Early Childhood Caries among a Bedouin community residing in the eastern outskirts of Jerusalem.

BMC Public Health. 2007;7:167

Authors: Livny A, Assali R, Sgan-Cohen HD

BACKGROUND: ECC is commonly prevalent among underprivileged populations. The Jahalin Bedouin are a severely deprived, previously nomadic tribe, dwelling on the eastern outskirts of Jerusalem. The aim of this study was to assess ECC prevalence and potentially associated variables. METHODS: 102 children aged 12-36 months were visually examined for caries, mothers' anterior dentition was visually subjectively appraised, demographic and health behavior data were collected by interview. RESULTS: Among children, 17.6% demonstrated ECC, among mothers, 37.3% revealed "fairly bad" anterior teeth. Among children drinking bottles there was about twice the level of ECC (20.3%) than those breast-fed (13.2%). ECC was found only among children aged more than one year (p < 0.001); more prevalent ECC (55.6%) was found among large (10-13 children) families than among smaller families (1-5 children: 13.5%, 6-9 children: 15.6%) (p = 0.009); ECC was more prevalent among children of less educated mothers (p = 0.037); ECC was more prevalent among mothers with "fairly poor" anterior dentition (p = 0.04). Oral hygiene practices were poor. CONCLUSION: ECC levels in this community were not very high but neither low. This changing population might be on the verge of a wider dental disease "epidemic". Public health efforts clearly need to be invested towards the oral health and general welfare of this community.

PMID: 17650296 [PubMed - indexed for MEDLINE]

Transcultural barriers and cultural competence in dental hygiene practice.

J Contemp Dent Pract. 2007;8(4):43-51

Authors: Rayman S, Almas K

AIM: The aim of this paper is to highlight the need to integrate cultural care into dental hygiene practice. BACKGROUND: Culture can be better understood through the concepts, beliefs, and norms of the culturally diverse population of the United States. It is important to understand cultural perceptions of oral health in order to manage transcultural barriers that may arise during the utilization of oral healthcare services. It is assumed cultural competence can only be achieved through the knowledge of various cultural backgrounds in an extremely diverse US population. CONCLUSIONS: There is a need to integrate cultural awareness, knowledge, identification, and respect into the dental hygiene curriculum through the incorporation of competencies and standards associated with dental hygiene practice. Future dental hygienists should be culturally competent to render oral care to an ever expanding and diversified US population.

PMID: 17486186 [PubMed - indexed for MEDLINE]

Status of oral health awareness in Indian children as compared to Western children: a thought provoking situation (a pilot study).

J Indian Soc Pedod Prev Dent. 2007 Mar;25(1):15-9

Authors: Grewal N, Kaur M

A study was conducted to evaluate the level of oral health awareness in a selected sample of Indian children and a selected sample of western children residing in Amritsar city of Punjab. Children were evaluated on the basis of a standardized questionnaire developed by WHO, for health awareness in children. Final results revealed the level of awareness in both the groups and the practical application of their knowledge about dental health in day to day life.

PMID: 17456961 [PubMed - indexed for MEDLINE]

A comparative evaluation of self-reported oral hygiene practices among medical and engineering university students with access to health-promotive dental care.

J Contemp Dent Pract. 2007 Jan 1;8(1):68-75

Authors: Doshi D, Baldava P, Anup N, Sequeira PS

AIM: This study was conducted to test the null hypothesis that no difference exists in the oral hygiene knowledge and practices of university students in different courses when they have equal opportunity to access health-promotive dental care. METHODS AND MATERIALS: The study was conducted using 120 students each from the medical and engineering colleges at the University of Manipal Academy of Higher Education who had easy access to the dental college within the campus which provides health-promotive dental care to all its patients. A self-administered structured questionnaire consisting of questions on demographic data, oral hygiene knowledge and practices, and dental service utilization patterns was distributed among the students. The data collected was analyzed using SPSS 10 version. RESULTS: Statistically significant differences were found between the two groups with respect to the knowledge of fluoridated toothpastes, frequency of toothbrush renewal, use of dental floss, and a tongue cleaner (p < 0.001). The groups were similar in all other practices including the utilization of dental services. There were no significant differences between the self-reported oral hygiene knowledge and practices among medical and engineering university students, but the knowledge levels of the students were considerably lower than expected.

PMID: 17211507 [PubMed - indexed for MEDLINE]

Assessment of full-time dental hygiene faculty participation in clinical practice.

J Dent Educ. 2006 Dec;70(12):1298-307

Authors: Kiser JR, Wilder RS, Fleming DE, George MC

The purpose of this research project was to determine how many U.S. dental hygiene (DH) programs had full-time (FT) faculty members who provided direct patient care unrelated to the curriculum. Questions in this project also assessed attitudes and opinions of DH directors regarding clinical practice and opportunities for salary supplementation. A questionnaire of twenty open-ended and closed-ended questions was designed on Survey Monkey, an online survey engine. After IRB approval and pilot testing, 278 U.S. DH program directors received two emails with the survey link requesting their participation. A response rate of 69.1 percent (n=192) was achieved. Results revealed that 14.2 percent of the programs required FT DH faculties to participate in clinical practice settings unrelated to the curriculum, while 67 percent of the programs had faculties who also participated in clinical practice. Eighty-three percent of respondents reported faculties who participated in clinical practice were financially compensated. The majority (95.4 percent) of directors indicated maintaining clinical skills was an advantage to clinical practice, while 48 percent of directors indicated participation takes time away from being an educator. Overall, the majority of DH programs did not require FT faculties to participate in clinical practice; however, respondents were generally in favor of allowing faculties the opportunity to practice and thought that it enhanced their competency as clinical instructors.

PMID: 17170320 [PubMed - indexed for MEDLINE]

Reasons for third molar teeth extraction in Jordanian adults.

J Contemp Dent Pract. 2006 Nov 1;7(5):88-95

Authors: Hamasha AA, Al Qudah MA, Bataineh AB, Safadi RA

AIMS: To assess reasons for third molar teeth extractions in a sample of Jordanian dental patients and to evaluate the association of extractions with other independent variables. METHODS AND MATERIALS: The study sample was comprised of dental patients in North Jordan who had third molar extractions. Data were collected from 36 dentists who were instructed to administer questionnaires to their adult patients undergoing third molar extractions and then to record the primary reason for those extractions. The data in this study was analyzed using a descriptive summary and chi square statistics. RESULTS: Dentists performed 810 extractions for 648 patients. The reasons for the extractions were: dental caries and its consequences about 42%, eruption problems 39%, periodontal diseases about 7%, and approximately 9% of extractions were a result of the dentist's choice. The percentage of extractions due to dental caries significantly increased with increasing age. However, significant numbers of teeth were extracted due to eruption problems (51%-69%) in young adults. For 46+ year olds, 23% of extractions were caused by periodontal diseases. Extraction due to dental caries was distributed equally among the sexes. Persons with irregular tooth brushing and fewer dental visits had significantly more third molar teeth extracted due to caries and periodontal diseases compared to persons with regular tooth brushing and dental visits.

PMID: 17091144 [PubMed - indexed for MEDLINE]

[Collective oral health: ways from sanitary dentistry to buccality]

Rev Saude Publica. 2006 Aug;40 Spec no.:141-7

Authors: Narvai PC

This essay focuses on the pioneer activities of public health dentistry in Brazil and its evolution in the 20th century with emphasis on the emergency of a landmark, the sanitary dentistry. Social and preventive dentistry and market dentistry, with reference to the main theoretical works representative of these trends, are presented. The essential characteristics of collective oral health (Brazilian variant of public health dentistry) and buccality are presented. The relationship between collective oral health and collective health as well as the implications of the buccality concept for the development of public health dentistry actions and new guidance of clinical practice in public services of the Brazilian Health System (SUS) are discussed. The key elements of an agenda for collective oral health based on proposals presented at the 3rd National Conference on Oral Health are addressed.

