Periodontal disease in pregnancy complicated by type 1 diabetes mellitus.

BACKGROUND: Systemic disease and hormonal changes have been implicated as complicating factors for periodontal disease. Diabetes has been identified as a risk factor for periodontal disease, and diabetics can experience periodontal destruction at an earlier age than non-diabetic individuals. Increased hormone levels during pregnancy can contribute to increased gingival inflammation. The purpose of this study was to examine the association of type 1 diabetes mellitus (DM) on the periodontal status of pregnant women. METHODS: Thirty-three (13 diabetic and 20 non-diabetic) subjects, 20 to 39 weeks gestation, participated in this study. The mean age of the diabetics and non-diabetics was 28.5 +/- 7.1 (SD) and 27.0 +/- 7.3 years, respectively. The following parameters were assessed at Ramfjord's reference teeth: plaque index (PI), gingival inflammation (GI), probing depth (PD), gingival margin (GM) location, and clinical attachment level (CAL). RESULTS: Diabetic subjects had significantly (P<0.001) higher PI (1.48 +/- 0.69) and GI (1.77 +/- 0.44) scores than non-diabetics (PI = 0.63 +/- 0.38; GI = 0.93 +/- 0.48). Mean PD for diabetics (2.95 +/- 0.69 mm) was significantly different (P<0.024) from that of non-diabetics (2.44 +/- 0.32 mm). Although mean GM location was coronal to the cemento-enamel junction (CEJ) in both groups, gingival margins were at a more apical position (P<0.001) in the diabetics (-0.20 +/- 1.24 mm) compared to non-diabetics (-1.76 +/- 0.53 mm). Mean CAL values also varied significantly (P<0.001) between diabetics (2.60 +/- 1.54 mm) and non-diabetics (0.68 +/- 0.65 mm). Significant differences were seen for GI (P<0.001), PD (P=0.005), GM location (P<0.001), and CAL (P<0.001) when assessing the effect of diabetes and controlling for plaque. When assessing the effect of plaque and controlling for diabetes, the only significant difference was GI (P=0.001). CONCLUSIONS: The results of this study demonstrate that periodontal inflammation and destruction are increased in pregnant diabetics as compared to non-diabetic pregnant patients. These findings may have implications for diabetic control and, hence, maternal and fetal outcomes in pregnant diabetic patients.

Perceptions of dental aesthetics in the United States and Nigeria.

The standard dental aesthetic index (DAI) is an orthodontic treatment need index based on perceptions of dental aesthetics in the United States. It is a regression equation that links perceptions of the social acceptability of dental aesthetics with the objective intraoral measurements of ten occlusal traits. For the index to be universally acceptable, the perceptions of dental aesthetics in other countries must be similar to those of the United States. This study was designed to determine whether the perceptions of dental aesthetics of Nigerian students are similar to those of different groups of the US population. The same 25 stimuli (photographs of dental configurations, a subset of the 200 stimuli used in deriving the standard DAI equation) were rated for dental aesthetics by Nigerian students. Their ratings were compared with ratings of the same 25 stimuli by US parents, students and orthodontists. Spearman rank-order correlations ranged from 0.75 to 0.84. These correlations were highly significant (P<0.0001), and showed that the perceptions of dental aesthetics of Nigerian students were very similar to those of the US groups. The study therefore concluded that standard DAI could be used as a screening tool and without modification in epidemiological surveys among Nigerians.

Evaluation of the Faces Pain Scale for use with the elderly.

OBJECTIVE: The specific objective for this research was to determine initial psychometric properties of the Faces Pain Scale (FPS) as a measure of pain intensity for use with the elderly. DESIGN: The study was descriptive correlational in nature, with nonrandom sampling. A total sample of 168 community subjects (30-121, depending on task completed), aged 65 or older, participated in the research protocol. To determine the validity, reliability, and scaling properties of the FPS, rating and ranking procedures, placement tasks, and test-retest methods were used. RESULTS: Response to six Likert-type items indicated that subjects agreed that the FPS represents pain: however, it is clear that the perception of the meaning of the faces can be influenced by the context in which they are presented. Rank ordering tasks for the individual faces demonstrated near-perfect agreement between the actual expected ranking and the ranking produced by the subjects (Kendall's W = .97, p = .00). When subjects placed individual faces along a 1-m-long red wedge indicating the amount of pain represented by each face, statistically significant separation of the faces in the anticipated equal interval position was demonstrated by the lack of overlap of the 95% confidence intervals when all faces were viewed and positioned simultaneously. However, when subjects placed faces independent of others, the expected placement fell outside the 95% confidence limit for three of the five faces placed. In addition, the actual intervals between the five faces placed by subjects demonstrated substantial variances from the 167 mm expected in several instances. Rating a vividly remembered painful experience about the degree of pain perceived using the FPS initially and again 2 weeks later, the FPS demonstrated strong reproducibility over time with a Spearman rho correlation coefficient of .94 (p = .01). CONCLUSION: These results provide preliminary support for the construct validity, strong ordinal properties, and strong test-retest reliability of the FPS with a sample of elderly individuals. The equality of intervals in the FPS has not been fully supported in the older adult, but given the complexity of the task used, the results should not be considered to be refuted. Further evaluation of the FPS with experimental and clinical pain conditions and comparison with other standard pain assessment instruments in the elderly population are warranted.

