Michael C. Manz

Socioeconomic factors in adolescents' oral health: are they mediated by oral hygiene behaviors or preventive interventions?

OBJECTIVES To determine whether there is a socioeconomic status (SES) disparity in caries experience (i.e., DMFT) in an adolescent sample from Pennsylvania and to determine whether differences in oral hygiene behaviors and preventive interventions account for this disparity. METHODS A cross-sectional clinical assessment was conducted on a representative sample of 9th grade and 11th grade students across Pennsylvania. These students also completed a brief questionnaire regarding their oral hygiene behaviors. From this group of students, a random subsample of 530 parents completed a questionnaire assessing SES, fluoride exposure, and recency of receipt of dental services. DMFT was examined at two thresholds of severity: simple prevalence (DMFT > 0) and severe caries (DMFT > 3). RESULTS Using structural equation modeling, we found that lower SES was associated with higher prevalence of DMFT and higher prevalence of severe caries. Although lower SES was associated with lower rates of brushing, less use of sealants, and less recent receipt of dental services, these oral health behaviors and preventive interventions did not account for the disparities in DMFT defined by SES. CONCLUSIONS There is an SES gradient in caries experience in adolescents in Pennsylvania. Disparities in caries experience, however, cannot be accounted for by SES-associated differences in brushing, flossing, sealant use, fluoride exposure, or recency of use of dental services. To facilitate the design of preventive interventions, future research should determine the pathways through which SES-associated disparities occur.

Prevalence and severity of dental caries among American Indian and Alaska Native preschool children

OBJECTIVES To describe the Indian Health Service (IHS) oral health surveillance system and the oral health status of American Indian and Alaska Native (AI/AN) children aged 1-5 years. METHODS A stratified probability sample of IHS/tribal sites was selected. Children were screened by trained examiners at community-based locations including medical clinics, Head Start, preschools, kindergarten, and Women, Infants, and Children (WIC). Data collection was limited to the primary dentition and included number of teeth present plus number of teeth with cavitated lesions, restorations, and extracted because of decay. Number of molars with sealants and urgency of need for dental care data were also obtained. Statistical analyses were performed with SAS (SAS Institute Inc., Cary, NC, USA). Sample weights were used to produce population estimates based on selection probabilities. RESULTS A total of 8,461 AI/AN children 12-71 months of age were screened at 63 IHS/tribal sites, approximately 7 percent of the estimated IHS user population of the same age. Overall, 54 percent of the children had decay experience, 39 percent had untreated decay, 7 percent had primary molar sealants, 36 percent needed early or urgent dental care, and 6 percent needed urgent dental care. The mean of decayed, missing, or filled teeth was 3.5 (95 percent confidence interval, 3.1-3.9). The prevalence of decay experience increased with age; 21 percent of 1-year-olds and 75 percent of 5-year-olds had a history of caries. When stratified by IHS area, there were substantial differences in the oral health of preschool children. CONCLUSIONS The results confirm that in the United States, AI/AN children served by IHS/tribal programs are one of the racial/ethnic groups at highest risk of caries.

An evaluation of the Periotest system. Part I: Examiner reliability and repeatability of readings. Dental Implant Clinical Group (Planning Committee).

The clinical success of endosseous dental implants is related to the extent of osseointegration. Many of the presently used methods of evaluating osseointegration are highly subjective. The Periotest is claimed to offer a more objective means to assess osseointegration and supporting bone stability of implants by means of microcomputer-controlled percussion. Investigators involved in a clinical study on dental implants being conducted by the Dental Implant Clinical Research Group participated in a two-part in vitro evaluation of the Periotest system. The first part, with which this article is concerned, involved each of 35 investigators taking three readings for each of 16 models designed to simulate an implant in place in the oral cavity and to cover most of the effective measuring range of the instrument. The Periotest system generally demonstrated a high degree of reliability and repeatability, with higher variability associated with specific model samples. Further evaluation of the Periotest as a research instrument will be conducted within the clinical environment of the Dental Implant Clinical Research Group study. (Implant Dent 1992;1:142–146)

Radiographic assessment of peri-implant vertical bone loss: DICRG Interim Report No. 9.

