Centric relation definitions taught in 7 dental schools: results of faculty and student surveys.

PURPOSE: The purpose of this investigation was to assess the level of consensus regarding the definition of centric relation and its clinical use in 7 US dental schools. MATERIALS AND METHODS: The preclinical and clinical faculty in the departments of prosthodontics, operative, and general dentistry (n = 137) at 7 dental schools and a convenience sample of fourth year students (n = 150) at the same schools were invited to complete 2-page surveys regarding the definitions and use of centric relation at their institutions. The faculty and student survey included 6 commonly used centric relation definitions from the 1994 Glossary of Prosthodontic Terms, and provided space for writing in definitions not listed on the form. The participants were asked to identify which definition was used at their school. RESULTS: Return rate was 85% for faculty and 75% for students. Both faculty and students identified a low level of consensus regarding the definition and clinical use of centric relation at their dental school. Numerous definitions are in use at each institution. Extramural practice participation and the number of years since dental school graduation were variables associated with the faculty's choice of definition. The faculty who did not participate in an extramural practice chose older definitions. Dental educators graduating before 1975 selected either the oldest or the most recent centric relation definition, whereas the more recent graduates frequently selected the newer definitions. There were no statistical differences between prosthodontic specialists and nonspecialists in choice of definitions. Three courses identified by the students as having the most influence on their understanding of centric relation were preclinical removable prosthodontics, preclinical occlusion, and clinical removable prosthodontics. CONCLUSION: The results of this survey suggest that the controversy will continue, because to date there is no consensus regarding the definition of centric relation within the 7 dental schools surveyed.

Survey of U.S. dentists' knowledge and opinions about oral pharyngeal cancer.

BACKGROUND: Oral pharyngeal cancer constitutes the most life-threatening of all dental and craniofacial conditions. The U.S. five-year survival rate of 52 percent for these cancers is one of the lowest and has not changed in decades. METHODS: The authors mailed a pretested survey to 7,000 randomly selected general dentists. They obtained information on 3,200 dentists' levels of knowledge about oral pharyngeal cancer risks and diagnostic procedures for providing an oral cancer examination, as well as about related opinions and interest in continuing education, or CE, courses on the topic. The authors carried out analyses using unweighted data; they used both bivariate and logistic analytical techniques and evaluated at a significance level of P < or = .01. RESULTS: Based on responses to 14 questions, the average knowledge of oral cancer risks score was 8.4. About one-half of dentists surveyed knew the two most common sites of intraoral cancer and that most oral cancers are diagnosed at a late stage. CONCLUSIONS: The reported knowledge of these dentists regarding oral cancer suggests that they are not as knowledgeable as they could be about cancer prevention and early detection and that they recognize these deficiencies. Most of the dentists were interested in oral cancer CE. CLINICAL IMPLICATIONS: Dentists need to know where in the mouth to look and what types of lesions to look for to provide a comprehensive oral cancer examination.

Oral pharyngeal cancer prevention and early detection. Dentists' opinions and practices.

BACKGROUND: The five-year survival rate for patients in the United States diagnosed with oral pharyngeal cancer is 52 percent, which suggests that these cancers are diagnosed at late stages. The authors conducted this study to determine U.S. dentists' opinions and practices regarding oral cancer prevention and early detection. METHODS: The authors mailed a pretested survey to 7,000 randomly selected general practitioners. A total of 3,200 dentists provided information on how they conduct oral cancer examinations, their use of health history questions to assess patients' oral cancer risks and their oral cancer training and practices. The authors carried out analyses using unweighted data; both bivariate and logistic analytical techniques at a P < or = .01 level of significance were used. RESULTS: On average, dentists assessed about five of the eight health history items on the survey. Eighty-six percent indicated that they did not conduct oral cancer examinations on edentulous patients 18 years of age or older; 81 percent, however, reported that they conducted oral cancer examinations for 100 percent of their patients 40 years of age or older on their initial appointment. CONCLUSIONS: The reported practices of these dentists regarding oral cancer, in conjunction with their opinions about key aspects of these practices and their training, point to a need for systematic educational updates in oral cancer prevention and early detection. CLINICAL IMPLICATIONS: Dentists need to determine their patients' risks for oral cancers and provide routine and comprehensive oral cancer examinations.

Providing oral cancer examinations for older adults.

Although cancer is not a part of the aging process, malignant neoplasms occur primarily in older adults. As the size of the elderly population increases, there will be many more older adults at risk for oral cancer. Many older adults do not seek dental care because they do not think they need it; and, therefore, they do not receive routine oral examinations. Dental practitioners need to encourage older patients to seek dental care so they can receive oral cancer examinations.

An assessment of oral cancer prevention curricula in U.S. medical schools.