PMID: 16924314 [PubMed - indexed for MEDLINE]

Oral healthcare for elderly: identifying the needs and feasible strategies for service provision.

Indian J Dent Res. 2006 Jan-Mar;17(1):11-21

Authors: Goel P, Singh K, Kaur A, Verma M

The aim of the present study was to assess the oral health practices, status and treatment needs of the rural elderly in national capital territory of Delhi. An effort was also made to identify patterns of utilization of dental services and test alternate strategies for service provision. A total of 96 elderly subjects (47 males and 49 females) in 5 rural areas were interviewed and clinically examined using Basic Oral Health Survey criteria of W.H.O. This was followed by a community trial in which the 5 villages were divided into control and test groups. Results of the survey found that both traditional as well as modern oral health practices co-exist in the rural community. Dental services were available to a majority (mostly through private sector), and edentulousness was a condition of primary concern among the elderly as a result of unmet treatment needs for dental caries and periodontal diseases. Age was a variable that was statistically significantly associated with edentulousness (p=0.005). Results of the community trial showed that higher utilization of care can be achieved by providing on-site dental care as compared to referring cases to tertiary care centers. Nevertheless provision of treatment alone is not a suitable policy recommendation since many elderly did not avail care even at on-site community dental health programmes that were operated free of cost. This emphasizes the need of health education over treatment in order to empower the elderly, especially the non-ambulatory patients, to practice prevention and develop favourable attitudes towards accepting prompt treatment at primary health care level.

PMID: 16900890 [PubMed - indexed for MEDLINE]

Sex differences among dentists regarding eating disorders and secondary prevention practices.

J Am Dent Assoc. 2006 Jun;137(6):773-81

Authors: Debate RD, Vogel E, Tedesco LA, Neff JA

BACKGROUND: The purpose of this cross-sectional study was to assess sex differences among dentists pertaining to current behaviors and behavioral beliefs with regard to eating disorders. METHODS: The authors collected data via a self-administered paper-and-pencil questionnaire from a randomized sample of 350 practicing male and female dentists. RESULTS: The results showed a low level of practice regarding secondary prevention (that is, measures leading to early diagnosis and prompt intervention) of eating disorders. The authors found statistically significant differences, with more female than male dentists reporting that they assessed patients for oral cues (P < .001), more female dentists reporting that they provided specific dental care instructions (P = .038) and more female dentists referring patients who have oral signs of eating disorders (P = .028). They also found sex differences with regard to mediating factors. Female dentists had greater knowledge of oral manifestations of eating disorders (P = .001), greater knowledge of physical cues of anorexia nervosa (P < .001), greater perception of the severity of anorexia nervosa (P = .007) and greater knowledge of physical cues of bulimia nervosa (P < .001). CONCLUSIONS: Although the dentist may be the first health care provider to assess oral effects of eating disorders, his or her involvement may be influenced in part by sex and sex-related health beliefs. CLINICAL IMPLICATIONS: Female dentists may be more sensitive to oral cues related to women's health issues. Further research is warranted to explore the mediating factors regarding secondary prevention of eating disorders.

PMID: 16803806 [PubMed - indexed for MEDLINE]

Child abuse and neglect: dental and dental hygiene students' educational experiences and knowledge.

J Dent Educ. 2006 May;70(5):558-65

Authors: Thomas JE, Straffon L, Inglehart MR

The objective of this study was to explore dental and dental hygiene students' educational experiences and knowledge concerning child abuse/neglect. Questionnaire data were collected from 233 dental (116 male/117 female; response rate=54.82 percent) and seventy-six dental hygiene students (all female; response rate=76.77 percent). Of those surveyed, 94.7 percent of the dental hygiene and 70.5 percent of the dental students reported having learned about child abuse/neglect in classroom settings, and 15.8 percent of the dental hygiene and 29.3 percent of the dental students reported having learned about it in clinical settings. Dental students reported more minutes of instruction about this topic than dental hygiene students (184.48 vs. 112.90 minutes; p=.006). Only 5.5 percent of the dental and 16.7 percent of the dental hygiene students defined child abuse correctly; 32.2 percent of the dental and 13.2 percent of the dental hygiene students did not know their legal responsibility concerning reporting child abuse; and 82.4 percent of the dental and 78.9 percent of the dental hygiene students did not know where to report child abuse. Dental care providers are likely to encounter child abuse and neglect in their professional lives and are legally required to respond to these matters. Dental and dental hygiene curricula should be revisited to ensure that students are adequately prepared for this professional task.

PMID: 16687641 [PubMed - indexed for MEDLINE]

The prevalence of mentoring programs in the transition from student to practitioner among U.S. dental hygiene programs.

J Dent Educ. 2006 May;70(5):531-5

Authors: Blanchard SB, Blanchard JS

Mentoring of students to assist them in the transition to clinical practice has been utilized in a number of health professions but has only been recently introduced in dental and dental hygiene education. A survey was sent to all U.S. dental hygiene program directors to determine the prevalence of mentoring programs in the dental hygiene curriculum that utilize practicing dental hygienists as mentors to facilitate the transition from student to practitioner. Results showed that less than 30 percent of dental hygiene programs are using this type of student mentoring. Dental hygiene program directors reported that the main benefit mentoring provided was "real world" experiences to their students. Lack of formal structure to the mentoring program was the most frequently cited weakness of existing programs. Programs not utilizing mentoring programs listed inadequate time in the existing dental hygiene curriculum as the main obstacle for not implementing a mentoring program. Student mentorship in other health professions has been shown to not only enhance personal and professional growth, but also to increase job satisfaction and retention. Further research, however, is needed on student mentoring programs in the dental and allied dental fields.

PMID: 16687638 [PubMed - indexed for MEDLINE]

Oral health beliefs in adolescence and oral health in young adulthood.

J Dent Res. 2006 Apr;85(4):339-43

Authors: Broadbent JM, Thomson WM, Poulton R

According to theory, health beliefs are related to health behaviors. We investigated whether individuals who hold favorable oral-health-related beliefs over time have better adult oral health than those who do not. Beliefs about the efficacy of water fluoridation, keeping the mouth clean, avoiding sweet foods, visiting the dentist, using dental floss, and using fluoridated toothpaste were assessed in a birth cohort at ages 15, 18, and 26 years. At each age, the majority of participants endorsed the importance of each practice. However, there was also evidence of instability across time. Individuals who held stable favorable dental beliefs from adolescence through adulthood had fewer teeth missing due to caries, less periodontal disease, better oral hygiene, better self-rated oral health, and more restorations. Dental beliefs can change between adolescence and young adulthood, and these changes are related to oral health. In particular, unfavorable dental health beliefs are related to poorer oral health.

PMID: 16567555 [PubMed - indexed for MEDLINE]

Oral health attitudes, knowledge, and behavior among school children in North Jordan.

J Dent Educ. 2006 Feb;70(2):179-87

Authors: Al-Omiri MK, Al-Wahadni AM, Saeed KN

The aim of this study was to assess the knowledge, attitude, and behavior of school children towards oral health and dental care as well as to evaluate the factors that determine these variables. School children (n=557) of an average age of 13.5 years attending public schools in North Jordan were recruited into this study. The subjects completed a questionnaire that aimed to evaluate young school children's behavior, knowledge, and perception of their oral health and dental treatment. The participants' oral hygiene habits (such as tooth brushing) were found to be irregular, and parents' role in the oral hygiene habits of their children was limited. The study population showed higher awareness of caries than periodontal conditions. Irregular visits to the dentist were found to be common, and toothache was the major driving factor for dental visits. Children had positive attitudes toward their dentists; nevertheless, they indicated that they feared dental treatment. The children in this study also recognized the importance of oral health to the well-being of the rest of the body. Parents were not proactive in making sure that their children received regular dental care. Parents' knowledge and attitudes about the importance of oral health care and their fears about dental treatment influenced their children's dental care. The results of this study indicate that children's and parents' attitudes toward oral health and dental care need to be improved. Comprehensive oral health educational programs for both children and their parents are required to achieve this goal.

