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Biomedical subjects

C W Douglass

Publications and source records attributed to C W Douglass.

At least 19 recordsLinked to original sources
PubMed1997

Update on student debt: trends and possible consequences.

This paper is an update on the issue of dental student debt and provides additional data and an exploration of continued trends which were outlined by Douglass and Fein in the 1995 IOM study of The Future of Dental Education. Dental school tuitions have continued to increase at rates at or above the consumer price index. These tuition bills are increasingly being met by debt financing on the part of the students. These trends are described and then related to recent data on the future plans of dental school seniors. The second part of the paper will provide new updated date on dentists' incomes and analyze the trend in dental fees versus the consumer price index. The final section provides a summary of pay back mechanisms currently being offered to students.

Education, Dental↗
PubMed1996

Cost effectiveness of periodontal services.

This paper presents the combined use of decision trees and cost-effectiveness analysis to determine on which patients new diagnostic tests can be useful, and whether they can change the dentist's decision to provide different services and thus improve patient outcomes in 5 different categories of patients. A decision tree is constructed in which the primary decision branches are "test" and "no test". The treatment and outcome branches in the test branch are affected by the results of the test which is then either negative or positive. In contrast, the treatment and outcome branches in the no-test branch represent pathways for patient therapy when the new (or additional) test is not used. Results show that even with excellent test efficacy parameters (sensitivity 0.87 and specificity 0.84) it is not cost effective to use a diagnostic test in the general population or for adults under age 45 years. However for adults > 45 years, patients referred to a periodontist, and patients with a history of periodontal disease, the test would change treatment decisions and improve patient care outcomes.

Adult↗
PubMed1996

Consequences of success: do more teeth translate into more disease and utilization?

OBJECTIVES: Increased tooth retention coupled with increased numbers of older adults means that the actual number of teeth at risk to dental disease will increase sharply. Whether this increase in the number of teeth will translate into more disease and utilization in unknown. The purpose of this study was to test this "more teeth, therefore more dental disease" theory using cross-sectional data. METHODS: In-home personal interview and oral examination data were obtained on a probability sample of elders aged 70 years and older living in the six New England states using the Medicare beneficiary list as a sampling frame. Data on dental utilization, number of teeth, dental caries, and periodontal disease were included in the current analysis. RESULTS: Analysis of variance on subjects with 1-10 (Group 1), 11-24 (Group 2), and 25-32 (Group 3) teeth show that the extent of bleeding on probing, pocket depth, and loss of attachment all increase as numbers of teeth increase. Similarly, a greater number of restored coronal and root surfaces were found in Group 3 relative to the other two groups. Mean numbers of decayed and filled coronal surfaces were 8.4 in Group 1.33.0 in Group 2, and 50.3 in Group 3. In contrast, unrestored coronal and root surface were significantly higher in Group 1 (mean root DS = 1.3) than Group 3 (mean root DS = 0.3). Utilization patterns of those with successful aging dentitions (Group 3) show that they are visiting dentists more frequently than the compromised group (Group 1). CONCLUSIONS: These cross-sectional data obtained from a probability sample of New England elders show that subjects who retained higher numbers of teeth have more periodontal disease and dental caries experience, and visit the dentist more frequently.

Aged↗
PubMed1996

Validity of a self-reported periodontal disease measure.

OBJECTIVES: The purpose of this study was to determine the validity of a self-reported periodontal disease measure for use in the Health Professionals Follow-up Study. METHODS: Participating dentists responded to the question "Have you had periodontal disease with bone loss?" Radiographs obtained from 140 participants were evaluated for bone loss at 32 posterior sites and used as the standard. A site was positive if it had bone loss > 2 mm and/or complete loss of crestal lamina dura. To avoid falsely classifying participants as positive, three blinded examiners independently evaluated each participant's radiographs. An a priori decision rule was used to classify a participant positive if all examiners independently assessed the same two or more sites positive. RESULTS: The validity of the self-reported measure was good among dentists, with positive and negative predictive values of 0.76 and 0.74, respectively. Among nondentists, the self-reported measure showed discriminatory power by confirming associations with known risk factors such as age and smoking. CONCLUSIONS: Dentists have a good perception of their periodontal status, and there is reasonable consensus among dentists regarding the threshold for defining periodontal disease. Self-reported measures might have potential for use in studies of other populations with substantial cost reduction, and deserve further evaluation.

