Biomedical subjects

J A Weintraub

Publications and source records attributed to J A Weintraub.

At least 19 recordsLinked to original sources

PubMed2006

Welfare dental intervention improves employment and quality of life.

Chronic, untreated oral disease adversely affects one's systemic health, quality of life, and economic productivity. This study evaluated the effect of rehabilitative dental treatment on the oral-health-related quality of life and employment of welfare recipients. Three hundred and seventy-seven participants in a novel welfare dental program received oral examinations, questionnaires, and rehabilitative dental treatment. Seventy-nine percent of participants exhibited improvement in their oral-health-related quality-of-life scores following dental treatment. Improved OHIP-14 change scores were associated with being Caucasian or African-American, initial poor general health, severity of treatment urgency, worse baseline oral-health-related quality-of-life scores, subsequent patient satisfaction with the Dental Program, and resolution of their chief complaint (all p < 0.04). Those who completed their dental treatment were twice as likely to achieve a favorable/neutral employment outcome (OR = 2.01, 95%CI = 1.12, 3.62). Thus, oral health improved the quality of life and employment outcome for this welfare population.

Adult↗

PubMed2006

Fluoride varnish efficacy in preventing early childhood caries.

To determine the efficacy of fluoride varnish (5% NaF, Duraphat, Colgate) added to caregiver counseling to prevent early childhood caries, we conducted a two-year randomized, dental-examiner-masked clinical trial. Initially, 376 caries-free children, from low-income Chinese or Hispanic San Francisco families, were enrolled (mean age +/- standard deviation, 1.8 +/- 0.6 yrs). All families received counseling, and children were randomized to the following groups: no fluoride varnish, fluoride varnish once/year, or fluoride varnish twice/year. An unexpected protocol deviation resulted in some children receiving less active fluoride varnish than assigned. Intent-to-treat analyses showed a fluoride varnish protective effect in caries incidence, p < 0.01. Analyzing the number of actual, active fluoride varnish applications received resulted in a dose-response effect, p < 0.01. Caries incidence was higher for 'counseling only' vs. 'counseling + fluoride varnish assigned once/year' (OR = 2.20, 95% CI 1.19-4.08) and 'twice/year' (OR = 3.77, 95% CI 1.88-7.58). No related adverse events were reported. Fluoride varnish added to caregiver counseling is efficacious in reducing early childhood caries incidence.

Cariostatic Agents↗

PubMed2001

Training status and interest in certification of nondiplomate faculty teaching predoctoral dental public health.

OBJECTIVES: A survey was conducted to better understand the training needs of faculty members without dental public health (DPH) specialty board certification who teach DPH to dental students. METHODS: An 11-item questionnaire was sent to 193 non-DPH diplomate faculty members at US dental schools who were dentists and at least one of the following: a member of the American Association of Dental Schools Community and Preventive Dentistry Section, a referral from an academic American Board of Dental Public Health diplomate, a DPH faculty listed on the school's Web pages, a DPH contact from the AADS Institutional Directory, or the school's dean if no other contact. RESULTS: A 70 percent response rate was obtained. Seventy-nine percent of the respondents taught at least one national board-related DPH topic. Among these faculty members, 67 percent have or are in training for the master of public health, 26 percent have completed or are in a DPH residency, and 63 percent desire training in one or more of the DPH topics. The majority (64%) does not plan to take the specialty exam, while 28 percent plan to take the exam within five years. About half reported no personal incentives to take the exam and 39 percent perceived no institutional incentives. CONCLUSIONS: These nondiplomate teachers of predoctoral DPH desire training, but appear to have barriers and perceive few benefits to achieving DPH board certification.

Attitude of Health Personnel↗

PubMed2001

Treatment outcomes and costs of dental sealants among children enrolled in Medicaid.

OBJECTIVES: This retrospective cohort analysis of children enrolled in the North Carolina Medicaid program compared the likelihood of restorative treatments and associated cumulative Medicaid expenditures for teeth with or without dental sealants. METHODS: We assessed the dental experience of the cohort of 15 438 children from 1985 to 1992 on the basis of enrollment and claims files. We conducted regression analyses for outcomes (caries-related services involving the occlusal surface [CRSOs] of permanent first molars) and cumulative expenditures, controlling for characteristics of the child, the treating dentist, and the child's county of residence. RESULTS: Overall, 23% of children received at least 1 sealant and 33% at least 1 CRSO. Sealants were effective in preventing CRSOs, although the degree of effectiveness was highest for children with the greater levels of CRSOs before sealant placement. Estimated cumulative Medicaid expenditures indicated expenditure savings from sealants within 2 years of application for children with 2 or more prior CRSOs. CONCLUSIONS: Sealant placement was associated with expenditure savings to Medicaid for certain high-risk children, so Medicaid and, more broadly, society will benefit by providing for sealant placement in these children.