PMID: 16478932 [PubMed - indexed for MEDLINE]

Reliability and validity of brief measures of oral health-related knowledge, fatalism, and self-efficacy in mothers of African American children.

Pediatr Dent. 2005 Sep-Oct;27(5):422-8

Authors: Finlayson TL, Siefert K, Ismail AI, Delva J, Sohn W

PURPOSE: Low-income African American children experience high rates of dental caries compared to the general population. Knowledgeable and efficacious caregivers can play an important role in caries prevention. The purpose of this study was to develop and evaluate 4 brief measures reflecting mothers' potentially modifiable cognitions associated with African American children's oral health: (1) knowledge about appropriate bottle use (KBU); (2) knowledge about children's oral hygiene (KCOH); (3) oral health-related fatalism (OHF); and (4) oral health-related self-efficacy (OHSE). METHODS: Questions were selected based on reviews of the health promotion and oral health literature, with input from low-income African American caregivers of young children. Reliability and validity were evaluated using survey and dental examination data from 719 low-income African American mothers and their 1- to 5-year-old children. RESULTS: Alpha reliabilities ranged from 0.76 to 0.91. KCOH was significantly associated with mothers' oral health perceptions and children's caries status. OHSE was significantly positively correlated with children's brushing frequency and with mothers' subjective perceptions of children's oral health, which was, in turn, significantly associated with children's caries status. CONCLUSIONS: Results support the reliability and validity of the new measures. If confirmed by further research, these measures can be used to develop tailored educational and cognitive-behavioral interventions to reduce oral health disparities.

PMID: 16435644 [PubMed - indexed for MEDLINE]

Risk factors of early childhood caries in a Southeast Asian population.

J Dent Res. 2006 Jan;85(1):85-8

Authors: van Palenstein Helderman WH, Soe W, van 't Hof MA

A retrospective cohort study on ECC and associated factors was conducted among mothers with 25- to 30-month-old infants in a community where prolonged breastfeeding was common practice. All infants who consumed sugary supplementary food or rice that was pre-chewed by the mother, or who fell asleep with the breast nipple in their mouths, had ECC. Infants without those habits, and who were breastfed up to 12 months, had no ECC. Breastfeeding during the day beyond the age of 12 months was not associated with ECC, but infants who were breastfed at night > 2 times had an OR for ECC of 35 (CI 6-186), and those who were exposed to > 15 min per nocturnal feeding had an OR for ECC of 100 (CI 10-995). The present study indicates that, in this population, besides the consumption of sugars and pre-chewed rice, nocturnal breastfeeding after the age of 12 months poses a risk of developing ECC.

PMID: 16373687 [PubMed - indexed for MEDLINE]

Insights from students following an educational rotation through dental geriatrics.

J Dent Educ. 2005 Dec;69(12):1368-76

Authors: MacEntee MI, Pruksapong M, Wyatt CC

Little is known about how dental students respond to dental geriatrics. This article describes a qualitative analysis of reflective journals submitted over two years by ninety-two senior students who participated in a brief clinical rotation in long-term care facilities. We used an inductive interpretive approach to analyze the journals. Eight themes emerged from the analysis: 1) complexity of the institutional environment; 2) heterogeneity of the resident population; 3) multidisciplinary environment; 4) record keeping; 5) interactions with residents; 6) the difficulty of oral health care for frail residents; 7) bridging the gap between theory and practice; and 8) the emotional impact of the clinical experiences. Apparently, the students appreciated the opportunity to witness the complexity of care in a multidisciplinary context and to observe a practical program of oral health care. They described the rotations as unique and emotionally challenging but very worthwhile. Overall, they wrote positively about their experiences with the elderly residents, acknowledged the contribution of the rotation as important to their clinical maturation, and reported that the experience enhanced their appreciation of a dentist's professional responsibilities.

PMID: 16352773 [PubMed - indexed for MEDLINE]

The need for tobacco education: studies of collegiate dental hygiene patients and faculty.

J Dent Educ. 2005 Dec;69(12):1340-52

Authors: Davis JM, Stockdale MS, Cropper M

The need for inclusion of comprehensive tobacco control education/training for health care providers continues to be stressed in publications addressing cessation services. The dental appointment presents an excellent opportunity to provide tobacco interventions to basically healthy people on regular intervals. The purpose of this study was twofold: 1) to assess the need (stage of change and concomitant need for tobacco cessation intervention) of dental hygiene patients at a Midwest dental hygiene clinic, and 2) to assess and compare the level of tobacco intervention education currently being offered by dental hygiene educators in a Midwestern state. Patients (n=426) of a collegiate dental health clinic completed a survey that assessed the level and type of tobacco cessation intervention patients might require. A statewide sample of dental hygiene faculty (n=97) were surveyed to determine the attitudes, perceived barriers, and current practices in tobacco education offered in their programs. Of patients who currently smoked (34.5 percent), 24.7 percent indicated being in the Action stage of change; 14.2 percent were in Preparation; 22.2 percent were in Contemplation; and 29 percent were in Precontemplation. Although faculty indicated tobacco education was very important (5.03 on 1-6 scale), they felt only moderately confident delivering tobacco education (3.18 on a 1-5 scale). Only 16 percent to 35 percent of faculty reported that their curriculum included brief motivational interviewing, pharmacotherapies, or setting-up a private practice tobacco control program. The results strongly suggest the need for a comprehensive, competency-based tobacco curriculum to enhance and expand existing dental hygiene programs.

PMID: 16352770 [PubMed - indexed for MEDLINE]

Knowledge, beliefs, and attitudes of dental and dental hygiene students toward obesity.

J Dent Educ. 2005 Dec;69(12):1332-9

Authors: Magliocca KR, Jabero MF, Alto DL, Magliocca JF

Obesity is recognized as a growing public health problem. The authors surveyed dental hygiene and dental students from one institution regarding education, knowledge, perceived professional duties, and attitudes toward the overweight and obese population. Half of the respondents reported no obesity education prior to professional dental education, and 80 percent received five hours or less while in professional training. While most students held a generally positive attitude regarding obese and overweight patients, a number of students demonstrated evidence of negative stereotyping. Obesity education and training must be integrated into dental education to permit greater understanding of coexisting medical problems, explore the basis for a negative attitude and work toward its elimination, and raise public health awareness within dentistry.

PMID: 16352769 [PubMed - indexed for MEDLINE]

[School-childrens' knowledge, habits, and perception of oral health in a rural area in Lugo]

Aten Primaria. 2005 Oct 15;36(6):346-7

Authors: T&#xFA;ñez Bastida F, Fernández Camiñas JA, Machín Fernández AJ

PMID: 16238951 [PubMed - indexed for MEDLINE]

Dental caries status of preschool children in Hong Kong.

Br Dent J. 1999 Dec 11;187(11):616-20; discussion 605

Authors: Chu CH, Fung DS, Lo EC

OBJECTIVE: To describe the dental caries status of preschool children in Hong Kong and factors which affect their caries status. DESIGN: 658 preschool children aged 4 to 6 years from six randomly selected kindergartens in Hong Kong were surveyed in December 1997. A questionnaire to investigate possible explanatory variables for caries status was completed by their parents. Dental caries was diagnosed according to the criteria recommended by the World Health Organization (1997). RESULT: Caries experience as measured by the mean number of decayed, missing and filled primary teeth (dmft) of the 4-, 5-, and 6-year-old children were found to be 0.9, 1.8, and 3.3 respectively. Overall, 61% of the children had a zero dmft score. Children born in Mainland China had a higher mean dmft score (4.6) than those born in Hong Kong (1.4). Statistically significant correlations were found between the children's dental caries status and their oral health practices as well as their socio-economic background. Parents' education level, dental knowledge and attitudes were also associated with the children's dental caries experience. CONCLUSION: In general, the caries status of Hong Kong Chinese preschool children was similar to that of children in industrialised countries and was better than that of children in the nearby areas. However, special dental programmes should be made available to children from lower socio-economic classes and new immigrants from Mainland China because they are the high risk groups for caries in Hong Kong.