Adult↗
PubMed1996

Poor oral health and coronary heart disease.

A few recent studies have shown associations between poor oral health and coronary heart disease (CHD). The objective of this study was to examine the incidence of CHD in relation to number of teeth present and periodontal disease, and to explore potential mediators of this association, in a prospective cohort study. This study is a part of the ongoing Health Professionals Follow-Up Study (HPFS). Participants included a US national sample of 44,119 male health professionals (58% of whom were dentists), from 40 to 75 years of age, who reported no diagnosed CHD, cancer, or diabetes at baseline. We recorded 757 incident cases of CHD, including fatal and non-fatal myocardial infarction and sudden death, in six years of follow-up. Among men who reported pre-existing periodontal disease, those with 10 or fewer teeth were at increased risk of CHD compared with men with 25 or more teeth (relative risk = 1.67; 95% confidence interval, 1.03 to 2.71), after adjustment for standard CHD risk factors. Among men without pre-existing periodontal disease, no relationship was found (relative risk = 1.11; 95% confidence interval, 0.74 to 1.68). The associations were only slightly attenuated after we controlled for dietary factors. No overall associations were found between periodontal disease and coronary heart disease. Tooth loss may be associated with increased risk of CHD, primarily among those with a positive periodontal disease history; diet was only a small mediator of this association.

Adult↗
PubMed1996

The impact of edentulousness on food and nutrient intake.

The authors collected dietary intake data about the food and nutrient intake of 49,501 male health professionals. Edentulous participants consumed fewer vegetables, less fiber and carotene, and more cholesterol, saturated fat and calories than participants with 25 or more teeth. These factors could increase the risks of cancer and cardiovascular disease. Mean differences in intake ranged from 2 to 13 percent, independent of age, smoking, exercise and profession. Longitudinal analyses suggest that tooth loss may lead to detrimental changes in diet.

Adult↗
PubMed1994

Epidemiologic study of sound surface trends in a 10-year longitudinal study.

Longitudinal data of 589 men aged 30-65 yr, each followed for 10 yr, were analyzed to identify variables which may be associated with healthy tooth surface loss. A longitudinal linear growth curve model was used. As expected, older cohorts tended to have fewer sound surfaces (P < 0.02), but they also tended to have greater rates of sound surface loss (P < 0.01). Age, bone loss, number of teeth at baseline, gingivitis, pocket depth and calculus were individually correlated (P < 0.05) with the rate of sound surface loss. The number of filled or diseased surfaces at baseline was also marginally correlated (P < 0.06) with rate of sound surface loss.

Adult↗
PubMed1994

The distribution of root caries in community-dwelling elders in New England.

An in-home examination of a probability sample of elders aged 70 and older living in the six New England states was conducted to estimate the prevalence and extent of root caries. Oral examinations were conducted by the visual-tactile method using a portable lamp, explorer, and a mouth mirror. Fifty-two percent of the study participants showed root caries experience and 22 percent had untreated root caries. In contrast to previous studies, this analysis showed that buccal root surfaces were no more likely than proximal surfaces to be affected by root caries. Logistic regression analysis showed that gingival recession and number of teeth were positively associated with root caries, while better oral hygiene maintenance and regular dental visits were negatively associated with root caries lesions (all factors: P < .05). The prevalence of root caries was found to increase with higher numbers of teeth except for a minority subgroup--i.e., those who retained 25 or more teeth. This study provides much-needed data on prevalence and extent of root caries in a probability sample of the oldest old in an entire region of the United States.

Age Distribution↗
PubMed1994

Periodontal disease among New England elders.

Much of the existing oral epidemiologic literature is limited by having inadequate numbers of the oldest-old in their sample, having used rudimentary periodontal measures, or not having examined probability samples of community-dwelling elders. The New England Elders Dental Study (NEEDS) is the first study that documents the periodontal disease status of a probability sample of 554 adults aged 70 to 96 living within an entire U.S. Public Health Service region. The NEEDS study revealed substantially higher estimates of periodontal destruction among older adults than previous national studies would suggest. These results are consistent with several papers in the literature that suggest that periodontal disease rates are on the increase in older adults. In the coming decades dentistry should be prepared to meet the increasing need and demand for periodontal services in the growing older population.

