Carlos F. Salinas

Disparities in Dental Insurance Coverage and Dental Care Among US Children: The National Survey of Children's Health

OBJECTIVES We sought to understand disparities in dental insurance coverage and dental care among US children by race/ethnicity, urban/rural residence, and socioeconomic status. METHODS Linked data from the National Survey of Childrens Health and Area Resource File were analyzed (N = 89 071). Multiple logistic regression analysis was used to adjust for confounders. RESULTS A total of 22.1% of US children lacked parentally reported dental insurance coverage in the preceding year, 26.9% did not have a routine preventive dental visit, and 5.1% had parentally perceived unmet need for preventive dental care. US born minority children were less likely to lack dental insurance than US-born white children; however, foreign-born Hispanic children were more likely to be uninsured. Rural children were more likely to be uninsured than urban children. Children with health insurance were more likely to have dental coverage. Children who lacked dental insurance were less likely to have received preventive care and more likely to have unmet need for care. Compared with US-born white children, all minority children were less likely to receive preventive care. These disparities were exacerbated among foreign-born children. Fewer race-based disparities were found for unmet need for dental care. Only black children, both US and foreign-born, had higher odds of unmet need for preventive services than US-born white children. Poor dental health was strongly associated with unmet need. Disparities in dental insurance coverage and dental care are also evident by family socioeconomic status. CONCLUSIONS Poor and minority children were less likely to receive preventive dental care, even when insurance status was considered. Rural children were less likely to have dental insurance than urban children. Foreign birth affected insurance status for Hispanic children and use of preventive services for all minority children.

Periodontal Disease Status in Gullah African Americans With Type 2 Diabetes Living in South Carolina

BACKGROUND African Americans have a disproportionate burden of diabetes. Gullah African Americans are the most genetically homogeneous population of African descent in the United States, with an estimated European admixture of only 3.5%. This study assessed the previously unknown prevalence of periodontal disease among a sample of Gullah African Americans with diabetes and investigated the association between diabetes control and the presence of periodontal disease. METHODS Two hundred thirty-five Gullah African Americans with type 2 diabetes were included. Diabetes control was assessed by percentage of glycosylated hemoglobin (HbA1c) and divided into three categories: well controlled, <7%; moderately controlled, 7% to 8.5%; and poorly controlled, >8.5%. Participants were categorized as healthy (no clinical attachment loss [AL] or bleeding on probing) or as having early periodontitis (clinical AL > or =1 mm in at least two teeth), moderate periodontitis (three sites with clinical AL > or =4 mm and at least two sites with probing depth [PD] > or =3 mm), or severe periodontitis (clinical AL > or =6 mm in at least two teeth and PD > or =5 mm in at least one site). Observed prevalences of periodontitis were compared to rates reported for the National Health and Nutrition Examination Survey (NHANES) studies. RESULTS All subjects had evidence of periodontal disease: 70.6% had moderate periodontitis and 28.5% had severe disease. Diabetes control was not associated with periodontal disease. The periodontal disease proportions were significantly higher than the reported national prevalence of 10.6% among African Americans without diabetes. CONCLUSION Our sample of Gullah African Americans with type 2 diabetes exhibited a higher prevalence of periodontal disease compared to African Americans, with and without diabetes, as reported in NHANES III and NHANES 1999-2000.

Oral health knowledge and behavior among adults with diabetes.

The purpose of this study was to determine levels of oral health knowledge and factors associated with adequate oral health knowledge in adults with diabetes. A convenience sample of 253 adult US residents with diabetes completed an oral health survey to assess their knowledge. Results showed that only 47% of the participants answered five or more (out of a maximum of seven) oral health knowledge items related to diabetes correctly. Participants who received oral health information related to diabetes have 2.9 times the odds of possessing adequate oral health knowledge (i.e., answered five or more items correctly) compared to participants who did not received that information controlling for education and race (OR=2.86, 95% CI 1.31-6.24, P=0.008). Given that oral health information provided by health professionals (dental and/or medical) contributes to improve oral health knowledge among adults with diabetes, health professionals should take the opportunity to educate patients with diabetes about the oral manifestations (e.g., dry mouth) and complications (e.g., periodontitis and oral candidiasis) of diabetes and to promote proper oral health behaviors.

