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PubMed1999

Development of effectiveness of care and use of services measures for dental care plans.

OBJECTIVES: Standardized measures to assess clinical aspects of the performance of managed dental care plans are not available. This project sought to develop and evaluate measures for effectiveness of care and use of services that could be calculated using a plan's administrative data. METHODS: Two panels of stake holders representing dental plans, purchasers, and dental providers participated in a modified Delphi process to refine initial sets of effectiveness of care and use of services measures modeled after HEDIS measures for medical care. The refined measures were then pilot tested in two dental health maintenance organizations. RESULTS: The development process resulted in specification of seven effectiveness of care measures assessing disease activity classification, and prevention and outcomes for caries, periodontal disease, and tooth loss. Six use of services measures focusing on prophylaxes, third molar surgery, preventive, restorative, prosthetic, surgical, and endodontic care also were specified. Pilot testing of the measures indicated reasonable reliability and sensitivity, but also demonstrated the need for supervision or auditing of the process. CONCLUSIONS: These standardized measures for dental care plan performance are available for immediate use. However, because the measures depend on diagnostic information (periodontal probing data and diagnoses associated with restorative treatments) in the administrative data set, their adoption will require changes in most plans' data systems and data collection policies.

Adolescent↗
PubMed1999

Post-extraction remodeling of the adult mandible.

Following tooth loss, the mandible shows an extensive loss of bone in some individuals. This may pose a significant problem in the prosthodontic restoration of function and esthetics. The many factors which have been proposed as being responsible for the inter-individual variation in post-extraction remodeling mean that a perfunctory analysis of the literature, in which well-controlled, relevant studies are scarce, may not provide the whole story. This article reviews the local and systemic factors which may play a role in the post-extraction remodeling of the mandible. Since severe residual ridge resorption may occur even when the bone status in the rest of the skeleton is good and vice versa, it is concluded that local functional factors are of paramount significance. It is now essential to determine how they can be modified and applied to help maintain ridge height and quality in our aging, edentulous population.

Adult↗
PubMed2002

Response to direct and indirect recruitment for a randomised dental clinical trial in a multicultural population of elders.

OBJECTIVES: Recruitment for randomised clinical trials and community-based studies has received little attention in the dental literature. The goal of this study was to report on our experiences with direct and indirect recruitment methods for a trial to prevent tooth loss in elders. METHODS: A direct approach, consisting of an introductory lecture with the help of a local contact person in each of the nine community centres, resulted in 208 recruits mostly from minority non-English speaking communities (52%), whereas the other 192 recruits who responded to newspaper announcements (48%) were, in large part, from the English-speaking community. RESULTS: The response suggests that a more direct and culturally specific approach is more productive when recruiting elders from ethnic minority groups, whereas elders from the dominant culture can be recruited indirectly and for about half the financial cost through newspaper announcements. CONCLUSION: We conclude, therefore, that both direct and indirect methods are needed to recruit a multiethnic sample of subjects for a trial.

Aged↗
PubMed2005

Psychometric properties of the Brazilian version of the Oral Health Impact Profile-short form.

OBJECTIVE: The aim of the study is to evaluate the measurement properties of the Brazilian version of the short form of the Oral Health Impact Profile (OHIP14). METHODS: Data were obtained from a cross-sectional study designed to assess the impact of toothache on quality of life during pregnancy. The sample consisted of 504 postpartum women (mean age 24 years; SD 6.2), most of whom had unsolved dental problems and belonged to low-income families. The questionnaire was administered in the form of interviews by two trained interviewers who also performed clinical examinations. Reliability was assessed in terms of internal consistency and stability. Construct validity was evaluated based on comparison of the total scores among groups according to: self-perceived and normative oral health care needs, self-perceived general and oral health status, presence of carious lesions and tooth loss. It was also hypothesized that the scores of OHIP14 and Oral Impacts on Daily Performances (OIDP) would correlate with each other. RESULTS: Both test-retest stability and internal consistency, as measured by the intra-class correlation coefficient (0.87) and by Cronbach's alpha (0.91), proved to be adequate. Construct validity was confirmed as the correlation between OHIP14 scores with self-perceived general and oral health were in the expected direction, and the differences in scores of the groups formed according to the selected attributes were significant at values of P < or = 0.05 (Mann-Whitney test). Moreover, the correlation coefficient between OIDP and OHIP14 was 0.76 (rs). CONCLUSION: The Brazilian version of OHIP14 has good psychometric properties, which are similar to those of the original instrument.

