Biomedical subjects

G H Gilbert

Publications and source records attributed to G H Gilbert.

At least 19 recordsLinked to original sources

PubMed2002

Tooth loss occurring at a place other than a health-care facility: 72-month incidence.

Dental care can occur within or outside the formal health-care system. We hypothesized that certain subject characteristics would partly explain one type of dental self-care, non-professional extractions. A representative sample of diverse groups of dentate adults was studied. In-person interviews and clinical examinations were conducted at baseline, 24, 48, and 72 months, with semi-annual telephone interviews in between. Of 699 participants, 291 (42%) reported loss of at least one tooth, of whom 42 (14% of those with tooth loss) reported having lost the tooth at a place other than a health-care facility. Ninety-four percent of non-professionally lost teeth were self-extracted; relatives extracted the remainder. Fifty-eight percent of these teeth were deliberately removed; the remainder came out while subjects were eating or brushing their teeth, or due to injury. Attachment loss and mobility at previous examination were consistent with the occurrence of non-professional extraction. The incidence magnitude was substantive and persistent throughout follow-up.

Aged↗

PubMed2001

Risk indicators of edentulism, partial tooth loss and prosthetic status among black and white middle-aged and older adults.

OBJECTIVES: To describe the prevalence and risk indicators of edentulism; to describe the frequencies of wearing removable dentures; to describe the prevalence and risk indicators of fixed prosthetic restorations; to test the hypothesis that fixed prosthetic restorations are most likely to have been placed in persons at lower risk for dental and periodontal diseases, and to test the hypothesis that, with dental disease, dental behaviors, dental attitudes and ability to afford crowns taken into account, blacks are less likely than whites to have received crowns. METHODS: The Florida Dental Care Study is a cohort study of subjects 45 years old or older. A telephone screening interview was done as a first stage to identify 5254 subjects who met eligibility requirements and who self-reported whether they were edentulous. In a second stage, a subsample of dentate subjects was contacted after they completed their telephone screening interview. Of these, 873 subjects completed a baseline in-person interview and dental examination. RESULTS: A total of 19% of first-stage subjects were edentulous. In a single multiple logistic regression, having a poorer self-rated level of general health was significantly associated with edentulism, as were being poor, older and white. Among the second-stage participants (all of whom were dentate), several prosthetic patterns were observed. For example, a total of 64% of maxillary full denture wearers reported wearing their denture all the time. Participants had also received numerous fixed prosthodontic services. The proportion of subjects with at least one crown varied widely by subject characteristics. CONCLUSIONS: A substantial percentage of non-ideal frequencies of wearing removable prostheses was reported, as were prosthesis-related soreness and broken prostheses. Although we expected and observed an association between having a fixed prosthetic crown and periodontal status, dental fillings, dental attitudes and financial resources, a residual association with race suggests that blacks are much less likely to receive prosthetic crowns. The several possible reasons for this circumstance warrant further investigation.

Black or African American↗

PubMed2000

Restoration fractures, cusp fractures and root fragments in a diverse sample of adults: 24-month incidence.

BACKGROUND: There are few reports in the literature regarding estimates of the occurrence of tooth fractures. Most studies have assessed tooth fractures in people seeking dental care, which may underestimate the incidence of the problem. METHODS: This study sought to estimate the incidence and prevalence of cusp and restoration fractures, as well as root fragments in participants in the Florida Dental Care Study, a diverse representative sample of community-dwelling residents of four north Florida counties made up of people who seek dental care regularly and those who do not. Participants received a dental examination and an in person interview at baseline and at a 24-month follow-up session. RESULTS: At least 20 percent of the participants were diagnosed as having bulk restoration fractures, cusp fractures or root fragments at the baseline visit. At the 24-month follow-up session, 26 percent of the participants had at least one new occurrence of these problems. Of those subjects presenting with tooth fracture, 25 percent had multiple teeth affected. African-Americans and people who sought care on a problem-oriented basis experienced twice the rate of cusp fracture and a higher rate of root fragments as did those who sought care on a regular basis. These data represent consecutive prevalence estimates rather than the true incidence, in that fractures that occurred after baseline may have been treated in the intervening 24 months. Thus, these data represent "lower-bound" incidence estimates. CONCLUSIONS: These results suggest that restoration fractures, cusp fractures and root fragments are a significant dental health problem, and that selected segments of the population are at greater risk of developing these problems. CLINICAL IMPLICATIONS: These data are useful for dentists in understanding the magnitude of the problem and the potential progression of fractures and root fragments.