PMID: 16163284 [PubMed - indexed for MEDLINE]

Improving oral care in patients receiving mechanical ventilation.

Am J Crit Care. 2005 Sep;14(5):389-94

Authors: Cutler CJ, Davis N

BACKGROUND: Comprehensive oral care is an evidence-based prevention strategy to reduce the risk of ventilator-associated pneumonia in patients receiving mechanical ventilation. Until recently, no comprehensive guidelines or standards existed to define necessary tasks, methods, and frequency of oral care to provide patients with optimal results. OBJECTIVES: To observe current practice of, define best practice for, and measure compliance with standardized comprehensive oral care. METHODS: This observational study was part of a larger research study performed at 5 acute care hospitals. Time blocks of 4 hours were randomized over 8 intensive care units and the 7 days of the week. Baseline data were collected before implementation of multifaceted education on an oral-cleansing protocol; interventional data were collected afterward. RESULTS: Oral care practices were observed for 253 patients. During the baseline period, oral cleansing was primarily via suction swabs. Toothbrushing and moisturizing of the oral tissues were not observed. Only 32% of the patients had suctioning to manage oral secretions. During the interventional period, 33% of patients had their teeth brushed, 65% had swab cleansing, and 63% had a moisturizer applied to the oral mucosal tissues. A total of 61% had management of oral secretions; 38% had oropharyngeal suctioning via a special catheter. CONCLUSIONS: Implementation of an evidence-based oral cleansing protocol improved the care of patients receiving mechanical ventilation. Multifaceted education and implementation strategies motivated staff to increase oral care practices.

PMID: 16120890 [PubMed - indexed for MEDLINE]

A look at allied dental education in the United States.

J Am Dent Assoc. 2005 Jun;136(6):797-804

Authors: Brown LJ, Wagner KS, Mikkelsen MC, Munson B

BACKGROUND: The American Dental Association conducts surveys of educational programs in dental assisting, dental hygiene and dental laboratory technology. The 2002-2003 survey included questions about enrollment, graduates, program information and trends. METHODS: The ADA Survey Center mailed the Survey of Allied Dental Education to 548 program directors of dental assisting, dental hygiene and dental laboratory technology educational programs. They also sent several follow-up notices as a reminder to complete the survey. A 100 percent response rate is mandatory for continued accreditation by the Commission on Dental Accreditation. Association staff members resolved inconsistencies in the data and analyzed them before producing a final report. RESULTS: The number of applications to, first-year enrollment in and number of graduates in dental hygiene and dental assisting educational programs have increased during the last five years. During the same period, the number of applications to, and graduates of, dental laboratory technology educational programs decreased, but first-year enrollment increased slightly. CONCLUSIONS: Results from these surveys help address the concerns of the public and the profession regarding allied dental manpower levels. They also provide information for those interested in applying to individual allied dental educational programs. PRACTICE IMPLICATIONS: Private dental practices employ the majority of graduates of allied dental educational programs. Recent graduates of dental assisting and hygiene programs continue to supply the office staff members needed to support the delivery of dental care.

PMID: 16022047 [PubMed - indexed for MEDLINE]

[Outside clinical setting experience in a public hospital and oral health promotion.]

Rev Saude Publica. 2005 Apr;39(2):305-10

Authors: Medeiros J&#xFA;nior A, Alves Mdo S, Nunes Jde P, Costa Ido C

OBJECTIVE: To describe a teaching aid activity aimed at providing experience for promoting collective oral health to graduating dental students. METHODS: This experience was based on the evaluation of students' performance as oral health educators as they had, among other duties, to motivate inpatients and their families to practice healthy habits aiming at a comprehensive and more human care of hospitalized patients. RESULTS: The results show that oral hygiene was incorporated into hospital routine, evidenced by the differences between baseline and final dental biofilm indices (1.72 and 1.17, respectively). Using the U-Mann-Whitney test, this difference was extremely significant (p<0.001) and reveals that mother-child were highly motivated with respect to oral hygiene. CONCLUSIONS: It is concluded that teaching-learning experiences derived from interdisciplinary and interdisciplinary activities have allowed for a better understanding of the health-disease process by dental students. It is also an opportunity for learning about planning and implementing education-prevention activities, which complement these students' technical-professional experience and promotes social sensitivity, which is essential to professional training.

PMID: 15895153 [PubMed - indexed for MEDLINE]

Factors related to dental health in 12-year-old children: a cross-sectional study in pupils.

Gac Sanit. 2005 Mar-Apr;19(2):113-9

Authors: Smyth E, Caamaño F

OBJECTIVE: The aim of this study was to identify factors related to the prevalence of caries in 12-year-old schoolchildren. METHODS: A cross-sectional study was carried out using a representative sample (n = 1217) of the population of 12-year-old schoolchildren in Galiza (northwest Spain). Independent variables were measured through a questionnaire, and dependent variables were determined through oral examination. Multiple and logistic regression were applied. RESULTS: The decayed, missing and filled permanent teeth/decayed, filled primary teeth (DMFT-dft) value in the sample was 1.83 (95% confidence interval [CI], 1.67-1.98), the DMFT value was 1.53 (95% CI, 1.37-1.67), and the prevalence of caries was 61% (95% CI, 57.7-64.5). The prevalence of caries was directly related to a low frequency of brushing, greater use of toothpaste, and a higher consumption of sweets. The prevalence of caries was higher in rural than in urban areas. In contrast, the higher the mother's level of education and the greater the subject's knowledge of dental health, the lower the prevalence of caries. CONCLUSIONS: The main goals of dental health programmes should be to achieve quality brushing every day in children, to reduce the consumption of sweets, and to increase knowledge of dental health.

PMID: 15860159 [PubMed - indexed for MEDLINE]

The effects of finger rest positions on hand muscle load and pinch force in simulated dental hygiene work.

J Dent Educ. 2005 Apr;69(4):453-60

Authors: Dong H, Barr A, Loomer P, Rempel D

One of the techniques taught in dental and dental hygiene programs is to use finger rests to stabilize the instrument while performing dental scaling or other types of dental work. It is believed that finger rests may also reduce muscle stress and prevent injury due to muscle fatigue. In this study the effects of three different finger rest positions on hand muscle activity and thumb pinch force were compared. Twelve predental students performed simulated dental scaling tasks on a manikin using three different finger rest positions: 1) no finger rest, 2) one finger rest, and 3) two finger rests. Muscle activity and thumb pinch force were measured by surface electromyography and a pressure sensor, respectively. Using two finger rests was always associated with reduced thumb pinch force and muscle activity, as compared to not using any finger rests (p<0.05), while using one finger rest reduced thumb pinch force and muscle activity in most cases. Hence, using finger rests plays an important role in reducing the muscle load of the hand in students performing simulated dental hygiene work. It is concluded that dental and dental hygiene students may benefit from instructions for using finger rests at an early stage of their clinical training. Including biomechanical and ergonomic principles in dental and dental hygiene curricula will raise awareness of ergonomics among dental practitioners and help them incorporate these principles into daily practice.

PMID: 15800259 [PubMed - indexed for MEDLINE]

Comparison of two cleansing pastes for the removal of biofilm from dentures and palatal lesions in patients with atrophic chronic candidiasis.

