns related to delegation of sealant applications. Results from a 1989 mailed survey were used to characterize Michigan general dentists (N = 300) who did or did not delegate sealant applications to auxiliaries and to identify factors associated with delegation. Nearly 50 percent of respondents were applying all sealants themselves. In offices that delegated the procedure, the mean proportion of sealants being applied by dentists was 39.9 percent. Registered dental hygienists were applying 51 percent, while registered dental assistants were applying 6.5 percent. Delegating dentists were more knowledgeable about sealant procedures, held more favorable attitudes, treated more young patients, placed more sealants, and were better informed about the legality of delegation according to the state practice act. Logistic regression analysis found that employing a registered dental hygienist was the most significant factor associated with sealant delegation, followed by employing a registered dental assistant. Findings suggest that dental auxiliaries, and particularly registered dental assistants, are underutilized for applying sealants. Approaches to increasing delegation of sealants may include changing dentists' traditional hiring patterns, highlighting the skills of auxiliaries such as the registered dental hygienist (RDH) and the registered dental assistant (RDA), and increasing awareness of legally allowable procedures that RDHs and RDAs can perform.

Educating dentists about fissure sealants: effects on knowledge, attitudes, and use.

This study evaluated the effects of three modes of education on dentists' knowledge, attitudes, and use of pit and fissure sealants. A randomly selected group of dentists was invited to participate in a sealant education initiative. During a 12-month period, a total of 662 dentists either (1) attended continuing education courses, (2) received written materials and videotapes by mail, or (3) received only written materials by mail. A comparison group (n = 337) received no materials until after the education phase and evaluation had been completed. Pre- and postintervention surveys were used to measure changes in knowledge, attitudes, and sealant use. Response rates to the two surveys were 62 percent and 76 percent, respectively. Preintervention values for knowledge scores, an attitude scale, and sealant use were similar among the four groups. At followup, the three education groups had significantly higher knowledge scores than the comparison group. Attitude values for all but one group were not significantly different, and sealant use by all groups was identical. The numbers of respondents not using sealants declined slightly between surveys in the three education groups while rising slightly in the No-Education Group. Because program outcomes were similar to those of another sealant initiative, it can probably be concluded that continuing education will increase dentists' knowledge about sealants, but have little effect upon their attitudes or their use of the technique. The changes observed in this investigation may be due to the particular capacity for cognitive and affective changes of participants, characteristics of the technology being promoted, and external forces in the professional environment.

Oral health knowledge and sources of information among elementary schoolchildren.

The dental health knowledge and sources of health information of 848 elementary schoolchildren (aged 9-12) in southwestern Michigan were assessed. Demographic parameters (education level, percent below poverty level, median income level) of the area were similar to state and national averages. The children were found to have some knowledge of caries and periodontal disease prevention, yet basic misconceptions were evident. More than one-third of the children thought that plaque should only be removed by a dentist. While 75 percent of the subjects knew that fluoride protected teeth from decay, only 4 percent of the children identified fluoridated water as the best source of this preventive agent. Knowledge of pit and fissure sealants was limited. Extent of correct dental knowledge was not related to age, sex, or mean DMFS scores. Children who answered the most questions correctly named parents and family as their source of information; dentist's office was the second most frequently mentioned source. Findings suggest a need to correct basic misinformation about dental health and to inform children about current efficacious preventive agents.

Oral health knowledge and attitudes of elementary schoolteachers in Michigan.

Teachers at elementary schools in two areas (urban and rural) of Michigan were surveyed to determine their sources of information about oral health and their knowledge and attitudes about dental diseases and disease prevention. Questionnaires were completed by 404 teachers (62% response rate). More than 80 percent of respondents from both areas were female. Demographic characteristics that were significantly different between groups included: median ages of urban and rural respondents (P less than .01), median numbers of years in teaching (P less than .01), and median years in residence (P less than .03). Despite these differences, responses to the questionnaire varied little. For both groups, the most frequently cited sources of information about dental health were dentist's office (82%), followed by magazines and books (74%). The teachers considered preventing tooth decay as the most important reason for good oral hygiene. When asked to rank the effectiveness of ten methods of preventing caries in children, teachers ranked efficacious methods such as fluoridated water and pit and fissure sealants lower than making regular dental visits and reducing intake of sugared foods. Asked to rank the most effective method for children to receive fluoride, urban respondents ranked fluoridated water first, while rural respondents ranked this measure third. Findings suggest that teachers' knowledge about oral health and current methods of prevention is incomplete, is inaccurate in some instances, and varies little by geographic area.