Adult↗

PubMed1999

Health care utilization by older adults in response to painful orofacial symptoms.

The purpose of this study was to determine which specific attributes of painful orofacial symptoms serve as predictors of health care utilization in a population based sample of elderly subjects. Furthermore, we documented patterns of health care utilization selection by type of health care provider. To our knowledge, these specific utilization patterns have never before been reported in the pain literature. Telephone interviews were conducted with a stratified random sample of 1636 community dwelling older (65+) north Floridians. A total of 5860 households were contacted and screened, with 75.3% participating to the point where their eligibility for the study could be determined. The percentage of subjects reporting health care utilization for a specific symptom ranged from 62 to 32%. One or more health care visits were reported by at least 50% of those reporting symptoms of toothache pain, facial pain, jaw joint pain and burning mouth in the past 12 months. These rates suggest that elderly individuals are willing and able to seek health care for painful orofacial symptoms. We found that pain intensity was the best predictor of whether an elderly individual utilized health care or not, which suggests that some pain intensity threshold may exist at which health care seeking behavior is initiated. The overall number of visits was not predicted by pain intensity but by other qualities more associated with time or level of dysfunction caused by the symptom. We also found that elderly adults, typically seek care for toothache from a dentist and from physicians for painful orofacial symptoms not associated with the teeth or mouth. These decisions regarding the selection of a health care professional may, in part, be a function of financial and insurance considerations, anatomical site and perception of the role of dentistry in orofacial care.

Aged↗

PubMed1999

Patterns of change in self-reported oral health among dentate adults.

BACKGROUND: Although self-assessments of oral health have become useful tools in dental research, the use of self-reports to study changes in oral health over time has been limited. The aim of this investigation was to describe how oral disease and tissue damage, pain, functional limitation, disadvantage, and self-rated oral health change over time. METHODS: The Florida Dental Care Study (FDCS) (n = 873) is a longitudinal study of oral health among dentate adults (age, > or = 45 years). Incidence rates and transition probabilities were used to describe changes in oral health over a 24-month period. RESULTS: The probability of reporting a specific problem during the 24-month study ranged from 0.52 for perceived need for dental care to 0.07 for avoided eating with others. Only dental sensitivity and perceived need for dental care had transition probabilities >0.20. Decomposition of transition probabilities revealed moderate probabilities of onset coupled with relatively high probabilities of recovery. CONCLUSION: Although oral health status is clearly dynamic, no individual measure exhibited profound fluctuation. Most oral health problems were episodic rather than chronic. Patterns of change in oral health varied across dimensional lines.

Adult↗

PubMed1999

Tooth-specific and person-level predictors of 24-month tooth loss among older adults.

OBJECTIVES: To describe: (1) the 24-month incidence of tooth loss in a diverse sample of dentate adults; and (2) the clinical, attitudinal, behavioral, and sociodemographic correlates of tooth loss incidence. METHODS: The Florida Dental Care Study is a prospective longitudinal cohort study of persons who at baseline had at least one tooth, were 45 years or older, and who resided in north Florida. An in-person interview and clinical examination were conducted at baseline and 24-months after baseline, with 6-monthly telephone interviews between those times. A two-level hierarchical generalized linear regression (logit model) was used to quantify tooth-specific and person-level factors simultaneously. RESULTS: Of the 739 persons who attended for a 24-month examination, 24% lost one or more teeth during follow-up. Tooth loss was more common in persons with dental disease at baseline, incident dental signs or symptoms, those with negative attitudes toward dental care and dental health, those with limited financial resources, older adults, blacks, females, and problem-oriented users of dental care (as distinct from regular attenders). Although disease presence at baseline was a major factor associated with incident tooth loss, most diseased teeth were in fact still present 24 months after baseline. CONCLUSIONS: Other than periodontal attachment loss, severe tooth mobility, and dental caries, no single factor was a dominant predictor of tooth loss; instead, numerous factors made statistically significant but small contributions to variation in tooth loss. Tooth loss apparently is the result of complex interactions among dental disease, incident dental signs and symptoms, tendency to use dental care in response to specific dental problems, dental attitudes, and ability to afford non-extraction treatment alternatives.