Vertical bone loss is being assessed radiographically as part of the Dental Implant Clinical Research Group studies through direct measurements on study radiographs taken longitudinally at surgery and recall appointments. Preliminary results and trends for the period between implant placement and 6 months after implant uncovering show more bone loss in implants that are 1) not coated with hydroxyapatite; 2) placed in the maxilla; 3) placed in anterior regions of the jaws; 4) in completely edentulous cases; and 5) placed in bone scored as having lower quality. Confounding relationships between predictor variables will require controlled statistical analyses when data collection is completed.

Success of multiple endosseous dental Implant designs to second-stage surgery across study sites

A multicenter clinical study of dental implants is being conducted by the Dental Implant Clinical Research Group to investigate the influence of implant design, application, and site on clinical performance and crestal bone. This article reports on the percentage of success up to implant uncovering for different implant designs and the distribution of failures across study sites. Data from 2,847 implants placed at 32 study sites were analyzed. Percentages of success up to implant uncovering were calculated for study implants overall, by implant design, by implant design within study strata, and according to individual study sites and quartile groupings of sites based on success. Comparisons were made, with chi-square and exact tests employed where appropriate. Differences were found between the different implant designs for the study overall, and between implant designs within the different study strata. Although some implant designs were found to have generally high success across study sites, some study sites designated as having surgeons with less experience tended to have higher failure levels, and one implant design failed at higher rates in a subset of study sites. The percentage and distribution of implant failures varied across study sites and by implant design. These differences appeared to be in part related to the level of experience of the surgeons. Further investigation should focus on identification of factors that contribute to higher success in implant placement with different implant designs.

Relations of Serum Ascorbic Acid and α-tocopherol to Periodontal Disease

Low concentrations of serum anti-oxidants, including ascorbic acid and α-tocopherol, are associated with higher risks of many inflammatory diseases that interrelate with oral health. The present study examined the longitudinal relationship of serum ascorbic acid and α-tocopherol to periodontal disease in 224 Japanese individuals, aged 71 yrs, for whom data were available for the years 1999-2007. Participants were classified by tertiles of serum ascorbic acid and of α-tocopherol. Full-mouth periodontal status, measured as clinical attachment level (CAL), was recorded at baseline and annual follow-up examinations. The number of teeth with a loss of CAL ≥ 3 mm at any site over the study period was calculated as ‘periodontal disease events’. Poisson regression analysis was conducted to assess predictors of periodontal disease events, with serum ascorbic acid and α-tocopherol as the primary predictors of interest. The multivariate adjusted relative risks (95% confidence intervals) in the highest, middle, and lowest tertiles were 1.00 (reference), 1.12 (1.01-1.26), and 1.30 (1.16-1.47) for ascorbic acid and 1.00 (reference), 1.09 (0.98-1.21), and 1.15 (1.04-1.28) for α-tocopherol, respectively. Our findings support the hypothesis that low serum levels of ascorbic acid and α-tocopherol may be a risk factor for periodontal disease in Japanese elderly.

Dietary antioxidants and periodontal disease in community-based older Japanese: a 2-year follow-up study.