Adult↗
PubMed1995

Strategies in the design of preventive programs.

Dental caries is mostly recorded at the cavity level only. A reduced mean number of cavities in new age cohorts is often thought of as a result of prevention of the disease, dental caries. However, what is measured is rather our success in controlling the disease in such a way that prevalence of its more severe manifestations (cavities) can be reduced in children. Caries lesions and periodontal breakdown are cumulative with age and progress steadily in all populations. Thus, caries is the predominant reason for tooth loss in almost all age groups. The low prevalence and skewed distribution of dental caries make several fluoride programs less (if at all) cost-effective. Rather than considering a "whole population strategy" as opposed to a "high-risk strategy", it is argued that they should go hand in hand. However, the high-risk strategy may appear to have an unfavorable ratio of benefits to costs. So far the available literature shows no evidence that we have tests which, with sufficient predictive power, can identify groups or individuals of "high risk". It is therefore concluded that a population strategy should be maintained and further developed with emphasis on oral hygiene, because it influences norms and behavior. More knowledge about the pathogenesis of oral disease is needed before we can develop truly cost-effective strategies for the prevention of caries and periodontal breakdown.

Adolescent↗
PubMed1993

Changing trends in dental caries experience in Great Britain.

Periodic national surveys of dental health since 1968, and a coordinated program of local surveys of children since 1985, have provided a comprehensive picture of trends in dental caries experience in Great Britain over the course of two decades. This review of some of the findings examines changes in adult caries experience, together with the related phenomenon of total tooth loss; presents evidence of a cohort effect in the decline in caries among children and young adults; and considers likely future trends and their implications for the dental services. Conclusions drawn were: (1) Although the proportion of the population with no natural teeth is declining rapidly among young adults, levels of edentulousness among older age groups will remain high for some time to come; (2) in England and Wales, a modest decline in caries experience of young adults between 1968 and 1978 accelerated between 1978 and 1988 [The greatest change in annual rate of reduction over two decades was in 16-24-year-olds, and in absolute terms, mean DMFT in this age group decreased from 15.7 to 10.4 during the period.]; (3) a cohort effect is discernible in the changing pattern [Thus, caries has apparently stabilized in young children, whereas in adolescents and young adults the rate of decline has increased.]; and (4) smaller improvements in dental health have occurred in Scotland than in England and Wales.

Adolescent↗
PubMed2003

Dental status, xerostomia and the oral health-related quality of life of an elderly institutionalized population.

The author examined the relative effects of tooth loss and xerostomia on the oral health-related quality of life of an elderly, medically compromised population, living in a long-term care setting. Data were collected from 225 subjects (mean age: 83 years) via a questionnaire and review of dental charts. Oral health-related quality of life was assessed using self-ratings, satisfaction ratings, an index of chewing capacity, the GOHAI, and OHIP-14. Almost all participants had one or more chronic medical conditions and were taking prescribed medications. Two-thirds of the study group was dentulous with a mean number of 16 remaining teeth. One-third of the participants had scores on a xerostomia index indicating marked oral dryness. In bivariate and multivariate analyses, xerostomia index scores were significantly associated with all oral health-related quality of life outcomes. Dental status was associated with chewing capacity only. The results suggest that xerostomia has an important influence on the well-being and quality of life of this population.

Aged↗
PubMed1993

Fish-eaters and farmers: dental pathology in the Arabian Gulf.

Twelve skeletal samples, previously published, from the Arabian Gulf have been used to trace differences in diet and subsistence patterns through an analysis of dental pathology. The skeletons date from 3,000 BC to AD 1,500 and cover a variety of geographical locations: off-shore islands, Eastern Arabia, and Oman. The dental conditions analyzed are attrition, caries, calculus, abscessing, and antemortem tooth loss (AMTL). Results indicate four basic patterns of dental disease which, while not mutually exclusive, correspond to four basic subsistence patterns. Marine dependency, represented by the Ras el-Hamra population, is indicated by severe attrition, low caries rates, wear-caused abscessing, and a lack of AMTL. The second group of dental diseases--moderate attrition and calculus, low rates of caries, wear-caused abscessing, and low-moderate rates of AMTL--affects populations subsisting on a mixture of pastoralism or fishing and agriculture (Failaka, Umm an-Nar, Bronze Age Maysar, Bronze Age Shimal, and Iron Age Galilah). Mixed farming populations (Iron Age Maysar and Islamic Bahrain) experienced low-moderate attrition, high rates of caries and calculus, abscessing due to caries, and severe AMTL. The final group of dental diseases affects populations practicing intensive gardening (Bronze and Iron Age Bahrain, and Sites 3 and 5, Ras al-Khaimah). These groups experienced slight attrition, high rates of caries, low rates of calculus deposition, and severe AMTL.

