Biomedical subjects

S M Levy

Publications and source records attributed to S M Levy.

At least 109 records · Page 6Linked to original sources

PubMedDate not supplied

Factors influencing nurses' aides' provision of oral care for nursing facility residents.

Nurses' aides provide the majority of direct care for nursing facility residents. This study investigated aides' self-reported oral care activities and personal, job, organizational, and resident factors associated with oral care. A 30-item questionnaire was completed by 488 aides, and interviews were conducted with 65 of these aides. Aides were performing oral care activities for residents. Associations between some of the four groups of factors proposed and aides' oral care provision were found. Aides' attitudes toward oral care, lack of time and staff to complete oral care, and behavioral and physical difficulties with residents may have affected the time spent by these aides in providing oral care. The study highlighted the need for further investigation and assessment of (1) aides' CNA training courses and (2) continuing oral health educational interventions in nursing facilities. Personal interview were found to be a useful qualitative instrument for conducting dental research in nursing facilities. Further investigation is needed of interviews and other methodologies, such as observation, to supplement self-report as a measure of aides' oral care activities.

Activities of Daily Living↗

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Medical and functional status changes among nursing facility residents: implications for dentistry.

This paper reports the results of a study that investigated changes in the medical and functional status of nursing facility residents over a 2.9 year period. Sixty-seven residents from 10 nursing facilities were included in the study, which demonstrated that the resident's medical and functional status deteriorated during this period. These changes adversely affected the residents' ability to receive recommended dental treatment, suggesting that early, definitive, and often aggressive treatment approaches be used in providing services to these individuals.

Aged↗

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Oral health of persons with and without dementia attending a geriatric clinic.

This study of 230 hospital geriatric clinic patients compared the oral health of individuals with dementias with that of persons with no dementing illnesses. Data collected included dental examinations, subject questionnaires and review of hospital records. There were few differences among groups of patients based on categorization into groups of those diagnosed with (1) no dementia, (2) dementia of the Alzheimer's type, and (3) other dementias. However, there were significant differences based on degree of cognitive impairment regardless of dementia diagnosis. Those with severe dementia had poorer gingival health and oral hygiene, but better self-perceived mouth health. There are numerous limitations and inherent difficulties in studies involving persons with dementia, and overcoming these in the future will likely require long-term, interdisciplinary approaches.

Aged↗

PubMedDate not supplied

Challenges in geriatric oral health research methodology concerning caregivers of cognitively impaired elderly adults.

Little is known about oral health care behaviors of community-dwelling, cognitively impaired elderly (CIE) persons. Few studies have been conducted regarding the actual provision of oral care for CIE persons or the attitudes and concerns about oral health among their caregivers. The CIE person's ability to perform self-care decreases over time, and the role of the caregiver in daily oral care becomes increasingly important. The purpose of this pilot study was to explore the attitudes toward oral health and identify related concerns among caregivers who care for community-dwelling CIE persons. Caregivers were surveyed by means of a self-administered, mailed questionnaire. To maintain confidentiality, an intermediary was used for recruitment and data collection. Overall, 148 caregivers were invited by an intermediary to participate in the survey; only 21 (14%) consented to participate and returned the questionnaire. This paper discusses some of the numerous methodological challenges identified when an attempt was made to survey care-givers' attitudes toward and barriers to providing oral care for a dependent CIE.

Activities of Daily Living↗

PubMedDate not supplied

Medical conditions associated with missing teeth and edentulism in the institutionalized elderly.