Child↗

PubMed2001

Pit and fissure sealants in high-caries-risk individuals.

This paper examines the evidence demonstrating the effectiveness of sealants in high-caries-risk children and discusses the Research Triangle Institute/University of North Carolina's (RTI/UNC) systematic review. The strict RTI/UNC protocol limited the number of sealant studies that could be included. This analysis expanded their criteria to permit additional methods of determining caries risk (for example, past caries experience, less than two pairs of sound first permanent molars available/child in half-mouth designs) and outcome measures in addition to DMFS (that is, percent sealant retention, survival rates, cost-effectiveness, changes in salivary S. mutans levels). Nine clinical studies with a randomized, half-mouth, clinical trial design and seven studies with observational study designs were included. There is good evidence that sealants can be used efficaciously and effectively in high-risk children as long as the sealant is retained. Sealants are more effective in preventing further caries and providing cost savings in a shorter time span if placed in children who have high rather than low caries risk.

Child↗

PubMed1999

Recommendations for endodontic referral among practitioners in a dental HMO.

This study assessed the effect of patients' presenting conditions on general practitioners' (GPs') self-reported endodontic referral patterns, and compared GPs' perceived indications for referral with those of endodontists. The study was based on a self-administered, confidential survey distributed to 79 GPs and 7 endodontists who provide care to members of one Dental HMO in the Pacific Northwest. GPs were most likely to recommend referral for teeth they felt needed surgical retreatment, but GPs and endodontists did not always agree on indications for referral. Compared with GPs, endodontists were more likely to recommend referral for patients with complex problems, but not necessarily technically difficult teeth. Compared with those with less experience, GPs with more than 10 yr both in dentistry and at this HMO were more likely to recommend (a) referring difficult cases rather than performing endodontic therapy themselves and (b) extracting perforated or root-fractured teeth prior to obturation rather than continuing treatment. Indications for referral that maximize favorable dental outcomes need to be identified.

Attitude of Health Personnel↗

PubMed1998

Prevention of early childhood caries: a public health perspective.

This paper proposes strategies for preventing early childhood caries (ECC), preferably for the greatest number of children at the lowest cost. Population-based, public health approaches are more likely to reach the target population groups at risk of developing ECC than individual, private practice-based approaches. Different prevention and early intervention strategies are discussed and the following recommendations are made: 1) Continue to promote community water fluoridation. 2) Evaluate the effectiveness of other public health oriented measures to prevent ECC. 3) Develop a national ECC and rampant caries registry. 4) Link oral health screening and easily implemented, low-cost interventions with immunization schedules and public health nursing activities. 5) Increase opportunities for community-based interventions conducted by dental hygienists. 6) Change insurance reimbursement schedules to provide incentives for dentists to prevent disease. 7) Include dentistry in new child health insurance legislation for children as well as parents of infants and preschool children.

Child↗

PubMed1998

Academic dental public health diplomates: their distribution and recommendations concerning the predoctoral dental public health faculty.

OBJECTIVE: The purpose of this study was to assess the representation of academically based diplomates of the American Board of Dental Public Health (ABDPH) and to identify their perceptions on the training of dental public health predoctoral faculty. METHODS: Data were collected by a mailed, self-administered, 13-item questionnaire. The population was the 48 diplomates of the ABDPH as of March 1997 associated with academic institutions. RESULTS: Twenty of the 55 US dental schools had a diplomate of the ABDPH with a mean of 1.8 diplomates per school with a diplomate. An average of 4.5 full-time faculty members per school were associated with teaching dental public health. A master's degree in public health (MPH) was the most frequently suggested educational requirement for dental public health faculty. Continuing education courses were training needs perceived for dental public health faculty. The lack of time, money, and incentives, along with perceived rigidity of requirements for board certification, were reported as major barriers for faculty becoming dental public health board certified. CONCLUSIONS: Numerous challenges confront the development of a strong dental public health presence in US dental schools. These challenges include, among others, insufficient numbers of academic dental public health specialists and insufficient motivations to encourage promising candidates to pursue specialty status.

