Ulrich Foerster

Risk indicators of edentulism, partial tooth loss and prosthetic status among black and white middle-aged and older adults

OBJECTIVES To describe the prevalence and risk indicators of edentulism; to describe the frequencies of wearing removable dentures; to describe the prevalence and risk indicators of fixed prosthetic restorations; to test the hypothesis that fixed prosthetic restorations are most likely to have been placed in persons at lower risk for dental and periodontal diseases, and to test the hypothesis that, with dental disease, dental behaviors, dental attitudes and ability to afford crowns taken into account, blacks are less likely than whites to have received crowns. METHODS The Florida Dental Care Study is a cohort study of subjects 45 years old or older. A telephone screening interview was done as a first stage to identify 5254 subjects who met eligibility requirements and who self-reported whether they were edentulous. In a second stage, a subsample of dentate subjects was contacted after they completed their telephone screening interview. Of these, 873 subjects completed a baseline in-person interview and dental examination. RESULTS A total of 19% of first-stage subjects were edentulous. In a single multiple logistic regression, having a poorer self-rated level of general health was significantly associated with edentulism, as were being poor, older and white. Among the second-stage participants (all of whom were dentate), several prosthetic patterns were observed. For example, a total of 64% of maxillary full denture wearers reported wearing their denture all the time. Participants had also received numerous fixed prosthodontic services. The proportion of subjects with at least one crown varied widely by subject characteristics. CONCLUSIONS A substantial percentage of non-ideal frequencies of wearing removable prostheses was reported, as were prosthesis-related soreness and broken prostheses. Although we expected and observed an association between having a fixed prosthetic crown and periodontal status, dental fillings, dental attitudes and financial resources, a residual association with race suggests that blacks are much less likely to receive prosthetic crowns. The several possible reasons for this circumstance warrant further investigation.

Twenty–Four Month Incidence of Root Caries among a Diverse Group of Adults

Objectives: (1) Describe for a diverse sample the 24–month incidence of root caries, and (2) test its association with a broad range of clinical, behavioral, financial, and sociodemographic factors. Methods: The Florida Dental Care Study was a cohort study of randomly selected subjects who had at least 1 tooth and were 45 years or older at baseline. In–person interviews and clinical examinations were conducted at baseline and 24 months, with 6–monthly telephone interviews between those times; 723 subjects participated for both examinations. A multinomial logistic regression was done to predict whether the subject was in one of four mutually exclusive groups [new root decay only (NDO); new root filling(s) only (NFO); both new decay and new filling(s) (BOTH), or had neither (NONE)]. Results: Thirty–six percent of subjects had at least 1 new root decayed and/or filled surface (DFS); 17% were in the NDO group, 14% in the NFO group, and 5% in the BOTH group. When limited to participants who had a nonzero increment, the mean (SD) DFS was 2.7 (2.9). Baseline clinical condition (presence of root decay, root filling(s), coronal decay, noncarious root defects, number of teeth present, percent of teeth with at least 4 mm of attachment loss) was predictive of moving from the NONE group into the NDO, NFO, or BOTH groups. The addition of behavioral, financial, and sociodemographic factors improved model fit. For example, regular dental attenders were significantly more likely to move from the NONE group into the NFO group, but regular attendance was not associated with a lower probability of moving from the NONE group into the NDO or BOTH groups. Conclusions: Root caries is a substantive dental health problem in this diverse sample of adults. These analyses demonstrate the utility of disaggregating caries incidence into four mutually exclusive groups for predictive models.

Coronal Caries, Root Fragments, and Restoration and Cusp Fractures in US Adults

The Florida Dental Care Study is a longitudinal study of changes in oral health that included at baseline 873 subjects (Ss) who had at least 1 tooth, were 45 years or older, and participated for an interview and examination. Forty-five percent of Ss had active coronal caries; 94% of the coronal carious surfaces were primary decay, and only 6% were secondary/recurrent. Ten percent of Ss had 1 or more root fragments, 16% of Ss had 1 or more teeth with restoration fractures, and 14% of Ss had 1 or more teeth with cusp fractures. Blacks, poor persons, and irregular attenders had more caries, root fragments, and cusp fractures, even though they had significantly fewer teeth. Blacks, poor persons, and irregular attenders were not at increased risk for restoration fractures, probably because fractures were associated with dental care use. These findings regarding caries and restorative treatment needs are consistent with a substantial burden in adult high-risk groups, and are relevant for dental primary health care policy.

Twenty–Four Month Coronal Caries Incidence: The Role of Dental Care and Race

Objectives: To describe for a diverse sample of dentate middle–aged and older adults: (1) the 24–month incidence of coronal caries, and (2) its association with a broad range of clinical, behavioral, financial, attitudinal, and sociodemographic factors. Methods: The Florida Dental Care Study is a prospective observational longitudinal cohort study of 873 persons who at baseline had at least 1 tooth and were 45 years or older. In–person interviews and clinical examinations were conducted at baseline and 24 months, with 6–monthly telephone interviews between those times. A multinomial logistic regression was done to predict whether a participant was in one of four mutually exclusive groups at the 24–month examination (new decay only [NDO]; new filling(s) only [NFO]; both new decay and filling(s) [BOTH]; or neither [NONE]). Results: Only 33% of the 24–month participants were in the NONE group. There was no significant difference in caries incidence between regular attenders and problem–oriented attenders, regardless of whether teeth crowned at baseline, incident crowns, or incident root fragments were excluded. However, once differences in incident tooth loss and baseline clinical, behavioral, financial, and attitudinal differences were taken into account, regular attenders did appear to benefit by developing fewer coronal lesions and fewer dental symptoms than problem–oriented attenders. Baseline carious surfaces, filled surfaces, number of teeth, and bulk restoration fractures predicted caries incidence, but baseline cusp fractures did not. Persons with negative dental attitudes were more likely to be in the NDO and BOTH groups, and negative attitude toward brushing and flossing (but not their frequency) also predicted caries incidence. Conclusion: Certain baseline clinical conditions, approach to dental care, ability to pay for dental care, dental attitudes, race, and age group were predictive of coronal caries incidence, and regular attenders appeared to benefit from regular attendance.