Several studies have reported the prevalence of medical conditions or investigated the relationships between the oral health status and general health conditions in the elderly. However, the relationship between medical conditions and oral health among the elderly is not well-described. Previous studies have not clearly identified a consistent association between medical conditions and oral health, specifically edentulism and tooth loss. The purpose of this study was to investigate the relationships between medical conditions and oral health, as assessed by edentulism and missing teeth, in an institutionalized elderly population. A systematic sample (n = 175), stratified by age and sex, was drawn from nursing home patients treated by the University of low' as Geriatric Mobile Unit (GMU) team. Data were extracted from GMU dental records, regarding history of medical conditions, medications, dental history, dentate status, and tooth-by-tooth conditions. Mean numbers of missing teeth were significantly higher among those who had a history of atherosclerotic vascular disease, heart failure, ischemic heart disease, and joint disease. Subjects who had a history of atherosclerotic vascular disease, heart failure, ischemic heart disease, and joint disease were more likely to be edentulous than subjects who did not have a history of those diseases. The biological basis for these relationships between dentate status and systemic medical conditions is unclear and warrants further study.

Aged↗

PubMedDate not supplied

Dental treatment outcomes among dentate nursing facility residents: an initial study.

This investigation used retrospective methodology to examine the outcomes of previous dental treatment and the incidence of developing restorative and extraction needs, including dental caries, among nursing facility residents. Data were taken from treatment records of 48 dentate residents in 10 nursing facilities who received comprehensive dental treatment delivered through the Geriatric Mobile Unit (GMU) program operated by the University of Iowa College of Dentistry and were examined an average of 2.9 years after initial examination. Residents had a mean age of 84 years at the second exam, and 90% were female. About 18% of all previously placed restorations needed to be replaced, and an additional 11% of teeth that received a restoration needed to be extracted at follow-up. At follow-up, nearly 70% (33/48) of residents needed restorative care, while 44% (21/48) needed extractions. The mean incidence of teeth developing new treatment needs between the two visits was 2.7 teeth/person (14.9% of teeth) for restorative need and 1.1 teeth/person (6.6% of teeth) for extraction need. Results suggest that successful treatment outcomes can be achieved for nursing facility residents, but that dental disease and treatment needs develop at a high rate among these residents.

Aged↗

PubMedDate not supplied

The accuracy of tooth loss data collected by nurses.

This paper reports on the accuracy of tooth counts conducted in 22 subjects by 10 trained nurses as part of a large longitudinal study of a pharmacological agent. These nurses participated in a training course consisting of seminars, discussion, demonstrations, and practice examinations. Each of the nurses then counted the teeth of 22 subjects and recorded their findings independently. The counts of the nurses were compared with those of the dentists to assess the accuracy of the nurses' counts. We found that nurses and dentists were in perfect agreement for 86% of the patient counts conducted. Individual nurses' levels of agreement with dentists ranged from 73% to 100%, with pairwise kappa statistic values ranging from 0.70 to 1.00. In addition, both Pearson correlation and interclass correlation measures exceeded 0.98 for every comparison of dentist and nurse counts. The results of this study suggest that training nondental health care workers may be an accurate and low-cost way of obtaining tooth loss data and other oral health measures, particularly when oral health data are collected as part of larger, multi-disciplinary studies.

Aged↗

PubMedDate not supplied

Tooth-surface progression and reversal changes in fluoridated and no-longer-fluoridated communities over a 3-year period.

OBJECTIVE: To compare permanent tooth surface-specific progression/reversal changes between fluoridation-ended (F-E) and still-fluoridated (S-F) communities in British Columbia, Canada, over a 3-year period. METHODS: D1D2MFS examinations were contrasted for 2,964 schoolchildren in 1993/94 (grades 2, 3, 8 and 9) and 1996/97 (grades 5, 6, 11 and 12). Generalized Estimating Equation (GEE) models explored the relation between progression/reversal changes and fluoridation status, age, gender, socioeconomic status, and dietary/fluoride histories. RESULTS: Within a scenario of low levels of caries overall, few children had multiple surfaces progressing. At least one smooth surface progressed in 31.4% of subjects; at least one pit-and-fissure (PF) surface progressed in 43.1% of subjects. At least one smooth surface reverted in 89% of subjects who had reversible stages; at least one PF surface reverted in 23.8% of subjects who had reversible stages. GEE (smooth) indicated that odds ratios of progression were twice as large in the F-E site compared to the S-F site, and slightly increased in older participants and in participants exposed to more fluoride technologies. GEE (PF) also indicated that progression was slightly more common in the F-E site; more frequent snacking and lower parental educational attainment had modest associations with increased progression in PF surfaces. For the two types of surfaces, GEE models demonstrated that unerupted surfaces were less likely to progress than sound surfaces. No associations were found between reversals and independent variables. CONCLUSION: Progressions were found to be weakly linked to socio-demographic factors; baseline surface statuses were better predictors of progression. Using the current definitions for disease transitions, F-E communities had more frequent progressions than a S-F community.

