Women's oral health awareness and care-seeking characteristics: a pilot study

The authors designed a pilot study to examine issues that affect women's oral health. They found a substantial lack of awareness regarding important oral health issues, and that 44 percent of the participants reportedly did not have regular dental care. High perceived dental need was reported concurrently with low dental care attendance. Additionally, reported lack of dental insurance and self-perception of low income and of poor dental health were important explanatory factors for the women who reportedly did not have regular dental care.     

Dental knowledge, attitudes towards oral health care and utilization of dental services among male industrial workers with or without an employer-provided dental benefit scheme

In industrialized countries various dental benefit schemes have been implemented to improve the utilization of dental services, though few studies have demonstrated that effect. Prior to a comprehensive clinical study in southern Finland, a postal questionnaire survey of male industrial workers (age 38-65 yrs) was conducted to investigate knowledge and attitudes concerning oral health care and whether access to an employer-provided dental benefit scheme was associated with the utilization of dental services. The response rate was 81% (n = 325) in the subsidized group and 69% (n = 174) in the control group. In both groups, 60% of the subjects had had their last dental visit within a year but 91% of the subsidized workers compared to 79% of the controls had visited a dentist in the past two years (P < 0.001). The subjects had similar attitudes towards the importance of regular dental care and its implications for dental and general health. Subsidization explained the disparity in the current dental visiting pattern between the groups better than the possibility of using working hours for dental visits. Backward stepwise logistic regression revealed that the probability of a dental visit within the past two years was positively associated with access to an employer-provided dental benefit scheme, tooth brushing to maintain dental health, and number of teeth, and negatively associated with number of carious teeth. Our results demonstrate a positive impact of subsidization on the utilization of dental services.     

Absorption and elimination kinetics of zidovudine in the cerebrospinal fluid in HIV-1-infected patients

The first two surveys of the dental health of young Finnish men were conducted in 1919 and 1965. The objective of four subsequent surveys (1976, 1981, 1986, and 1991) was to collect both interview and clinical examination data for the monitoring of changes in the oral health status of the recruits. A significant reduction in self-reported toothache, gingival bleeding, and number of decayed teeth was observed from 1976 to 1991. At examination, the numbers of decayed teeth, teeth indicated for extraction, teeth in need of fillings, and missing teeth decreased substantially, as did the teeth with visible plaque, subgingival calculus, and teeth with 4-mm or deeper periodontal pockets. This comprehensive series of successive cross-sectional oral health surveys clearly shows that since 1976 a significant decrease in oral disease and treatment needs has taken place among the Finnish population of young men.     

An experimental test of adolescents' compliance with dental appointments

This study assessed factors associated with adolescents' compliance with dental appointments. Patients (n = 162) attending an adolescent clinic were administered a pretest questionnaire assessing health locus of control, self-esteem, and beliefs and attitudes about dental health from the Health Belief Model. Adolescents needing dental care were randomly assigned to groups for whom their dental appointment was made by a health professional or one in which the patient made his or her own appointment and to groups receiving an appointment reminder card versus not receiving a reminder card. Dental records were then reviewed to examine previous experiences with dental treatment. Neither the method used for making the appointment nor the use of reminder cards had a significant effect on compliance with the dental appointments. Also, compliance was not associated with health locus of control, self-esteem, or variables from the Health Belief Model. Older patients were more noncompliant than younger patients (tau = 0.14). Noncompliance was negatively correlated with the number of previous dental visits and previous dental procedures, oral hygiene instruction, and x-rays. Number of previous x-rays and previous broken appointments explained 5.1% of the variation in noncompliance. The Health Belief Model was not successful in predicting compliance behavior in this sample of adolescents.     