A new Seckel‐like syndrome of primordial dwarfism

Seckel syndrome is a rare, recessively inherited disorder of severe growth retardation and distinct craniofacial, orodental, and skeletal anomalies. Even though there are well-established minimum diagnostic criteria for this syndrome, controversy exists about its boundaries and criteria for exclusion. We studied 2 remarkably similar, unrelated children with most of the clinical and radiographic manifestations of Seckels original patient. Although their craniofacial and orodental anomalies are typical of Seckel syndrome, 1 child has unusual appearance of the hands and feet that have not been previously associated with it. This patient appears to define a new Seckel-like syndrome and suggests heterogeneity in this type of primordial dwarfism.

Factors that limit access to dental care for adults with spinal cord injury.

This study investigated dental care service utilization among adults with spinal cord injury (SCI) and identified barriers and other factors affecting utilization among this population. There were 192 subjects with SCI who participated in the oral health survey assessing dental care service utilization and they were compared with subjects from the 2004 Behavioral Risk Factors Surveillance System (BRFSS). There was no significant difference in the proportion of subjects with SCI who visited the dentist for any reason in the past year compared to the general population (65.5% vs. 68.8%, p= .350). However, subjects with SCI were less likely to go to the dentist for a dental cleaning in the past year compared to the general population (54.6% vs. 69.4%, p < .001). The three most commonly reported barriers to accessing dental care were cost (40.1%), physical barriers (22.9%), and dental fear (15.1%). Multivariate modeling showed that physical barriers and fear of dental visits were the two significant factors deterring subjects from dental visits in the past year. Physical barriers preventing access to dental facilities and dental fear are prevalent and significantly impede the delivery of dental health care to adults with SCI. Dentists should undertake necessary physical remodeling of their facilities to accommodate wheelchair users and implement appropriate strategies for the management of dental fear among patients with SCI.

2008 International Conference on Ectodermal Dysplasias Classification: conference report.

There are many ways to classify ectodermal dysplasia syndromes. Clinicians in practice use a list of syndromes from which to choose a potential diagnosis, paging through a volume, such as Freire‐Maia and Pinheiros corpus, matching their patients findings to listed syndromes. Medical researchers may want a list of syndromes that share one (monothetic system) or several (polythetic system) traits in order to focus research on a narrowly defined group. Special interest groups may want a list from which they can choose constituencies, and insurance companies and government agencies may want a list to determine for whom to provide (or deny) health‐care coverage. Furthermore, various molecular biologists are now promoting classification systems based on gene mutation (e.g., TP63‐associated syndromes) or common molecular pathways. The challenge will be to balance comprehensiveness within the classification with usability and accessibility so that the benefits truly serve the needs of researchers, health‐care providers, and ultimately the individuals and families directly affected by ectodermal dysplasias. It is also recognized that a new classification approach is an ongoing process and will require periodical reviews or updates. Whatever scheme is developed, however, will have far‐reaching application for other groups of disorders for which classification is complicated by the number of interested parties and advances in diagnostic acumen. Consensus among interested parties is necessary for optimizing communication among the diverse groups whether it be for equitable distribution of funds, correctness of diagnosis and treatment, or focusing research efforts.

Factors associated with oral problems among adults with spinal cord injury.

Abstract Objective: To explore factors associated with self-reported current oral (tooth and gum) problems and oral pain in the past 12 months among adults with spinal cord injury. Methods: An online oral health survey on the South Carolina Spinal Cord Injury Association website. Respondents were 192 adult residents of the US who identified themselves as having spinal cord injury at least 1 year before the survey date. Results: Approximately 47% of respondents reported having oral problems at the time of the survey, and 42% reported experiencing oral pain in the 12 months before the survey date. Multiple predictor analyses (controlling for age, gender, income, and dental insurance) indicated that current oral problems were positively associated with dry mouth symptoms, financial barriers to dental care access, smoking, and paraplegia. Oral pain experienced in the past 12 months was positively associated with dry mouth symptoms, financial barriers to dental care access, minority race, and paraplegia. Conclusions: Adults with spinal cord injury reported a high prevalence of oral problems and oral pain. Those with paraplegia were more likely to report problems than those with tetraplegia. Because dry mouth and smoking were significantly associated with these problems, patient education from both dental and medical providers should emphasize awareness of the side effects of xerostomia-causing medications, dry mouth management, and smoking cessation. Findings also indicate unmet needs for low-cost preventive and treatment dental services for this vulnerable population.