Braz Dent J. 2004;15(3):220-4

Authors: Andrucioli MC, Macedo LD, Panzeri H, Lara EH, Paranhos Hde F

The efficacy of 2 oral hygiene products, an experimental toothpaste specific for complete denture cleansing and a regular standard toothpaste, was compared in terms of denture biofilm removal and cure of palatal lesions in patients with atrophic chronic candidiasis. The degree of correlation between presence of biofilm and mucosa erythema was also evaluated. Twenty-four complete denture wearers (45-80 years old) were divided into 2 groups: experimental paste and standard toothpaste (Sorriso-Kolynos, Brazil). Both groups received soft toothbrushes. The internal surfaces of upper dentures were stained using 1% sodium fluorescein and photographed at a 45 masculine angle at 0, 15, 30 and 60 days. The slides were scanned and the areas of interest (denture total area and biofilm area) were measured (Image Tool software). The degree of erythema was evaluated on slides according to the Prosthesis Tissue Index. There was a significant reduction (1%) in the degree of biofilm (ANOVA/Tukey) between the two initial visits (0 and 15 days) and the two final visits (30 and 60 days), and in the average erythema scores (Kruskal-Wallis) between 0 and 60 days, in both groups. The Mann-Whitney test showed a significant difference (1%) between pastes in terms of biofilm degree, but no difference was found for the erythema score. Correlation values between biofilm and erythema degree were 0.3801 (experimental paste) and (0.3678 (standard toothpaste). We may therefore conclude that the experimental product was efficient for the removal of denture plaque biofilm.

PMID: 15798827 [PubMed - in process]

Predictive validity of dental hygiene competency assessment measures on one-shot clinical licensure examinations.

J Dent Educ. 2005 Mar;69(3):363-70

Authors: Gadbury-Amyot CC, Bray KK, Branson BS, Holt L, Keselyak N, Mitchell TV, Williams KB

The purpose of this study was to examine the predictive validity of traditional and nontraditional dental hygiene competency assessment measures on one-shot clinical licensure examinations in a baccalaureate dental hygiene program. Traditional assessment data including overall grade point average (GPA), Clinical GPA, National Board Dental Hygiene Examination (NBDHE) scores, and Central Regional Dental Testing Service (CRDTS) scores along with nontraditional assessment data in the form of Portfolio scores were collected from seventy-four students. Factor analysis and subsequent linear regression modeling were used to explore the ability of four variables (Overall GPA, NBDHE, Portfolios, and Clinical GPA) to predict one-shot clinical licensure examination (CRDTS) scores. A two-factor solution was obtained with one factor defined as dental hygiene cognition and the second factor defined as dental hygiene clinical performance. Factor scores were subsequently used in a linear predictive model to assess the shared and unique contribution of factors to the one-shot clinical licensure examination score. The shared contribution of both factors only accounted for 13.9 percent of variance in the outcome measure of one-shot clinical licensure examination scores. The lack of concordance between previously validated measures of dental hygiene student competency or predictors of student success (Overall GPA, NBDHE, and Portfolios) and a one-shot clinical licensure examination (CRDTS) raises serious concern about the validity of our current dental hygiene licensing procedure which uses the CRDTS clinical examination to make decisions about granting licenses to practice.

PMID: 15749947 [PubMed - indexed for MEDLINE]

Variation in periodontal diagnosis and treatment planning among clinical instructors.

J Dent Educ. 2005 Mar;69(3):325-37

Authors: Lanning SK, Pelok SD, Williams BC, Richards PS, Sarment DP, Oh TJ, McCauley LK

Consistency in clinical decision making may be necessary for reliable assessment of student performance and teaching effectiveness, yet little has been done to examine variation in periodontal diagnosis and treatment planning among dental school faculty. The purpose of this investigation was to examine variation among faculty in diagnosis and management of common periodontal diseases. Twenty-seven clinical instructors (periodontists, general dentists, dental hygienists, and first- and second-year periodontal graduate students) reviewed three web-based cases and answered a brief questionnaire focusing on radiographic interpretation, periodontal diagnosis, and treatment planning. Response rates for the three cases ranged from 62 percent to 70 percent. Clinical instructors' rating of percent bone loss in the majority of cases varied between three descriptive categories for the same tooth. Greater consistency in periodontal diagnosis was noted within the graduate student group as compared to periodontal and dental hygiene faculty groups. Diagnoses offered for one of the three patients varied between gingivitis and chronic and aggressive periodontitis. Six to nineteen different treatment plans (many with subtle differences) were submitted for each of the three cases. Inter-rater variation was qualitatively more prevalent than intra-rater variation. To our knowledge, this is the first study to document substantial variation among instructors in radiographic interpretation, diagnosis, and treatment planning for common periodontal diseases. Qualitative judgments speculating on the impact of variability among dental school faculty on student performance and patient care can be made but as yet remain unknown. Consistent use of accepted practice guidelines and greater consensus-building opportunities may decrease variation among faculty and enhance dental education.

PMID: 15749943 [PubMed - indexed for MEDLINE]

Gender-specific oral health attitudes and behavior among dental students in Jordan.

J Contemp Dent Pract. 2005 Feb 15;6(1):107-14

Authors: Al-Omari QD, Hamasha AA

The aim of this study was to determine the difference in oral health attitudes and behavior between male and female dental students at Jordan University of Science and Technology (JUST). A self-administered questionnaire based on a modified version of the Hiroshima University Dental Behavior Inventory (HU-DBI) was distributed among 375 dental students. The response rate was 83.7% with 48% males and 52% females responding. Female students reported brushing their teeth more frequently than male students (P<0.001). Approximately 47% of the male students brushed their teeth less than twice daily compared to 21% of the female students. Also, female students believed in the necessity of using toothpaste during brushing more often than male students (P<0.01). On the other hand, smoking was much more frequent among males than among females (31% vs. 4%) (P<0.001). Male students indicated they had been smoking for longer periods of time than female students. This survey shows male students visit the dentist only when they have dental pain. While this was more than their female peers, it was not statistically significant (P= 0.056). In general the present study showed dental students in Jordan had poor oral health. Further research is needed to examine the students clinically for periodontal and caries conditions. Students should be encouraged to be a model for oral health for their families, friends, and patients.

PMID: 15719082 [PubMed - indexed for MEDLINE]

Information from your family doctor. Your baby's teeth.

Am Fam Physician. 2004 Dec 1;70(11):2121-2

Authors:

PMID: 15606060 [PubMed - indexed for MEDLINE]

A practical guide to infant oral health.

Am Fam Physician. 2004 Dec 1;70(11):2113-20

Authors: Douglass JM, Douglass AB, Silk HJ

Early childhood caries is the most common chronic disease in young children and may develop as soon as teeth erupt. Bacteria, predominately mutans streptococci, metabolize simple sugars to produce acid that demineralizes teeth, resulting in cavities. Physicians should examine children's teeth for defects and cavities at every well-child visit. Any child with significant risk factors for caries (e.g., inadequate home dental care and poor oral hygiene, a mother with a high number of cavities, a high sugar intake, enamel defects, premature birth, special health care needs, low socioeconomic status) should be referred to a dentist by 12 months of age. Promoting appropriate use of topical and systemic fluoride and providing early oral hygiene instruction can help reduce caries in young patients, as can regularly counseling parents to limit their child's consumption of sugar.

PMID: 15606059 [PubMed - indexed for MEDLINE]

The aetiology and treatment of oral halitosis: an update.

Hong Kong Med J. 2004 Dec;10(6):414-8

Authors: Lee PP, Mak WY, Newsome P

Halitosis refers to the condition of offensive mouth odour. More than 90% of cases of halitosis originate from the oral cavity. The implicated bacteria (Fusobacterium nucleatum, Prevotella intermedia, and Tannerella forsythensis) are located in stagnant areas in the oral cavity, such as the dorsal surface of tongue, periodontal pockets, and interproximal areas. These bacteria proteolyse the amino acids releasing volatile sulphur compounds. The management of halitosis involves determining and eliminating the causes, which includes identifying any contributory factors, because certain medical conditions are also associated with characteristic smells. Professional advice should be given on oral hygiene and diet, and treatments should include dental scaling, and root planing of the associated periodontal pockets to reduce the bacterial loading. In addition to the normal oral hygiene practice, tongue cleaning and use of mouthwash are advocated. This paper discusses the common aetiological factors, classification of oral halitosis, and its treatment.