Aged↗

PubMed1998

Determinants of dental care use in dentate adults: six-monthly use during a 24-month period in the Florida Dental Care Study.

The objective of this study is to describe for a diverse sample of dentate adults the incidence of dental care use and predisposing, enabling, and need correlates of that use. The Florida Dental Care Study (FDCS) is a prospective longitudinal cohort study of persons who at baseline had at least one natural tooth, were 45 years or older, and who resided in north Florida, U.S.A. An in-person interview and clinical dental examination were conducted at baseline and 24 months after baseline, with 6-monthly telephone interviews between those times. Seventy-seven percent of subjects reported one or more dental visits during the 24 months of follow-up. Six-monthly use ranged from 46% to 55%. Incident perceived need for care and certain incident self-reported oral signs and symptoms were strongly predictive of incident dental care use. Decrements in oral functional limitation, oral disadvantage, and self-rated oral health were predictive of less care bivariately, but were not salient in a multivariate model, with two notable exceptions: two measures related to esthetics. The conclusions are that certain measures of need (perceived need and specific self-reported signs and symptoms) were important predictors of incident dental care. However, persons with need as determined by direct clinical examination and persons with need as determined by self-reported decrements in the more distal measures of oral health (oral functional limitation, oral disadvantage, and self-rated oral health) were actually less likely to seek dental care. The salience of esthetics in predicting use is consistent with cross-sectional findings that dental esthetic cues are important to oral "health". Typical approach to care, dental attitudes, ability to pay for care, race, and sex were also important for understanding incident dental care use.

Dental Care↗

PubMed1998

Orofacial pain symptom prevalence: selective sex differences in the elderly?

This study investigated sex differences in orofacial pain symptoms in a sample of elderly adults. Furthermore, differences across sex were tested on symptom continuity, overall duration, pain severity, activity reduction, and health care utilization, related to each specific symptom. Telephone interviews were conducted with a stratified random sample of community dwelling older (65+) north Floridians. A total of 5860 households were contacted and screened, with 75.3% participating to the point where their eligibility for the study could be determined. Of the remaining households, 1636 completed the interview. Of the total sample, 17.4% reported experiencing at least one of the four target orofacial pain symptoms (jaw joint pain, face pain, oral sores, burning mouth) during the past year, suggesting that orofacial pain symptoms are common in older adults. Our findings for prevalence of each specific symptom (jaw joint pain, 7.7%; face pain, 6.9%; oral sores, 6.4%; toothache, 12.0%; burning mouth, 1.7%) are similar to those estimated by the 1989 National Health Interview Survey, for the US adult population. Consistent with other epidemiological and clinical studies, we found that females were more likely to report jaw joint pain and face pain than males. In contrast to clinical studies, no differences were found on subjective ratings of pain severity, for any symptom. Differences across sex were most likely to be reported for jaw joint pain related variables, suggesting undetermined sex-uniqueness for these symptoms. In contrast to previous studies, older females tended to report lower levels of health care utilization than older males. This is the first study to our knowledge that reports orofacial symptom-specific sex differences among the elderly.

Adult↗

PubMed1998

Satisfaction with chewing ability in a diverse sample of dentate adults.

The Florida Dental Care Study (FDCS) is a longitudinal study of changes in oral health, which included at baseline 873 subjects who had at least one tooth, were 45 years or older, and who participated for an interview and clinical examination. Two objectives of the FDCS were to: (i) describe satisfaction with chewing ability in a diverse sample of dentate adults; and (ii) quantify the associations between satisfaction with chewing ability and other measures of oral health. Approximately 16% of subjects reported that they were dissatisfied or very dissatisfied with their chewing ability. Bivariate and multivariate results provided consistent evidence of the construct validity of a proposed multi-dimensional model of satisfaction with chewing ability. Multiple regression analysis suggested that dissatisfaction with chewing ability was independently associated with 12 specific clinical and self-reported measures of oral disease/ tissue damage, pain, functional limitation, and disadvantage. The self-reported measures of oral health and the proposed model of satisfaction with chewing ability improve our understanding of this important oral health outcome in diverse population groups.