Adult↗
PubMed1991

Relationship between number of teeth and periodontal pockets.

The relationship between number of teeth and the prevalence of periodontal disease is an important factor to consider when planning future needs for periodontal care. This is of particular relevance today, when the level of tooth loss is steadily reducing. The aim of the present study was to examine this relationship. Three dependent variables associated with periodontal disease were included in the analysis: 1. The probability of having pockets 4 mm or more. 2. The mean pocket depth for individuals with pockets 4 mm or more. 3. The number of pockets for individuals with pockets 4 mm or more. Age was included in the analysis as a control variable. The study population comprised 2219 individuals in the county of Trøndelag, Norway. The data were analyzed using logistic regression and multiple regression analysis. The probability of having pockets 4 mm or more increased with increasing number of teeth. The average pocket depth decreased with increasing number of teeth. There was no relationship between number of pockets and number of teeth. The increase in the probability of having pockets with a marginal increase in number of teeth was greatest for those aged 53 years and above. It is concluded that this group of people are likely to have the greatest need for periodontal care.

Adult↗
PubMed1997

Edentulousness and its rehabilitation over a 10-year period in a Finnish urban area.

In 1977 78, a baseline study group of 449 Finnish adults aged 30 years and over was examined in an urban area with a very high supply of dental services. The follow-up study in 1988 represents longitudinal data on 297 of these adults. In 1989 a new sample of persons aged 30-39 years was also obtained to provide cross-sectional information comparable to that of the corresponding age group in the 1977-78 survey. At baseline in 1977-78, the prevalence of total tooth loss was 19.4% for adults aged 30 years and over. The corresponding figures for maxillary and mandibular edentulousness alone were 16.7% and 0.4% respectively. Ninety-four percent of totally edentulous and 89.6% of single-arch edentulous subjects were prosthetically rehabilitated. In the follow-up study, 7.7% of the originally dentate women and 6.7% of men had lost the rest of their teeth. For the new totally edentulous subjects the mean number of teeth lost was 5.7 (s 3.45), most of which were incisors. In the follow-up study, 89% of the new edentulous subjects had already been edentulous in the maxilla at baseline. Among 30-39-year-olds the proportions of upper-arch and totally edentulous subjects in 1977-78/1989 were 6.7%/0.8% and 2.2%/0.8% respectively (P=0.024 for the difference between the time points). In the light of the repeated cross-sectional study, we can conclude that edentulism is very uncommon in the 30-39-year age group in this urban area.

Adult↗
PubMed2001

Comparison of the GOHAI and OHIP-14 as measures of the oral health-related quality of life of the elderly.

OBJECTIVES: This paper compares the performance of the GOHAI and the OHIP-14 as measures of the oral health-related quality of life of the compromised elderly. METHODS: Data were obtained from a cross-sectional survey of 225 participants, most of whom lived in a large geriatric care centre. RESULTS: The mean age of subjects was 83 years and the majority had one or more chronic medical conditions and physical disabilities. Their main oral problems were high rates of tooth loss and xerostomia. Additive and simple count methods were used to derive GOHAI and OHIP-14 scores. Using the additive method, 8.4% had a GOHAI score of zero and 30.3% an OHIP-14 score of zero. Using the simple count method the percentage with a score of zero was 15.1% and 45.8%. Both measures discriminated between dentate subjects with and without one or more dentures, with and without a chewing problem and with and without dry mouth. Both also showed significant associations with self-rated oral health and satisfaction with oral health status. Associations tended to be stronger between GOHAI scores and these variables. The measures were equally good at predicting overall psychological well-being and life satisfaction. Although the GOHAI identified more oral functional and psychosocial impacts than the OHIP-14, neither was markedly superior to the other when used as discriminatory measures. However, the high prevalence of subjects with zero scores may compromise the ability of the OHIP-14 to detect within-subject change.