Patterns of fluoride dentifrice use among infants.

The early use of fluoride dentifrice and use of larger quantities recently have been identified as risk factors for dental fluorosis. However, little is known about fluoride dentifrice use and ingestion among infants and young children whose developing permanent teeth are at risk for dental fluorosis. This paper reports on patterns of fluoride dentifrice use among a birth cohort up to 12 months of age as reported by mothers by written questionnaire. Among those with teeth, percentages whose teeth were brushed at age 6, 9, and 12 months were 12.9%, 36.7%, and 64.5%, respectively. Percentages brushing with fluoride dentifrice were 1.9%, 11.7%, and 31.7%. Among those using dentifrice, the percentages using fluoride dentifrice were 94-97%. Among those using dentifrice, mean estimated quantities of fluoride from dentifrice used per brushing were 0.11, 0.14, and 0.17 mg F (range up to 0.88 mg). Among users, mean quantities of fluoride from dentifrice used per day were 0.21, 0.20, and 0.19 mg F (range up to 1.75 mg). Results suggest that fluoride dentifrice use among infants varies greatly, can be substantial, and can be a risk factor for dental, fluorosis.

Risk factors for advanced-stage oral cavity cancer.

OBJECTIVE: To assess the association between risk factors for inadequate surveillance of oral cavity cancer and stage of disease (localized, T1, T2/N0 vs advanced, T1, T2/N1-3, T3, T4/N0 or N1-3). DESIGN: Convenience sample from a case series. SETTING: Otolaryngology clinic in a tertiary care hospital. PARTICIPANTS: Fifty-three patients with cancer of the oral cavity who were treated at The University of Iowa, Iowa City, from October 1990 through March 1994, participated in the study. Selection criteria included pathologic confirmation of squamous cell carcinoma (SCC) of the oral cavity, the capacity to retrieve data regarding tumor characteristics at initial presentation, and completion of a 30-item questionnaire by the patient. INTERVENTION: Administration of questionnaire identifying factors contributing to inadequate surveillance of cancer of the oral cavity. OUTCOME MEASUREMENTS: Advanced-stage cancer of the oral cavity was identified by the presence of large tumors (T3, T4) and cancer metastatic to the neck lymph nodes (N1, N2, N3). Comparison groups were built to determine the relationship between these two dependent variables and multiple independent variables. Descriptive statistics and tests of association were used to assess relationships. RESULTS: Two of the 53 patients performed self oral examinations specifically designed to screen for cancer prior to finding cancer of the oral cavity. Knowledge of the warning signs of cancer of the oral cavity was denied by 87%. The rate of cancer growth in the oral cavity was variable from first discovery by the patient to the time of tumor staging by otolaryngologists. The interval from discovery of the tumor to tumor staging (delay in diagnosis) was greatest for floor of the mouth cancers and shortest for those cancers located on the tongue. Thirty-seven percent of the patients younger than age 64 years were edentulous in contrast to 62% edentulism in patients older than 65 years. There was a significant, inverse relationship between time since last dental visit and late-stage disease. CONCLUSIONS: Patients with advanced-stage cancer of the oral cavity tended to be elderly, more often wore dentures, and seldom visited the dentist. Treatment of cancer of the oral cavity as localized disease, with an associated decrease in morbidity and mortality, is likely to result by targeting this population as one in need of more intense surveillance.

Predictors of hepatitis B vaccine acceptance in health care workers.

