Biomedical subjects

S A Eklund

Publications and source records attributed to S A Eklund.

At least 19 recordsLinked to original sources

PubMed2001

Adverse events associated with hepatitis B vaccine in U.S. children less than six years of age, 1993 and 1994.

PURPOSE: This study evaluated infrequent adverse reactions to hepatitis B vaccine by investigating the association of this vaccine with adverse health outcomes for U.S. children less than six years of age. The evaluation of the association between hepatitis B vaccine and chronic arthritis provides needed data, relevant to the Institute of Medicine's Report that there are inadequate data available to assess the causal relationship of hepatitis B vaccine to arthritis risk. METHODS: The 1993 (n = 5505 children) and 1994 (n = 6515 children) National Health Interview Survey (NHIS) datasets were analyzed to provide post-marketing surveillance data from probability samples of the U.S. population. Incident cases of adverse events were determined from the temporal association between the hepatitis B vaccination and the adverse events. Logistic regression modeling was used to adjust for potential confounding. RESULTS: Controlling for age, race, and gender simultaneously in the 1994 NHIS, hepatitis B vaccine was found to be associated with prevalent arthritis [odds ratio (OR) = 5.91, 95% confidence interval (CI) = 1.05-33.14], incident acute ear infections (OR = 1.60, 95% CI = 1.00-2.58), and incident pharyngitis/nasopharyngitis (OR = 1.41, 95% CI = 0.95-2.09). CONCLUSIONS: Evidence from this study suggests that hepatitis B vaccine is positively associated with adverse health outcomes in the general population of US children.

Arthritis↗

PubMed2001

Third-molar removal patterns in an insured population.

BACKGROUND: The authors examined third-molar removal patterns in an insured population to see how these patterns compare with recommendations in the literature. METHODS: The source of treatment data was insurance claims for services rendered from July 1991 through December 1999; it included approximately 100 million dental procedures provided to about 7.4 million patients from all 50 states. The insured were public and private employees or retirees and their dependents. RESULTS: The authors found that third molars were the most commonly extracted permanent teeth, and they most often were removed from adolescents. Friday was the day of the week on which most extractions occurred, and the favored month was August, followed by July, December and June. Another important pattern revealed by the authors' analysis was that there was substantial variation among dental practices in whether patients had third molars removed and in the timing of the removal. They found that adolescent patients in some dental practices rarely were referred for third-molar removal, while in other practices, most or all had third molars removed. CONCLUSIONS: Third-molar removal patterns suggest that many third molars are not removed in response to acute pathology, and the observed variation in the likelihood and timing of these extractions reflects the lack of consensus on this topic in the dental literature. CLINICAL IMPLICATIONS: The apparent lack of consensus on third-molar removal should be resolved for the profession to maintain the confidence of the public that the recommended care is based on sound evidence.

Adolescent↗

PubMed2000

Professionally applied topical fluoride and restorative care in insured children.

OBJECTIVES: This study evaluates the association between use of professionally applied topical fluoride and use of interproximal restorations in primary and permanent teeth of children. METHODS: Insurance claims from 15,190 children, for treatment provided by 1,556 different dentists, were analyzed to look for associations between frequency of use of professionally applied topical fluoride and use of interproximal restorations. The average follow-up period for the children included in the analysis was 5.3 years, with the range from 3.0 to 7.9 years. RESULTS: Both tabular and regression results failed to demonstrate an association between frequency of use of professionally applied topical fluoride and use of interproximal restorations in either the primary or permanent dentition. The most powerful predictor of restorative care for these children was the overall propensity of the dentist to place restorations in children. CONCLUSIONS: In this group of insured children, we were unable to find an association between the frequency of use of professionally applied topical fluoride and restorative care. Further, despite numerous recommendations that professionally applied topical fluorides should be used only in moderate- and high-caries children, approximately two-thirds of these children received topical fluoride at every recall visit, nearly two times per year.

Adolescent↗

PubMed1999

Water consumption in the United States in 1994-96 and implications for water fluoridation policy.

OBJECTIVES: The purpose of this project was to describe current water consumption patterns and to compare them to findings from earlier studies. Current water consumption data also were used to reevaluate the association between water consumption and climate. These findings are of importance in estimating fluoride intake from fluoridated water. METHODS: Findings from the 1994-96 Continuing Survey of Food Intakes by Individuals (CSFII) were compared to those from two earlier dietary studies, the 1977-78 Nationwide Food Consumption Survey (NFCS) and the pioneering research of Galagan and colleagues in the 1950s. Food consumption data were analyzed for 14,619 persons with food and beverage intake data for two 24-hour periods in the CSFII. RESULTS: Increased consumption of infant formulas and decreased consumption of tap water and cow's milk were seen in the CSFII for infants compared to the NFCS. Older children and adults showed increased consumption of carbonated beverages and juices. While Galagan and colleagues found about a 60 percent increase in water consumption between the coldest (55 degrees F) and warmest (85 degrees F) conditions, only a 20 percent difference was seen between the winter and summer months in certain regions in the CSFII. CONCLUSIONS: No obvious strong or consistent association between water intake and month or season was apparent in these recent data. These findings are preliminary, and suggest that water fluoridation policy requires further research regarding water consumption and climate.