Attitude of Health Personnel↗

PubMed1998

The development of competencies for specialists in dental public health.

This paper describes the process of developing new competency statements and performance indicators for the specialty of dental public health. These competencies help define the specialty and provide a base for educational curricula and the specialty board examination. The process included a survey of four target groups: all board members, all directors or co-directors of advanced education programs in dental public health, people who had become diplomates in the last three years, and all students currently enrolled in dental public health programs. Many constituencies were represented at the workshop, conducted in May 1997, to develop the competency document. After the workshop, the document underwent a series of review activities.

Clinical Competence↗

PubMed1998

A longitudinal study of schoolchildren's experience in the North Carolina Dental Medicaid Program, 1984 through 1992.

OBJECTIVES: This evaluation of a state Medicaid dental program describes dental treatment received, relates treatment needed to treatment received, and describes enrollment and use over an 8-year period. METHODS: Three databases were linked: (1) clinical records from a 1986/87 statewide epidemiological survey, providing data on treatment need; (2) Medicaid dental claims from 1984 through 1992, providing data on treatment received; and (3) Medicaid enrollment files from 1984 through 1992. RESULTS: Half of Medicaid-enrolled children never used dental services. Among users of dental services, 45% and 25% of children needed restorations in primary and permanent teeth, respectively. In this group, 29% had all needs met, 28% had needs partially met, and 43% had no needs met. Forty-six percent of children sought care for only 1 year. CONCLUSIONS: Federal guidelines for dental care are not met in this typical Medicaid population of short-term enrollees who use services sporadically. Programs should aim to increase use and ensure that all needed services, especially preventive procedures such as sealants, can be completed within the short period of time a child attends for care.

Adolescent↗

PubMed1998

Uses of oral health related quality of life measures in Public Health.

OBJECTIVE: The purpose of this paper was to review the current status of oral health related quality of life (OHRQoL) measures from a dental public health perspective. METHOD: Three questions are posed. (1) What additional work is needed in the development or application of quality of life measures? (2) How can existing quality of life measures be used most effectively now? (3) Can existing data be used for secondary analyses of 'generic questions' concerning the relationships between oral health care and quality of life outcomes? In answering these questions, methodological issues are discussed, existing sources of data are described, and recommendations are suggested for future directions. CONCLUSIONS: Current measures can be used for assessment of oral health impacts in adults, and to a lesser extent, for policy development. Other measures need to be developed that are relevant for children and their families, and for disease prevention and health promotion programmes. Continued psychometric analyses are needed to provide short, valid and reliable instruments that can be easily administered in public health settings. Longitudinal studies are needed to determine if the OHRQoL measures are responsive to access to dental care, different types of care including early diagnosis and treatment, and completion of care. The extensive array of existing measures need to be compared, equivalency of scores determined, and recommendations made for the appropriateness of their use in different circumstances and for different purposes.

Adult↗

PubMed1997

Factors related to loss of root canal filled teeth.

OBJECTIVES: This case-control study characterized factors related to loss of root canal filled (RCF) teeth among members of the Kaiser Permanente Dental Care Program, a dental health maintenance organization based in Portland, Oregon. METHODS: Individuals were identified who were enrolled continuously from January 1, 1987, through December 31, 1994, underwent initial root canal therapy on a permanent tooth (excluding third molars) in 1987 or 1988, had a clinical examination within two years after endodontic access, and were at least 21 years old at access. Patients who lost the RCF tooth by December 31, 1994, were defined as cases (n = 96); those who did not were defined as controls (n = 120). Computerized data, dental radiographs, and chart entries were reviewed to ascertain variables of interest, and multivariable logistic regression was used to describe differences between the groups. RESULTS: RCF teeth of cases had fewer proximal contacts at access than RCF teeth of controls (odds ratio = 2.7; 95% Cl = 1.4, 5.1). Cases were older (odds ratio = 1.4; 95% Cl = 1.1, 1.9 per 10-year increase) and more likely to have had a facial injury than controls (odds ratio = 3.6; 95% Cl = 1.2, 10.5). Cases also had more missing teeth (odds ratio = 1.5; 95% Cl = 1.0, 2.1) and more plaque (odds ratio = 1.7; 95% Cl = 1.0, 2.6). CONCLUSIONS: Conditions evident during treatment planning may help dentists assess patients' chances of losing an RCF tooth.