PMID: 15591601 [PubMed - indexed for MEDLINE]

Survey of dental prophylaxes rendered by pediatric dentists in New England.

J Contemp Dent Pract. 2004 Nov 15;5(4):14-22

Authors: Nainar SM, Redford-Badwal DA

BACKGROUND: The objective of this anonymous postal survey was to assess the provision of dental prophylaxis by pediatric dentists in New England. METHODS: The questionnaire survey was sent by first class mail in September, 2001 to all 217 American Academy of Pediatric Dentistry (AAPD) members in active private practice in the six New England States of Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont. A self-addressed, stamped envelope was provided to facilitate the returned response. RESULTS: The survey had a response rate of 70%. Most practitioners (93%) routinely recommended dental prophylaxis for their recall patients. The proportion of practitioners who considered the following indications for recommending dental prophylaxis was: plaque, stain, and/or calculus removal - 99%; caries prevention - 75%; prior to topical fluoride application - 82%; prior to sealant application - 58%; and for behavioral modification - 68%. Almost two thirds of the practitioners (62%) defined dental prophylaxis as referring to both rubber cup pumice prophylaxis as well as to toothbrush prophylaxis. However, only one in four practitioners (26%) had modified her/his clinical practice to substitute toothbrush prophylaxis in lieu of rubber cup pumice prophylaxis. CONCLUSION: Pediatric dentists in New England routinely provide dental prophylaxis to their recall patients.

PMID: 15558086 [PubMed - indexed for MEDLINE]

Trends in dental and allied dental education.

J Am Dent Assoc. 2004 Sep;135(9):1253-9

Authors: Neumann LM

BACKGROUND: Educational programs play an important role in preparing a qualified dental work force. This article reviews the current status and trends in dental, advanced dental and allied dental education programs in the United States and examines their impact on the dental work force. OVERVIEW: This analysis focuses on survey data collected by the American Dental Association during the past 10 to 15 years and compares recent patterns in applications, enrollment and graduation with previous trends. The numbers of educational programs, applicants, enrollees and graduates have increased in dentistry, dental hygiene and dental assisting, while dental laboratory technology has declined in all measures. The proportion of women in dentistry has increased, while the ethnic profile of dental and allied personnel has shown little change. Both the cost of dental education and student debt continue to increase. CONCLUSIONS: Despite increases in the number of educational programs and overall numbers of graduates from dental and allied dental education programs, the proportion of underrepresented groups still lags behind their representation in the overall population, and the number of allied personnel falls short of practice needs. PRACTICE IMPLICATIONS: Patterns in applications, enrollment and graduation are important determinants of the dental and allied dental work force. The cost and funding of education significantly affect the attractiveness of dental careers and the sustainability of educational programs and should be monitored carefully by the profession.

PMID: 15493389 [PubMed - indexed for MEDLINE]

Physicians' oral health education in Kentucky.

Fam Med. 2004 Sep;36(8):544-6

Authors: Gonsalves WC, Skelton J, Smith T, Hardison D, Ferretti G

OBJECTIVES: The Physicians' Oral Health Education in Kentucky (POHEK) curriculum was developed to teach family medicine residents to (1) perform oral health screening and risk assessment and (2) recognize and manage common oral conditions for children ages 5 years and under. METHODS: Family medicine residents in urban and rural settings received didactics and hands-on experience providing oral screening, risk assessments, and counseling for their pediatric patients. EVALUATION: Residents were evaluated by comparing pretest and posttest means of surveys that assessed attitudes and knowledge. Chart audits were also performed. CONCLUSIONS: Residents' knowledge and attitudes improved in the oral health care of their pediatric patients.

PMID: 15343413 [PubMed - indexed for MEDLINE]

Abutment tooth loss in patients with overdentures.

J Am Dent Assoc. 2004 Jun;135(6):739-46; quiz 795-6

Authors: Ettinger RL, Qian F

BACKGROUND: Since the 1960s, the use of natural teeth as overdenture abutments has become part of accepted clinical practice. Several longitudinal studies have been conducted, but tooth loss has not been reported to be a significant problem. The aim of this study was to identify the incidence and causes of tooth loss in a prospective cohort study of subjects wearing overdentures. METHODS: The study, conducted between 1973 and 1994, evaluated 273 subjects (62.3 percent male) with a mean age of 59.6 years. RESULTS: Of the 273 subjects with 666 abutments, 74 lost 133 abutments. The most common cause of tooth loss was periodontal disease (29.3 percent) followed by periapical lesions (18.8 percent) and caries (16.5 percent). Through logistic regression, the authors found that subjects who lost teeth were more likely to have medical problems that could cause soft-tissue lesions of the oral mucosa, were less likely to use fluoride daily and were less likely to return for yearly recall visits. The authors found 22 vertical fractures in 17 subjects. Chi2 analysis revealed that overdenture teeth in the maxillary arch that were opposed by natural teeth were more likely to experience vertical fractures. CONCLUSIONS: In a study that followed up some patients for as long as 22 years, the rate of tooth loss was 20.0 percent. Many of these failures could have been prevented if patients had practiced better oral hygiene. CLINICAL IMPLICATIONS: The findings suggest that if a dentist recommends overdenture therapy, the patient needs to be examined regularly to reduce the risk of experiencing caries and periodontal disease. Also, if the abutments are in the maxilla and are opposed by natural teeth, the dentist should consider using thimble crowns to reduce the risk of vertical fractures.

PMID: 15270156 [PubMed - indexed for MEDLINE]

Awareness of infective endocarditis prophylaxis and dental hygiene in cardiac patients after physician contact.

Indian J Pediatr. 2004 Feb;71(2):184

Authors: Chatterjee A, Das D, Kohli P, Das R, Kohli V

PMID: 15053389 [PubMed - indexed for MEDLINE]

A comparison of health professions student attitudes regarding tobacco curricula and interventionist roles.

J Dent Educ. 2004 Mar;68(3):370-7

Authors: Fried JL, Reid BC, DeVore LE

Health care providers who feel prepared are more apt to assume tobacco interventionist roles; therefore, educational preparation is critical. A nonprobability sample of health professions students at an urban academic health center were asked to respond to a twenty-two-item survey eliciting demographic, behavioral, and tobacco-related attitudinal information. Frequency distributions were assessed with Pearson chi-square statistics. The overall response rate was 76.7 percent, and final sample size was 319. Current use of spit tobacco (ST) was 2.5 percent and current smoking 5.6 percent. In comparing current smokers to nonsmokers and current ST users to nonusers, we found that no differences in proportion agreeing with any of the five questions about attitudes and opinions were statistically significant at p-value 0.05. At least 70 percent of students from each of six health professions programs agreed it was their professional responsibility to help smokers quit, and at least 65 percent agreed to the same responsibility for helping ST users quit. The proportion agreeing that their programs had course content describing their role in helping patients quit tobacco use varied widely by program from 100 percent agreement among dental hygiene and pharmacy students to 14.6 percent of physical therapy students (p-value <0.001). When asked whether their program adequately prepared them to help smokers quit, agreement ranged from 100 percent among dental hygiene students to only 5.5 percent among physical therapy students (p-value <0.001). Almost 90 percent of dental hygiene students agreed that they were adequately trained to help ST users quit, but no other program had a percentage of agreement above 34 percent (p-value <0.001). Consistent and comprehensive multidisciplinary tobacco-related curricula could offer desirable standardization.

PMID: 15038638 [PubMed - indexed for MEDLINE]

Development and evaluation of an interactive tobacco cessation CD-ROM educational program for dental students.