This article examines the relative importance of occupational, epidemiologic, and attitudinal factors in hepatitis B vaccine acceptance. A stratified random sample of 1,018 health care workers at risk for occupational blood exposure at our university hospital were contacted in 1992 and 919 (90%) participated. Potential reasons for vaccine acceptance or refusal were evaluated with factor analysis. Logistic regression models were calibrated on a stratified random subsample to identify independent predictors of initiating and completing the series, then validated on the remaining subjects. Fifty-four percent (482 of 898) of previously nonimmune workers had completed the series, while 70% (626) had received one or more doses. Hepatitis B vaccine acceptance was related strongly to social influence (physicians, supervisors, role models, friends, and spouse) and knowledge of the disease and vaccine, whereas refusal was primarily related to concern about vaccine side effects and problems with vaccine access. Independent predictors of initiating the vaccine series included younger age (odds ratio [OR] 0.98 per year, 95% confidence interval [CI95] 0.96-0.997), occupation (housestaff: OR 2.9, CI95 1.1-7.9; nurses: OR 2.1, CI95 1.0-4.3 versus housekeepers), increased blood exposure frequency (OR 2.4, CI95 1.6-3.5 for 1-6 versus 0 exposures in past year), and increased frequency of recent influenza vaccination (OR 3.3, CI95 2.0-5.3 for 1 versus 0 doses in prior 3 years). Occupation (increased acceptance among housestaff, nurses, nursing assistants, laboratory technicians), increased frequency of blood exposure, and recent influenza vaccination also were predictors of series completion. Factors such as occupation, blood exposure frequency and acceptance of other preventive services may help identify health care worker groups with low vaccine acceptance most likely to benefit from targeted vaccine delivery. Hepatitis B vaccine should be offered routinely during evaluation for occupational blood exposure. Future vaccine implementation efforts should emphasize the involvement of physicians and supervisors and education about occupational disease risk, liability, and the safety of the vaccine.

Infants' fluoride ingestion from water, supplements and dentifrice.

Concerns about dental fluorosis and the paucity of detailed fluoride intake data prompted this longitudinal study of fluoride intake in infants from birth to 9 months of age. On average, water fluoride intake greatly exceeded that from dietary fluoride supplements or fluoride dentifrice. However, fluoride supplements and dentifrice contributed substantial proportions of fluoride intake among children using them. Some children had estimated fluoride intake from water, supplements and dentifrice that exceeded the recommended "optimal" intake (a level that has yet to be determined scientifically). Practitioners should estimate fluoride ingestion from all these sources if considering systemic fluoride supplementation.

Infants' fluoride intake from drinking water alone, and from water added to formula, beverages, and food.

In infants, the majority of total ingested fluoride is obtained from water, formula and beverages prepared with water, baby foods, and dietary fluoride supplements. Few studies have investigated the distribution of fluoride intake from these sources among young children at risk for dental fluorosis. The purpose of this study was to assess estimated water fluoride intake from different sources of water among a birth cohort studied longitudinally from birth until age 9 months. Parental reports were collected at 6 weeks, 3 months, 6 months, and 9 months of age for water, formula, beverage, and other dietary intake during the preceding week. Fluoride levels of home and child-care tap and bottled water sources were determined. This report estimates daily quantities of fluoride ingested only from water--both by itself and used to reconstitute formula, beverages, and food. Daily fluoride intake from water by itself ranged to 0.43 mg, with mean intakes < 0.05 mg. Water fluoride intake from reconstitution of concentrated infant formula ranged to 1.57 mg, with mean intakes by age from 0.18 to 0.31 mg. Fluoride intake from water added to juices and other beverages ranged to 0.67 mg, with means < 0.05 mg. Estimated total daily water fluoride intake ranged to 1.73 mg fluoride, with means from 0.29 to 0.38 mg.

Low cholesterol concentrations and severe depressive symptoms in elderly people.

OBJECTIVE: To investigate the reported association between low serum cholesterol concentration and severe depressive symptoms in an elderly population. DESIGN: Cross sectional analysis of pooled data from three communities of the established populations for epidemiologic studies of the elderly. Participants who completed their interview, including the Centers for Epidemiologic Studies' depression scale and consented to measurement of their cholesterol concentration were included in the study. SUBJECTS: 3939 men and women aged > or = 71. METHODS: chi 2 analysis, t tests, and multivariate regression analysis of the association between low cholesterol concentration and severe depressive symptoms. All analyses were stratified by sex, and multivariate analyses were adjusted for age, self reported health, physical function, number of drugs used, and weight loss. MAIN OUTCOME MEASURE: Score of depressive symptoms on the Centers for Epidemiologic Studies' depression scale. RESULTS: Depressive symptoms, cholesterol concentration, weight, and use of drugs were all associated with age in men and women. The relative odds of severe depressive symptoms (score > or = 16) for those with low cholesterol concentrations (< 4.14 mmol/l) were 1.9 (95% confidence interval, 1.1 to 3.3) for the older group of men and 1.8 (1.1 to 2.9) for the older group of women. This association was also observed when depressive symptoms were analysed as a continuous rather than a categorical variable. In multivariate models that adjusted for age, self reported health, physical function, number of drugs used, and weight loss, the association was substantially weakened. CONCLUSIONS: After several factors relating to health had been controlled for, no significant association between low cholesterol concentration and severe depressive symptoms was found.