Adult↗

PubMed1997

Dental caries and treatment need in schoolchildren related to Medicaid enrollment.

OBJECTIVES: This study compared dental caries status and treatment need in four groups of children: those not enrolled in Medicaid, those enrolled in Medicaid who used dental services prior to a dental survey, those enrolled in Medicaid who used services after the survey, and those enrolled in Medicaid who did not use dental services. METHODS: This study used data on 6,620 children 5 to 18 years of age, who were representative of North Carolina schoolchildren and who participated in a statewide oral health survey in 1986-87. Clinical results from the survey were linked with a separate data base of Medicaid claims and enrollment files from 1984 to 1992. With this link, the surveyed children were classified into the four study groups and dental status compared. RESULTS: Medicaid-enrolled children who used services prior to the survey had the highest caries prevalence of all groups (DMFS = 1.74 at ages 6 to 11 years), and had fewer treatment needs (D/DMFS = 19%) than children outside of Medicaid (DMFS = 0.95, D/DMFS = 33%). Enrolled children who never used dental services had a caries prevalence (DMFS = 0.83) similar to children outside of Medicaid, yet had greater unmet treatment need (D/DMFS = 62%). CONCLUSIONS: Caries prevalence did not differ substantially among groups; however, the level of unmet treatment did very. Some Medicaid-enrolled children had a significant portion of their restorative treatment needs met.

Adolescent↗

PubMed1997

The relationship between clinical tooth status and receipt of sealants among child Medicaid recipients.

This study investigated the association between caries status and sealant need at a prior survey and subsequent sealant use in a Medicaid program. Clinical data from a 1986-87 statewide epidemiological survey (N = 8026) representative of North Carolina (NC) schoolchildren (grades K-12) were linked with all NC Medicaid dental claims submitted during 1987-92, yielding 570 children in the survey who had at least one dental visit during 1987-1992. From the 570, 390 children were included: 71 who received sealants (S) and 319 who received non-sealant care (NS). Children were excluded based on age, having preexisting sealants, or having no sealant-eligible molars or premolars. S and NS were compared on baseline dfs, DMFS, and sealant need, controlling for the patient's age, number of visits, and the provider's propensity to seal. At all ages, NS was twice as likely to have had prior dfs or DMFS (OR = 2.04, 95% CI = 1.15, 3.70). The association between sealant receipt and prior sealant need varied by age. At 6 to 11 years, S and NS had equal likelihood of sealant need (OR = 1.41, 95% CI = 0.62, 3.18). At 12 to 15 years, NS had a greater likelihood of sealant need (OR = 6.82, 95% CI = 1.60, 29.08). Caries-free status was associated with subsequent sealant receipt. Prior sealant need caused variability in dentists' decisions, depending on the child's age and past caries experience. Sealants were used infrequently by most providers and for a minority of patients. These findings are important for the Medicaid program and for future non-randomized studies of sealant effectiveness.

Adolescent↗

PubMed1996

Exploratory case-control analysis of psychosocial factors and adult periodontitis.

We explored the association between social factors and adult periodontitis by comparing self-reported information for daily strains and symptoms of depression in 71 cases and 77 controls. Cases and controls were selected from among 1,426 participants in the Erie County Risk Factor Study. We found differences among those who scored higher than their peers on measures of social strain. The odds ratio (OR) and 95% confidence interval (95% CI) for the association between case status and Role Strain score of 2.27 or more was 2.84, 95% CI = 1.08 to 7.46. We also examined serum antibody, dichotomized at the median, for three periodontal pathogens (Bacteroides forsythus [IgG Bf], Porphyromonas gingivalis [IgG Pg], Actinobacillus actinomycetemcomitans [IgG Aa]), and assessed interaction between antibody levels and a Depression score derived from the Brief Symptom Inventory. IgG Pg and IgG Aa were both strongly associated with case status (OR = 4.52, 95% CI = 1.99 to 10.3 and OR = 5.29, 95% CI = 2.34 to 12.0, respectively). IgG Bf was associated with periodontal disease but only among individuals who had higher scores for Depression (OR = 6.75, 95% CI = 1.25 to 36.5). Smoking status was associated with case status (OR = 4.95, 95% CI = 1.86 to 13.2). We assessed these findings prospectively by examining factors associated with more extensive disease among the 71 case subjects after 1 year of follow-up. We found baseline smoking status and IgG Bf among individuals scoring high on Depression at baseline to be associated with more extensive disease (8.1% or more of the sites showing further breakdown). In this population an elevated Depression score may be a marker for social isolation, which could play a role in immune function during periods of social strain. This exploratory analysis has served to identify specific lines of inquiry concerning psychosocial measures as important environmental factors in adult periodontitis.

