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Biomedical subjects

J A Brunelle

Publications and source records attributed to J A Brunelle.

At least 19 recordsLinked to original sources

Evaluation of a school-based fluoride mouthrinsing and clinic-based sealant program on a non-fluoridated island.

For many years the children of Guam have experienced a high prevalence of dental caries. Surveys conducted on the fluoride-deficient island found that caries levels were double those of US mainland children. In 1976 a school-based fluoride mouthrinse program was initiated involving over 22,000 children in grades kindergarten through eight in weekly rinses with 0.2% neutral NaF. A clinic-based dental pit and fissure sealant program was added in 1984 to the fluoride mouthrinse program. Over 15,000 children participated annually in the sealant program where more than 75,000 teeth were sealed the first year. After 8 yr of fluoride mouthrinsing (1976-1984) mean DMFS scores were 1.79 surfaces per child lower compared to baseline, a decrease of 0.22 DMFS per child per year. During this period proximal DMFS scores decreased 61%, buccal-lingual surfaces 31%, and occlusal surfaces 7%. After 2 yr of fluoride mouthrinsing and sealant application combined overall DMFS scores decreased an additional 2.34 surfaces per child, a reduction of 1.17 DMFS per child per year. Most of this decline took place on pit and fissure surfaces. For the 10-yr period a reduction of 4.13 DMFS per child was seen--a decline from 7.06 DMF at baseline to 2.93 DMF surfaces per child in 1986. This long-term evaluation indicates that dental sealants when used in combination with fluoride mouthrinse were particularly effective in lowering the prevalence of dental caries. Schoolchildren in participating grades on Guam now have dental caries rates close to those of US schoolchildren.

Adolescent

Caries prevalence in Head Start children, 1986-87.

Since the early 1970s, caries prevalence among school-aged children in the United States has declined. It appears that a small percentage of the children experience most of the caries increment. In addition, a large proportion of children in the US who need dental care receive it. An important factor in the amount of treatment received by children is the socioeconomic status of the family. Data on caries prevalence among preschool populations are limited. The Head Start program serves low-income families in the US and offers a unique opportunity to look at individuals who may be at greater risk of health problems and may experience less access to health services. A survey of 1,796 three- to five-year old Head Start children from low-income families was conducted in 1986-87. Caries prevalence, baby bottle tooth decay prevalence and relative need for dental care are reported for fluoridated and non fluoridated communities in California, Hawaii, and Micronesia. The data reveal scores that are higher in the sample population than in five-year-olds in national surveys and among Head Start children in previous surveys.

Child

Recent trends in dental caries in U.S. children and the effect of water fluoridation.

The decline in dental caries in U.S. schoolchildren, first observed nationwide in 1979-1980, was confirmed further by a second national epidemiological survey completed in 1987. Mean DMFS scores in persons aged 5-17 years had decreased about 36% during the interval, and, in 1987, approximately 50% of children were caries-free in the permanent dentition. Children who had always been exposed to community water fluoridation had mean DMFS scores about 18% lower than those who had never lived in fluoridated communities. When some of the "background" effect of topical fluoride was controlled, this difference increased to 25%. The results suggest that water fluoridation has played a dominant role in the decline in caries and must continue to be a major prevention methodology.

Adolescent

Dental caries and periodontal disease among Mexican-American children from five southwestern states, 1982-1983.

Analysis of Southwestern HHANES data showed that the prevalence of dental caries among Mexican-American children is similar to that of children of the same age examined during the NIDR survey (1979-1980), despite a lower level of restorative treatment. Approximately 50% of Mexican-American children 17 years of age, however, had five or more teeth that were either decayed or filled. Occlusal surfaces of molars were the most susceptible teeth to decay; few anterior teeth were affected. This distribution of dental caries strongly supports the use of fissure sealants on molar teeth. Children from low-income families had two times more decayed teeth than children from high-income families. Mild gingivitis and poor oral hygiene were more prevalent in the Mexican-American children than in the child population for the region examined during NHANES I in 1971-1974. Children from high-income families had better periodontal health than those from low-income families.

Adolescent

Prevalence of total tooth loss, dental caries, and periodontal disease in Mexican-American adults: results from the southwestern HHANES.

The Southwestern portion of the Hispanic Health and Nutrition Examination Survey (HHANES) was conducted by the National Center for Health Statistics (NCHS) in 1982 and 1983. The survey population was Mexican-Americans residing in five Southwestern states. This report presents data on the prevalence of total tooth loss, dental caries, and periodontal diseases in 3860 Mexican-American adults aged from 18 to 74. Results show that 4.3% of this group was edentulous. Among the dentate, Mexican-Americans had lower overall DMF scores but higher numbers of untreated decayed teeth than did residents of the same region seen in the NHANES I survey in 1971-1974. Caries of the smooth surfaces in both posterior and anterior teeth was more pronounced in the older than in the younger age groups. Mexican-Americans had more gingivitis but fewer periodontal pockets than did the general population in the Western states during NHANES I. The caries pattern in the Mexican-Americans suggests that caries among adults may remain a problem in the future, with the possibility of increased involvement with the aging, although modest, of smooth tooth surfaces.

Adolescent

Prevalence of dental caries and periodontal disease in Mexican American children aged 5 to 17 years: results from southwestern HHANES, 1982-83. National Health and Nutrition Examination Survey.

