Depression and Differential Oral Health Status Among U.S. Adults With and Without Prior Active Duty Service in the U.S. Military, National Health and Nutrition Examination Survey 2011-2018.

INTRODUCTION: Veterans suffer from lower overall well-being than non-veterans because of their unique life course. This study aims to compare the impact of depression on oral health for veteran and non-veteran populations. MATERIALS AND METHODS: Data from 11,693 adults (18+) participating in the National Health and Nutrition Examination Survey (2011-2018) were analyzed. The outcome variables were dichotomous (at/above mean) decayed, missing, and filled teeth due to caries (DMFT), as well as the components, namely, missing teeth, filled teeth (FT), and decayed teeth (DT). The primary predictor variable combined depression screening outcome and veteran status (veteran/depressed, veteran/not depressed, non-veteran/depressed, and non-veteran/not depressed). Covariates included socioeconomic factors, demographics, wellness factors, and oral health-related habits. Associations between outcome and predictor variables were assessed with a fully adjusted logistic regression analysis. RESULTS: Veterans, regardless of depression status, had more DMFT, FT, missing teeth, and DT compared to non-veterans. After controlling for covariates, veterans suffering from depression had higher odds of DT (1.5, 95% CI, 1.0-2.4) compared to non-veterans without depression. In general, veterans who screened negative for depression had better oral health compared to all groups, with lower odds of DT (0.7, 95% CI, 0.6-0.9) and higher odds of FT (1.4, 95% CI, 1.1-1.7) compared to non-veterans with and without depression. CONCLUSIONS: This study found that not only veterans have higher odds of overall caries experience, but also veterans suffering from depression have higher odds of active caries compared to non-depressed veterans. Most veterans lack Veterans Health Administration dental benefits and face challenges maintaining oral health on top of medical and mental health burdens. Our results add further urgency to increasing dental care access for this vulnerable population because of the exacerbation of unmet oral health care needs attributable to the additional mental health challenges veterans face.

Evaluating a Cultural Competency Curriculum: Changes in Dental Students' Perceived Awareness, Knowledge, and Skills.

In response to current and projected demographic changes in the United States, many dental schools have taken steps to increase the cultural competence of their students through various educational methods. The aim of this study was to evaluate the effectiveness of the cultural competency curriculum at Boston University Henry M. Goldman School of Dental Medicine (GSDM). The curriculum was evaluated using a pre and post design, utilizing an instrument developed for pharmacy students and modified for dental students. The questionnaire was comprised of 11 items designed to assess changes in students' awareness, knowledge, and skills in providing culturally competent care. Data were collected for two classes of second-year DMD students and first-year Advanced Standing students. The total number of returned surveys was 485, for a response rate of 79.5%. The students' post-curriculum mean scores were all higher than their pre-curriculum scores for overall cultural competence (pre 26.5±6.3 to post 29.8±7.2) and for individual subscores on awareness (pre 5.3±1.4 to post 5.5±1.5), knowledge (pre 7.2±1.9 to post 8.1±2.1), and skills (pre 14.1±4.4 to post 16.2±4.4). The improvements on all scores were statistically significant (p<0.0001), with the exception of the awareness component. This evaluation suggests that the cultural competency curriculum at GSDM has been effective in producing improvements in these students' cultural competence in the domains of knowledge and skills.

Dental professionals' knowledge and perceived need for education in bioterrorism preparedness.

Dental professionals should be well prepared to provide care during bioterrorist events. In this study, we assessed the knowledge, opinions about playing various roles during a bioterrorist event, and perceived need for education of dental professionals (dentists and dental hygienists) from one region (Oregon) that had been exposed to bioterrorism and from another region (New England) not exposed. This cross-sectional study used an eighteen-item pretested, self-administered questionnaire distributed at the 2005 Oregon Dental Conference (n=156) and 2005 Yankee Dental Conference (n=297). Dental professionals' knowledge and perceived need for education on bioterrorist preparedness were quantified by multivariate linear and logistic modeling. More than 90 percent of the dental professionals were willing to provide care during bioterrorist events. Perceived knowledge was high; however, actual knowledge was low. Dental professionals who wanted to attend a continuing education course and who thought dental professionals should play more roles during a bioterrorist attack had higher actual knowledge. Willingness to provide care was not supported by adequate knowledge. No significant differences between New England and Oregon dental professionals were observed in terms of actual knowledge or perceived need for bioterrorism education. Integrating training and education into the predoctoral dental and dental hygiene curricula and developing continuing education courses would improve knowledge and better prepare dental professionals to effectively perform American Dental Association-recommended roles during any future bioterrorism events.

Oral health status of refugee torture survivors seeking care in the United States.

We assessed the oral health status of 216 refugee torture survivors seeking care at an urban torture treatment center in the United States. Results showed that patients' dental health ranged from poor to fair; 76% had untreated cavities, and approximately 90% required immediate or near-immediate dental care. Torture treatment centers, in addition to offering safe environments for educating and examining patients, are ideal settings to provide basic oral health services without the risk of retraumatization.

Willingness of New England dental professionals to provide assistance during a bioterrorism event.

