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.

Hepatitis B prevalence and infection control among dental health care workers in a community in South Korea.

OBJECTIVES: The objectives of this study were to investigate the prevalence of hepatitis B vaccine and use of infection control procedures by dental health care workers in Taegu, South Korea. METHODS: Information was obtained with a mailed questionnaire sent to 300 private dental practices. Surveys were received from 177 dentists, 104 dental hygienists, and 46 dental assistants. All dental health care workers were asked to donate a blood sample for analysis of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs). RESULTS: Vaccination against hepatitis B virus was reported by 63 percent of the respondents. About 40 percent of all participants answered that they were anti-HBs positive, while another 43 percent did not know their status. About 89 percent of dentists reported that they wore a mask with all patients, while hygienists (13.6%) and assistants (13.0%) were less likely to do so. Reported use of gloves (4.5%) and protective eyewear (14%) with all patients was extremely low in every group. Among the 56 dentists who were tested for HBV markers, 23 did not receive the vaccine against hepatitis B, and 13 percent (3 of 23) were positive for HBsAg as carriers. CONCLUSIONS: About 37 percent (120 of 327) of dental health care workers surveyed in this study in Korea did not receive the vaccine against HBV infection. Basic barrier techniques to prevent cross-contamination were not being used consistently. Nationwide guidelines for barrier techniques and hepatitis vaccinations should be developed and disseminated to dental personnel.

Factors associated with dental anxiety.

This study assessed dental anxiety in adults living in the Detroit tricounty area and identified factors associated with it. The prevalence of dental anxiety was 10.0 percent. Regression analysis revealed six factors associated with dental anxiety: unfavorable attitudes toward dentists, infrequent checkups, dissatisfaction with one's month, small numbers of filled surfaces, being female and lower income. Dentists should be aware of these factors when assessing dental anxiety in their patient populations.

Preventive oral health behaviors among African-Americans and whites in Detroit.

OBJECTIVE: This study compared the preventive oral health behaviors of African-Americans and whites. METHODS: Face-to-face interviews were conducted with a probability sample of 384 African-American and 358 white adults living in the greater Detroit area. Questions focused on brushing, flossing, and dental visits. RESULTS: More than 95 percent of both groups reported brushing daily; however, whites were more likely to brush all teeth, including parts that do not show. Frequency of flossing did not differ between groups. African-Americans, however, were less likely to floss all of their teeth. Whites were more likely than African-Americans to get dental check-ups at least once a year and much less likely to indicate they had never had a dental check-up. African-Americans tended to have less education and lower family income than whites and were more likely than whites to have Medicaid. Race differences in brushing thoroughness and annual check-ups were greatly reduced when income, education, and insurance were controlled statistically. CONCLUSIONS: African-Americans are less likely than whites to brush thoroughly, floss thoroughly, and get dental check-ups. These differences are partly traceable to differences in socioeconomic status and access to professional oral health care.

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.

Usefulness of multiple equations for predicting preventive oral health behaviors.

Canonical correlation analyses of a previous dental survey suggested that dental checkups, flossing, and tooth brushing could all be predicted from a single equation. Most theories and research about the influence of beliefs on behavior, however, suggest different behaviors will be best predicted by different behavior-specific measures. The current survey investigated influences on brushing, flossing, and dental checkups in a probability sample of adults in the Detroit tri-county area. Both behavior-specific variables, such as perceived benefits and costs of flossing, and general variables, such as gender, were included as predictors. Canonical correlation analysis indicated three equations were needed to predict the three oral health behaviors. Flossing frequency, for example, was best predicted by confidence in flossing ability and beliefs about the benefits of and barriers to flossing. The results suggest that even these closely related behaviors are best predicted using separate equations that include mostly behavior-specific predictors.

A community collaboration: the dental emergency assistance program.

The Dental Emergency Assistance Program is a collaboration between Michigan dentists and a United Way agency. The program's goal is to provide timely, accessible dental care to underserved people in a large metropolitan area. The authors analyzed the program's 1993 activities to determine sources of patient referrals, patients' demographic characteristics, and the types and value of services provided by participating dentists. The evaluation indicated that the Dental Emergency Assistance Program was successfully addressing the emergency dental needs of an underserved portion of the community.

Accessing MEDLINE from the dental office.

Electronic access to on-line information is now available for dentists. One such resource is MEDLINE, a database of more than 7,500,000 biomedical references indexed by the National Library of Medicine. MEDLINE searching can be performed on-line or locally using a CD-ROM drive. Dentists should evaluate equipment requirements, availability of training, extent of the bibliographic database, ease of using the searching software and adequacy of documentation before selecting a mode of MEDLINE access.