Aged↗

PubMed1998

Multidimensionality of oral health in dentate adults.

OBJECTIVES: An understanding of the validity and usefulness of self-reported measures (as distinct from clinically determined measures) of oral health is emerging. These self-reported measures include self-rated oral health (SROH). Three objectives were to: (1) describe self-rated oral health in dentate adults, (2) quantify associations between self-rated oral health and other measures of oral health (oral disease and tissue damage, pain and discomfort, functional limitation, and disadvantage), and (3) assess the construct validity of a model of oral health proposed herein. METHODS: The Florida Dental Care Study is a longitudinal study of oral health, which included at baseline 873 subjects who had at least one tooth, were 45 years or older, and who participated for an interview and clinical examination. RESULTS: The prevalence of self-rated oral health decrements was substantial; approximately one fourth of subjects reported their oral health as only fair or poor. Bivariate and multivariate results provided consistent evidence of the construct validity of the proposed model of oral health. Additionally, the salience of one measure of dental appearance suggests that persons may use esthetic cues when rating their oral health. CONCLUSIONS: The proposed multidimensional model of oral health has construct validity. Self-rated oral health is affected by oral disease and tissue damage, oral pain and discomfort, oral functional limitation, and oral disadvantage. These self-reported measures and the proposed model should provide useful information for dental care effectiveness research. General health status has been disaggregated into the "physical" and the "mental;" an additional separation into the "oral" aspects of health seems warranted.

Aged↗

PubMed1998

Evaluation for an observation effect in a prospective cohort study of oral health outcomes.

OBJECTIVES: Evaluation for changes in behavior due to research participants' knowledge that behavior is being observed (also referred to as a Hawthorne effect or reactivity) has received little attention in the dental literature. The Florida Dental Care Study, a prospective, non-randomized, longitudinal study of oral health outcomes, provides some inferential power to evaluate for an effect on dental care use due to participants' knowledge that this behavior was being observed. The purpose of this paper is to document that an observation effect can occur in dental studies, and to estimate its magnitude in four groups that were defined by their typical approach to dental care as stated at baseline: consistent regular attenders (CRAs); inconsistent regular attenders (IRAs); consistent problem-oriented attenders (CPOAs); and inconsistent problem-oriented attenders (IPOAs). METHODS: At baseline, 873 respondents with at least one natural tooth and who were 45 years of age or older participated for an interview and clinical dental examination. Respondents were asked about their dental care use in general and check-up use in particular at 6-month intervals over a period of 24 months. RESULTS: Dental care use in general and check-up use in particular varied across time points and across the four groups of the sample. There was some stimulation in dental care use for the sample overall, but by the 18-to-24-month period, use had returned to baseline levels. In a direction opposite from that hypothesized, results from the CRAs suggested decreased use of dental care over the course of the 24 months of observation. No consistent pattern was evident for the IRAs, CPOAs, or IPOAs. CONCLUSIONS: An observation effect was evident, but was modest in magnitude and differed within and between sub-groups of the sample. While self-selection into dental care user groups is an expected and desirable feature of this design, the size of the user/non-user groups was affected for some subgroups. We conclude that dental care studies with the potential for an observation effect should evaluate for this effect by distinguishing sub-groups of the sample based on their propensity (as stated at baseline) to use dental care. These differential effects across sub-groups should be taken into account as inferences are made.

Chi-Square Distribution↗

PubMed1998

Taking dental self-care to the extreme: 24-month incidence of dental self-extractions in the Florida Dental Care Study.

OBJECTIVE: A common response to health-related symptoms is to treat oneself in lieu of or prior to seeking formal health care. Among the more extreme forms of dental self-care is dental self-extraction. To our knowledge, no study of the incidence of this behavior has been conducted. The objective of this study was to determine if one form of dental self-care, dental self-extraction, is a real phenomenon, and if so, to determine its incidence. METHODS: The Florida Dental Care Study is a longitudinal study of changes in oral health, whose subjects participated for an interview and clinical examination at baseline and 24 months after baseline. RESULTS: Of the 739 persons who participated through 24 months 176 lost one or more teeth. Of these 176 persons, 13 (7%) extracted one or more of their own teeth. The clinical status at baseline of the self-extracted teeth was consistent with the ability to self-extract. CONCLUSION: The phenomenon of dental self-extraction is real and is not limited to residents of developing nations or geographically isolated areas. Because of the potential for prolonged bleeding or bacterial endocarditis in certain population groups, community health clinicians and officials should be cognizant of this behavior.