Comparing ethnic group-specific DAI equations with the standard DAI.

The Standard DAI is an orthodontic index based on public perceptions of dental aesthetics in the USA and is a regression equation linking the relative social acceptability of dental appearance and the objective, physical measurements of ten occlusal traits. It can be used in surveys of need for orthodontic treatment and as a screening tool in public programmes providing orthodontic care. To determine if the Standard DAI could be used internationally, 200 stimuli (photographs of dental configurations) were rated for dental aesthetics by 413 Chinese students, 418 Latvian students and 428 Native Americans. To develop ethnic group-specific DAI equations these ratings were linked by regression procedures to the occlusal trait measurements available for each of the 200 stimuli. Using these equations, group-specific DAI scores were calculated for the 200 stimuli. At all levels on the DAI scale the percentage agreements, sensitivities and specificities ranged from 73 to 100 per cent indicating that the Standard DA can be used without modification to calculate DAI scores among Chinese, Latvians and Native Americans.

Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index.

Brief measurement devices can alleviate respondent burden and lower refusal rates in surveys. This article reports on a field test of two shorter forms of the Center for Epidemiological Studies Depression (CES-D) symptoms index in a multisite survey of persons 65 and older. Factor analyses demonstrate that the briefer forms tap the same symptoms dimensions as does the original CES-D, and reliability statistics indicate that they sacrifice little precision. Simple transformations are presented to how scores from the briefer forms can be compared to those of the original.

Predicting handicapping malocclusion using the Dental Aesthetic Index (DAI).

The Dental Aesthetic Index (DAI) is an orthodontic index based on socially defined aesthetic standards. The DAI is useful in both epidemiological surveys to identify unmet need for orthodontic treatment as shown by its use by WHO in ICS-II and as a screening device to determine priority for subsidised orthodontic treatment. The purpose of this study was to determine a decision point on the DAI scale that predicts the clinical judgments of orthodontists in separating handicapping from non-handicapping malocclusion. Orthodontists' decisions were available on a sample of 1306 models representing untreated occlusions found in half a million children. DAI scores were calculated for each model. By correlating orthodontists' decisions with DAI scores a cut-off point was established. Agreements between DAI scores and orthodontists' decisions were best at the 86th percentile on the DAI scale. The DAI score of 36 at the 86th percentile yielded an 88 per cent agreement, a specificity of 93 per cent and a sensitivity of 54 per cent. Cases with scores of 36 and higher would be considered handicapping according to the DAI.

Established populations for epidemiologic studies of the elderly: study design and methodology.

A project initiated by the intramural Epidemiology, Demography and Biometry Program of the National Institute on Aging, entitled "Established Populations for Epidemiologic Studies of the Elderly" (EPESE), has developed information on death, chronic conditions, disabilities, and institutionalization for representative samples of elderly people living in communities. The EPESE consists of prospective epidemiologic studies of approximately 14,000 persons 65 years of age and older in four different communities: East Boston, Massachusetts; two rural counties in Iowa; New Haven, Connecticut; and segments of five counties in the north-central Piedmont area of North Carolina. The study design includes an initial baseline household interview followed by continued surveillance of morbidity and mortality. Participants are re-contacted annually in conjunction with the collection of data on cause of death and factors related to hospitalization and nursing home admissions. Concurrently, the investigators developed substudies focused on specific problems of the elderly. The value of this research lies in the longitudinal design which allows for analyses aimed at identifying risk factors of diseases, disabilities, hospitalizations, institutionalization, and mortality.

Active life expectancy for 10,000 Caucasian men and women in three communities.

Active life expectancies (ALEs) were calculated using increment-decrement life table techniques for 10,000 Caucasian men and women from three geographic areas. This technique is more appropriate than the single decrement model originally used, and resulting ALE was substantially greater among initially independent men and women aged 65 years: from 9.3 for men and 10.6 for women to 11.3 to 13.0 for men and 15.5 to 17.1 for women. These increases may be attributable to factors other than the change of method, however, including the change in time from 1975 to 1982 and the change from one state to three communities. The sex differences suggest that the added years of life that women have enjoyed over men are neither solely added years of vigor nor solely added years of disability, but added years with the same mix of independence/dependence that the shorter-lived males experience. The age patterns suggest that at any age the future presents a relatively constant expectation of the total duration of dependency, and concordantly, as one ages, there is a relatively uniform decrease in the proportion of active life to remaining years.

