OBJECTIVE: To investigate the oral health status of adults on Sheffield's Learning Disability Case Register, and their reported use of dental services. DESIGN: A short questionnaire interview of subjects with learning disabilities or their carers followed by a standardised epidemiological examination, by one trained and calibrated examiner. SETTING: Residential homes, day centres or community homes of people with learning disabilities in Sheffield. SUBJECTS: A 20% random sample of adults (18-65 years) on the register. RESULTS: A response rate of 209 (67%) was achieved, 62% (n=130) of whom were living in the community. People living in residential care were significantly older (43.2 years) than those based in the community (36.3 years) (P<0.05). Both groups had similar mean DMFT scores; however, adults living in the community had significantly more untreated decay (DT = 1.6) and poorer oral hygiene than their counterparts in residential care (DT = 0.7). Adults in residential care had significantly more missing teeth (MT = 10.1) than those in community care (MT = 7.5). General and community dental services were the main providers of dental care. Subjects living in the community were significantly less likely to have a dentist and to use community dental services than their residential counterparts; they were more likely to attend only when having trouble. CONCLUSIONS: Adults with learning disabilities living in the community have greater unmet oral health needs than their residential counterparts and are less likely to have regular contact with dental services. Commissioners and providers of dental services have a responsibility to ensure that the health of adults with learning disabilities is not compromised by 'normalisation'.
PURPOSE: The purposes of this study were to: (1) determine the prevalence of early childhood caries (ECC) among young children accessing dental services at a community dental clinic; (2) identify factors associated with the presence of ECC; and (3) determine the percentage of children who received treatment for ECC in this setting and the number who required referral to specialists. METHODS: The study population comprised children younger than 72 months attending the clinic between 1991 and 2004. A chart review was conducted. RESULTS: Eight hundred thirty-four charts met inclusion criteria; 71% had ECC, while the mean deft was 3.7+/-3.9 (SD). The average age at the first visit was 50.0+/-12.7 (SD) months. Those with ECC were significantly older at the first visit (P<.001), and the prevalence increased with family size (P=.011) and number of siblings (P=.019). ECC children were significantly more likely to come from households with lower monthly incomes (P=.033). The prevalence of ECC did not vary according to specific areas in Winnipeg where children resided (P=.20). CONCLUSIONS: Key risk factors for ECC included: (1) the child's sex; (2) low monthly income; (3) whether the child resided with both parents; and (4) a history of foiled dental visits. These data may assist in identifying children at greatest risk for ECC and may help public health agencies develop appropriate prevention strategies, including promoting early dental visits for infants.
The British Association for the Study of Community Dentistry (BASCD) is responsible for the coordination of locally based surveys of child dental health which permit local and national comparisons between health authorities and regions. These surveys began in 1985/86 in England and Wales, 1987/88 in Scotland and 1993/94 in Northern Ireland. BASCD has taken an increasing lead in setting quality standards in discussion with the NHS Epidemiology Coordinators of the Dental Epidemiology Programme. This paper comprises guidance on the statistical aspects of training and calibration of examiners for these surveys.
Section One: Dental Care Delivery. Dental Public Health: An Overview. An Overview of the US Dental Care Delivery System. The Dental Workforce. Infection Control and the Role of the Dental Team. Paying for Dental Care. Section Two: Demographic Shifts and Dental Health. Recognizing Cultural Differences. Geriatric Oral Health. Dental Health of Children and Strategies for Prevention. Section Three: Distribution of Dental Disease and Prevention. The Epidemiology of Oral Diseases. Effective Community Prevention Programs for Oral Diseases. Dental Health Education. Planning for Community Dental Programs. Program Evaluation in Health Care. Section Four: Research in Dental Public Health. Introduction to Biostatistics. Analysis of the Dental Literature: More Accessible Through Informatics. Section Five: Ethics and the Law in Community Dental Health. Ethical Issues in Community Dental Health. The Impact of Transmissable Disease in the Practice of Dentistry. Risk Management in Dental Practice. Appendix A: Departments of the Federal Government. Appendix B: National Resources Hotlines.