Legal abortion in Denmark during the past 25 years: aspects of public health and ethics

The present study was designed to investigate the relationship between self-reported oral handicap as measured by socio-dental indicators and both dental state and felt need for dental treatment in a group of frail and functionally dependent older adults. A total of 263 housebound adults over the age of 60 years were investigated with regard to their self-reported dental handicap using the socio-dental indices derived by Locker (Community Dent Health 1992;9:109-24). Of these, 117 were in long-stay residential facilities, 67 in sheltered housing and 79 in private housing. The majority were female (76%) and the largest age group comprised 81-90-year-olds (44%), while only 8% were in the youngest group of 60-70-year-olds. A high level of handicap was recorded. In the previous 4 weeks, 74% of the group experienced difficulty in chewing, 54% some other functional handicap, 22% oral pain, 72% some incident of discomfort and 30% some social problem related to their oral condition. The socio-dental indices related more to the number of teeth than to age or gender. Ability to chew five index foods was related directly to the number of teeth present (P<0.001) but unless there were more than 20 teeth present, subjects with natural teeth were more dissatisfied with their appearance than those with complete dentures (P=0.002). The 57 subjects (29%) who expressed a desire for treatment had significantly higher handicap scores (P<0.001). Thus the results indicate that there are high levels of oral handicap in frail and functionally dependent older adults that are related to both the number of natural teeth retained and desire for treatment.     

Multidimensionality of oral health in dentate adults

OBJECTIVES: An understanding of the validity and usefulness of self-reported measures (as distinct from clinically determined measures) of oral health is emerging. These self-reported measures include self-rated oral health (SROH). Three objectives were to: (1) describe self-rated oral health in dentate adults, (2) quantify associations between self-rated oral health and other measures of oral health (oral disease and tissue damage, pain and discomfort, functional limitation, and disadvantage), and (3) assess the construct validity of a model of oral health proposed herein. METHODS: The Florida Dental Care Study is a longitudinal study of oral health, which included at baseline 873 subjects who had at least one tooth, were 45 years or older, and who participated for an interview and clinical examination. RESULTS: The prevalence of self-rated oral health decrements was substantial; approximately one fourth of subjects reported their oral health as only fair or poor. Bivariate and multivariate results provided consistent evidence of the construct validity of the proposed model of oral health. Additionally, the salience of one measure of dental appearance suggests that persons may use esthetic cues when rating their oral health. CONCLUSIONS: The proposed multidimensional model of oral health has construct validity. Self-rated oral health is affected by oral disease and tissue damage, oral pain and discomfort, oral functional limitation, and oral disadvantage. These self-reported measures and the proposed model should provide useful information for dental care effectiveness research. General health status has been disaggregated into the "physical" and the "mental;" an additional separation into the "oral" aspects of health seems warranted.     

The effect of social and personal factors on the utilisation of dental services in Glasgow, Scotland

This study examined potential mediators of dental attendance among two distinct adult populations who lived in contrasting social environments (deprived and affluent). The aim of the study was to describe and quantify the effect of both the potentially modifiable and the fixed factors which influence use of dental services. A two-stage weighted random sampling technique was used to select 863 participants who were interviewed. Of these participants, 372 lived in 'affluent' areas and 491 in 'deprived' areas. The 45 minute interview explored many aspects of oral health, and related behaviour and attitudes. The results showed a highly significant association between social deprivation and reported dental attendance (P < 0.001). Social environment was also significantly related to asymptomatic dental attendance. Deprived respondents' dental behaviours were significantly affected by life events and yet structural/organisational barriers to attendance had a significantly greater impact on the affluent population's dental visiting patterns than they did on the deprived population's. A regression model indicated that the best predictors of dental attendance were social environment, dental anxiety, perceptions about denture wearers and the value placed upon restored teeth. The study suggests that the barriers to dental attendance experienced by deprived populations are not easily modifiable, but belong instead to a group which relate to the socio-political agenda. The study also demonstrates the importance of accurate and regularly updated community registers for use in population based health services research.     