Aged↗
PubMed1998

Assessing change in quality of life using the Oral Health Impact Profile.

UNLABELLED: Traditionally, longitudinal studies of oral health have measured only disease progression and ignored improvements in health. OBJECTIVES: This study examines methodological issues that arise in longitudinal assessment of change in oral health-related quality of life (OHRQOL). METHODS: Baseline and 2-year follow-up data were used from an observational longitudinal study of 498 people aged 60 years or more living in South Australia. Oral health-related quality of life was measured using the Oral Health Impact Profile (OHIP). Three hypothesized risk predictors (tooth loss, problem-based dental visits and financial hardship) were selected to examine the effects of four methods of measuring change: categorical measures of improvement, deterioration and net change, and a quantitative measure of net change in OHIP scores. RESULTS: Some 31.7% of people experienced some improvement and 32.7% experienced some deterioration in OHRQOL. All three high-risk groups had approximately twice the rate of deterioration in OHRQOL compared with their corresponding low-risk groups. Surprisingly, high-risk groups also had higher rates of improvement. When measured categorically, these effects did not cancel one another, indicating that improvement and deterioration in OHRQOL can be experienced simultaneously. However, quantitative analyses cause improvements and deteriorations to cancel, and analysis of mean OHIP scores created a spurious impression that change in OHRQOL did not differ between dental visit groups. Furthermore, changes in mean OHIP scores were masked by regression to the mean. CONCLUSIONS: Oral health-related quality of life measures capture both improvement and deterioration in health status, creating new complexities for conceptualizing and analyzing change in longitudinal studies.

Aged↗
PubMed1995

An assessment of the association between functional edentulism, obesity, and NIDDM.

OBJECTIVE: To assess the association between a measure of extensive tooth loss (functional edentulism) and obesity with non-insulin-dependent diabetes mellitus (NIDDM) in a racially heterogeneous sample. RESEARCH DESIGN AND METHODS: A cross-sectional survey (370 subjects) was performed by reviewing the medical and dental records of dependently or independently living individuals who were treated as inpatients and/or outpatients at a Department of Veterans Affairs facility. Frequencies and descriptive measures were derived; univariate and multiple logistic regression analyses were conducted to test for associations, confounding, effect modification, and interaction using functional edentulism and obesity as the independent variables and NIDDM as the dependent measure. RESULTS: Functionally edentulous individuals were at significantly greater risk for NIDDM (estimated odds ratio [OR] = 4.06), than the obese (OR = 3.29). These relationships were not confounded by age or race in this sample. Obesity did confound functional edentulism in the multivariable model, suggesting that they act independently on the outcome variable (NIDDM). CONCLUSIONS: Dentist-assessed functional edentulism and physician-diagnosed obesity were significantly associated with NIDDM in this sample of predominantly older men. This finding ought to be considered by primary care providers in formulating dietary strategies in order to facilitate the realization of their therapeutic goals.

Adult↗
PubMedDate not supplied

Dental self-care among dentate adults: contrasting problem-oriented dental attenders and regular dental attenders.

Self-care behaviors are common and can act as substitutes for or supplements to formal health care services. We tested the hypothesis that problem-oriented dental attenders (POAs) report more dental self-care behaviors than do regular dental attenders (RAs), presumably as a substitute for professional care. The Florida Dental Care Study is a longitudinal cohort study of changes in oral health, in which we measured dental self-care behaviors related to three common dental problems: toothache pain, bleeding gums, and tooth loss. Despite using less dental care, POAs were less likely to report "conventional" methods as means to prevent the three dental problems; however, they were more likely to report that homemade remedies, topical medications, or mouthwashes were ways to prevent or treat these problems. POAs were also more likely to believe that "nothing can be done" to prevent these problems. Additionally, POAs had more negative dental attitudes, used less dental care during follow-up, had more dental disease, were the only persons who extracted at least one of their own teeth, and were more likely to use tobacco. With the exception of dental self-extractions, no single self-care belief or behavior distinguished POAs from RAs, nor were POAs likely to have different explanations for dental problems. Instead, the pattern was one of modest differences on a number of items. Although POAs use less dental care, they do not compensate by employing more "conventional" dental self-care behaviors, but report being more likely to employ "unconventional" behaviors. They also are more likely to believe that nothing can be done to prevent dental problems.