Dental fear is a widely experienced problem. Through a "vicious cycle dynamic," fear of dental treatment, lower use of dental services, and oral health diseases reinforce each other. Research on the antecedents of dental anxiety could help to break this cycle, providing useful knowledge to design effective community programs aimed at preventing dental fear and its oral health-related consequences. In this regard, frameworks that analyze the interplay between cognitive and psychosocial determinants of fear, such as the Cognitive Vulnerability Model, are promising. The onset of dental fear often occurs in childhood, so focusing on the child population could greatly contribute to understanding dental fear mechanisms and prevent this problem extending into adulthood. Not only can public mental health contribute to population health, but also community dentistry programs can help to prevent dental fear. Regular dental visits seem to act in a prophylactic way, with dental professionals playing an important role in the regulation of the patients' anxiety-related responses. Both public mental health and community dentistry could therefore benefit from a multidisciplinary approach to dental fear and oral health.
BACKGROUND: Oral health is a significant measure of overall health, and regular dental visits are recommended for the maintenance of oral health. The purpose of this study is to determine the pattern (amount and type) of, and factors associated with dental care use among Ontarians. METHODS: Data from the 2014 cycle of the Canadian Community Health Survey was used and analysis was restricted to individuals aged 12 and above residing in Ontario. Dental care use was defined by two distinct outcomes: not visiting a dentist within the past year and visiting a dentist only for emergencies. Multivariable logistic regression was performed to examine the association between socio-demographic, health behavior, oral health, and other health-related factors and the two outcomes. RESULTS: More than a quarter of participants reported not visiting the dentist in the last year, and 19% reported usually visiting a dentist only for emergencies. Multivariable logistic regression analysis suggested that males, individuals of Aboriginal status, those with low educational attainment, low household income, no dental insurance, who smoked, less frequent teeth brushing, poor health of teeth and mouth, or had diabetes were at a significant increased likelihood of not visiting the dentist within the past year, and only visiting a dentist for emergency care. CONCLUSIONS: Socioeconomic status, self-reported oral health, and general health behaviors were associated with dental care use. These findings highlight the need for focusing efforts toward improving dental care use among Ontarians.
BACKGROUND: Pre-school children in families of recently settled refugees often have very high rates of early childhood caries (ECC). ECC is associated with a high level of morbidity and is largely preventable, however effective culturally appropriate models of care are lacking. This study aimed to provide a deeper understanding of the refugee experience related to early oral health by exploring pre-school refugee families (i) understanding of ECC and child oral health, (ii) experiences of accessing dental services and (iii) barriers and enablers for achieving improved oral health. The knowledge gained will be critical to the development of effective early oral health programs in refugee children. METHODS: Community based participatory qualitative methodology using focus groups of resettled refugee families and community refugee nurse interviews. A community reference group was established and a bi-lingual community research associate was employed. Transcripts were analysed for thematic content using NVivo software. RESULTS: There were 44 participants: eight focus groups (nine countries of origin) and five interviews. Emergent themes were (i) the major influence of parents' previous experience, including their beliefs about deciduous (baby) teeth, traditional feeding practices and poverty; and a consequent lack of understanding of the importance of early oral health and early dental caries, (ii) the burden of resettlement including prioritising, parenting, learning about new foods and how to assimilate into the community, and (iii) refugees' difficulties in accessing both information and dental services, and the role of schools in addressing these issues. An Opportunities for Change Model was proposed. CONCLUSIONS: The main implication of the study is the demonstration of how enhanced understanding of the refugee experience can inform improvement in early oral prevention and treatment. The community participatory methodology of the study provided a basis for cross-cultural understanding and has already assisted in translating the findings and raising awareness in the provision of targeted refugee oral health services.