Five-year incidence of tooth loss in Iowans aged 65 and older.

The prevalence of missing teeth has been described for US adults, but little is known about the incidence of tooth loss in any segment of the population. This study investigated the 5-yr incidence of tooth loss in a random sample of Iowans aged 65 yr and older residing in two rural counties. These people had an average of 20 teeth at baseline and approximately 40% lost at least one tooth in the subsequent 5 yr. The incidence of tooth loss was highest for mandibular molars and lowest for mandibular canines. Men were more likely than women to lose teeth. Although we were able to identify a number of statistically significant potential risk factors for tooth loss, the multivariate models that incorporated all these factors were not good predictors of which people were at highest risk for tooth loss.

Differences in need for orthodontic treatment between Native Americans and the general population based on DAI scores.

Clinical impressions by Indian Health Service (IHS) dentists of a greater frequency of severe dental malrelations among Native Americans than in the general US population have never been objectively confirmed. This study uses the DAI as the standard to determine whether there is a greater prevalence of severe malocclusions among Native Americans. Four hundred eighty-five Native American students in grades 7-12 from two remote sites--Pine Ridge, SD, and Many Farms, AZ--and one nonremote site--Lapwai, ID--were scored for the DAI. The mean scores from each reservation, as well as the mean score from the three reservations combined, were significantly higher, indicating poorer aesthetics, than the mean DAI score from a large sample of the general US population. These data confirm the clinical impressions of IHS dentists that Native Americans residing on reservations have significantly poorer dental aesthetics than the aesthetics found in the general US population; therefore, Native Americans have greater needs for orthodontic treatment.

Effects of etching and rinsing times and salivary contamination on etched glass-ionomer cement bonded to resin composites.

This study investigated the effect of salivary contamination on glass-ionomer/resin-composite bond strength after establishment of an appropriate etching and rinsing time for the glass-ionomer cement. Three hundred and thirty samples of glass-ionomer cement (Ketac-Fil) were injected into cavities prepared in acrylic molds. Groups containing 15 samples each were etched for 0, 15, 30, or 60 sec, after which Scotchbond and either Silux or P-30 were applied and polymerized. The samples were stored under water for 24 hr at 37 degrees C and were then tested in shear. A 30-second etching time was found to be optimal when Silux and P-30 were considered together. In a similar manner, a 20-second optimal rinsing time was determined. Samples of glass-ionomer cement were then contaminated with saliva, dried, and bonded to composite resins and tested in shear as before. Significantly lower bond strengths resulted than with the uncontaminated controls. Efforts to clean contaminated samples by rinsing or re-etching failed to increase the bond strength obtained with the contaminated samples.

Marginal ridge strength of restored teeth with modified Class II cavity preparations.

This study compared marginal ridge fracture resistance in two groups of teeth restored with modified Class II cavity preparations, with control groups. The results indicated that the composite resin and dental amalgam restored teeth fractured at compressive loads that were not statistically different from those of the control (unprepared, intact) teeth. The marginal ridges of the unrestored, prepared teeth were significantly weaker.

Utility of the dental aesthetic index in industrialized and developing countries.

To be truly useful, an index must be applicable universally without modification. The data presented in this article support the use of the standard DAI without modification to assess need for orthodontic treatment in both developing and industrialized countries. When students from Thailand, Australia, the German Democratic Republic, and Native Americans residing on Indian reservations rated the same 25 occlusal stimuli (photographs of dental configurations) for dental aesthetics, their ratings of these stimuli when arranged in rank order were highly correlated with those of US students. These 25 occlusal stimuli were a subset of the original 200 occlusal stimuli used in deriving the standard DAI regression equation. This article presents data indicating that when a Native American DAI was derived based on Native American ratings of the same 200 occlusal stimuli used in deriving the standard DAI, the Native American DAI and the standard DAI had the same ten components (orthodontic measurements) and strikingly similar regression coefficients (weights). Further analysis indicated that the two equations were sufficiently similar to justify using the standard DAI to obtain DAI scores on Native Americans and to estimate the relative social acceptability of their dental aesthetics. If ratings for dental aesthetics for the full set of 200 stimuli were available for each of the countries where only 25 were rated, we expect that, as in the case of Native Americans, a country-specific DAI, if computed, would be sufficiently similar to the standard DAI that no modification would be needed to allow use of the standard DAI in that country.(ABSTRACT TRUNCATED AT 250 WORDS)