J Dent Educ. 2004 Mar;68(3):361-9

Authors: Gordon JS, Severson HH, Seeley JR, Christiansen S

Dentists and dental hygienists can be effective in providing advice and brief counseling to tobacco-using patients. However, lack of training in effective interventions is a barrier to incorporating tobacco cessation interventions into routine practice. After we developed and evaluated an interactive CD-ROM tobacco cessation training program, we evaluated the effect of using the program on the knowledge level and attitudes of forty-seven third-year dental students and thirty dental hygiene students and also obtained their opinions of program quality and utility. Significant change was observed from pre- to post-intervention (t (46) = -11.62, p <.001; Cohen's d = 1.36). Program use was strongly related to change in the measure of tobacco cessation knowledge, attitudes, and beliefs (semi-partial r = .57, p <.001). In addition, participants rated the program highly on measures of satisfaction. The results of our evaluation provide strong support for the efficacy of the program with dental and dental hygiene students. An interactive educational program such as the one reported herein could be a useful tool for enabling dental professionals to obtain the skills necessary to help their patients quit using tobacco.

PMID: 15038637 [PubMed - indexed for MEDLINE]

Outcomes assessment related to professional growth and achievements of baccalaureate dental hygiene graduates.

J Dent Educ. 2004 Jan;68(1):35-43

Authors: Rowe DJ, Weintraub JA, Shain S, Yamamoto J, Walsh MM

The goals of the entry-level baccalaureate dental hygiene (DH) program at the University of California, San Francisco, include the preparation of scholars who will pursue additional study and research and the development of DH educators and leaders in the field of DH. The objective of this study was to evaluate whether the goals of the program were being achieved by assessing the professional growth and achievements of the graduates. Questionnaires were mailed to graduates of classes from 1960 to 2000, and the response rate was 66 percent (N = 468). Results indicated the following: 21 percent of the respondents completed a graduate or professional program, with most degrees being master's related to education (53 percent) and dental degrees (28 percent); 20 percent have held a faculty position in a DH educational program, with 26 percent holding leadership positions; 60 percent have been regular participants in DH professional organizations, with 36 percent of them holding leadership positions; and 61 percent have been active in a community organization, with 60 percent of them holding leadership positions. This outcomes assessment indicates that many UCSF DH graduates have become scholars, educators, and leaders in DH, and thus, the current program is successful at achieving its educational goals. Future studies should evaluate graduates of other DH programs on similar outcomes measures.

PMID: 14761171 [PubMed - indexed for MEDLINE]

A pilot study of risk-based prevention in private practice.

J Am Dent Assoc. 2003 Sep;134(9):1195-202

Authors: Bader JD, Shugars DA, Kennedy JE, Hayden WJ, Baker S

BACKGROUND: Risk-based prevention is a means of ensuring that patients receive preventive treatment appropriate for their risk of disease. While straightforward, its application in private practice has not been examined. METHODS: Volunteer clinicians in 15 offices participated in a six-month pilot study to test methods for a larger, risk-based prevention demonstration study operated by a dental insurer. Concomitant with oral examinations for patients of this insurer, clinicians identified patients at elevated risk of developing dental caries and periodontitis. For these patients, the reasons for elevated risk (risk indicators), as well as planned preventive treatment in response to that risk, were recorded and transmitted to the insurer via the claim form. RESULTS: The clinicians identified relatively small percentages of patients as being at high risk of developing caries (4 percent) and periodontitis (7 percent), with little variation across the 15 offices. Larger proportions of patients were identified as being at moderate risk of developing caries (29 percent) and periodontitis (30 percent), with more extensive variation across offices. In general, patients classified as being at elevated risk had received more disease-related treatment than patients at low risk before the classification, which provided some validation for the accuracy of risk assessment. CONCLUSIONS: The results of this pilot study suggest that formal, risk-based prevention can be accomplished in dental offices. Clinicians' reported risk assignments and indicators, together with their planned preventive treatments, demonstrate a good understanding of risk-based prevention. CLINICAL IMPLICATIONS: Researchers may need to clarify the criteria used to assess moderate risk of developing dental caries, and clinicians may need to emphasize greater use of fluorides and more frequent recall visits for adults at elevated risk of developing dental caries.

PMID: 14528991 [PubMed - indexed for MEDLINE]

Oral health profile of education and health professionals attending handicapped children.

Pesqui Odontol Bras. 2003 Jan-Mar;17(1):11-6

Authors: Pomarico L, de Souza IP, Tura LF

The purpose of this study was to evaluate the knowledge and attitudes toward oral health of education and health professionals working in a children care program for handicapped children from 0 to 6 years of age, run by a public municipal institution in Rio de Janeiro. Using a printed questionnaire, 67 professionals (teachers, attendants and health professionals) were interviewed. The results were compared to the children's oral hygiene habits, by directly observing their daily nursery routine. Although 97.0% said that oral health could play a part in general health, only 37.3% of the professionals answered correctly on this matter. As for methods for preventing caries, although 92.5% said that they were aware of them, only 17.9% went to the dentist for preventive treatment. Although the majority (81.3%) indicated oral hygiene as a way of preventing caries, observation showed that this practice is not always put into effect in the program's day nursery. Regarding when to start toothbrushing in children, 75.0% of the teachers and 94.4% of the health professionals said that they were aware of the need to begin brushing before one year of age, although this reply was given by only 52.5% of the attendants (chi-square, p = 0.006). In view of these results, it was concluded that attitudes toward oral health were not always coherent with the knowledge that these professionals express.

PMID: 12908053 [PubMed - indexed for MEDLINE]

Oral health risk assessment timing and establishment of the dental home.

Pediatrics. 2003 May;111(5 Pt 1):1113-6

Authors: Hale KJ,

Early childhood dental caries has been reported by the Centers for Disease Control and Prevention to be perhaps the most prevalent infectious disease of our nation's children. Early childhood dental caries occurs in all racial and socioeconomic groups; however, it tends to be more prevalent in low-income children, in whom it occurs in epidemic proportions. Dental caries results from an overgrowth of specific organisms that are a part of normally occurring human flora. Human dental flora is site specific, and an infant is not colonized until the eruption of the primary dentition at approximately 6 to 30 months of age. The most likely source of inoculation of an infant's dental flora is the mother or another intimate care provider, through shared utensils, etc. Decreasing the level of cariogenic organisms in the mother's dental flora at the time of colonization can significantly impact the child's predisposition to caries. To prevent caries in children, high-risk individuals must be identified at an early age (preferably high-risk mothers during prenatal care), and aggressive strategies should be adopted, including anticipatory guidance, behavior modifications (oral hygiene and feeding practices), and establishment of a dental home by 1 year of age for children deemed at risk.

PMID: 12728101 [PubMed - indexed for MEDLINE]

Insufficient awareness of endocarditis prophylaxis in patients at risk.

Swiss Med Wkly. 2003 Mar 8;133(9-10):155-9

Authors: Stucki C, Mury R, Bertel O

OBJECTIVE: To determine whether patients at risk for development of infective endocarditis (IE) have adequate knowledge of IE and the need for endocarditis prophylaxis (EP), and to test the impact of reeducation on subsequent knowledge. METHODS: We assessed awareness of IE and EP in 139 patients at risk. To assess their knowledge of IE and EP, patients were asked to complete a questionnaire. 59 patients underwent education concerning IE and EP. RESULTS: On the basis of 123 analysed questionnaires, 87 patients were considered high risk and 36 moderate/low risk. Overall, 59% displayed inappropriate knowledge of IE and EP, 15% did not remember receiving IE education, nor had they been given an EP card. The term "endocarditis" was correctly defined by 45%. 63% were aware of the precautions necessary for IE and 55% remembered the need for antibiotic prophylaxis prior to invasive dental procedures. More than two thirds of the patients with prior education and an EP card could not recall having their knowledge of IE and EP "brushed up" by their primary care physicians. Only 21% had not informed their dentist of their risk for IE. CONCLUSIONS: Many patients at risk for IE have an inadequate knowledge of their heart disease, IE, and EP. Most of them are unaware of the need for good dental hygiene. Educational efforts should be intensified and regularly upgraded in adults with valvular disease. Communication between patient, physician and dentist needs to be improved in order to address these issues.