Adolescent↗

PubMed1999

Changing treatment patterns.

BACKGROUND AND OVERVIEW: Patterns of clinical care are closely linked to the nature of diseases in the population. During the past decade, the nature of both dental caries and periodontitis has undergone a transformation that has implications for dental practice. Especially in younger cohorts, the overall need for extensive restorative and periodontal treatment is much reduced, compared with that of prior generations. CONCLUSIONS: Over the next several decades, there will be a slowly declining per-capita need for restorative and surgical care. The overall mix of services will continue to shift toward diagnostic and preventive services. PRACTICE IMPLICATIONS: At least in terms of today's conventional dental care, each provider in the future should be able to manage the oral health care needs of larger numbers of patients than is possible today.

DMF Index↗

PubMed1999

Hepatitis B vaccine and liver problems in U.S. children less than 6 years old, 1993 and 1994.

Data to assess the benefits and risks of hepatitis B vaccine for the general population of U.S. children are sparse. This study addressed the problem of external validity found in previous studies of high risk populations by evaluating the benefit of hepatitis B vaccination for the general population of American children. We calculated the risk of liver problems among hepatitis B vaccinated and non-hepatitis B vaccinated children using logistic regression. Hepatitis B vaccinated children had an unadjusted odds ratio of 2.94 and age-adjusted odds ratio of 2.35 for liver problems compared with non-hepatitis B vaccinated children in the 1993 National Health Interview Survey. Hepatitis B vaccinated children had an unadjusted odds ratio of 2.57 and age-adjusted odds ratio of 1.53 for liver problems compared with non-hepatitis B vaccinated children in the 1994 National Health Interview Survey dataset.

Age Distribution↗

PubMed1998

Trends in per-patient gross income to dental practices from insured patients, 1980-1995.

The authors discuss changes that occurred in per-patient gross income to dental practices from insured patients between 1980 and 1995. The current young-adult cohort appears to provide lower per-patient practice incomes compared with earlier young-adult cohorts. These changes may be the result of differences in the need for restorative care among young adults who benefited from the childhood caries decline of the 1970s and 1980s. If this reduced use of restorative services pattern persists as this young-adult cohort and succeeding cohorts age, the effect on dental practices could be substantial.

Adolescent↗

PubMed1997

Dental caries and dental fluorosis at varying water fluoride concentrations.

OBJECTIVES: The purpose of this study was to investigate the relationships between caries experience and dental fluorosis at different fluoride concentrations in drinking water. The impact of other fluoride products also was assessed. METHODS: This study used data from the 1986-87 National Survey of US School-children. Fluoride levels of school water were used as an indicator of the children's water fluoride exposure. The use of fluoride drops, tablets, professional fluoride treatments, and school fluoride rinses were ascertained from caregiver questionnaires. Only children with a single continuous residence (n = 18,755) were included in this analysis. RESULTS: The sharpest declines in dfs and DMFS were associated with increases in water fluoride levels between 0 and 0.7 ppm F, with little additional decline between 0.7 and 1.2 ppm F. Fluorosis prevalence was 13.5 percent, 21.7 percent, 29.9 percent, and 41.4 percent for children who consumed < 0.3, 0.3 to < 0.7, 0.7 to 1.2, and > 1.2 ppm F water. In addition to fluoridated water, the use of fluoride supplements was associated with both lower caries and increased fluorosis. CONCLUSIONS: A suitable trade-off between caries and fluorosis appears to occur around 0.7 ppm F. Data from this study suggest that a reconsideration of the policies concerning the most appropriate concentrations for water fluoridation might be appropriate for the United States.

Adolescent↗

PubMed1997

Validity of two methods for assessing oral health status of populations.