Trends in students' knowledge, opinions, and experience regarding dental informatics and computer applications.

OBJECTIVE: This study investigated knowledge, opinions, and experience regarding dental informatics and computers among first-year dental students (D1s) and fourth-year dental students (D4s). DESIGN: First-year (N = 95) and fourth-year (N = 91) students in 1990 and first-year (N = 97) and fourth-year (N = 91) students in 1993 at a school of dentistry were surveyed. MEASUREMENTS: Demographic characteristics and computer ownership were assessed. Knowledge was measured using an 18-item scale (range 0-18). Opinions were measured using a 13-item scale (range 13-65; alpha = 0.81). Experience was measured using a 28-item scale (range 28-140). RESULTS: Response rates were all nearly 100%. Computer ownership by the D1s increased from 17.9% to 43.8% in the three years between surveys. Knowledge and opinions of the 1990 and 1993 D1s were similar, although the latter reported more experience with hardware and software. Experience with dental informatics applications was lacking in both groups. The 1993 D4s had completed more computer courses than had the 1990 D4s (2.3 vs 0.9), and demonstrated significantly more knowledge and experience. Opinion scores were nearly identical for these groups. The D4s in 1993 who had been D1s in 1990 had increased their knowledge of and experience with informatics applications during dental school. A difference in computer knowledge between the entering D1 males and females was observed in 1990, but was essentially gone by 1993 for the same individuals. CONCLUSIONS: Entering students had more computing knowledge and skill than their predecessors. Informatics knowledge and experience increased during dental school, and knowledge disparities between genders disappeared.

Preventive behaviors as correlates of periodontal health status.

OBJECTIVES: This investigation examined current practices of brushing, flossing, and periodic dental visits and their association with periodontal health status. METHODS: Data were collected using face-to-face interviews and 40-minute in-home dental examinations with a probability sample of adults 18 years of age or older, having at least one tooth, and living in housing units in the Detroit tricounty area. Complete examinations were performed on 319 individuals. RESULTS: On average, subjects reported brushing their teeth about twice a day. About one-third of the population reported flossing at least once a day. Loss of periodontal attachment was related to frequency of brushing while subjects who exhibited acceptable flossing ability had less plaque and calculus, shallower pocket depths, and less attachment loss. Subjects reporting a periodic dental visit at least once a year had less plaque, gingivitis, and calculus than subjects reporting less frequent visits. In regression analyses, brushing thoroughness, flossing ability and frequency, and dental visit frequency were predictors of lower plaque, gingivitis, and calculus scores. In turn, these scores were predictors of shallower pocket depths and less attachment loss. CONCLUSIONS: Brushing, flossing, and periodic dental visits were correlated with better periodontal health. The behaviors appeared to be indirectly related to pocket depth and attachment loss through their associations with plaque, gingivitis, and calculus levels.

Preventive oral health behaviors among Detroit-area residents.

PURPOSE: It has been recommended that adults brush and floss their teeth daily and have periodic oral health checkups. A study was conducted to determine if those recommendations are followed. METHODS: Data were collected during face-to-face interviews with a probability sample of 662 dentate adults residing in the Detroit metropolitan area from August to November 1989. Participants were asked how frequently they brushed, flossed, and had checkups. They were also asked about the thoroughness with which they brushed and flossed, and about the advantages and disadvantages of all three behaviors. Descriptive statistics were calculated. RESULTS: The response rate was 72%. While 97% of subjects reported brushing at least once a day and 32% reported flossing at least once a day, 13% indicated they did not brush all teeth or all parts of teeth, and one-third of those who said they flossed daily did not floss all teeth. Seventy-three percent of respondents reported getting dental checkups at least once a year. For brushing, insufficient thoroughness was more commonly a problem than insufficient frequency. CONCLUSIONS: Patient education efforts related to brushing will probably be more effective if they focus on thoroughness rather than frequency. Interventions to increase flossing should probably focus on overcoming skill deficits.

Constructing a dental electronic information resource (DEIR).

This paper discusses the construction of a dental electronic information resource (DEIR). Development is based on the Internet gopher client/server model. Information is organized in a series of hierarchical menus. A DEIR can be browsed by traversing the menu hierarchy or by performing keyword searches. Searches can result in a menu of found items from across the Internet. Initially, contents of the DEIR will be text files. Electronic copy will be given to an editorial board that will review submissions for conformity to publication standards. A current estimate for electronic storage costs of a DEIR is $1.25/Mb per year. There will be additional costs associated with any purchases of data (e.g. Current Contents), production of data (e.g. development time), and editorial and managerial activities. The DEIR will be accessible from any computer or terminal that can connect to the Internet. Primary user groups will be faculty, staff, and students of dental schools. However, access to the DEIR will be free, and an extensive user community will be encouraged, including practicing dentists, dental associations, public health agencies, and dental insurance companies.