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↗
PubMed2000

Acute-phase inflammatory response to periodontal disease in the US population.

Moderate elevation of serum C-reactive protein (CRP) is a risk factor for cardiovascular disease among apparently healthy individuals, although factors that create this inflammatory response in the absence of systemic illness have not been clarified. This study aimed to: (1) evaluate associations among periodontal disease, established risk factors for elevated CRP, and CRP levels within the US population; and (2) determine whether total tooth loss is associated with reduced CRP. Data were obtained from the third National Health and Nutrition Examination Survey. A random sample of the US population was interviewed in their homes and examined at mobile examination centers. CRP was quantified from peripheral blood samples and analyzed as a continuous variable and as the prevalence of elevated CRP (> or = 10 mg/L). Some 12,949 people aged 18+ years who had periodontal examinations and an additional 1,817 edentulous people aged 18+ years were included in the analysis. Dentate people with extensive periodontal disease (> 10% of sites with periodontal pockets 4+ mm) had an increase of approximately one-third in mean CRP and a doubling in prevalence of elevated CRP compared with periodontally healthy people. Raised CRP levels among people with extensive periodontal disease persisted in multivariate analyses (P < 0.01), with established risk factors for elevated CRP (diabetes, arthritis, emphysema, smoking, and anti-inflammatory medications) and sociodemographic factors controlled for. However, CRP levels were similarly raised in edentulous people. Furthermore, the established risk factors for elevated CRP modified relationships between oral status and CRP levels. Periodontal disease and edentulism were associated with systemic inflammatory response in the US population, most notably among people who had no established risk factors for elevated CRP.

Acute-Phase Reaction↗
PubMed2002

Edentulousness and oral rehabilitation: experiences from the patients' perspective.

The psychological effects of tooth loss in the permanent dentition are relatively unknown. Complete edentulousness is a serious life event in terms of readjustment. The aim of the study was to describe the process patients with deteriorating dental status had gone through before treatment with a fixed prosthesis (Brånemark System, Novum), and to describe what living with a fixed prosthesis means to the patients themselves. In-depth interviews were carried out with 18 patients, and the interviews were transcribed verbatim and analysed in open, axial and selective coding processes according to Grounded Theory. In the analysis, four categories were developed and labelled: 'alterations in self-image', 'becoming a deviating person', 'becoming an uncertain person' and 'becoming the person I once was'. 'Alterations in self-image' was identified as the core category and was related to the other three categories. The core category describes the changes in self-image starting with the subjects' increasingly worsened dental status, followed by a period of them having to live and cope with a denture and, finally, their living with a fixed prosthesis. The motive power for the decision to undergo treatment with a fixed prosthesis seems to be a desire to restore dental status and also to recapture attractiveness, self-esteem and a positive self-image.

Adaptation, Psychological↗
PubMed2005

The relationship between bone mineral density and the number of remaining teeth in community-dwelling older adults.

Tooth loss and osteoporosis may share common aetiologic agents which influence the process of both diseases. The purpose of this study was to evaluate the relationship between bone mineral density (BMD) of the os calcis and the number of remaining teeth, controlling the known confounding factors. Among all 70-year-old inhabitants in Niigata City, Japan, 600 people were selected randomly in order to have approximately the same number of each gender. We analysed 460 subjects. We evaluated the BMD of the os calcis using an ultrasound bone densitometer, then we counted the number of remaining teeth excluding the third molars. Stiffness is a clinical index which is calculated by the spread speed of supersonic waves. To monitor the general health condition of the subjects, serum levels of disease markers and smoking habits were also investigated. The mean number of remaining teeth for the osteopenia group (OG) and the no-osteopenia group (NOG) was 15.97+/- 9.98 and 18.31+/- 8.06, respectively in females, and 16.32+/- 9.93 and 18.12+/- 9.33, respectively in males (OG versus NOG, P=0.047 by two-way anova). In addition, stiffness was significantly associated with the number of remaining teeth (CV=-0.157, P=0.005) using linear multiple regression analysis adjusted by four other variables. In this study, there was a significant relationship between the number of remaining teeth and BMD of the os calcis.

Adipose Tissue↗