Age Factors↗

PubMed1998

Oral functional limitation among dentate adults.

OBJECTIVES: The purpose of this study was to measure the prevalence of oral functional limitation in adults and to identify clinical and sociodemographic factors associated with that limitation. METHODS: The Florida Dental Care Study is a longitudinal study of risk factors for changes in oral health. Subjects (n = 873) with at least one tooth who were 45 years old or older participated in a baseline in-person interview and dental examination. Subjects were queried about oral functional limitations. RESULTS: Twenty-three percent of subjects reported difficulty chewing one or more foods using a five-item chewing index, and 10 percent reported difficulty speaking or pronouncing words because of problems with the mouth. The covariates in a multiple logistic regression identified as being significantly associated with chewing difficulty were fewer pairs of occluding anterior teeth, fewer pairs of occluding posterior teeth, more posterior teeth that are root tips, more anterior teeth that are mobile, reporting tooth pain, reporting bad breath, having but not wearing prosthetic appliances, reporting dry mouth, and being female. Having fewer anterior teeth, reporting a sore and/or broken denture, reporting unattractive teeth, and being black were significantly associated with speaking difficulty/difficulty pronouncing words because of problems with the teeth, mouth, or dentures. CONCLUSIONS: The findings in this study suggest a significant prevalence of oral functional limitation in dentate adults. Certain clinical and sociodemographic factors were strongly and independently associated with its presence.

Aged↗

PubMed1997

Dental health attitudes among dentate black and white adults.

OBJECTIVES: Blacks and poor persons share a greater burden of oral disease and are less likely to seek dental care on a regular basis. The role of dental attitudes and knowledge of services on this circumstance is unclear. The authors quantified group differences in dental attitudes and knowledge of services and related them to regularity of dental care use. METHODS: As part of the baseline phase of The Florida Dental Care Study, a longitudinal study of oral health, 873 respondents who had at least one tooth and who were 45 years or older participated for an interview and a clinical dental examination. Dental care use, seven dental attitudinal constructs, and knowledge of dental services were queried. RESULTS: Forty-five percent of respondents reported going to a dentist only when they have a problem, and 17% of respondents had not seen a dentist in more than 5 years. Ten percent of respondents reported that they had at least one permanent tooth removed by someone other than a dentist (typically, the respondent himself). Blacks and poor persons had more negative attitudes toward dental care and dental health and were less knowledgeable of dental services. Multivariate analyses suggested that dental attitudes were important to understanding the use of dental care services for this diverse group of adults, and that race and poverty contributed independently to dental care use even with dental attitudes taken into account. CONCLUSIONS: Dental attitudes contribute to race and poverty differences in dental care use among adults. The persistence of race and poverty effects with attitudes taken into account suggests that additional explanatory factors contribute as well. These differences may contribute to more prevalent and severe oral health decrements among the same adults who also are more likely to suffer from other health decrements.

Black or African American↗

PubMed1997

Behavioral risk indicators of attachment loss in adult Floridians.

This study investigated behavioral and sociodemographic risk indicators of attachment loss (AL) at baseline in subjects of the Florida Dental Care Study: 873 subjects with at least 1 tooth, and who were 45+ years or older, participated for an in-person interview and dental examination; 761 subjects were probed for AL. Calibrated examiners used a modified NIDR protocol from the 1985-86 Survey of US Employed Adults and Seniors. Results were weighted to reflect actual population proportions. 92% of subjects had at least 1 site of 4+ mm AL, and 35% had at least 1 severe site (7+ mm AL). In a single multivariate regression, not having a recent dental check-up, not using dental floss, being a current smoker, and being diabetic were significantly associated with a higher probability of having 1 or more severe sites. Blacks were less likely than whites to be regular users of dental care, use dental floss, and be non-smokers. Similar findings were found for low income adults and rural residents. Risk groups (low income, blacks, rural residents) were more likely to present with modifiable risk indicators for AL, suggesting the need for targeted interventions.