This paper describes the estimated prevalence of dental caries and periodontal disease in 2,550 children, 5 through 17 years of age, who resided in five southwestern states of the United States and were examined in the Hispanic Health and Nutrition Examination Survey (HHANES) of 1982-84 of the National Center for Health Statistics. Dental caries in the Mexican American children was predominantly a disease of occlusal surfaces of molars; few smooth surfaces of posterior and anterior teeth were affected by caries. This intra-oral distribution of dental caries strongly supports the use of fissure sealants as a preventive procedure. Filled tooth surfaces contributed about 66 per cent of the total DMFS (decayed, missing, filled surfaces) scores. The analysis also shows that about 50 per cent of the 17 year old Mexican Americans had five or more filled or decayed teeth. Mild gingivitis was prevalent (76.9 per cent) in the Mexican American children.

Adolescent

Examiner consistency and group balance at baseline of a caries clinical trial.

Two experienced investigators (G.L. & H.H.) independently examined 629 children in grades 6-9 (ages 10-17 yr) for baseline DMFS data in a clinical trial of a caries preventive. The examiners used the same written and visual (slides) criteria for dental caries diagnosis, but did not standardize or calibrate their methods before or during the survey. Results showed overall mean DMFS scores for Examiners 1 and 2 that were remarkably similar, 8.35 and 8.16, respectively; coefficients of variation were identical, C.V. = 87%. The reliability coefficient for the two sets of data showed that only 4% of the variability in DMFS scores was due to examiner inconsistency and other measurement errors. The findings indicate that, without undergoing clinical calibration, the two experienced examiners attained a high level of agreement in scoring dental caries merely by adhering to clearly defined written and visual criteria. Only the 308 children in the 6th grade (ages 10-14 yr) participated in the study (children in grades 7-9 were a reference population). Participants were randomly assigned to one of two treatment groups. The allocation procedure produced mean DMFS scores for Groups I and II of 7.87 and 6.17 (Examiner 1) and 8.07 and 6.41 (Examiner 2), respectively. The mean scores differed by about 21% (II compared with I) for each examiner. Both differences were clinically and statistically significant (P less than 0.05). Randomized assignment had generated an imbalance of baseline DMF scores by group.

Adolescent

Costs of school-based mouthrinsing in 14 demonstration programs in USA.

The purpose of this study was to determine the economic costs of school-based mouthrinsing in the demonstration programs. Costs for two complete years were expressed in 1978 dollars, and divided into explicit and implicit categories. Costs per participant were found to vary among programs (ranges of average total costs - period I: $2.35-$8.05, period II: $1.46-$7.94), and a tendency for some average costs to increase with size was identified. That costs were higher than the conventionally reported $0.50-$1.00 reflects 1) the organization of these federally funded programs and, 2) the use of an accounting method which describes the real economic costs of public programs.

Child

Quantitative multi-detector emission computerized tomography using iterative attenuation compensation.

An iterative procedure to correct for attenuation has been developed for a multidetector, single-photon emission tomographic scanner. The difference between measured and estimated data projections is used at each iteration to form an error image which is used, in turn, to correct the image. A damping factor that minimizes chi2 is applied after each iteration to speed convergence. Several phantoms of different size, with various concentration distributions, have been used to compare this method with a first-order multiplicative attenuation correction used previously with this scanner. The first-order correction is inadequate for most of the phantoms studied, whereas relative and absolute quantitative capability is demonstrated for the iterative attenuation correction. The reconstructed average number of counts per pixel is a linear function of activity concentration up to 5 muCi/ml for all regions of uniform activity whose size is greater than or equal to 5 cm. The importance of using an accurate attenuation distribution with this method is demonstrated with a torso-like phantom.

Mathematics

Caries-preventive effects of fluoride tablets in schoolchildren four years after discontinuation of treatments.

The Wayne County data indicate that administration of fluoride tablets in school should be recommended in nonfluoridated areas as an effective public health measure to prevent dental caries. In addition to reducing dental caries effectively, administering fluoride tablets in school has a number of other desirable features; it is safe and relatively inexpensive; it requires no paper products and thus eliminates waste disposal; it takes little time to administer (less than three minutes per day for a classroom of average size); it is easy for young children to learn and to do; and it can be supervised by teachers, aides, or volunteers after minimal training. Findings that benefits still persist, although perhaps to a slightly lesser degree, four years after treatment is discontinued further accentuate the public health appeal of the procedure. The data give no indication that two fluoride tablets a day are more protective than one tablet a day. Therefore, a single one-mg fluoride tablet daily is recommended for school programs because of lower cost and greater feasibility.

Acidulated Phosphate Fluoride

Plaque, caries, periodontal diseases, and acculturation among Yanomamö Indians, Venezuela.

The number of DM and d teeth and surfaces was recorded for 220 Yanomamö Indians from three groups of villages with different degrees of contact with Western culture. Specimens of plaque were taken from the teeth, transported in a holding solution, cultured, and examined for specific oral streptococci. In addition, the periodontal health and oral hygiene of one group of villagers were assessed using the Russell PI and the Greene & Vermillions OHIS. Caries experience among the Yanomamö was shown to be positively associated with exposure to Western culture. S. mutans was recovered with about the same frequency from specimens taken from the teeth of Indians living at all three village locations. However, the presence of S. mutans alone did not account for the disparity in dental caries scores. The examinees had abundant and persistent accumulations of soft deposits on their teeth accompanied by markedly inflamed gingival tissues. However, periodontal pockets and loss of appreciable amounts of bone did not appear as early in life nor were they as severe as reported for some other populations which practice little oral hygiene. Those disparities in the distribution of plaque-induced oral diseases between Western populations and the Yanomamö warrant further study.

Acculturation