PMID: 12707843 [PubMed - indexed for MEDLINE]

Oral cleansers.

J Am Dent Assoc. 2003 Jan;134(1):108

Authors:

Toothette Disposable Oral Swabs are oral cleansers intended for hospital and nursing home patients who cannot practice normal oral hygiene methods. The foam applicator contains sodium bicarbonate and is grooved to facilitate the removal of thick ropy saliva. The Toothette Single Use System is a kit that includes the Toothette Disposable Oral Swab, tubes of moisturizer and Prox-A-Mint solution, which is an oral d&#xE9;briding agent. The swab can be connected to a suction apparatus, allowing a safe and thorough oral cleaning, which is particularly useful in intubated and non-responsive patients.

PMID: 12555964 [PubMed - indexed for MEDLINE]

Curriculum evaluation of ethical reasoning and professional responsibility.

J Dent Educ. 2003 Jan;67(1):55-63

Authors: Christie CR, Bowen DM, Paarmann CS

This exploratory study evaluated curricular content and evaluation mechanisms related to ethics and professionalism in the baccalaureate dental hygiene program at Idaho State University. Competency-based education requires enhanced student preparation in ethical reasoning, critical thinking, and decision-making. Graduates must integrate concepts, beliefs, principles, and values to fulfill ethical and professional responsibilities. Methods included 1) development of five supporting competencies defining ethics and professionalism to provide a framework for curricular evaluation; 2) assessment of all course content and evaluation methods for each supporting competency; 3) evaluation of students' clinical performance based on professional judgment grades; and 4) survey of junior (n=30) and senior (n=27) students' attitudes about dental hygiene practice related to ethics and professionalism. Results revealed that most courses include content and evaluation related to at least one supporting competency; however, authentic evaluation is weak. Clinical instructors rarely relate evaluations to ethical principles or values. Surveys showed significant differences between junior and senior students' attitudes about ethics and professionalism in six of thirty-four areas (the six were laws and regulations; communication and interpersonal skills; problem solving; professional activities/programs; integrity; and safe work environment). This article shares one approach for evaluating curricular content and evaluation methods designed to develop student competence in ethical reasoning and professionalism. Based upon the study's findings, recommendations are made for curricular enhancement via authentic evaluation and faculty training.

PMID: 12540106 [PubMed - indexed for MEDLINE]

Tooth whitening today.

J Am Dent Assoc. 2002 Nov;133(11):1535-8; quiz 1541

Authors: Sarrett DC

BACKGROUND: Methods to improve the esthetics of the dentition by tooth whitening are of interest to dentists, their patients and the public. In the past 20 years, research on bleaching and other methods of removing tooth discolorations has dramatically increased. Dentist-supervised and over-the-counter products now are available to solve a variety of tooth discoloration problems without restorative intervention. The indications for appropriate use of tooth-whitening methods and products are dependent on correct diagnosis of the discoloration. OVERVIEW: Tooth-whitening methods include the use of peroxide bleaching agents to remove internal discolorations or abrasive products to remove external stains. Peroxide bleaching procedures are completed by the dentist in single or multiple appointments, or by the patient over a period of weeks to months using custom trays loaded with a bleaching agent. Both methods are safe and effective when supervised by the dentist. Microabrasion is indicated for the removal of isolated discolorations that often are associated with fluorosis. Whitening toothpastes remove surface stains only through the polishing effect of the abrasives they contain. CONCLUSIONS AND PRACTICE IMPLICATIONS: Tooth whitening is a form of dental treatment and should be completed as part of a comprehensive treatment plan developed by a dentist after an oral examination. When used appropriately, tooth-whitening methods are safe and effective.

PMID: 12462698 [PubMed - indexed for MEDLINE]

Intentional use of the Hawthorne effect to improve oral hygiene compliance in orthodontic patients.

J Dent Educ. 2002 Oct;66(10):1129-35

Authors: Feil PH, Grauer JS, Gadbury-Amyot CC, Kula K, McCunniff MD

The purpose of this study was to evaluate whether the home care of noncompliant adolescent orthodontic patients with "poor" oral hygiene could be improved through the use of a deception strategy designed to intentionally induce the Hawthorne effect. This effect is often cited as being responsible for oral health improvements of control groups that receive placebo treatments. It is thought that participating in and fulfilling the requirements of a study alters subjects' behavior, thereby contributing to the improvement. Forty patients with histories of poor oral hygiene were assigned, in a quasi-random fashion, to two groups. Experimental subjects (n = 20) were presented with a situation that simulated participation in an experiment. These included the use of a consent form; distribution of tubes of toothpaste labeled "experimental"; instructions to brush twice a day for two minutes using a timer; and a request to return unused toothpaste. Control subjects (n = 20) had no knowledge of study participation. Tooth surface area covered with plaque was used as a proxy measure of home care behavior. It was measured at baseline, three months, and six months. Mean percentages of tooth surface covered with plaque for the experimental and control groups were 71 (+/- 11.52) and 74 (+/- 11.46) at baseline; 54 (+/- 13.79) and 78 (+/- 12.18) at three months; and 52 (+/- 13.04) and 79 (+/- 10.76) at six months. No statistically significant difference (p > .05) was obtained between groups at baseline. Statistically significant differences (p < .05) were found between groups at three and six months. Significant differences (p < .05) were also found only for the experimental subjects between baseline and each of the two subsequent observation periods. The efficiency and potential effectiveness of this strategy suggest that additional research be conducted to assess oral health improvements and possible applications to the private practice setting.

PMID: 12449206 [PubMed - indexed for MEDLINE]

Brief chewing of Garcinia manii stick reverses reduced saliva pH after a glucose rinse.

Med Sci Monit. 2002 Nov;8(11):CR746-50

Authors: Addai FK, Nuamah IK, Parkins GE

BACKGROUND: A popular variety of wood, pieces of which are chewed as an oral hygiene practice in Southern Ghana, was tested for its capacity to reverse experimentally lowered pH of saliva. This was done to determine whether (Garcinia manii) stick-chewing neutralizes acidogenic challenge to teeth, and thereby potentially affords dental caries prevention benefit. MATERIAL/METHODS: Seventy-two volunteer medical students gave (baseline) saliva samples by spitting 3-4 times into a 25 ml conical flask. They then rinsed their mouths with a five-percent aqueous solution of glucose. Subsequent to the glucose rinse, half of the subjects (chewers), pre-selected by drawing lots, chewed a popular chewing stick Garcinia manii for five minutes, while the other half (controls) did not. The pH of saliva samples given by the volunteers at various time intervals was measured using a Kent EIL 7020 pH meter, and the results were analysed by the Analysis of Variance (Anova) method. RESULTS: As expected, saliva pH was reduced in both groups after the glucose rinse, but increased significantly faster in stick chewers compared with controls. CONCLUSIONS: It is suggested from this study that brief (Garcina manii) stick-chewing confers a caries prevention/control benefit by reversing acidogenic challenge to teeth.

PMID: 12444378 [PubMed - indexed for MEDLINE]

Pursuing community-oriented primary care in a Russian closed nuclear city: the Sarov-Los Alamos community health partnership.

Am J Public Health. 2002 Nov;92(11):1740-2

Authors: Rhyne RL, Hertzman PA

The Russian health care system historically has not relied on medical evidence to guide practice, uses centralized management, and is burdened by overspecialization. In 1999, a community health partnership was established between Sarov, Russia, and Los Alamos, NM, 2 cities linked by their nuclear weapons histories. Health problems addressed include asthma and diabetes, pediatric dental caries, low prevalence of breastfeeding, and adolescent drug abuse and sexually transmitted diseases. A community-oriented primary care approach was adopted that includes (1) implementing a "train the trainers" strategy to educate health professionals and lay people, (2) adapting established clinical practice guidelines based on local resources, (3) restricting use of expensive or limited resources, and (4) securing commitments from local government for expendable supplies and medications.

PMID: 12406797 [PubMed - indexed for MEDLINE]