This study investigated the effect of geographic location on Severe Early Childhood Caries (S-ECC) in Native American Children three years of age from a Norther Plains Tribal Community. Geographic location of study participants was ascertained by postal district and categorized into geographic regions as well as dental clinic accessibility, defined as dental services present or absent in that district. The association of location category and dental caries (dmfs) was evaluated cross-sectionally at 36 months of age. Descriptive statistics demonstrated differences in dental caries distribution by geographic region and accessibility category. Bivariate analysis of disease by location showed a significant difference in dmfs between 4 geographic regions (p=0.0159) but not between accessibility categories (p=0.0687). Multivariable regression modeling for geographic region demonstrated the unique effect of geographic region on dental caries experience as well as five other key risk factors. Incident Rate Ratios (IRR) were computed for each of the risk factors, including number of erupted teeth (IRR=1.89, p=0.0147), fluoride exposure from tap water (IRR=1.70, p=0.0173), annual family income (IRR=1.58, p=0.0392), maternal DMFS (IRR=1.02, p=0.0040), and Mean Adequacy Ratio (IRR=1.05, p=0.1042). This study demonstrated statistically significant variation in cumulative dental caries experience of Native American children aged 36 months among geographic regions and identified the specific unites of association through multivariate modeling. These findings can be used for local dental caries prevention programs and contribute to a broader understanding of S-ECC among very young Native American children.

Objectives: To determine oral health literacy levels among Hispanic adults living in Iowa, and assess the relationship between oral health literacy and dental utilization. Methods: This cross-sectional study included a convenience sample of self-identifying Hispanic/Latino adults. Participants were recruited via mass email, word of mouth, and from faith-based organizations that provided church services in Spanish. Participants were recruited from urban and rural communities in Central and Eastern Iowa. Participants were asked to complete a questionnaire, in either English or Spanish, that contained questions pertaining to: oral health literacy, dental utilization, acculturation, language proficiency, demographic information, country of origin, number of years living in the United States, and preferences pertaining to the characteristics of their dental providers (e.g. importance of dentist to be able to speak Spanish). Oral health literacy was assessed using the Comprehensive Measure of Oral Health Knowledge (Macek and colleagues). Oral health knowledge levels were categorized as low (0-14) or high (15-23). Dental utilization was defined as visiting a dental provider within the past 12 months or more than 12 months ago. Bivariate analyses were conducted using the Chi-square test with oral health knowledge and dental utilization being the two main outcome variables. Multiple logistic regression models were created to identify the variables related to low oral health knowledge irregular dental utilization. Statistical significance was set as p<0.05. IRB approval was obtained prior to conducting the study. Results: Three hundred thirty-eight participants completed the questionnaire. Sixty-seven percent of participants (n=228) completed the questionnaire in Spanish. The mean oral health knowledge score was 14 (low knowledge =51% vs. high knowledge = 49%). Thirty-five percent reported visiting the dentist <12 months ago. Bivariate analyses revealed that the following respondents were more likely to have low oral health knowledge (p<0.05): being older (i.e. 55-71 years of age), male, self-reporting low health literacy, having less than a high-school education, earning ≤$25,000, not having dental insurance, having low acculturation, being born outside of the United States, preferring a dental provider who speaks Spanish, perceiving one’s oral health to be fair/poor/or not knowing the status of one’s oral health, seeking dental care someplace other than a private dental office, and being more likely to seek care for a problem related visit rather than routine care. Having low oral health knowledge was statistically significantly associated visiting a dentist >12 months ago. Many other variables were also associated (p<;0.05) with infrequent dental utilization: low health literacy, being male, having <12th grade degree or a high school diploma, earning ≤$25,000, not having dental insurance, having low acculturation, reporting fewer years living in the United States, preferring a dental provider who speaks Spanish, perceiving one’s oral health to be fair/poor/or not knowing the status of one’s oral health, and seeking dental care someplace other than a private dental office. Final logistic regression analyses indicated that having less than a 12th grade education, lack of dental insurance, and a preference for receiving care from a Spanish speaking dental provider were associated with low oral health literacy. Furthermore, final logistic regression results predicting irregular dental utilization demonstrated that the following variables were statistically significant: being male, earning ≤$25,000 per year, not having dental insurance and having a history of tooth decay. Conclusion: Dental utilization and oral health knowledge appear to be associated. Patients with low oral health literacy may be less likely to utilize dental care, thus decreasing the opportunity to increase dental knowledge. Dental teams should recognize which patients are more likely to have low oral health literacy and provide dental education in patients’ preferred language.