OBJECTIVE To investigate the longitudinal relationship between the intake of dietary antioxidants and periodontal disease in community-dwelling older Japanese. DESIGN A retrospective cohort study, with a follow-up of 2 years (2003-2005). Intakes of dietary antioxidants (vitamin C, vitamin E, α-carotene and β-carotene) were assessed with a validated FFQ. Participants were classified by tertile of antioxidant intake. Full-mouth periodontal status, measured as the clinical attachment level, was recorded at baseline and follow-up examinations. Periodontal disease progression was considered as loss of attachment of 3 mm or greater over the study period at the interproximal site for each tooth. Finally, the number of teeth with periodontal disease progression per person was calculated and was used as the outcome. Poisson regression analysis was conducted, with dietary antioxidants as the main exposure, to estimate their influence on the number of teeth with periodontal disease progression. SETTING Niigata City (Japan). SUBJECTS Dentate individuals aged 75 years in 2003, for whom data were available, were included in the analyses (n 264). RESULTS A higher intake of dietary antioxidants was inversely associated with the number of teeth with periodontal disease progression, controlling for other variables. The multivariate-adjusted incidence rate ratios in the first, second and third tertiles were 1·00, 0·76 (95 % CI 0·60, 0·97) and 0·72 (95 % CI 0·56, 0·93) for vitamin C; 1·00, 0·79 (95 % CI 0·62, 0·99) and 0·55 (95 % CI 0·42, 0·72), for vitamin E; and 1·00, 1·02 (95 % CI 0·81, 1·29) and 0·73 (95 % CI 0·56, 0·95) for β-carotene. CONCLUSIONS The study results suggest that higher intake of antioxidants may mitigate periodontal disease in community-dwelling older Japanese.

An evaluation of the Periotest system. Part II: Reliability and repeatability of instruments. Dental Implant Clinical Research Group (Planning Committee).

Investigators involved in a clinical study on dental implants being conducted by the Dental Implant Clinical Research Group participated in a two-part in vitro evaluation of the Periotest system. The first part involved each of 35 investigators taking three readings for each of 16 models designed to simulate an implant in place in the oral cavity and to cover most of the effective measuring range of the instrument. The second part, with which this article is concerned, was conducted by three study investigators to determine the level of agreement in readings for six different Periotest instruments. Readings were taken according to the manufacturers instructions until two coincident readings were obtained. The readings were compared to evaluate inter- and intrainstrument reliability. Instrument repeatability was evaluated by examining the number of attempts required to obtain the two coincident readings. The Periotest system generally demonstrated a high degree of repeatability and reliability, with higher variability associated with specific model samples. (Implant Dent 1992;1:221-226)

Hyposalivation and dietary nutrient intake among community‐based older Japanese

Saliva is important for maintaining oral function and regulating oral health. Reduced saliva flow rate, which is common among older adults, has been reported to be associated with perceived chewing and swallowing difficulties; however, its relationship to actual nutrient intake is unclear. The aim of the present cross‐sectional study was to evaluate the relationship between hyposalivation and nutrient intake among older Japanese adults.

Perceptions of oral health adequacy and access in Michigan nursing facilities

OBJECTIVE To determine practices and perceived access barriers (facility resources, attitudes and professional dental involvement) related to oral health by surveying directors of nursing (DONs) in Michigan nursing homes (NHs). BACKGROUND DONs are crucial to NH practice and policy, so understanding their perceptions of oral health care is vital. METHODS A 27-item questionnaire exploring aspects of oral health was mailed to all 402 Michigan NH. Descriptive statistics were calculated for response items. RESULTS Facility response rate was 32% (n = 129). Sixty-three per cent of facilities had a written dental care plan primarily co-ordinated by nursing staff and social workers. Stationary dental equipment was available in 3% of facilities. Thirty-eight per cent stated an examination by a dentist was provided to new residents. Seventy-five per cent of residents identified as needing dental treatment were likely to receive it. Of the 28% of residents receiving dental treatment beyond an examination in the past year, 28% received emergent care. Over 50% of responding DONs indicated satisfaction with how oral hygiene needs were met in their facilities. The greatest perceived barriers were willingness of general and specialty dentists to treat residents at the nursing facility and/or their private offices as well as financial concerns of the resident and/or family. Generally, greater resources were available in urban facilities, but substantial barriers to care were uniformly perceived. CONCLUSION Oral health policies and practices within Michigan NH vary, as measured by resources, attitudes, and the availability of professional care. Dental involvement in policy creation, provision of consultation, and service is limited.