OBJECTIVE: This investigation assessed two methods for estimating epidemiologic indicators of oral health status among children: (1) a visual-only screening, performed independently by a dental hygienist and a registered nurse; and (2) a parent- or guardian-completed questionnaire. The indicators included dichotomous variables measuring dental caries and treatment needs, presence of sealants, injuries to the anterior teeth, and dental fluorosis. METHODS: Following training and calibration, data were collected over an eight-day period in April 1994 among 632 elementary schoolchildren (aged 5 to 12 years) in Monticello, Georgia. Both screening and questionnaire findings were compared pairwise with results from visual-tactile examinations done by a dentist. Validity, represented by sensitivity, specificity, and predictive values, was assessed for screening results from the dental hygienist, the nurse, and the parent-completed questionnaire. RESULTS: Validity was high for screening for caries and treatment needs (> 90% for sensitivity, specificity, and predictive values in a sample having 30% to 40% prevalence). Less valid data--mainly an effect of false negatives--were obtained for fluorosis, injuries, and presence of sealants. No significant difference in validity was observed between the nurse and the dental hygienist. One-third of respondents to the questionnaire did not know if their children needed fillings (a proxy for untreated decay) or had received sealants; only knowledge of restorations was comparable to results from screening. Intraexaminer reliability for the two screeners ranged from 85 to 100 for percent agreement and 0.70 to 0.93 for kappa scores. CONCLUSIONS: Screening by dental hygienists or nurses can provide valid data for surveillance of dental caries and treatment needs. Training for visual assessment of fluorosis and injuries must be improved to diminish the proportion of false negatives. A parent-completed questionnaire is less effective than visual screening for evaluating oral health status in children.

Child↗

PubMed1997

Trends in dental care among insured Americans: 1980 to 1995.

This article presents data on the use of a wide range of dental services by insured patients between 1980 and 1995. The patterns of dental care revealed in this study show clear trends that indicate profound improvements in oral health. These improvements are evident in all age groups, and the effect of the caries decline in children that began about 20 years ago has moved well into the adult population. As those born since about 1950 continue to age and represent an ever-increasing proportion of the population, the overall need for restorative care of all types will continue to diminish.

Adolescent↗

PubMed1995

Sugar consumption and caries risk in schoolchildren with low caries experience.

This paper assesses the risk from sugar consumption in a population of school children with low caries experience. It relates eight different measures of sugar consumption to the occurrence of any DMFS increment, and, separately, to approximal and pit-and-fissure DMFS. The data are from a 3-yr longitudinal study of 429 children, initially aged 11-15, residing in non-fluoridated rural communities in Michigan, USA. All children completed at least three dietary interviews, were present for baseline and final dental examinations, and had a parent or guardian provide questionnaire information on residence history, use of fluoride and dental services, and family history. Results indicated that a higher proportion of total energy intake from sugars increased the probability of caries on all surfaces, and a higher total intake of sugars was also associated with total caries increment. No relationship, however, was found between DMFS increment and the frequency of eating high sugar foods. Each additional 5 g of daily sugars intake was associated with a 1% increase in the probability of developing caries, and those whose energy intake from sugars was 1 SD above the mean had 2.0 times the risk of developing approximal caries than did children whose energy intake from sugars was 1 SD below the mean.

Adolescent↗

PubMed1995

Longitudinal evaluation of sealing molars with and without incipient dental caries in a public health program.

OBJECTIVES: This study undertook a retrospective evaluation of the effect of sealants on the caries experience of initially sound and incipient permanent first molar pit and fissure surfaces. METHODS: Records of children with complete five-year records were obtained from a school-based dental sealant program in a fluoridated community. Sealants were placed on 677 tooth surfaces in 96 children; 120 tooth surfaces in 17 children who received baseline examinations were not sealed because of lack of caregiver consent. Tooth surfaces were initially diagnosed as being sound or having incipient lesions, and evaluated for caries status after five years. RESULTS: For initially incipient surfaces the five-year decay rate was 10.8 percent (41 of 380 surfaces) for sealed surfaces and 51.8 percent (29 of 56 surfaces) for nonsealed surfaces with an odds ratio of 8.88 (95% CI = 4.56, 17.35). Initially sound surfaces had a decay rate of 8.1 percent (24 of 297 surfaces) for sealed surfaces and 12.5 percent (8 of 64 surfaces) for nonsealed surfaces with an odds ratio of 1.63 (95% CI = 0.63, 4.08). The two odds ratios were significantly different. CONCLUSIONS: Initially sound tooth surfaces were unlikely to become decayed in five years, and did not benefit greatly from the application of sealants. Within the limitations of this study, there were clear efficiencies in sealing incipient, but not sound, surfaces. The targeting of teeth with incipient caries for sealants is therefore recommended.

Bisphenol A-Glycidyl Methacrylate↗

PubMed1995

How fee and insurance changes could affect dentistry: results from a microsimulation model.

Dentists have become concerned about the possible impact of reductions in dental insurance coverage. The authors used a microsimulation model of the dental sector to assess the potential impact of reductions in the percentage of Americans with dental insurance, in universal dental insurance coverage for children and in fees paid to dentists for their services. The model predicted that reductions in dental insurance coverage would reduce per capita dental expenditures, but that the impact would not be large. Fee reductions had the greatest impact on dental expenditures of any change simulated by the model.

