Knute D. Carter

Trends in prevalence of complete tooth loss among Australians, 1979–2002

Edentulism is a key indicator of the oral health status of populations and is associated with reduced quality of life.

Time to first dental visit after initially enrolling in Medicaid and S-SCHIP.

Background:Accessing dental care is a significant problem for children in Medicaid and S-SCHIP (Separate State Childrens Health Insurance Program). Previous studies have indicated that the design of the Medicaid or S-SCHIP dental program can have an impact on the ability to use services. Objective:To evaluate the factors related to how quickly children had any dental visit and had a preventive dental visit after first enrolling in the Iowa Medicaid and S-SCHIP programs. The primary question was whether the structure of the dental plan was related to improved access to care. Methods:Iowa Medicaid and S-SCHIP dental claims and enrollment files for FY 2001 through 2003 were used to identify children who were newly enrolled in the programs and their use of dental services. Factors related to the time to a childs first dental visit were analyzed using survival analytic techniques. Results:After 6 months in the program, between 21% and 36% of children had received their first dental visit, depending on their dental plan. This increased from 39% to 56% after 1 year. Based on the survival analysis, earlier dental utilization was related to the type of plan in which the child was enrolled as well as the childs age, race, and urban/rural location. Conclusions:Children in the S-SCHIP 2 dental plan, which had an open provider network and paid dentists’ full charges, were most likely to have had a dental visit sooner after enrollment. States looking for options to improve access to dental care in their Medicaid and S-SCHIP programs should consider contracting with dental plans with these features.

Completely Isolated? Health Information Seeking Among Social Isolates

To better target messages it is important to determine where people seek their health information. Interpersonal networks are a common way most people gather health information, but some people have limited networks. Using data from the 2004 General Social Survey (N = 984), we compared social isolates and nonisolates in their health information—seeking behaviors. Results indicate that those with limited social networks are less likely to use interpersonal communication to seek health information and are also less likely to use mediated channels. The results suggest that isolates may also be suffering from a health knowledge gap.

The Importance of Efficacy Using the Extended Parallel Process Model to Examine Factors Related to Preschool-Age Children Enrolled in Medicaid Receiving Preventive Dental Visits

Early preventive dental visits are vital to the oral health of children. Yet many children, especially preschool-age children enrolled in Medicaid, do not receive early visits. This study attempts to uncover factors that can be used to encourage parents to seek preventive dental care for preschool-age children enrolled in Medicaid. The extended parallel process model was used as a theoretical framework for this research. This model suggests that people will act if the perceived threat (severity and susceptibility) is high enough and if efficacy levels (self-efficacy and response efficacy) are likewise high. Following Witte’s method of categorizing people’s perceptions and emotions into one of four categories based on levels of threat and efficacy, this article describes four groups (high threat/high efficacy, high threat/low efficacy, low threat/high efficacy, and low threat/low efficacy) of parents and how they compare to each other. Using logistic regression to model if a child had a preventive visit, results indicate that parents with low threat/high efficacy and parents with high threat/high efficacy had approximately 2.5 times the odds of having a child with a preventive oral health visit compared to parents with low threat/low efficacy, when controlling for perceived oral health status, health literacy, and child’s age. The importance of efficacy needs to be incorporated in interventions aimed at increasing preventive dental visits for young children.

Segmenting Audiences and Tailoring Messages Using the Extended Parallel Process Model and Cluster Analysis to Improve Health Campaigns

Half of all pregnancies in young adult women are unintended, but few interventions have been successful in encouraging contraceptive use. The group heterogeneity likely contributes to the lack of success. Segmenting based on theories that provide meaningful information may improve tailoring and targeting of behavioral interventions. Previous research has indicated that threat, efficacy, and fear were important factors in influencing intentions to use contraceptives; therefore, the extended parallel process model (EPPM) was used for this cluster analysis. A telephone survey of randomly selected 18- to 30-year-old women in Iowa was conducted (N = 401). The constructs of EPPM and age were used for conducting a K means cluster analysis with four clusters. The cluster analysis pointed to the importance of fear, perceived susceptibility, and age. All of the clusters had varying degrees of ambivalence about the severity of a pregnancy. Cluster 1 (27.8%) had high susceptibility, with little fear. Cluster 2 (23.8%) had high efficacy and higher fear. The third cluster (34.7%) was not fearful and had low susceptibility. The final cluster (13.8%) was younger than the other groups and had the lowest efficacy. Additional analyses were conducted to explore how the clusters varied on other variables. The clusters help campaign developers prioritize audiences and tailor messages.