Adolescent↗

PubMedDate not supplied

Fluoride, beverages and dental caries in the primary dentition.

Knowledge concerning risk factors for primary dentition caries in young children is incomplete. Models are presented for caries development using longitudinally gathered fluoride exposure and dietary intake data in the Iowa Fluoride Study. Primary tooth caries examinations were conducted at age 5. Dietary (beverage) and fluoride exposure data were gathered longitudinally from age 6 weeks through 4 years (n = 291); 23% had decayed or filled surfaces. Logistic regression revealed that beverage components and toothbrushing made unique contributions to caries experience. Water consumption (36-48 months), milk consumption (24-36 months), and fluoridated toothpaste brushings (36-48 months) were negatively associated with caries; sugared beverages and milk (6 weeks to 12 months) were positively associated. Although fluoride exposure is important, sugared beverages contribute substantially to caries risk, while water and milk consumption and frequent toothbrushing early can have protective effects.

Animals↗

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Socio-demographic features and fluoride technologies contributing to higher fluorosis scores in permanent teeth of Canadian children.

OBJECTIVE: To examine levels of fluorosis among children in two Canadian communities exposed to fluoride. BACKGROUND: One community had discontinued fluoride, the other had maintained it. Water supplies, however, were fluoridated for all the children when their esthetically important teeth were mineralized. METHODS: We examined 8,277 children to assess Thystrup-Fejerskov Index (TFI) scores. Multivariate Poisson regression models were used to identify the relationship between TFI and water fluoride status, age, gender, SES, and dietary and fluoride exposure histories (supplements, rinses, toothpaste amount, tooth brushing frequency, and tooth brushing starting age). Parent(s) completed questionnaires. RESULTS: Overall, levels of fluorosis were low to mild, with residents of the fluoridation-ended communities having marginally higher TFI scores than those of the still-fluoridated community. Females had higher TFI scores than males. Children aged 10 years or more had higher TFI scores than younger children. Consuming bottled water between birth and 6 months of age was protective. Exposure to fluoridation technologies was consistently associated with fluorosis experience. Children who began brushing with fluoride toothpaste between their first and second birthdays had higher TFI scores than those who began between their second and third birthdays, regardless of daily brushing frequency. Children who regularly used supplements had higher TFI scores than those who did not. Children with a college-educated father had higher TFI scores than those whose fathers had less education. CONCLUSIONS: Higher fluoride exposure slightly increased the likelihood that a child had a higher TFI score, especially when more fluoridation technologies were used at home.

Age Factors↗

PubMedDate not supplied

Temporal experience in the aged: body integrity and the social milieu.

Variation in temporal experience among the aged has been found to be a function of a number of variables. The sociological and phenomenological literature suggest two as being of crucial importance: work and retirement and health and illness. These were investigated in the present study making use of a structured interview format with seventy male retirees. Differences in affect and temporal experience were examined using a 2 x 2 x 2 factorial design comparing groups in terms of Health, Willingness to Retire, and Time Since Retirement. In general, it was found that early in retirement those individuals who were healthy but had not wanted to retire resembled the chronically ill in terms of negative affect and temporal structure (that is, loss of a sense of future, constricted present, and "disconnected" past). Over time, however, these individuals restructured their world, reflecting a positive affect and a "full" temporal experience. This restructuration was in contrast to that which occurred in the chronically ill, who, irrespective of whether they wanted to retire or not, and irrespective of time since retirement, remained uniform in terms of negative affect and loss of temporal structure.