African trypanosome infections in mice that lack the interferon-gamma receptor gene: nitric oxide-dependent and -independent suppression of T-cell proliferative responses and the development of anaemia

This paper presents an analysis of the main policy and organisational issues confronting dental health systems in Japan and Australia. Using the changes in the epidemiology of dental disease (the oral disease which still affects much of public dental health planning) as evidence of fundamental differences in the dental health systems of the two countries, the analysis seeks to illuminate, first, the structures and processes in both nations to review and implement changes to educational practices and workforce planning and, second, the constraints on each nation's capability to respond quickly and appropriately to the changing dental health needs. It is argued that Japan's ability to rapidly change its oral health outcomes, its dental educational system and its traditional workforce structure and service-mix, is more constrained than appears to be the case in the Australian dental system. The major barriers to Japan's ability to change appear to lie in both its traditional cultural decision-making processes and in a series of specific health and educational structures which place high reliance on a private educational system for health providers, a national insurance system which rewards treatment under a fee-for-service reimbursement scheme and the lack of a formal, transparent, infra-structure for planning health priorities. Barriers to Australia achieving culturally appropriate oral health outcomes for the next century appear more related to whether national unity in goal setting and implementation strategies can be achieved. The constraints in Australia are related to its federal system and to the low priority given to financing public dental services.     

A report on Indiana PANDA. Prevention of Abuse and Neglect through Dental Awareness

Since originally surveying Indiana dentists' knowledge of child abuse and neglect in 1990, numerous efforts have been made to help dental professionals improve their ability to identify and report instances of abuse. This article explains the purpose for the 1995 follow-up survey and why dental professionals' assistance is needed to complete the surveys. A second survey is scheduled for distribution six months after the Prevention of Abuse and Neglect through Dental Awareness (PANDA) efforts have been implemented to determine if those efforts are far having an effect throughout Indiana.     

Dental health attitudes among dentate black and white adults

OBJECTIVES: Blacks and poor persons share a greater burden of oral disease and are less likely to seek dental care on a regular basis. The role of dental attitudes and knowledge of services on this circumstance is unclear. The authors quantified group differences in dental attitudes and knowledge of services and related them to regularity of dental care use. METHODS: As part of the baseline phase of The Florida Dental Care Study, a longitudinal study of oral health, 873 respondents who had at least one tooth and who were 45 years or older participated for an interview and a clinical dental examination. Dental care use, seven dental attitudinal constructs, and knowledge of dental services were queried. RESULTS: Forty-five percent of respondents reported going to a dentist only when they have a problem, and 17% of respondents had not seen a dentist in more than 5 years. Ten percent of respondents reported that they had at least one permanent tooth removed by someone other than a dentist (typically, the respondent himself). Blacks and poor persons had more negative attitudes toward dental care and dental health and were less knowledgeable of dental services. Multivariate analyses suggested that dental attitudes were important to understanding the use of dental care services for this diverse group of adults, and that race and poverty contributed independently to dental care use even with dental attitudes taken into account. CONCLUSIONS: Dental attitudes contribute to race and poverty differences in dental care use among adults. The persistence of race and poverty effects with attitudes taken into account suggests that additional explanatory factors contribute as well. These differences may contribute to more prevalent and severe oral health decrements among the same adults who also are more likely to suffer from other health decrements.     

Prevalence of antibodies to Toxoplasma gondii in cattle and swine in The Netherlands: towards an integrated control of livestock production

V3703 (Stomadhex) is a tablet with bioadhesive properties enabling it to remain in place for several hours after it has been placed on the oral mucosa. It continuously releases chlorhexidine and niacinamide. In a study conducted in 15 dogs, the tablets were well tolerated by the animals. The product significantly reduced (p < 0.05): dental plaque; quantitative periodontopathogen and total anaerobic bacterial counts; spirochetes; and halitosis when used daily over a 14 day period. Gingivitis was also reduced, though not significantly (p = 0.07). Stomadhex treatment can provide a carry-over effect following dental scaling by reducing oral microflora and retarding the reappearance of dental plaque.     