Adolescent↗

PubMed1994

Risk factors for total tooth loss in the United States; longitudinal analysis of national data.

The NHANES I Epidemiologic Follow-up Study (NHEFS) of 1982-84 collected longitudinal data from 10,523 individuals initially seen during the first National Health and Nutrition Examination Survey (NHANES I) of 1971-75. Among this additional data was information on the incidence of total tooth loss during the 10 years between the surveys, which could then be added to NHANES I data to identify risk factors. In this analysis, a series of bivariate analyses were carried out, followed by logistic regression analysis to assess the simultaneous effect of major variables. Results showed that 7.4 percent of dentate Americans aged 25-74 at NHANES I became edentulous over the next 10 years. In bivariate analyses, the incidence of edentulism was correlated with baseline measures of lower income and education status, poorer oral health, self-perceptions of poor general health and oral health, absence of a regular dentist, and a lower number of remaining teeth at baseline. No correlation was found with gender and geographic region, nor with self-reported diabetes and arthritis, and age was not a factor when the number of remaining teeth at baseline were taken into account. In a logistic regression model assessing the effect of these variables simultaneously, none of the demographic variables retained significance; the only variable statistically significant in both age groups was the number of teeth remaining at baseline. Other significant variables in younger persons were higher periodontal disease scores, perceived poor dental health, perceived need for extractions, history of smoking, and low ascorbic acid intake. Some of these variables were reflections of negative health behavior and attitudes rather than direct correlates. Principal findings from this study were the importance of early tooth loss in eventual edentulism and the virtual disappearance of gender and age as determinants of total tooth loss.

Adult↗

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 use of a rapid enzymatic assay in the field for the detection of infections associated with adult periodontitis.

There are few objective assays for studies of the epidemiology of periodontal diseases. The PerioScan is an assay capable of detecting three periodontal pathogens, namely T. denticola, P. gingivalis, and B. forsythus, which have been associated with adult periodontitis. The PerioScan was tested in a sample of 301 Brazilians. Clinical indices--bleeding, probing depth, gingival index, and periodontal index--were recorded from four sites in each subject. Subgingival plaque samples were collected from those sites and placed on the PerioScan card. Color results were scored in the field after 15 minutes. The plaque samples were screened with polyclonal antibodies for the three species by an ELISA system. The PerioScan, when compared with the ELISA system, yields a sensitivity of 91 percent, specificity of 89 percent, and an accuracy of 90 percent. When the PerioScan was compared to clinical indices, there was a high sensitivity (at least 93%) and a low specificity (no less than 47%), with an accuracy of at least 61 percent.

Adolescent↗

PubMed1989

Possible effect of medically administered antibiotics on the mutans streptococci: implications for reduction in decay.

The decline in dental caries in children in North America, Scandinavia, Britain, Ireland and many Commonwealth nations is well documented. The multiple uses of fluoride can account for most, but not all, of this reduction. In this investigation, data are provided which suggest a relationship between antibiotic usage for medical purposes and a decline in both mutans streptococci (MS) and caries. Children attending Grades 1 and 2 in the Coldwater, Michigan school system and who reportedly never received antibiotics had significantly higher proportions of MS in the fissure plaques of first molars than subjects who received antibiotics. The level of decay in the primary dentition was inversely related to the reported usage of antibiotics. The frequent usage of antibiotics could reduce the incidence of dental caries by delaying the colonization of the teeth by the MS. This was evaluated by a prospective study in infants to determine what effect reported antibiotic usage would have on the colonization of newly erupting primary teeth. Only 2 of 10 infants cultured at 2 to 3 week intervals for periods up to 1 year after tooth eruption became colonized by the MS. One had never received antibiotics and the second had been on antibiotics for a single 5-day period. Seven of the 8 non-colonized infants had received antibiotic therapy for periods ranging from 10 to 181 days. Both the Coldwater study and the prospective study of infants suggested a relation between frequency of antibiotic usage for medical purposes and the MS levels on the teeth.

Anti-Bacterial Agents↗

PubMed1988

Development of an oral health survey: Columbus, Ohio.

This article describes the method used to develop and implement a local oral health survey (Columbus, Ohio) conducted in 1986. With the shift in the national dental disease pattern in the past decade, local oral health information is essential for program planning purposes. A collaborative effort by a city health department, a state health department, a dental school, and a school of public health demonstrated how this group worked harmoniously in a relatively inexpensive venture to determine the oral status of various age groups (grades 1-2, grades 6-7, age 35-44, and age 65+). This information provided part of the framework for a five-year dental plan at the Columbus Health Department. The survey design will serve as a basis for conducting a similar survey statewide. Modifications of existing oral health survey instruments are discussed.

Adolescent↗