Relation of sources of systemic fluoride to prevalence of dental fluorosis.

The prevalence of dental fluorosis in a nonfluoridated area was determined and related to the reported fluoride ingestion histories of the children examined. A convenience sample of 543 schoolchildren in rural areas of Michigan was examined for fluorosis using the Tooth Surface Index of Fluorosis. Questionnaires that asked about previous use of fluorides were sent to parents of all children examined. The response rate was 76 percent (412 usable questionnaires). A criterion for inclusion in the data analysis stipulated that only fluorosed surfaces that occurred bilaterally would be included. Fluorosis was found on 7 percent of all tooth surfaces and only in the mild form. Twenty-two percent of the subjects were classified as having fluorosis. Dietary supplement was the only fluoride that was found to be significantly related to the occurrence of fluorosis. A greater proportion of the subjects with fluorosis listed physicians, rather than dentists, as the source of fluoride prescriptions. The results demonstrate similarities to the fluorosis reported in other studies in nonfluoridated areas, but also suggest the need to minimize the occurrence of fluorosis through proper assessment of a child's fluoride exposure and the judicious use of additional fluoride.

Self-reported health behavior and dental knowledge of a migrant worker population.

In conjunction with operation of a summer school-based dental program in Michigan, 101 children from migrant families, primarily Mexican-American, completed questionnaires relating demographic background, past dental experience, and knowledge of caries preventive methods. A smaller number of available mothers were asked these questions plus others relating to family dental problems, diet and knowledge of periodontal disease. Adults and children reported similar demographic backgrounds. Most children (68.7%) listed brushing as the best way to prevent cavities as did 60% of the mothers. Less than 2% of the children considered use of fluoride in any form as the best way to prevent cavities and only two of 20 mothers mentioned fluoride in this context. Members of this selected population were weak in their knowledge of the relation between a sweet diet and caries, the relation between oral hygiene and periodontal health, and the role of fluorides in caries prevention.

Oral health of children of migrant farm workers in northwest Michigan.

A considerable number of Hispanic agricultural workers come to Northwest Michigan during the summer every year to harvest fruit and vegetable crops. The Department of Community Dentistry of The University of Michigan School of Dentistry helps provide dental services for these migrant workers and their families. Some 203 five-to-14-year-old children of migrant farm workers were examined for caries and periodontal condition and the results compared with recent national surveys. Traditional indicators of dental caries experience (DMFT/dft and DMFS/dfs indices), periodontal disease (PI), and oral cleanliness (OHI-S) were used by one examiner. These migrant children presented higher numbers of decayed teeth and lower numbers of restored teeth than United States schoolchildren generally. Migrant children also presented less caries-free teeth and higher PI and OHI-S scores than United States children generally.

Reduction of dental decay in rampant caries individuals following short-term kanamycin treatment.

A week of kanamycin gel treatment before and after the placement of dental restorations, compared to a placebo gel treatment, significantly reduced the levels of cultivable bacteria, S mutans and S sanguis, in the plaque samples collected immediately after the completion of the gel treatments, and was associated with a 46% reduction in new carious surfaces in the 14- to 37-month period following the gel treatment.

Collagenolytic activity of dental plaque associated with periodontal pathology.

Certain dental plaques, removed from sites of gingival and periodontal pathology in mentally retarded, institutionalized individuals, when incubated in phosphate buffer with Achilles tendon collagen, gave rise to an increase in ninhydrin-positive material. These plaques, while showing great variability, released significantly more ninhydrin-positive material per milligram of plaque (wet weight) than did either the endogenous or heat-treated controls. Certain plaques could also break down soluble, tritiated, labeled collagen isolated from the calvaria of chicken embryos. Bacteroides melaninogenicus and Clostridia histolyticum were found in plaques by either fluorescent antibody or cultural methods. C. histolyticum, when detected, accounted for about 0.01 to 0.1% of the bacteria in plaque. A conspicuous isolate from some plaques was a Bacillus species which rapidly liquefied gelatin. Cell-free supernatants of this organism were able to degrade about 50 to 70% of the soluble collagen when incubated at 36 C. C. histolyticum ATCC 8034 caused an 80% degradation of the collagen under the same conditions of incubation. The Bacillus strains were facultative, could ferment glucose, reduced nitrate to nitrite, and were catalase, indole, and urease negative. The limited taxonomic information for the isolates is compatible with the description given for Bacillus cereus.