Retrospective analysis of factors associated with the success of stepwise excavation procedure in deep carious lesions

BACKGROUND Recent scientific evidence regarding the stepwise excavation procedure (SWP) has not addressed the consideration of patient factors when selecting SWP as treatment for deep carious lesions (DCLs). This study assessed patient factors predicting a successful SWP defined as a tooth restored with SWP and did not result in root canal treatment or a dental extraction. METHODS SWPs completed in 626 patients without symptomatic irreversible pulpitis at the University of Iowa College of Dentistry from January 2004 through December 2012 were evaluated. Patient demographic and tooth-specific characteristics were assessed in their relationship with the main outcome. RESULTS SWPs had a 75% success rate when evaluated within 36 months of the initial treatment. Findings showed that patients who had successful SWP treatment of DCLs were somewhat younger than patients whose SWP treatment was not successful (mean age, 37.4 years and 40.5 years, respectively; odds ratio, 0.981; 95% confidence interval, 0.967 to 0.994; P = .0058). Patients who returned to their second appointment within 5 to 9 months were more likely to have a successful SWP treatment than those returning sooner than 5 months (odds ratio, 0.338; 95% confidence interval, 0.210 to 0.545; p < .0001). CONCLUSION Treatment of deep carious lesions with SWP is effective for pulp preservation and patient age may influence the outcome. PRACTICAL IMPLICATIONS Although a somewhat younger mean patient age was associated with successful treatment of DCLs, SWP can be successful regardless of patient age and clinicians should consider SWP in treating DCLs.

Survival analysis of caries incidence in African-American school-aged children: Survival analysis of dental caries

OBJECTIVES To conduct an assessment of time-dependent covariates related to dental caries of the permanent dentition among a low socioeconomic status, understudied cohort of children, incorporating time-dependent covariates through the application of extended Cox proportional hazards modeling. METHODS This study modeled the time to first cavitated dental caries in permanent teeth among school-aged children and assessed factors associated with this event. A cohort of 98 low socioeconomic status African-American children with mean age of 5.85 years at baseline was recruited in Uniontown, Alabama and followed prospectively for 6 years. None of these children had dental caries on permanent teeth at baseline, and oral examinations were performed annually. Caries-free survival curves were generated to describe time to event (having first decayed, filled, or missing permanent surface). Bivariate and multivariable extended Cox hazards modeling was used to assess the relationships between time-dependent and time-independent covariates and time to event. RESULTS Twenty-eight children (28.6 percent) had their first permanent tooth caries event during the 6-year follow-up. Multivariable results showed that greater consumption of water was associated with lower dental caries hazard, while previous primary tooth caries experience was associated with greater dental caries hazard after adjustment for frequency of consumptions of milk, added-sugar beverages, and 100 percent juice. CONCLUSIONS There was a global/overall significant caries protective effect of water consumption during the school-age period of child development.

Mutans Streptococci and Dental Caries: A New Statistical Modeling Approach

Survival analyses have been used to overcome some of the limitations encountered with other statistical analyses. Although extended Cox hazard modeling with time-dependent variables has been utilized in several medical studies, it has never been utilized in assessing the complex relationship between mutans streptococci (MS) acquisition (time-dependent covariate) and time to having dental caries (outcome). This study involved secondary analyses of data from a prospective study conducted at the University of Alabama at Birmingham. Low socioeconomic status, African-American preschool children from Perry County, AL, USA (n = 95) had dental examinations at age 1 year and annually thereafter until age 6 years by three calibrated dentists. Salivary MS tests were done at ages 1, 1.5, 2, 2.5, 3, and 4 years. The patterns of and relationship between initial MS detection (time-dependent covariate) and dental caries experience occurrence were assessed, using extended Cox hazard modeling. The median time without MS acquisition (50% of the children not having positive MS test) was 2 years. Approximately 79% of the children had positive salivary MS tests by the age of 4 years. The median caries experience survival (50% of the children not having dental caries) was 4 years. During the follow-up period, 65 of the children (68.4%) had their initial primary caries experience. Results of the extended Cox hazard modeling showed a significant overall/global relationship between initial caries experience event at any given time during the follow-up period and having a positive salivary MS test at any time during the follow-up period (hazard ratio = 2.25, 95% CI 1.06-4.75). In conclusion, the extended Cox modeling was used for the first time and its results showed a significant global/overall relationship between MS acquisition and dental caries. Further research using causal mediation analysis with survival data is necessary, where the mediator “presence of MS” is treated as a time-dependent variable.

Disparities in Wait-List Outcomes for Adults With Congenital Heart Disease Listed for Heart Transplantation Before and Since Revision of Status I Listing

Medical and surgical advances in the late 20th century that allowed the majority of children born with congenital heart disease (CHD) to survive have resulted in a shift of the burden of morbidity and mortality into adulthood. Heart failure is the leading cause of death in adults with CHD. This study aimed to address the gap in understanding of outcomes of adults with CHD who have heart failure and are listed for heart transplantation compared with those without CHD. The study analyzed data from the US Scientific Registry of Transplant Recipients database, categorized by the listing era (on/before or after January 19, 1999). The primary combined outcome was death while waiting for an organ or delisting due to worsening clinical condition. Overall, there was a significant decrease in the probability of the primary outcome in the current compared with the early era for both adults with CHD (13.2% vs 18.6%, p = 0.01) and non-CHD (12.1% vs 15.9%, p < 0.0001). However, this improvement was only observed among adults with CHD listed in Status I, whereas adults without CHD saw significant improvement in both statuses I and II. Furthermore in the current era, when compared with their non-CHD counterparts, adults with CHD continue to have worse wait-list outcomes irrespective of listing status. In conclusion, outcomes for adults with CHD listed for heart transplantation have improved since the revision of Status I listing in 1999. Despite such improvements there continues to be a significant disparity in wait-list outcomes between adults with compared with those without CHD.