Aged↗
PubMed1993

Dentin as a possible bio-epidemiological measure of exposure to mercury.

The subtle human health effects from prolonged exposure to small amounts of mercury vapor are unknown. It has been difficult to study possible effects of low-dose exposure for lack of a good measure of long-term exposure. Current methods which use blood, urine, hair, and nails reliably measure only recent exposures. Long-term exposure to lead has been measured using levels found in human dentin. The purpose of this study was to determine whether mercury also accumulates in dentin. In this study, dentin from 16 human teeth, all without dental amalgam restorations, was analyzed by thermal neutron activation analysis. The teeth were selected from people with and without dental mercury amalgam restorations elsewhere in their dentitions. Mercury was found in amounts up to 5.9 ppm. While the highest mercury level was from a sample from someone who had dental amalgam restorations elsewhere in their dentition, the second highest was from someone who had no amalgam restorations. Also, a sample which was not used for any statistical comparisons but which was analyzed because the tooth contained an amalgam restoration had one of the lowest levels of mercury. These results, while inconclusive due to a small sample size, suggest that inorganic mercury vapor is a relatively small contributor to the overall body burden of mercury.

Adolescent↗
PubMed1993

Oral health status of the elderly in New England.

The New England Elders Dental Study (NEEDS) reports the prevalence, extent and severity of oral diseases and conditions among a representative sample of community-dwelling elders age 70 and older residing throughout the six New England states. In-home, full-mouth examinations were conducted by four calibrated dentists who used National Institute of Dental Research (NIDR) standardized disease measures plus additional diagnostic codes on all tooth surfaces. Only 37.6% of elders age 70 and older were edentulous, while dentate elders had a mean number of teeth per person ranging from 21.5 to 17.9 across age and gender cohorts. The prevalence of untreated coronal decay in elders with teeth was 28% in female elders and 34% in male elders. More than 90% of all elders with teeth had coronal fillings and 22% exhibited untreated root caries. Periodontal destruction was substantial, with 66% of dentate elders exhibiting moderate periodontal pockets (4-6 mm) while 21% exhibited severe periodontal pocketing (> 6 mm). Comparisons with national surveys suggest that periodontal disease prevalence and severity appear to have been underestimated in previous national studies of the elderly. Because of aging and tooth retention trends, the periodontal disease problem of the elderly may be increasing in the face of dentists' tendency to underdiagnose the periodontal diseases, legal constraints on dental hygienists to independently treat them, and inadequate funding for conservative nonsurgical therapies.

Aged↗
PubMed1993

Longitudinal statistical models for loss of sound surfaces.

Longitudinal data of 50-yr-old men, followed for 10 yr, were analyzed to identify variables which may be associated with healthy tooth surface loss. Three types of longitudinal models were used, arriving at similar conclusions. Predictors of sound tooth surface loss with aging included pocket depth, mobility, and recession.

Aging↗
PubMed1993

Beneath the surface of coronal caries: primary decay, recurrent decay, and failed restorations in a population-based survey of New England elders.

A cross-sectional study was conducted of the oral health status of a random sample of community dwelling elders, aged 70 and older, living within the six New England states. Four examining teams, each composed of a trained and calibrated dentist and a field technician, collected data during an in-home oral examination. The prevalence of carious, filled, recurrent decayed, and non-carious but failed restored coronal surfaces was recorded. For the 1,151 respondents, the mean DFT was 6.16 (SD = 6.96) and the mean DFS was 18.83 (SD = 23.37), with 37.6 percent of the sample edentulous. Eleven percent of the population had 70 percent of the coronal decay. Males (OR = 2.2, CI = 1.3-3.8) and elders with less education (OR = 1.8, CI = 1.0-3.0) were at higher risk for three or more surfaces of coronal decay. Recurrent decay was present in 16 percent of the dentate population. However, more noncarious but failed restored coronal surfaces (332) were recorded in the population of New England elders than were surfaces of recurrent decay (234). The New England elders have higher rates of decay than New England children, although the rates matched those of previous national studies. The findings signal a need to develop targeted preventive regimens for older adults and greater understanding of dental treatment needs of elders.

Aged↗