Marita R. Inglehart

Effect of 5% fluoride varnish application on caries among school children in rural Brazil: a randomized controlled trial

OBJECTIVES To determine the efficacy of 5% sodium fluoride (NaF) varnish application in reducing caries increments in the permanent dentition of rural Brazilian school children over the course of 12 months. METHODS A double-blind, randomized, placebo-controlled trial was conducted with 379 children aged 7-14 years who attended three schools in Brazil between January 2006 and December 2007. During this period, each school was visited four times at 6-month interval for recruitment, dental examinations, and fluoride varnish applications. Recruited children were randomly assigned to either a treatment (5% NaF varnish, n = 198) or a control group (placebo, n = 181). Trained interviewers collected data on oral health habits and sociodemographic characteristics from the children. Information on the childs diet was collected through a 7-day food frequency diary. Caries examinations were conducted using the International Caries Detection and Assessment System (ICDAS). The efficacy of fluoride varnish application on caries prevention was reported as a preventive fraction (PF). Crude caries increments of decayed and filled surfaces (DFS) were compared between fluoride varnish and placebo groups. A generalized linear model (GLM) was constructed to test the differences in DFS increments between the groups after accounting for confounding factors. RESULTS Of the total sample (N = 379), 210 (55.4%) children had completed 12 months of follow-up including one or two applications of fluoride varnish or placebo. At the baseline examination, the children in the treatment and control groups presented on average 6.2 and 5.6 DFS, respectively (P < 0.001). After 12 months of follow-up, the children in the varnish group showed significantly lower DFS increments than did children in the control group (10.8 versus 13.3; P < 0.007), with PF of 40% (95% CI: 34.3-45.7%; P < 0.0001). CONCLUSIONS The results of this study suggest that applications of 5% NaF varnish can be recommended as a public health measure for reducing caries incidence in this high-caries-risk population.

Choosing Academia Versus Private Practice: Factors Affecting Oral Maxillofacial Surgery Residents' Career Choices

PURPOSE This study explored how residents who intend to enter private practice versus academic careers differ in their background and educational characteristics, engagement in different professional activities, professional values, and satisfaction. MATERIALS AND METHODS Survey data were collected from 257 residents in oral and maxillofacial surgery programs in the United States. The responses of the respondents who planned a career in private practice (65%) and who considered academia (35%) were compared with χ(2) and independent-sample t tests. RESULTS Residents who considered academia were more likely to be women (29% vs 8%; P < .001), from non-European American backgrounds (37% vs 20%; P = .006), were less likely to be married (43% vs 71%; P < .001), and were less likely to have children (17% vs 40%; P < .001) than residents who planned to become private practitioners. A larger percentage of residents with interest in private practice reported having debts of

Providing Care for Underserved Patients: Periodontists' and Periodontal Residents' Educational Experiences, Attitudes, and Behaviors

301,000 to

Reverberation Theory: Stress and Racism in Hierarchically Structured Communities

400,000 compared with the percentage of residents interested in academia. No differences were found in the way they financed their education or in their financial considerations. However, the 2 groups differed in the importance they placed on different characteristics of their professional lives and in their job-related satisfaction. Residents interested in academia responded less positively to the statement that they are extremely satisfied with their career compared with residents interested in private practice. Future clinicians placed a higher value on having manageable hours and more time performing outpatient procedures than future educators. CONCLUSIONS These findings showed, first, that the characteristics at the beginning of residency programs that are likely to indicate an increased interest in academic careers are being a woman, from a non-European American background, and having an interest in research. Second, once residents are admitted, different types of surgeries and different types of professional activities tend to appeal to residents who want to practice in private practice settings versus work in academia. Third, residents interested in academia have a relatively lower level of satisfaction compared with residents interested in practicing outside of academia.