Dental caries is the main reason for placement and replacement of restorations (Keene, 1981). More than 60 percent of dentists' restorative time is spent replacing existing restorations. The replacement of restorations can result in a cavity preparation larger than its predecessor which leads to weakening of the remaining tooth structure (Mjör, 1993). Considering the traditional surgical dental caries management philosophy, it was based on "extension for prevention" and restorative material needs rather than on preserving the healthy tooth structure (Black, 1908). In the 1970s, the surgical dental paradigm began shifting to a new approach for caries management: Minimally Invasive Dentistry (MID). It was based on the medical model that prioritizes caries risk assessment, early caries detection, remineralization of tooth structure, and especially preservation of tooth structure through minimal intervention in the placement and replacement of restorations (Yamaga et al, 1972). The minimal intervention paradigm emphasizes use of adhesive restorative materials in order to minimize the size of cavity preparation (Murdoch-Kinch & McLean, 2003). Hence, a cross-sectional study using an online survey instrument (30-item) was conducted among National Network for Oral Health Access (NNOHA) and American Association Community Dental Programs (AACDP) members. Besides demographics, the survey addressed the following items using a 5-point Likert scale: knowledge, attitudes and behavior concerning MID among general practitioners. Specific questions focused on practitioner and practice characteristics, previous training and knowledge of MID, knowledge use of restorative, diagnostic and preventive techniques and whether MID was considered to meet the standard of care in the U.S., which was the main outcome of the study. Chi-square, Fisher's exact test, Wilcoxon rank-sum test, and two-Sample t-test were used to identify factors associated with beliefs that MID meets the standard of care. Overall, 86% believed MID met the standard of care for primary teeth, and 77% believed this for permanent teeth. The study found that those with more favorable opinions of fluoride to be more likely to believe MID met the standard of care, but no demographic or practice characteristics were associated MID standard of care beliefs.

Thesis (M.S.P.H.)--University of Michigan, 1942.

Thesis (M.S.P.H.)--University of Michigan, 1942.

Individuals with advance-stage illnesses frequently face illness or treatment-related adverse effects in the mouth. These adverse effects can have serious consequences. Despite that, the importance of oral care in this population is often overlooked and there are no definitive guidelines as to what kind of oral care should be provided to these individuals. Given that, our study aims were to explore and better understand the oral health-related concerns, perceived oral care needs of palliative care patients and the berries that face in accessing dental care services. We conducted a qualitative description study by recruiting a purposive sample of 11 participants with advanced stage health conditions from the outpatient palliative care services of the University of Iowa Hospitals and Clinics. Data were collected using in-depth, semi-structured interviews using an interview guide. All interviews were fully transcribed, with the data managed with Atlas.ti software to facilitate the analysis. All participants had oral concerns although they varied widely from person to person and their illness statuses. The most significant concerns were related to dry mouth, loose dentures, and eating difficulties. Among those who stated that they would seek dental care if required, they were not planning on seeking dental care even though they had treatable oral problems, suggesting a mismatch between their oral health status and their perceived needs. The frequently observed barriers that prevented them from seeking dental care were their illness and illness related priorities, finances, feeling discriminated against by the dentist, and a dislike towards the dentist. Providing information to the palliative care clinicians about the significance of oral health and its impact, incorporating a dental care provider in palliative care team, and providing timely information to individuals with advanced health conditions may enhance the understanding of their oral health problems and help them better manage their oral health and may enhance their dental care seeking behavior.

Not many studies have been conducted in the past to determine patients' level of satisfaction in academic dental hygiene settings. This patient satisfaction study analyzed the level of patient satisfaction with the dental hygiene clinic at East Tennessee State University, Johnson City, TN. The purpose of the study was to determine if there was a statistically significant influence of demographic characteristics of the patients and the affective behavior of the care providers on level of patient satisfaction. It was concluded that except for age, other demographic variables did not have any statistically significant influence on patient satisfaction. Also, care provider's affective behavior significantly influenced patient satisfaction. Overall, the dental hygiene patients were satisfied with the clinic. As patients' needs are prioritized in this customer-driven industry, such positive patient satisfaction data can be used for the welfare of the patients, the care providers, and the health care organization.