Black or African American↗

PubMed1997

Oral disadvantage among dentate adults.

Oral disadvantage can be defined as the avoidance of certain daily activities because of decrements in oral health. These decrements include oral disease and tissue damage, pain, and functional limitation. The Florida Dental Care Study (FDCS) is a longitudinal study of changes in oral health, which included at baseline 873 subjects who had at least 1 tooth, were 45 years old or older, and who participated for an interview and clinical examination. Three objectives of the FDCS are: (1) to describe selected psychometric properties of the measurement of oral disadvantage; (2) to describe oral disadvantage in a diverse sample of dentate adults; and (3) to describe the relationship between disadvantage and other aspects of oral health, such as disease/tissue damage, pain, and functional limitation. The prevalence of oral disadvantage within the previous 6 months, using eight self-reported measures, ranged from 5% to 25%, depending upon the measure. Factor analysis suggested that oral disadvantage is best described as three factors: disadvantage due to (1) oral disease/tissue damage, (2) oral pain, and (3) oral functional limitation. Irregular dental attenders, poor persons, and blacks had the highest prevalence of oral disadvantage. Clinical measures of oral disease/tissue damage, self-reported measures of oral disease/tissue damage, oral pain, and oral functional limitation were strongly associated with the presence of oral disadvantage. In multivariate analyses that accounted for differences in clinical measures of disease/tissue damage, self-reported disease/tissue damage, oral pain, and oral functional limitation, females were more likely to report disadvantage due to disease/tissue damage, and middle-aged persons and irregular dental attenders were more likely to report oral disadvantage due to pain. In these same regressions, differences in disadvantage due to race, poverty status, socioeconomic status, and rural/urban area of residence were not evident. These results have implications regarding the use of oral disadvantage to assess the long-term effectiveness of dental care.

Activities of Daily Living↗

PubMed1997

Rural-urban comparisons of age and health at the time of nursing home admission.

This study re-examines the contention that rural elders admitted to nursing homes are younger and healthier than their counterparts who enter urban facilities. The analysis uses interview data gathered in both urban and rural nursing homes. Residents were interviewed at or near the time of admission regarding their health and circumstances immediately prior to entering the nursing home. The findings indicate few and modest differences between urban and rural residents. In those instances where differences are observed, there is ambiguity--some measures indicate lower health status in the case of rural residents, while others suggest that urban residents are more likely to report health impairments. The divergence of these findings from earlier research may be due to differences in the study populations, measurement differences, or, more likely, that policies and processes have changed over time.

Activities of Daily Living↗

PubMed1997

Evaluation of bias and logistics in a survey of adults at increased risk for oral health decrements.

OBJECTIVES: Designing research to include sufficient respondents in groups at highest risk for oral health decrements can present unique challenges. Our purpose was to evaluate bias and logistics in this survey of adults at increased risk for oral health decrements. METHODS: We used a telephone survey methodology that employed both listed numbers and random digit dialing to identify dentate persons 45 years old or older and to oversample blacks, poor persons, and residents of nonmetropolitan counties. At a second stage, a subsample of the respondents to the initial telephone screening was selected for further study, which consisted of a baseline in-person interview and a clinical examination. We assessed bias due to: (1) limiting the sample to households with telephones, (2) using predominantly listed numbers instead of random digit dialing, and (3) nonresponse at two stages of data collection. RESULTS: While this approach apparently created some biases in the sample, they were small in magnitude. Specifically, limiting the sample to households with telephones biased the sample overall toward more females, larger households, and fewer functionally impaired persons. Using predominantly listed numbers led to a modest bias toward selection of persons more likely to be younger, healthier, female, have had a recent dental visit, and reside in smaller households. Blacks who were selected randomly at a second stage were more likely to participate in baseline data gathering than their white counterparts. Comparisons of the data obtained in this survey with those from recent national surveys suggest that this methodology for sampling high-risk groups did not substantively bias the sample with respect to two important dental parameters, prevalence of edentulousness and dental care use, nor were conclusions about multivariate associations with dental care recency substantively affected. CONCLUSIONS: This method of sampling persons at high risk for oral health decrements resulted in only modest bias with respect to the population of interest.

Adult↗