Adaptation, Psychological↗

PubMedDate not supplied

A review of fluoride dentifrice related to dental fluorosis.

Introduced to the commercial market 40 years ago, fluoride dentifrice now accounts for nearly all dentifrice purchased in the United States. During this same time, the prevalence and severity of dental caries has declined while dental fluorosis prevalence has increased. While the caries decline can be largely attributed to widespread fluoride dentifrice use, as well as many other sources of fluoride, several recent studies have attributed much of the increase in fluorosis prevalence to early use of fluoride dentifrice. This paper reviews these studies, as well as the efficacy of fluoride dentifrices with lower fluoride concentrations. Finally, recommendations regarding fluoride dentifrice to maintain caries prevention and reduce the risk of dental fluorosis are presented.

Adolescent↗

PubMedDate not supplied

Non-nutritive sucking behaviors in preschool children: a longitudinal study.

PURPOSE: Prolonged duration of non-nutritive sucking behaviors may have consequences in regard to the developing orofacial structures and occlusion. Little is known as to why some children have prolonged sucking habits beyond the first 2 to 3 years of life. This paper reports on non-nutritive sucking patterns among a large cohort of healthy children from birth to 36 months of age and older, and identifies factors predictive of prolonged non-nutritive sucking habits. METHODS: Over 600 children were followed from birth to at least 36 months of age using mailed questionnaires sent when children reached the ages of 6 weeks, and 3, 6, 9, 12, 16, and 24 months, and then yearly thereafter. Parents answered questions concerning non-nutritive sucking behaviors including use of pacifier and digit sucking. The study categorized children who maintained habits to 36 months of age or older as having prolonged habits, and using multivariate analyses, compared them to children without prolonged habits on various sociodemographic variables. RESULTS: The study found that for over 20% of the children, a non-nutritive sucking habit was prolonged to 36 months of age or older. Factors associated with prolonged sucking habits included older maternal age, higher maternal education level, and having no older siblings. CONCLUSIONS: Identifying factors related to prolonged non-nutritive sucking habits may be important in developing and targeting recommendations regarding such behaviors in an effort to prevent malocclusions that result from prolonged sucking habits.

Chi-Square Distribution↗

PubMedDate not supplied

Factors affecting dentifrice use and ingestion among a sample of U.S. preschoolers.

PURPOSE: This study was performed to assess the actual amount of dentifrice used and ingested and factors associated with use/ingestion among 28 U.S. preschoolers aged 40 to 48 months. METHODS: Using their regular dentifrice brands/flavors and small child-sized toothbrushes (Oral -B 5), the participants or their parents placed dentifrice on toothbrushes three times to assess the quantity used and its consistency. Their brushing behaviors were observed and the amounts of dentifrice ingested were indirectly measured. Afterward, the parents and children placed a "pea-sized" amount of dentifrice on their toothbrushes. RESULTS: The participants were generally consistent in quantity applied, averaging 0.256 g (range 0.035 g-0.620 g; standard deviation 0.177 g) of dentifrice per brushing. Children, either alone or with parental assistance, placed more dentifrice than either mother or father alone (P = 0.007). The estimated mean ingested fluoride was 0.17 mg F per brushing, an average of 62% of the amount of dentifrice used (range up to 98%). Amount of ingested fluoride was positively associated (P < 0.05) with the amount of dentifrice used, and negatively associated with parental assistance in brushing. When asked to apply a pea-sized quantity, the mean quantity applied was 0.314 g (range 0.064 g-0.521 g). CONCLUSIONS: This study further supports the use of small amounts of dentifrice in young children, because they ingest substantial proportions of dentifrice.