Dental students' attitudes towards access to dental care for the underserved may be impacted by participation in community oral health promotion programs that target individuals in underserved communities. At the University of Southern California School of Dentistry, freshman dental students provide classroom oral health promotion and preventive dental care programs to underserved elementary school children. One hundred forty-four freshman dental students were surveyed three times during their freshman year-before, during, and after participation in these programs. The students' attitudes about societal expectations, health professionals' responsibility, access to care, and students' personal efficacy to positively impact the need for expanded oral health care services for segments of the population were measured. Students reported positive attitudes in all categories throughout the study period. The students' attitudes about societal expectations to care for the oral health of the underserved remained stable over the study period, but they became more uncertain of who should be responsible for fulfilling that obligation, who should receive that care, and their capability to provide this care while in dental school. These changes in attitude may reflect the students' greater understanding of the complexity of the determinants of oral health as a consequence of their community education experiences.
OBJECTIVES: We tested a dental health program in remote Aboriginal communities of Australia's Northern Territory, hypothesizing that it would reduce dental caries in preschool children. METHODS: In this 2-year, prospective, cluster-randomized, concurrent controlled, open trial of the dental health program compared to no such program, 30 communities were allocated at random to intervention and control groups. All residents aged 18-47 months were invited to participate. Twice per year for 2 years in the 15 intervention communities, fluoride varnish was applied to children's teeth, water consumption and daily tooth cleaning with toothpaste were advocated, dental health was promoted in community settings, and primary health care workers were trained in preventive dental care. Data from dental examinations at baseline and after 2 years were used to compute net dental caries increment per child (d₃mfs). A multi-level statistical model compared d₃mfs between intervention and control groups with adjustment for the clustered randomization design; four other models used additional variables for adjustment. RESULTS: At baseline, 666 children were examined; 543 of them (82%) were re-examined 2 years later. The adjusted d₃mfs increment was significantly lower in the intervention group compared to the control group by an average of 3.0 surfaces per child (95% CI = 1.2, 4.9), a prevented fraction of 31%. Adjustment for additional variables yielded caries reductions ranging from 2.3 to 3.5 surfaces per child and prevented fractions of 24-36%. CONCLUSIONS: These results corroborate findings from other studies where fluoride varnish was efficacious in preventing dental caries in young children.
Dental caries has a polymicrobial etiology within the complex oral microbial ecosystem. However, the overall diversity and structure of supragingival plaque microbiota in adult dental health and caries are not well understood. Here, 160 supragingival plaque samples from patients with dental health and different severities of dental caries were collected for bacterial genomic DNA extraction, pyrosequencing by amplification of the 16S rDNA V1-V3 hypervariable regions, and bioinformatic analysis. High-quality sequences (2,261,700) clustered into 10,365 operational taxonomic units (OTUs; 97% identity), representing 453 independent species belonging to 122 genera, 66 families, 34 orders, 21 classes, and 12 phyla. All groups shared 7522 OTUs, indicating the presence of a core plaque microbiome. α diversity analysis showed that the microbial diversity in healthy plaques exceeded that of dental caries, with the diversity decreasing gradually with the severity of caries. The dominant phyla of plaque microbiota included Bacteroidetes, Actinobacteria, Proteobacteria, Firmicutes, Fusobacteria, and TM7. The dominant genera included Capnocytophaga, Prevotella, Actinomyces, Corynebacterium, Neisseria, Streptococcus, Rothia, and Leptotrichia. β diversity analysis showed that the plaque microbial community structure was similar in all groups. Using LEfSe analysis, 25 differentially abundant taxa were identified as potential biomarkers. Key genera (27) that potentially contributed to the differential distributions of plaque microbiota between groups were identified by PLS-DA analysis. Finally, co-occurrence network analysis and function predictions were performed. Treatment strategies directed toward modulating microbial interactions and their functional output should be further developed.