A bioterrorism attack could overwhelm medical personnel and facilities, suggesting a need for aid from nonmedical personnel. The American Dental Association suggests that dental professionals should assist in such cases, utilizing their strong scientific and technical skills. This study describes New England dental professionals' willingness, potential roles, motivators, and barriers to providing this aid. This cross-sectional study used a self-administered survey to collect data addressing the knowledge and opinions of dental professionals concerning acting as responders. The survey was distributed to 370 attendees of the 2005 Yankee Dental Conference, in Boston, Massachusetts. Most dental professionals expressed willingness to help during an attack (N = 340, 92%), reporting that dental professionals, in general, should perform a mean number of 6 roles. Three-quarters of dentists and dental students were personally willing, with proper training, to give immunizations, and 54% would perform triage. Knowledge was weak, but most dental professionals were interested in obtaining further education (83%). Since dental professionals are willing to assist during a bioterrorism attack and are motivated to obtain disaster response training, government officials and local directors and managers of disaster/emergency response agencies should consider incorporating dental professionals into their disaster management plans.

The association between cumulative periodontal disease and stroke history in older adults.

BACKGROUND: Since the late 1980s, several studies have been conducted to investigate the relationship between periodontal disease and ischemic stroke. The purpose of this study is to investigate the relationship of periodontal disease to the self-reported history of stroke in the elderly (60 years of age and older) by examining the data of the Third National Health and Nutrition Examination Survey (NHANES III). METHODS: Data from NHANES III, a large population-based cross-sectional survey of the United States, were used for this study. Because 1,563 of the 5,123 subjects in the study were edentulous, and periodontal disease is a major cause of tooth loss, it was necessary to account for edentulousness in the statistical analysis to avoid bias. Hence, a new index called the periodontal health status (PHS) index was developed to address this problem. Two measures of PHS were developed: PHS I, based on the median percentage of sites with >/=2 mm clinical attachment loss (CAL), and PHS II, based on the median percentage of sites with >/=3 mm CAL. Multiple logistic regression analysis was used to test for the association of PHS with stroke history. Two types of a multiple logistic regression model were fit: 1) logistic regression modeling with adjustment for age and tobacco use only; and 2) logistic regression modeling with adjustment of all statistically significant confounders. RESULTS: Based on multiple logistic regression analysis of PHS with adjustment for age and tobacco use only, completely edentulous elderly adults (PHS Class 5) and partially edentulous (teeth in one arch) elderly adults with appreciable clinical attachment loss (PHS Class 4) were significantly more likely to have a history of stroke compared to dentate adults (teeth in both arches) without appreciable clinical attachment loss (PHS Class 1). When multiple logistic regression models were fit with adjustment of all significant confounders, no statistically significant association was found between PHS and stroke. CONCLUSIONS: Based on the results of this study, there is evidence of an association between cumulative periodontal disease, based on PHS, and a history of stroke. However, it is unclear whether cumulative periodontal disease is an independent risk factor for stroke or a risk marker for the disease.

Are varicose veins a marker for susceptibility to coronary heart disease in men? Results from the Normative Aging Study.

Clinical observations suggest that varicose veins (VV) are less frequent in patients undergoing infrainguinal bypass surgery for femoral artery occlusive disease. While some previous studies support this relationship, others report that VV are more prevalent in coronary heart disease patients (CHD). This study used the Normative Aging Study (NAS) population to examine the association between VV and symptomatic CHD. The incidence of CHD over 35 years of follow-up was determined in the 2280 initially healthy male volunteers enrolled in the NAS. The incidence of CHD in the VV population and the subjects without VV were compared using Kaplan-Meier survival curves and the log-rank test. A time-dependent proportional hazards regression method was used to further explore the relationship between VV disease and subsequent development of CHD after adjusting for other cardiovascular risk factors. A total of 569 subjects (24.9%) were diagnosed with VV prior to the development of symptomatic CHD, and 1708 (75.1%) were not. Over 35 years of follow-up, 98 subjects with VV developed symptomatic CHD (17.2%), while 363 of those without VV subsequently developed symptomatic CHD (21.2%). Kaplan-Meier survival curves suggested a reduced risk of symptomatic CHD for subjects with VV (p = 0.0001). Further exploration of this relationship in a proportional hazards multivariate model showed VV to be associated with a 36% decreased risk of symptomatic CHD after adjusting for other recognized cardiovascular risk factors. In the NAS population, men with VV were less likely to develop symptomatic CHD over the 35+ years of follow-up than were subjects without VV.

Lymphedema and quality of life in survivors of early-stage breast cancer.

BACKGROUND: The standard of care for early-stage breast cancer includes surgical removal of the tumor and axillary lymph node dissection (ALND). Despite increased use of breast-conserving surgery, lymphedema rates are similar to those with more radical surgery. HYPOTHESIS: Women who experience breast cancer-related lymphedema have a measurable reduction in quality of life compared with women without lymphedema. DESIGN: In a retrospective cohort study, we explored the association between lymphedema and quality of life, controlling for patient demographics, surgical factors, and treatment types. SETTINGS: An urban academic medical center and a community hospital. PARTICIPANTS: A total of 151 women surgically treated for early-stage breast cancer (stages 0-II) were assessed at least 1 year after their ALND. The women had been treated with either conservative surgery and radiation or mastectomy without radiation. MAIN OUTCOME MEASURES: Arm volume was measured by water displacement. Grip strength and range-of-motion measurements assessed arm function. The Functional Assessment of Cancer Therapy-Breast (FACT-B) quality-of-life instrument assessed breast, emotional, functional, physical, and social well-being. RESULTS: Lymphedema (an arm volume difference > or =200 cm(3)) was measured in 42 women (27.8%). Mastectomy or conservative surgery patients had similar lymphedema rates. Women with lymphedema in both surgical groups scored significantly lower on 4 of the 5 subsections than women without lymphedema, even after adjusting for other factors influencing quality of life. CONCLUSIONS: Lymphedema occurs at appreciable rates, and its impact on long-term quality of life in survivors of early-stage breast cancer should not be underestimated.