Child, Preschool↗

PubMedDate not supplied

Prevalence of enamel hypoplasia and isolated opacities in the primary dentition.

PURPOSE: Enamel hypoplasia is of interest to both the clinician and the basic scientist because it may indicate an increased risk for caries and can contribute to the understanding of enamel development. The purpose of this paper is to report the prevalence of enamel hypoplasia and isolated enamel opacities in a cohort of healthy, well-nourished children in Iowa. METHODS: The study sample consisted of 698 children examined at 4-5 years of age. Individual tooth surfaces were scored for the presence of enamel hypoplasia (EH) and isolated enamel opacities. Prevalence of EH and isolated opacities were determined by tooth type and by gender. RESULTS: Six percent of the children examined had at least one tooth with EH; 27% had at least one tooth with isolated enamel opacities. There was no difference in the prevalence of EH between boys and girls, but significantly more boys than girls had enamel opacities. CONCLUSIONS: The prevalence of enamel defects in this study group is comparable to that seen in other studies of normally developed children except that in this study, the primary tooth types most commonly affected with enamel hypoplasia or isolated opacities were mandibular second molars and maxillary second molars, respectively.

Adult↗

PubMedDate not supplied

Pacifier use and the occurrence of otitis media in the first year of life.

PURPOSE: The purpose of this study was to assess pacifier use as a risk factor for otitis media during the first year of life. METHODS: A volunteer cohort of 1,375 infants was recruited from eight hospital postpartum units in Iowa. Parents were asked to provide detailed information on their child's health at 6 weeks, 3, 6, 9 and 12 months of age. Questions were posed concerning occurrence of specific childhood illnesses, including otitis media, at each time point, as well as other factors. RESULTS: Over 70% of children were reported to have experienced one or more episodes of otitis media during their first year of life, with its occurrence much more common during the second six months. Multivariate analyses using Generalized Estimating Equations assessed factors associated with otitis media during the entire 12-month period. These analyses showed that pacifier use, age, male sex, greater number of childcare days, and higher family incomes were significantly associated with occurrence of otitis media. CONCLUSIONS: Multivariate analyses found that the occurrence of otitis media was associated with pacifier use, one of few modifiable risk factors for otitis media.

Female↗

PubMedDate not supplied

Arizona providers' use and knowledge of fluoride supplements.

Dietary fluoride supplements are recommended for dental caries prevention in children without access to optimally fluoridated water. Previous studies have shown deficiencies in dentists' and physicians' knowledge about dietary fluoride supplementation. Data were collected from dentists, physicians and other healthcare provider groups to assess dietary fluoride supplement knowledge and practices. Pediatricians and dentists were found to be the most knowledgeable concerning the recommended prescribing protocols. Substantial proportions of all practitioner groups had insufficient knowledge about the recommended dosages of dietary fluoride supplements by age, fluoride levels in local water supplies, and the effectiveness of fluoride delivery methods. Baseline knowledge and practices were determined for healthcare provider groups within Arizona.

Arizona↗

PubMedDate not supplied

A pilot study of preschoolers' use of regular-flavored dentifrices and those flavored for children.

Ingestion of fluoride dentifrice by preschool children recently has been implicated as a risk factor for dental fluorosis. The availability of dentifrices flavored for children could increase fluoride ingestion by young children at risk for dental fluorosis. This article reports results of a pilot study of use of regular-flavored dentifrice and those flavored for children among 29 preschool children. Using a crossover design, larger quantities of fluoride dentifrice specially flavored for children were used compared with the quantities of regular-flavored dentifrice. Pediatric dentists and other health care providers should advise parents to supervise preschoolers' toothbrushing. Preschoolers should use only small, pea-sized quantities of dentifrice to avoid increased risks of dental fluorosis.

Child, Preschool↗