OBJECTIVE: To investigate the relationship of dental anxiety with oral health status and oral health-related quality of life (OHQoL) among dentate subjects living in Hong Kong. METHODS: One thousand Hong Kong residents who were aged 25-64 years and predominantly Chinese were asked to complete the Chinese short-forms of the Dental Anxiety Inventory (SDAxI) and Oral Health Impact Profile (OHIP-14S). Dental (DMFT index) and periodontal statuses [full-mouth clinical attachment level (CAL)] were also assessed. RESULTS: Ninety-six (9.6%; mean SDAxI, 9.6), 799 (79.9%; mean SDAxI, 15.0), and 105 (10.5%; mean SDAxI, 27.4) participants had low, average, and high dental anxiety, respectively. The mean DMFT/CAL scores of each SDAxI subgroup were 8.5/1.4, 9.3/1.9, and 9.8/3.6, respectively. The corresponding mean OHIP-14S scores for each SDAxI subgroup were 4.0, 8.1, and 13.2, respectively. Post hoc analysis, adjusted for possible confounding factors, revealed statistically significant differences in DMFT and CAL scores in subjects with low versus high level of SDAxI, and significant differences in OHIP-14S scores between all 3 SDAxI categories. CONCLUSION: The trait disposition of dental anxiety may be a significant risk indicator of poor dental and periodontal status and is associated with a worse OHQoL.
Dental examinations were carried out as part of the Evergreen project, which focuses on functional capacity and health among the elderly residents of the city of Jyväskylä, central Finland. Dental status was examined in 1990 for the whole population born in 1910 (n = 226). Mortality data were collected over 10 yr. The aim of the study was to assess the possible role of dental health as a predictor of mortality. The Kaplan-Meier method was used to analyse survival curves and Cox regression models, with the number of chronic conditions and self-rated health used as covariates in analysing the risks of death. The results showed that the more teeth or filled teeth a subject had, the smaller was their risk for death. The effect of missing teeth was significant after adjusting for the general health variables. Thus, our results support the hypothesis that poor dental health is linked to increased mortality among elderly people.
Dental disease in children is one of the most common health problems encountered.1-3 Fifty percent of children have one or more carious teeth by the age of 2 years. Gingivitis occurs in a major portion of the child population and may lead to periodontal disease, the leading cause of tooth loss in adults. Cleft palate, with or without cleft lip, occurs once in every 700 births. Half of the school-age population has some form of malocclusion. So prevalent are these problems and so great is the backlog of dental neglect, that treatment of these defects is beyond the capabilities of the limited dental manpower we have in this country. In addition, treatment is time-consuming and expensive and the costs of dental services are constantly rising. It is obvious from these facts that dental disease cannot be controlled by treatment alone. It is only by preventing the occurrence of new disease, beginning with the child, that the problem of dental disease can be brought into a manageable form. Pediatricians are in a unique position to have a significant impact on the dental health of their patients and communities. Since the pediatrician gives care to the child from birth, he can detect any existing abnormality early in life and promptly refer or treat the problem. Control of dental disease can best be accomplished if preventive measures are started shortly after birth. It is interesting to note that few children are seen by the dentist at the recommended age of 2½ to 3 years.
OBJECTIVE: The aim of this study was to explore older persons' beliefs and attitudes towards oral health and access to and use of dental care services. BACKGROUND: As the proportion of dentate older people increases, the need and demand for dental services will rise (J Public Health Dent, 60, 2000, 276). DESIGN: Focus groups and semi-structured interviews were used for data collection. SETTING AND SUBJECTS: The study participants included 63 older people in Perth, WA. RESULTS: Five major themes emerged from the interviews - the need for information and knowledge; accessibility of services; cost and affordability of oral care; fear and anxiety regarding dental visits and relationships with dentists. Attitudes and behaviours were slow to change in this group. CONCLUSION: This investigation provided important perspectives regarding oral health and dental access for older people residing in the community and demonstrated the importance of understanding this group when considering provision and use of services.