BACKGROUND: Oral cancer is readily detectable through routine examination, but five-year survival rates remain low. Physicians bear the same responsibilities as dentists in the early detection of oral cancers, because high-risk patients utilize medical services more often than dental services. METHODS: Because physicians' practices are largely influenced by their training, this study assessed the level of oral cancer education provided to undergraduate U.S. medical students. Health history and physical diagnosis course curricula were assessed for relevant content. RESULTS: The response rate from the U.S. medical schools was 63.2%. When compared with the "gold standard," the average score was 43% of the optimum. Seven percent of the schools did not require inspection of the mouth, 29% required inspection of all oral structures, and intraoral palpation was advocated by 43% of the schools. Although most schools included questions about alcohol and tobacco use, only 13% asked about sunlight exposure. CONCLUSION: Preliminary oral cancer training in medical schools regarding physical assessment and elicitation of signs, symptoms, and high-risk behaviors lacks both adequacy and comprehensiveness.

Knowledge, opinions and practices of general dentists regarding oral cancer: a pilot survey.

The authors mailed a pilot survey to 500 randomly selected general dentists. Although most dentists reported their knowledge of oral cancer to be current, their actual knowledge of oral cancer risk factors and signs and symptoms was inconsistent. Conflicting data were also found between their level of knowledge and their provision of oral cancer examinations. Most respondents agreed that patients should undergo an oral cancer examination annually, yet many do not provide this service.

Trends in predoctoral education in geriatric dentistry.

Historically, education in geriatric dentistry has been limited in both quantity and quality. More recently, a number of educational initiatives have been developed in response to the growing number of older adults and their changing oral health status and dental treatment needs. A survey of U.S. and Canadian dental schools examined curriculum trends and assessed the effectiveness of educational initiatives and the value of AADS/AoA geriatric dental curricular materials. All schools responded. Compared to previous reports, more schools had geriatric didactic course(s), clinical rotations, and faculty with geriatric dental training. Fifty-eight percent of dental schools support geriatric dentistry in their budgets. The primary barriers to program expansion continue to be the lack of trained faculty members, a crowded curriculum, and fiscal concerns.

Maryland adults' knowledge of oral cancer and having oral cancer examinations.

OBJECTIVES: This study sought to determine (1) knowledge of risk factors for oral cancer, (2) knowledge of signs and symptoms of oral cancers, and (3) factors associated with having had an oral cancer examination among 916 Maryland adults 18 years of age and older. METHODS: A statewide, random-digit dial, computer-assisted telephone survey was conducted. The pretested instrument consisted of 32 questions that required 12 minutes to complete. RESULTS: Overall, level of knowledge about risk factors for and signs and symptoms of oral cancers was low; misinformation was high. Although 85 percent reported hearing about oral or mouth cancer, only 28 percent of the respondents reported having had an oral cancer examination. Of these, 20 percent had the exam during the past year--the recommended frequency for persons 40 years of age or older. In logistic regression analysis, adults more likely to have had an oral cancer examination included those who thought personal behavior causes more cancer than environmental factors; had more knowledge about risk factors for oral cancer; and were 40-64 years of age, white, and better educated than their counterparts (P < .05). The primary reasons for not having an exam were "no reason/didn't know I should" and "doctor/dentist didn't recommend." CONCLUSIONS: These results demonstrate a need for interventions designed to increase knowledge levels of risk factors for, signs, and symptoms of oral cancers and the need for oral cancer examinations; and to increase oral cancer examinations.

Knowledge, opinions, and practices related to oral cancer: results of three elderly racial groups.

A study of 204 inner-city, senior center participants (ages ranged from 41-96 years) was conducted to assess their knowledge, opinions, and practices related to oral cancer. Participants were either White, African-American, or of Korean descent. The interview/questionnaire revealed this cohort to lack correct knowledge of the signs, symptoms, and risk factors of oral cancer, and to have had risk behaviors associated with oral cancer. Given that oral cancer is most frequently diagnosed in those aged 65 years and older, and that this cohort tends not to obtain routine preventive oral health care, it is imperative that these seniors be educated about the risks associated with oral cancer and their need for routine oral examinations.

The need for health promotion in oral cancer prevention and early detection.

OBJECTIVES: This review paper provides a rationale for using health promotion to help reduce morbidity and mortality due to oral cancers by identifying barriers to prevention and early detection of these cancers and discussing strategies for change. METHODS: A literature review of the following areas was conducted: epidemiology of and risk factors for oral cancers; knowledge, opinions, and practices of health care providers and the public regarding prevention, early detection, and control of oral cancers; and policies and regulations that either enhance or act as barriers to the prevention and early detection of oral cancers. RESULTS: Overall, the public is ill-informed about risk factors for and signs and symptoms of oral cancers and relatively few US adults have had an oral cancer examination. Further, health care providers are remiss in providing oral cancer examinations and detecting early oral cancers. CONCLUSIONS: To achieve the 13 oral cancer objectives contained in "Healthy People 2000," health care providers and the public must know the risk factors for these cancers as well as their signs and symptoms. Further, health care providers need to provide oral cancer examinations routinely and competently. Equally important, the public needs to know that an examination for oral cancer is available and that they can request one routinely. Thus, a vigorous agenda that includes education, policy, and research initiatives is needed to enhance oral cancer prevention and early detection.