Periodontal Health in Women With Early-Stage Postmenopausal Breast Cancer Newly on Aromatase Inhibitors: A Pilot Study

BACKGROUND Patients with special health care needs (SHCNs) and patients from underrepresented minority and/or low socioeconomic backgrounds are more likely to have problems accessing oral health care services. The objectives of this study are: 1) to explore how well the dental education of periodontists prepared them to treat these underserved patients, 2) to assess related professional attitudes and confidence when treating these patients as well as professional behaviors, and 3) whether educational experiences are related with attitudes, confidence, and behaviors in this context. METHODS Survey data were collected from a randomly selected sample of 291 members of the American Academy of Periodontology (AAP) and 64 periodontal residents. RESULTS Overall, large percentages of residents agreed that their predoctoral and graduate dental educations had prepared them well to treat patients with special needs (predoctoral education: 58%; clinical graduate education: 45%; and classroom-based graduate education: 37%), from different ethnic/racial backgrounds (predoctoral education: 74%; clinical graduate education: 74%; and classroom-based graduate education: 60%), and on Medicaid (predoctoral education: 60%; clinical graduate education: 61%; and classroom-based graduate education: 42%). Practicing clinicians were least positive about their educations. Students were more positive about treating patients on Medicaid and pro bono cases than practicing clinicians. However, the two groups did not differ in their confidence when treating underserved patients. The quality of predoctoral and graduate educations regarding underserved patients correlates with the attitudes, confidence, and behaviors of providers concerning providing care for these patients. CONCLUSIONS The findings of this study stress the importance of preparing future periodontists in their predoctoral and graduate programs for providing care for underserved patients such as patients with SHCNs. The better that dental education prepares future periodontists to provide care for underserved patients, the more confident periodontists will be when encountering these patients in their own practices and the more likely they will be to contribute to reducing disparities in oral health care access in the United States by treating these patients.

Implant Associated Soft Tissue Defects in the Anterior Maxilla: A Randomized Control Trial Comparing Subepithelial Connective Tissue Graft and Acellular Dermal Matrix Allograft

In the 21st century, historians of the social sciences and particularly psychology might look back and conclude that two research topics, stress and racism, received an exorbitant amount of attention in the 20th century. They might argue that this scientific interest reflected the fact that these two issues — stress and ethnic and racially based conflicts — were of central personal, social and political significance in this era. While researchers engage in specific, relatively isolated analyses of these issues, however, a person living in the 20th century will not experience these two problems in the neatly compartmentalized way that researchers treat them. Quite the contrary, on a personal as well as on a community level, stress and racism are uniquely intertwined. In this chapter we propose that it is time for social scientists to recognize the intimate intermingling among community stress, racial and ethnic conflict, and racism and to bring together these concepts in one theoretical framework.

Periodontal health, perceived oral health, and dental care utilization of breast cancer survivors

BACKGROUND Aromatase inhibitor (AI) use results in low estrogen levels, which in turn affect bone mineral density (BMD). Periodontitis, alveolar bone loss, and tooth loss are associated with low BMD. The goal of this study is to assess the prevalence of periodontitis and perceived oral health and evaluate salivary biomarkers in postmenopausal women who are survivors of early-stage (I to IIIA) breast cancer (BCa) and receive adjuvant AI therapy. METHODS Participants included 58 postmenopausal women: 29 with BCa on AIs and 29 controls without BCa diagnoses. Baseline periodontal status was assessed with: 1) periodontal probing depth (PD); 2) bleeding on probing (BOP); and 3) attachment loss (AL). Demographic and dental utilization information was gathered by questionnaire. Linear regression modeling was used to analyze the outcomes. RESULTS No differences were found in mean PD or number of teeth. The AI group had significantly more sites with BOP (27.8 versus 16.7; P = 0.02), higher worst-site AL (5.2 versus 4.0 mm; P <0.01), and more sites with dental calculus (18.2 versus 6.4; P <0.001) than controls. Linear regression adjusted for income, tobacco use, dental insurance, and previous radiation and chemotherapy exposure demonstrated that AI use increased AL by >2 mm (95% confidence interval, 0.46 to 3.92). Median salivary osteocalcin and tumor necrosis factor-α levels were significantly higher in the AI group than the control group. CONCLUSION This first investigation of the periodontal status of women initiating adjuvant AI therapy identifies this population as having an increased risk for periodontitis.