Active and Suppressor T Cells: Diminution in a Patient with Dyskeratosis Congenita and in First-Degree Relatives

Active, total and nonspecific suppressor T cells were studied in a 15-year-old black male with dyskeratosis congenita syndrome, a precancerous mucosal disease, and in 7 siblings and several other relatives in three generations. The propositus and 1 elder sister, products of a second-cousin marriage, died with dyskeratosis congenita. The mother had dermatomyositis, and the maternal grandmother and her sister reportedly had rheumatoid arthritis. Studies of available siblings, father, and grandparents revealed a high incidence of deficiency in number of active and/or suppressor T cells, sometimes severe enough to result in a decrease in total T cells. The patient had many stigmata of precocious aging, as did the sibling who died with the same syndrome. The laboratory data suggest that a defect in cell-mediated immunity, involving mainly or exclusively suppressor T cells, is associated with, and is presumably the cause of, precocious aging; perhaps an abiotrophy in this cell subpopulation results in physiologic aging.

Factors Associated with Toothache among African American Adolescents Living in Rural South Carolina

The aim of this study is to explore behavioral factors associated with toothache among African American adolescents living in rural South Carolina. Using a self-administered questionnaire, data were collected on toothache experience in the past 12 months, oral hygiene behavior, dental care utilization, and cariogenic snack and nondiet soft drink consumption in a convenience sample of 156 African American adolescents age 10 to 18 years living in rural South Carolina. Univariable and multivariable logistic regression analyses were used to assess the associations between reported toothache experience and sociodemographic variables, oral health behavior, and snack consumption. Thirty-four percent of adolescents reported having toothache in the past 12 months. In univariable modeling, age, dental visit in the last 2 years, quantity and frequency of cariogenic snack consumption, and quantity of nondiet soft drink consumption were each significantly associated with experiencing toothache in the past 12 months (all p values < 0.05). Multivariable logistic regression analysis indicated that younger age, frequent consumption of cariogenic snacks, and number of cans of nondiet soft drink consumed during the weekend significantly increased the odds of experiencing toothache in the past 12 months (all p values ≤ 0.01). Findings indicate age, frequent consumption of cariogenic snacks, and number of cans of nondiet soft drinks are related to toothache in this group. Public policy implications related to selling cariogenic snacks and soft drink that targeting children and adolescents especially those from low income families are discussed.

An evaluation of serum albumin, root caries, and other covariates in Gullah African Americans with type-2 diabetes

OBJECTIVES Associations between dental conditions and overall health have been previously reported. Investigators have also shown significant inverse relationships between serum albumin (a general health status marker) and root caries. This relationship was explored among a study population of Gullah African Americans (who have a considerably lower level of non-African genetic admixture when compared to other African American populations) with type-2 diabetes (T2DM) and self-reported history of normal kidney function (N=280). METHODS Root caries indices were defined as total decayed and/or filled root surfaces. The coronal caries index [total decayed, missing, and/or filled coronal surfaces (DMFS)], level of glycemic control, total number of teeth, and other covariates were also evaluated. Logistic regression models were used to evaluate the associations between these factors and hypoalbuminemia (serum albumin concentrations <4 g/dl). RESULTS Serum albumin concentrations ranged 2.4-4.5 g/dl (mean=3.8, SD=0.3), with 70.4% exhibiting hypoalbuminemia. Root caries totals ranged 0-38 (mean=1.3, SD=4.5) surfaces decayed/filled, while total teeth ranged 1-28 (mean=19.4, SD=6.2). DMFS totals ranged 2-116 (mean=55.2, SD=28.0). We failed to detect significant associations for root caries; however, the final multivariable logistic regression models showed significant associations between hypoalbuminemia and total teeth [odds ratio (OR)=0.93, P=0.01], poor glycemic control (OR=2.49, P<0.01), elevated C-reactive protein (OR=1.57, P<0.01), glomerular filtration rates ≥60 (OR=0.31, P=0.03), and age (OR=0.97, P=0.03). CONCLUSIONS Previously reported inverse relationships between serum albumin and root caries were not evident in our study population. We propose that these null findings are because of the considerably lower level of root caries as well as other differing characteristics (including oral health status, the chronic presence of T2DM, and predominantly younger age) within our study population compared to these previously assessed groups.