Do workshops make a difference in improving the capability of physicians?

Continuing medical education (CME) activities have been shown to improve the capability and capacity of physicians for appropriate management of their patients. However, doubts have been raised about the role of workshops and seminars. This study is an attempt to find out whether workshops can improve the knowledge (capability) of practicing physician. Participants of 10 randomly selected workshops conducted in whole of Sindh were included for this study. A pre-test followed by post-test methodology used for 214 participants demonstrated that physicians' knowledge increased for some of the basic facts after attending the workshop. However, when their knowledge was assessed with some problem-solving approach, no significant (P < 0.05) change could be noted. It is recommended that workshops should be designed and conducted more carefully. Besides, some innovative approaches for CME should be compared with 'workshops' approach to determine their effectiveness.     

Seafaring: a risk for seamen's oral health?

Information about the oral status and dental health behavior and the working history of 369 Finnish seamen on different types of ships was gathered by means of a questionnaire. A control group of workers on shore was formed for sailors 35-44 years of age. Removable dentures were worn by 16% of the seamen. Oral disorders during the week before the study were reported by one-third. During the previous 2 years 14% of the sailors had had at least one episode of oral troubles, 15% twice and 9% three or even more times. One-third of seamen with oral trouble had needed pain-killing tablets or antibiotics. Sick leave days had been needed by 3% of respondents during the previous 2 years because of oral disorder (mean length of sick leave period was 1.4 days). The control group reported gum bleeding more often than the seafarers. Even though there were no signs of poorer dental condition in sailors than in the controls on shore, the possibility that the seafaring could constitute a risk for the oral health of seamen in other age groups cannot be excluded.     

Clinical evaluation of pulsed ND:YAG dental laser applied on oral soft tissues

This investigation was conducted to evaluate the pulsed Nd: YAG dental laser, as a surgical tool for many of the oral surgical procedures. Gingivoplasty, minor gingivectomy, operculectomy excision of pedunculated tumors, frenectomy, incision and drainage of oral abscesses, control of oral bleeding and many other procedures were included in the study. The results presented here suggest that the pulsed Nd: YAG laser can be used to cut efficiently through vascular tissues, necrotic tissues and thin pedunculated masses. So it could be considered selective but not conclusive in surgery of the oral soft tissues.     

Do health and use of services differ in residents of sheltered accommodation? A pilot study

OBJECTIVE: To compare the rates of mental health problems, disability and use of health and social services of older people living in sheltered accommodation with those of the rest of the community in the same age group. DESIGN: Door-to-door survey in randomly selected enumeration districts. The districts contained three sheltered accommodation complexes. Residents from these addresses were compared with the others. SETTING: London Borough of Islington. SUBJECTS: 700 men and women aged 65 or over. MAIN OUTCOME MEASURES: Short-CARE depression, dementia and activity scales; the Guy's/Age Concern anxiety scale; individual items detailing problems with mobility, vision and hearing; use of a number of health and social services. RESULTS: The only difference in mental health variables on univariate analysis was a greater severity of cognitive impairment and dementia symptoms in sheltered accommodation. When demographic differences were taken into account, the association with cognitive impairment became statistically insignificant. There were significant associations between residence in sheltered accommodation and several of the disability variables. Increased use of health and social services by sheltered residents remained significant after disability and living alone were taken into account. CONCLUSIONS: The residents of sheltered accommodation were more disabled than the general elderly population but, in contrast to those in residential care, did not have a great excess of mental health problems. Indeed, the possibility was raised that sheltered accommodation may protect against depression in people who live alone.     