Adult↗

PubMed1995

A quarter century of changes in oral health in the United States.

This paper provides an overview of the oral health status of Americans since the 1960s. Data from seven national surveys, conducted between 1960 and 1987, have been presented. Estimates of coronal and root caries, periodontal diseases, and tooth loss were reviewed. In addition, data on edentulism and oral cavity and pharyngeal cancer were included. Although the purpose of this paper is descriptive rather than analytical, some important trends have been noted: The number of children who were free from dental caries increased dramatically between 1963 and 1987. By 1987, almost one-half of school children between the ages of 5 and 17 were caries-free. Among those children with dental decay, the number of teeth affected has also declined. The oral health of adults also improved during the 27-year period included in this review. In particular, the mean number of missing teeth and the percentage of edentulous adults have declined substantially. Trends in periodontal diseases were difficult to determine due to changes in the measures of periodontal diseases utilized in the surveys. In the most recent survey of employed U.S. adults, approximately 44 percent were found to have gingivitis and slightly more than 13 percent had periodontal pockets 4-5 mm in depth. Approximately 30,000 new cases of oral cavity and pharyngeal cancer were diagnosed in 1993, resulting in approximately 8,000 deaths. African Americans have higher incidence and mortality rates than white Americans and also have a much lower five-year survival rate.

Adolescent↗

PubMed1993

A retrospective analysis of the cost-effectiveness of dental sealants in a children's health center.

A retrospective patient record analysis was conducted to study the cost-effectiveness of dental sealants placed under routine, unrestricted practice condition in a fluoridated community. The 26 dentists who provided care at the clinic over the period of the study used their own clinical judgement to determine sealant placement or alternative treatment. Dental services for 275 patients at a children's dental clinic for low-income families were evaluated. All children had at least 3 years between their first and last dental visit (mean = 5.8 years). A lifetable analysis was conducted to compare the probability of survival (restoration-free tooth years) and costs incurred to first molars of children who did not receive sealants, received any sealants, or received sealants on all first molars. Among the children with sealants, comparisons were also made between sealed and unsealed teeth in children who did and did not have a first molar restoration prior to sealant placement. Costs included the costs of sealants and restorative treatments for these teeth over time. Depending on the conditions under which sealants were placed, cost-savings or improving cost-effectiveness with time were found. A strategy of identifying children with prior restorations and sealing the remaining molars showed cost-savings within 4-6 years. For other comparisons, incremental cost-effectiveness ratios became more favorable over time.

Child↗

PubMed1993

The oral health burden in the United States: a summary of recent epidemiologic studies.

The nation's health care system is currently under scrutiny. A topic of great interest to the dental community is whether dentistry should be included in a plan for national health reform, and if so, what procedures should be covered. To answer this question, 1) the current oral disease burden in the United States should be assessed, and 2) factors associated with this burden should be described. This paper reviews several recent large-scale epidemiologic surveys of oral health in the United States, summarizes their major findings, outlines important risk factors for oral disease, and makes recommendations regarding future oral epidemiologic surveys. The discussion is limited to the following conditions: dental caries, periodontal diseases, tooth loss, edentulism, oral cancer, and orofacial clefts. Five out of six 17-year-olds have at least one decayed, missing, or filled tooth surface (DMFS), with a mean of eight DMFS per 17-year-old. However, 25 percent of the country's children have 75 percent of the dental caries; minority children, rural dwellers, those with minimal exposure to fluoride, and those from less educated or poorer families tend to have a greater caries experience. Root caries, gingivitis, periodontal pockets, and loss of periodontal attachment are more common among older individuals. Whites have more teeth than do Blacks of similar ages, and edentulism is more common among those with less education and income. Of those age 65+, over 40 percent are edentulous and only 2 percent have all 28 teeth. An estimated 30,000 new cases and 8,000 deaths were attributed to oral cancer in 1991, with Black males having higher incidence and mortality rates than other subgroups. Oral clefts occur in about one in 700 total births, with Native Americans having the highest incidence.

Adolescent↗