Stuart A. Lockwood

Trends and differentials in mortality from cancers of the oral cavity and pharynx in the United States, 1973–1987

Background. This analysis consisted of an examination of trends and differentials in mortality from cancers of the oral cavity and pharynx in the United States for a recent 15‐year period.

Occupational blood exposures in dentistry: a decade in review.

This review summarizes data from self-reported and observational studies describing the nature, frequency, and circumstances of occupational blood exposures among US dental workers between 1986 and 1995. These studies suggest that, among US dentists, percutaneous injuries have declined steadily over the 10-year period. Data also suggest that, in 1995, most dental workers (dentists, hygienists assistants, and oral surgeons) experienced approximately three injuries per year. Work practices (eg, using an instrument instead of fingers to retract tissue), safer instrumentation or design (eg, self-sheathing needles, changes in dental-unit design), and continued worker education may reduce occupational blood exposures in dentistry further.

Percutaneous injuries during oral and maxillofacial surgery procedures

PURPOSE This study estimated the frequency of percutaneous injuries (Pls) to dental health-care workers during oral and maxillofacial surgery and examined the circumstances surrounding the incidents. MATERIAL AND METHODS A self-reported, prospective study was conducted to document Pls incurred during oral and maxillofacial surgery performed on outpatients and inpatients over 1-month and 6-month periods, respectively. Among the study variables examined were the numbers of patients treated, number and types of procedures performed, duration of treatment, numbers and types of health care workers at risk, treatment setting, and number of injuries. RESULTS Four injuries were recorded during 362 operating room procedures on 236 inpatients, for a rate of 1.1 Pls per 100 procedures (95% confidence interval: 0.3 to 2.8) and 1.7 Pls per 100 patients (95% confidence interval: 0.5 to 4.6). These four injuries occurred during 1,665 person-procedures (mean number of workers present at each procedure times the total number of procedures) for a rate of 0.24 Pls per 100 person-procedures (95% confidence interval: 0.1 to 1.0). Three injuries took place during fracture reductions; two were caused by surgical wire and the third by a needlepoint Bovie tip. One injury occurred during orthognathic surgery and involved a Woodson elevator. Residents recorded no injuries while treating 521 outpatients (0 Pls per 100 patients; 95% confidence interval: 0 to 0.6). CONCLUSION The results support previous findings that Pls rarely occur during outpatients oral and maxillofacial surgery procedures. However, the findings suggest that operating room procedures for oral and maxillofacial surgery that use wire or involve fracture reduction may be associated with an increased risk of injury. Strategies such as using a cork or sponge to cap sharp wires or instruments, and protecting hands and fingers by double gloving, may be used to decrease the risk of Pl.

Occupational blood exposure and HIV infection among oral and maxillofacial surgeons

OBJECTIVE The purpose of this study was to examine occupational blood exposure and the seroprevalence of HIV infection among oral and maxillofacial surgeons. STUDY DESIGN Three hundred twenty-one oral and maxillofacial surgeons attending an annual meeting voluntarily and anonymously participated in an HIV serosurvey and completed a questionnaire assessing practice and demographic factors. Statistical tests included the Wilcoxon rank-sum test and the chi-squared test. RESULTS Eighty percent of those who completed the survey reported one or more blood-skin contacts within the previous month. The mean number of percutaneous injuries within the previous year was 2.36 +/- 0.2. Wire was most commonly associated with percutaneous injuries. Oral maxillofacial surgeons who reported three or more percutaneous injuries performed more fracture reductions than oral and maxillofacial surgeons reporting no percutaneous injuries (p < 0.01). No participant was HIV-positive; the upper limit of the 95% confidence interval was 1.15%. CONCLUSION The findings suggest that the occupational risk for HIV infection in oral surgery is very low even though most oral and maxillofacial surgeons experienced blood contact. Associations of percutaneous injuries with fracture reductions and wire may assist in the development of new techniques and equipment to minimize blood exposures.

Factors Associated with Hepatitis B Vaccine Response Among Dentists

The objective of this study was to evaluate personal and immunization factors associated with serologic evidence of hepatitis B virus (HBV) vaccine response. A study was conducted using data from United States dentists participating from 1987 to 1991 in the Health Screening Program of the American Dental Associations annual session. This study included dentists (n = 507) who (1) received their most recent dose of HBV vaccine within the previous 10 months, (2) completed a core questionnaire, and (3) were tested for HBV markers (HBsAg, anti-HBs, and anti-HBc) and were found not to have evidence of past or present infection. Non-responders were defined as dentists testing negative for all three markers (n = 100). Responders were defined as dentists having serological evidence of anti-HBs alone (n = 407). Logistic regression models were used to assess the relationship of vaccine response to the variables sex, age, number of vaccine doses, site of vaccination, type of vaccine, and history of hepatitis. Vaccine response was most strongly associated with sex, age, and number of doses. Factors unrelated to vaccine response included type of vaccine and history of hepatitis. Adherence to the recommended number of doses and early vaccination are critical to adequate protection against hepatitis B infection of dentists, who are often exposed to blood and other body fluids.

Impact of increasing Medicaid dental reimbursement and implementing school sealant programs on sealant prevalence.

UNLABELLED We examined the impact of two financing strategies--increasing Medicaid dental reimbursements and providing school sealant programs--on dental sealant? prevalence (number of children with at least one sealant) among 7- to 9-year-olds in Alabama and Mississippi counties from 1999 to 2003. METHODS We used Medicaid claims data in a linear regression model. We regressed number of children sealed per county onto eligible children, median family income, dentist-to-population ratio, and indicator variables for reimbursement increase, presence of community health center (CHC) or school sealant program, and interaction between reimbursement increase and presence of school program or CHC. We also calculated the average incremental cost per sealant from increasing the Medicaid reimbursement rate and then disaggregated it into cost to provide additional sealants and cost to provide the same number of sealants under the higher rate. RESULTS Increasing the sealant reimbursement rate was associated with a 102 percent increase and a 39 percent increase in sealant prevalence in Mississippi and Alabama, respectively. Introducing school sealant programs more than doubled sealant prevalence in both states. In Mississippi, 85 percent of the average incremental cost from implementing the higher reimbursement rate was due to providing new sealants and 15 percent was due to paying a higher rate for sealants that likely would have been delivered at the old rate. CONCLUSION Depending on supply and demand conditions in dental markets, both strategies can be effective in increasing sealant prevalence.