Oral disease and physical disability in community-dwelling older persons

OBJECTIVE: The aim of this epidemiologic investigation was to determine whether poor oral health in older persons was associated with physical disability. DESIGN: The study was a cross-sectional survey involving in-home interviews and dental examinations of older persons. SETTING: A random sample of 68 cities and towns was selected from the six New England states, with stratification according to population size. PARTICIPANTS: The study sample consisted of 1,156 community-dwelling (non-institutionalized) individuals aged 70 and over, randomly selected from the Medicare beneficiary lists for each city and town. MEASUREMENTS: Oral health was assessed by three dichotomous indices: edentulism (no teeth); current caries, including either coronal or root decay; and periodontal disease, as measured by gingival pocket depth. Physical disability was indicated by the subject's self-report of difficulty in the areas of personal care (eating, bathing, dressing, and using the toilet) and mobility (walking, bed transfer, getting outside). Additional independent variables included age, sex, number of teeth, education, living alone, oral hygiene practices, and time since last dental visit. RESULTS: We found a direct association between specific areas of physical disability and current caries and edentulism. The risk of poor oral health did not increase with advancing age once the related risk factors were controlled for. Those subjects with mobility disabilities were at increased risk of tooth loss; those with personal care limitations were at increased risk of current caries. CONCLUSIONS: Physical disability should be added to the list of known risk factors for oral disease among the older population. Our findings call attention to the need for health care providers to screen for oral health problems among disabled older persons. Further gerontologic research is needed to identify the mechanisms linking physical disability with oral disease in older persons.     

A rapid method for regulating xenobiotics in the atmosphere for chemical accident situations

PURPOSE: The purpose of this study was to survey dental hygiene graduates to determine utilization in the private practice setting of expanded functions taught in school. METHOD: A questionnaire was sent to 90 dental hygiene graduates from the classes of 1990-1994, of Indiana University-Purdue University, Fort Wayne. Analysis was done on utilization of specific expanded functions taught in school. Frequency tabulations of procedures performed and adequacy of preparation were done using the SAS software. The results were graphically represented in tables. RESULTS: Equal response from each class resulted in the total response rate of 74%. The expanded functions most frequently performed by dental hygienists were placing sealants followed by making cast impressions. Placing temporary and amalgam restorations were rarely performed. The majority of graduates felt adequately trained to perform these skills. CONCLUSION: Skills being required and taught in school are not being delegated in private practice. This survey shows the need for curriculum revisions and discrepancies between educational requirements and utilization.     

Improving the professional self-efficacy cognitions of immigrant doctors with Balint groups

The City of North York Public Health Department (NYPHD) operates a school-based dental programme that provides preventive and treatment services to children according to evidence-based practice guidelines. This programme and private dental practices (PDP) represent the only sources of dental care for children in North York. The purpose of our study was to compare the oral health and family characteristics of clients from the NYPHD and PDP using a dental examination and a parent interview. Results showed that NYPHD and PDP clients had similar levels of fluorosis, calculus, and periodontal health, but NYPHD clients had experienced greater levels of decay. Clients of the NYPHD and PDP also had significantly different family characteristics, many of which were significantly associated with the presence of one or more decayed primary or permanent teeth. Multivariate logistic regression identified mother's immigration history, past caries experience, and parents' rationale for scheduling their child's dental appointments as the principle risk makers for dental decay. When compared with PDP clients, the NYPHD serves higher-needs children who otherwise might not receive care.     

Oral complications during treatment of malignant diseases in childhood: effects of tooth brushing

During anticancer treatment, oral lesions considerably aggravate the child's clinical condition and increase the risk of infection. This prospective study evaluated the incidence, nature and chronology of oral complications arising during the first 6 weeks of chemotherapy. 131 children were included in this study, and their oral and dental health evaluated on enrolment. Each child was observed once a week, for 6 weeks. Fifty-two per cent (68/131) of the children presented with at least one oral lesion. Two oral healthcare regimens (with or without tooth brushing) were evaluated. Tooth brushing significantly reduced the number of children affected. Standardised multicentre studies should permit the definition of oral care regimens which would eliminate pain and reduce the risk of infection in children hospitalised for cancer.