Nurses' oral health assessments of nursing home residents pre- and post-training: a pilot study.

The purpose of this study was to determine if instruction in how to perform the MDS (Minimum Data Set) oral health assessment and RAP (Resident Assessment Protocol) Summary required by federal regulations will improve nurses' accuracy of the assessments. Fifty residents, admitted within 90 days before a training lecture, were assessed by 18 nurses. A 30-minute training session demonstrated how to perform an oral examination, including hands-on practice under a dentist's supervision. Seven to ten days after the lecture, the nurses re-examined the same residents. These assessments were compared with the admission assessments and a dentist's findings (reference). The results of this study indicate that a 30-minute training session made a significant difference in improving nurses' accuracy in completing the assessments with regard to oral health status and treatment need.

The effect of nurses' background on performance of nursing home resident oral health assessments pre- and post-training.

The purpose of this study was to determine the effect of nurses' background on their accuracy in determining oral health status and treatment need of newly admitted nursing home residents before and after tutoring. Eighteen nurses examined 50 nursing home residents before and after an In-service training lecture. Examinations performed by a dentist served as reference. Background items evaluated were: regularity of each nurse's own dental visits; years since graduation from nursing school; length of experience in an LTC facility; and training received in oral health care. At the second evaluation, nurses greatly improved the % agreement on all items. The results of this study indicate that, regardless of background characteristics, the combination of training, the presence of the dentist, and knowledge that they were in a study appeared to improve nurses' performance on the assessment. Before training, more experienced nurses were better able to determine hard tissue abnormalities than their less experienced counterparts; before training, neither group performed well in assessing soft tissue lesions. Therefore, improvements in basic nursing training in this area appear to be necessary.

Assessment of alcohol and tobacco use in dental schools' health history forms.

Health history forms are an integral component of students' clinical and didactic training in physical assessment and often serve as a model for students to use in their future practices. This study examined how alcohol and tobacco use are assessed in patient health history forms used in the dental schools of the United States and Canada (n = 63). Deans of schools were requested to send a copy of their health history and other supplemental forms used for patient care. The response rate was 98 percent. Almost 25 percent of the schools' forms did not address either alcohol or tobacco use; 37 percent failed to address one or both risk behaviors; 25 percent did not request tobacco information; and 36 percent did not address alcohol use. Major inconsistencies regarding the inclusion, content, and quantity of alcohol and tobacco questions were noted. Consensus among dental schools as to which questions to include in their health forms was not apparent.

Assessing physicians' and dentists' oral cancer knowledge, opinions and practices.

Oral cancer is responsible for more than 8,000 deaths each year. This mortality may be attributed to lack of effective oral examinations by dental and medical primary care clinicians. This pilot project assessed the knowledge, opinions and practices of a group of Maryland physicians and dentists in oral cancer prevention, diagnosis and detection. Dentists performed more oral cancer examinations, although physicians saw more high-risk patients.

Oral cancer mortality in Maryland.

Oral cancer mortality is one of the most preventable types of cancer deaths when the lesion is detected early. The survival rate is quite low, however, when oral cancer is diagnosed at an advanced stage. While the Maryland oral cancer incidence rate is lower than the US average, the state ranks fourth in the country for overall age-adjusted oral cancer mortality; Maryland's African-American population has the highest oral cavity and pharyngeal mortality rate. Delayed diagnosis may explain this occurrence since groups at high risk for developing oral cancer, such as the elderly and minority groups, do not have ready access to the Maryland oral health care system. As the elderly annually use physicians' services almost twice as much as they use dentists' services, physicians are encouraged to routinely complete an oral cavity and pharyngeal examination. Inclusion of oral health services into a Maryland health system reform benefits package would also improve routine screening frequency for oral cancer.

The need for geriatric dental education.

The poor oral health status of the elderly and the structural and attitudinal barriers that prevent dental care utilization by them, present a serious challenge for the elderly as well as for the dental profession. This challenge becomes even greater when the importance of good oral health status to the quality of life is considered. The aged person's feeling of individual well-being and favorable self-image, ability to communicate and socialize, ability to maintain adequate nutrition, and to taste and enjoy foods can be dependent upon good oral health status and hygiene. Older patients benefit physically and psychologically from more efficient dental treatment and more compassionate care given by people who understand the problems they face. In short, a better understanding of the principles of geriatric care by health professionals and staff will save both public money and private anguish. Tomorrow's elderly are expected to demand more attention and intervention to meet their changing needs. There is no reason to believe that the extension of education and training cannot begin to achieve this goal.