Dental caries is the most common chronic disease in children, and prevalence rates are disproportionately higher in American Indian/Alaska Native (AI/AN) populations. The Association of State and Territorial Dental Directors (ASTDD) recommends annual oral health screening for children in Head Start programs using the Basic Screening Survey (BSS). The 2014 study was a follow-up to a 2010 national survey of AI/AN children ages five and under that assessed oral health outcomes such as untreated decay, decay experience, urgent need for treatment, presence of sealants and decayed, missing and filled deciduous teeth (dmft) scores, and investigated the changes in Early Childhood Caries (ECC) prevalence from 2010 to 2014 in the Indian Health Service (IHS) Nashville Area. A gap analysis was completed comparing current recommended practices among dental clinics that participated in the IHS ECC Collaborative ASTDD Framework to Prevent and Control Childhood Tooth Decay (ASTDD Framework). Due to historical mistreatment of AI/AN populations in research, and out of respect for the sovereignty of the Tribal Nations that participated in the study, there limited data was made available for this study. In 2010, 579 children were screened in the Nashville Area; 1231 children participated in 2014. While there was a statistically significant, yet clinically small 9.36% reduction of untreated decay from 2010 (30.33%) to 2014 (27.49%), the ECC Collaborative did not reach their objective of a 25% reduction. There was also a significant increase in urgent need for treatment (3.17% in 2010 to 4.35% in 2014), and in presence of sealants (4.54% in 2010 to 10.01% in 2014). Gaps in best practices identified were related to need for increased risk assessments and enhancing policy development. Based on study findings and the limited access to data on Tribal and Area levels, development of culturally appropriate policies that are unique to individual Tribal needs, and focus on perinatal care, is recommended. Individual Tribal programs also need to be evaluated and surveillance needs to be continued to establish trend data. All program evaluations and research should be conducted in an ethical manner that is community-based and considerate of the needs of the Tribe.

The purpose of this study was to determine the awareness and attitudes of dental hygienists in Ohio regarding the Advanced Dental Hygiene Practitioner (ADHP) as an occupation proposed by the American Dental Hygienists’ Association and to determine whether the ADHP could be a viable career option for Ohio dental hygienists. I developed a survey to assess dental hygienists’ awareness, attitudes, and their views regarding the new mid-level dental provider. The study was limited to licensed dental hygienists in Ohio. The study included a simple random sample of 400 of the 4100 dental hygienists in Ohio obtained by a systematic approach, a random start and selection of subjects at a constant interval. The method of data collection was electronic surveys. Fifty-four dental hygienists (13% of the sample) participated in the study. The results show that most of those responding were aware of the ADHP. Also, their attitude regarding the new mid-level dental provider was positive. Attitudes varied more when the respondents provided data on the adoption of legislation for the new provider. There was no consensus among respondents regarding the ADHP as a viable career option. More robust research is needed on the viability of the ADHP in Ohio.

This mixed-methods study examined patterns of dental health care utilization in adult Hispanic migrant farmworkers (AHMFW) with special emphasis on non-compliance with the American Dental Association (ADA) and the American Dental Hygienists Association (ADHA) recommendation of visiting the dentist at least once a year; while also exploring the group’s social and cultural construction of oral health. A total of 278 farmworkers responded to a close ended survey. Binary and hierarchical logistic regression analysis were employed in identifying predisposing, enabling, and needs factors associated with non-compliance. Following the survey, fourteen ethnographic interviews were conducted with respondents who volunteered to participate in this phase of the study. Most participants (79.5%) were non-compliant with the ADA and the ADHA recommendation. Binary logistic regression results indicated that AHFW reporting need for dental treatment were compliant with the recommendation. In contrast, those who brushed their teeth more often, experienced oral health impact, and reported poor perception of their mouth condition were non-compliant. Hierarchical logistic regression results pointed to those who used floss and reported need for dental treatment as compliant with the recommendation. Participants reporting poor perception of their mouth condition were non-compliant. Eight themes emerged from the qualitative analysis (understanding of the mouth, meaning of oral health, history of dental care; dental problems, barriers to dental care, caring of the teeth/mouth, medications, oral health quality of life). Farmworkers were knowledgeable of oral health, however, this knowledge, particularly the practice of brushing twice a day, made them less likely to seek regular dental care. Ultimately, a dental visit hinged on their limited finances, lack of dental insurance, and family responsibilities. Together, these decreased access to preventive dental services and increased risk of experiencing oral health problems.