Patient-Centered Perspectives and Understanding of Peri-Implantitis

Introduction:This randomized controlled clinical pilot trial compared the efficacy of 2 soft tissue grafting methods for correcting esthetic discrepancies associated with definitively restored implant crowns. Methods:Thirteen patients presenting with implants displaying recession, thin biotype, concavity defects, or a combination thereof associated with single crowned dental implants randomly received subepithelial connective tissue grafts (SCTG) in the control group (N = 7) or acellular dermal matrix (ADM) allografts in the test group (N = 6), both under coronally positioned flaps. Data regarding soft tissue, hard tissue, esthetics, and quality of life (QoL) parameters were collected over 6 months. Results:Both groups gained tissue thickness (SCTG: 63% and ADM: 105%), reduced concavity measures (SCTG: 82% and ADM: 96%), and improved recessions (SCTG: 40% and ADM: 28%) from baseline to 6 months. Clinicians determined improvement in esthetics for both groups (P = 0.001), unlike patients who did not change their esthetic ratings. No statistical differences were noted for QoL assessment; however, ADM subjects had more eventful wound healing (P = 0.021). Conclusions:Within the limitations of this study, both SCTG and ADM result in increased mucosal thickness, reduction in concavity dimensions, and have a potential for recession reduction on definitively restored dental implants.

Interactions Between Patients and Dental Care Providers: Does Gender Matter?

OBJECTIVES This population-based analysis examined the prevalence of periodontal diseases along with the self-perceived oral health and patterns of dental care utilization of breast cancer survivors in the United States. METHODS Data from the 1999-2004 National Health and Nutrition Surveys were utilized, examining information from 3,354 women between 50 and 85 years of age. Primary outcomes were gingivitis and periodontitis, self-perceived oral health, and dental care utilization. Logistic regression analyses were used to estimate relationships of breast cancer diagnosis and primary outcomes while controlling for confounding factors. RESULTS Breast cancer survivors were more likely to be older than 55 years, white, nonsmokers, have higher levels of education and income, and a higher prevalence of osteoporosis. Breast cancer survivors were significantly less likely to have dental insurance (P = 0.04). Utilization of dental services and reason for last dental visit did not significantly differ between groups. A history of a breast cancer diagnosis did not increase the odds of gingivitis [odds ratio (OR):  1.32; 95 percent confidence interval (CI): 0.53-3.63], periodontitis (OR: 1.82; 95 percent CI:  0.89-4.01), or poor self-perceived oral health (OR: 0.89; 95 percent CI: 0.61-1.33) after adjusting for age, race, education, dental care utilization, and smoking status. CONCLUSIONS In this sample, a history of breast cancer does not significantly impact periodontal health, self-perceived oral health, and dental care utilization. However, efforts should be made to assure that breast cancer survivors have dental insurance.

Oral health-related concerns, behavior, and communication with health care providers of patients with breast cancer: impact of different treatments

BACKGROUND Patients undergoing dental treatment have an uncertain understanding about dental implant therapy and its complications. Therefore, the aims of this study assess the following: 1) level of knowledge, awareness, and attitudes about peri-implantitis; 2) information provided by dentists/specialists who perform the treatment; and 3) perceptions, level of satisfaction, and impact on patient quality of life (QoL). METHODS Patients with implant restorative therapy currently undergoing peri-implant maintenance therapy were recruited. Participants completed an anonymous questionnaire that included general aspects of prognosis, including the following: 1) peri-implantitis; 2) etiology; 3) awareness; 4) attitudes; 5) treatment; 6) prevention; 7) risk factors; 8) quality of information; 9) level of patient satisfaction; and 10) QoL. Associations among questionnaire data were identified using univariate and multivariate analyses. RESULTS Overall, 411 implants were included from 135 patients with implants. Frequency of peri-implantitis in the survey was 17.8% at the participant level, with 70% of them reporting high level of post-surgical satisfaction. Worry and concern were frequent findings among patients with peri-implantitis (64%), and 32% reported that living with the disease was terrible. The vast majority of patients (74.1%) did not have knowledge about peri-implant pathology. Patients with peri-implantitis showed statistically significantly better understanding of implant therapy (P <0.001) and also higher average concern (P = 0.004). CONCLUSIONS Patients generally have a poor understanding and perception of peri-implantitis and its impact. QoL was impaired by the presence of peri-implantitis with high level of concern and low level of therapeutic satisfaction. Therefore, it is important to develop standardized information brochures to educate patients on risk factors and indicators of the disease to assist in the prevention of peri-implantitis.