The relation of preventive dental behaviors to periodontal health status.

Current recommendations for periodontal health maintenance emphasize toothbrushing, flossing and periodic dental checkups. The purposes of this study were to examine (1) the effects of these practices on periodontal health and (2) the relationships of demographic and socioeconomic variables with these behaviors and with periodontal health. Adults (n = 319) in the Detroit, Michigan tri-county area were asked how frequently they performed the 3 preventive behaviors. Levels of plaque, gingivitis, calculus, and periodontal attachment were then assessed during in-home dental examinations. There were no statistically significant differences in these health measures between those with acceptable and unacceptable brushing behavior. About 20% of the subjects reported acceptable flossing behavior, and these individuals had significantly less plaque and calculus than other participants. Over 3/4 of subjects reported having a dental checkup at least 1 x a year, and these persons were found to have significantly less plaque, gingivitis, and calculus compared to less frequent attenders. Acceptable brushing behavior was not associated with any particular demographic or socio-economic characteristic, while differences in acceptable flossing behavior were found among age groups. Frequencies of yearly dental checkups varied significantly within every demographic and socioeconomic characteristic.

CPITN, DMFT, and treatment requirements in a Nicaraguan population.

WHO basic methods were used to assess CPITN, DMFT, and treatment requirements in a population of 178 persons aged 12-64 yr living in urban and rural areas of Nicaragua. Two groups were examined: individuals presenting for dental treatment at health clinics (30%) and subjects chosen randomly at other locations (70%). Mean ages of both groups were similar although females were found in higher percentages among those presenting for dental care. With the exception of one young individual, all subjects had calculus in at least one sextant. About 26% of the subjects who presented for treatment had a > or = 6 millimeter pocket compared to about 14% of the remainder of subjects. The mean DMFT for health clinic subjects was 16.1 compared to 10.3 for subjects from other locations. Subjects presenting for treatment had twice as many missing teeth and a mean of 0.5 filled teeth compared to 2.4 filled teeth for other subjects. Subjects at the clinics were in greater need of restorative care and extractions, while subjects from other locations were found to have more teeth that did not require any treatment. Health clinic subjects reported more visits to the dentist in the last year than other subjects. Only 80% of those presenting for treatment owned a toothbrush compared to 97% of those examined in other locations, and the latter group reported brushing their teeth more frequently. Attrition was a commonly encountered tooth disorder with 53% of all subjects exhibiting this condition.

Tooth brushing, flossing, and preventive dental visits by Detroit-area residents in relation to demographic and socioeconomic factors.

A survey was conducted to identify (a) factors that influence preventive dental behaviors and (b) target groups for interventions. Data were collected in face-to-face interviews with a probability sample of 662 dentate adults living in the Detroit tricounty area. The interviews included questions about demographic and socioeconomic variables and about three preventive behaviors: brushing, flossing, and preventive dental visits. All behaviors were positively associated with socioeconomic status. Females were more likely than males to perform each of the behaviors at the recommended frequency. The behaviors were only weakly associated with age. Whites were more likely than nonwhites to make regular dental visits, but frequency of brushing and flossing did not vary substantially across racial groups. The impact of race on frequency of dental visits was reduced when socioeconomic status was statistically controlled. Findings suggest that socioeconomic status, race, and sex remain important considerations when planning dental health education or other interventions.

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.

An application of computer conferencing in dental education.

A computer conference was used as an instructional tool in a dental school course on health education. Second year students (N = 84) were divided into 17 groups to design community education programs. A student from each group participated in the conference to electronically discuss their program with peers. The conference operated for 52 days. The 28 conference topics were displayed 1028 times. There were 279 conferencing uses lasting 8125 min (135.4 h); a mean of 29.1 min/use. Mean responses per students was 25. Mean student terminal time was 7.8 h. Instructor terminal time was 20.8 h; 5.4 h were spent managing the conference. Of the available conferencing funds ($440.00), $218.35 was expended with students using $168.24. Mean dollars spent per student was $9.90. Quantitative evaluation of participation was based on: (a) number of individual responses made compared to mean responses; (b) timely item placement on the conference; and (c) the percentage of responses made in other students' items. Student evaluation of conferencing was positive and acknowledged the value of computer skills.