A current review of the available epidemiological data from many countries clearly indicates that there is a marked increase in the prevalence of dental caries. This global increase in dental caries prevalence affects children as well as adults, primary as well as permanent teeth, and coronal as well as root surfaces. This increase in dental caries signals a pending public health crisis. Although there are differences of opinion regarding the cause of this global dental caries increase, the remedy is well known: a return to the public health strategies that were so successful in the past, a renewed campaign for water fluoridation, topical fluoride application, the use of fluoride rinses, a return to school oral health educational programs, an emphasis on proper tooth brushing with a fluoride dentifrice, as well as flossing, a proper diet and regular dental office visits. If these remedies are not initiated, there could be a serious negative impact upon the future oral health (and systemic health) of the global community, as well as a strain on the dental profession along with a major increase in the cost of dental services.
Dental caries and periodontal diseases have historically been considered the most important part of the global burden of oral diseases. At present, the distribution and severity of oral diseases vary in different parts of the world and within the same country or region. Dental caries is still a major public health problem in most industrialized countries, affecting 60-90% of schoolchildren and the vast majority of adults. It is also a prevalent oral disease in several Asian and Latin American countries, while it appears to be less common and less severe in most African countries. It is expected, however, that the incidence of dental caries will increase in the near future in many developing countries of Africa, as a result of growing consumption of sugars and inadequate exposure to fluorides. The significant role of socio-behavioural and environmental factors in oral disease and health is demonstrated in a large number of epidemiological surveys. The current pattern of dental caries reflects primarily distinct risk profiles across countries (related to living conditions, lifestyles and environmental factors) and the implementation of preventive oral health systems. In some industrialized countries there has been a positive trend in the reduction of tooth loss among adults in recent years, though the proportion of edentulous persons in the elderly population is still high in some countries. In most developing countries, access to oral health services is limited and teeth are often left untreated or are extracted because of pain or discomfort. Tooth loss and impaired oral function are therefore expected to increase as a public health problem in many developing countries. Tooth loss in adult life may also be attributable to poor periodontal health. Severe periodontitis, which may result in tooth loss, is found in 5-15% of most populations. In industrialized countries, studies show that tobacco use is a major risk factor for adult periodontal disease. With the growing consumption of tobacco in many developing countries, the risk of periodontal disease and tooth loss may therefore increase. Oral cancer is closely related to the use of tobacco and excessive consumption of alcohol. The prevalence of oral cancer is particularly high among men, and is the eighth most common cancer worldwide. In south and central Asia, consumption of tobacco in various forms is particularly high, and cancer of the oral cavity ranks among the three most common types of cancer. Periodontal disease and tooth loss are also related to chronic diseases such as diabetes mellitus: the growing incidence of diabetes may further impact negatively on oral health of people in several developing countries. …
BACKGROUND: Based on the hypothesis that a vicious cycle of dental fear exists, whereby the consequences of fear tend to maintain that fear, the relationship between dental fear, self-reported oral health status and the use of dental services was explored. METHODS: The study used a telephone interview survey with interviews predominantly conducted in 2002. A random sample of 6,112 Australian residents aged 16 years and over was selected from 13 strata across all States and Territories. Data were weighted across strata and by age and sex to obtain unbiased population estimates. RESULTS: People with higher dental fear visited the dentist less often and indicated a longer expected time before visiting a dentist in the future. Higher dental fear was associated with greater perceived need for dental treatment, increased social impact of oral ill-health and worse self-rated oral health. Visiting patterns associated with higher dental fear were more likely to be symptom driven with dental visits more likely to be for a problem or for the relief of pain. All the relationships assumed by a vicious cycle of dental fear were significant. In all, 29.2% of people who were very afraid of going to the dentist had delayed dental visiting, poor oral health and symptom-driven treatment seeking compared to 11.6% of people with no dental fear. CONCLUSION: Results are consistent with a hypothesised vicious cycle of dental fear whereby people with high dental fear are more likely to delay treatment, leading to more extensive dental problems and symptomatic visiting patterns which feed back into the maintenance or exacerbation of existing dental fear.
Dental caries in very young children may be severe, result in serious infection, and require general anesthesia for treatment. Dental caries results from a shift within the biofilm community specific to the tooth surface, and acidogenic species are responsible for caries. Streptococcus mutans, the most common acid producer in caries, is not always present and occurs as part of a complex microbial community. Understanding the degree to which multiple acidogenic species provide functional redundancy and resilience to caries-associated communities will be important for developing biologic interventions. In addition, microbial community interactions in health and caries pathogenesis are not well understood. The purpose of this study was to investigate bacterial community profiles associated with the onset of caries in the primary dentition. In a combination cross-sectional and longitudinal design, bacterial community profiles at progressive stages of caries and over time were examined and compared to those of health. 16S rRNA gene sequencing was used for bacterial community analysis. Streptococcus mutans was the dominant species in many, but not all, subjects with caries. Elevated levels of S. salivarius, S. sobrinus, and S. parasanguinis were also associated with caries, especially in subjects with no or low levels of S. mutans, suggesting these species are alternative pathogens, and that multiple species may need to be targeted for interventions. Veillonella, which metabolizes lactate, was associated with caries and was highly correlated with total acid producing species. Among children without previous history of caries, Veillonella, but not S. mutans or other acid-producing species, predicted future caries. Bacterial community diversity was reduced in caries as compared to health, as many species appeared to occur at lower levels or be lost as caries advanced, including the Streptococcus mitis group, Neisseria, and Streptococcus sanguinis. This may have implications for bacterial community resilience and the restoration of oral health.
Dental caries can be prevented by a combination of community, professional, and individual measures including water fluoridation, professionally applied topical fluorides and dental sealants, and use of fluoride toothpastes. Yet, tooth decay is the most common chronic disease of childhood. Dental care is the most prevalent unmet health need in US children with wide disparities existing in oral health and access to care. Only 1 in 5 children covered by Medicaid received preventive oral care for which they are eligible. Children from low income and minority families have poorer oral health outcomes, fewer dental visits, and fewer protective sealants. Water fluoridation is the most effective measure in preventing caries, but only 62% of water supplies are fluoridated, and lack of fluoridation may disproportionately affect poor and minority children. Childhood oral disease has significant medical and financial consequences that may not be appreciated because of the separation of medicine and dentistry. The infectious nature of dental caries, its early onset, and the potential of early interventions require an emphasis on preventive oral care in primary pediatric care to complement existing dental services. However, many pediatricians lack critical knowledge to promote oral health. We recommend financial incentives for prioritizing Medicaid Early and Periodic Screening, Diagnostic, and Treatment dental services; managed care accountability; integration of medical and dental professional training, clinical care, and research; and national leadership. JAMA. 2000;284:2625-2631.
Six dental schools have closed in the last decade and others are in jeopardy. Facing this uncertainty about the status of dental education and the continued tension between educators and practitioners, leaders in the profession have recognized the need for purpose and direction.This comprehensive volume--the first to cover the education, research, and patient care missions of dental schools--offers specific recommendations on oral health assessment, access to dental care, dental school curricula, financing for education, research priorities, examinations and licensing, workforce planning, and other key areas.Well organized and accessible, the book Recaps the evolution of dental practice and education. Reviews key indicators of oral health status, outlines oral health goals, and discusses implications for education. Addresses major curriculum concerns. Examines health services that dental schools provide to patients and communities. Looks at faculty and student involvement in research. Explores the relationship of dental education to the university, the dental profession, and society at large. Accreditation, the dental workforce, and other critical policy issues are highlighted as well.Of greatest interest to deans, faculty, administrators, and students at dental schools, as well as to academic health centers and universities, this book also will be informative for health policymakers, dental professionals, and dental researchers.