Thesis (M.P.H.)--University of Michigan, 1945.

Thesis (M.P.H.)--University of Michigan, 1945.

Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 1963. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves [111]-113).

Magister Scientiae Dentium - MSc(Dent) / Patient satisfaction is critical for the growth of oral health service and practice. The present study was a descriptive study on patient satisfaction with oral health care provided by a district dental clinic. The aim of the study was to determine whether patients attending the dental clinic of the Lagos State University hospital were satisfied with the care they received. / South Africa

There are many factors that affect the hours worked by various professions. The literature discusses some of these factors in professions such as management and various fields of medicine. However, no information has been gathered on factors that affect the practice of dentists. A survey was disseminated to all Iowa dentists inquiring about various factors that may affect the number of hours they spend at work. The survey inquired about demographics, educational indebtedness, caregiving responsibilities of both children and dependent adults, contribution to household income, relationship status, domestic responsibilities, busyness and type of practice. The data was collected and analyzed. It was hypothesized that there was no difference in the number of hours worked between male and female Iowa dentists and there was no difference in the number of hours worked between female Iowa dentists with minor children (18 years old or younger) and female dentists without minor children. When hypotheses were statistically analyzed, the data showed there was no difference between male and female dentists' working hours in the bivariate analysis. In the multiple logistic regression model, while controlling for various factors such as age and busyness, gender was statistically significant in the number of hours worked. When evaluating the hours worked between female dentists with and without minors, there was a statistically significant difference in the number of hours worked between women with minor children and women without minors. However, in the multiple logistic regression model, presence of minors was not statistically significant. This lack of statistical significance is likely attributed to the small sample size of women dentists. As such, there was not enough power to have more than 2 variables and minor children was not included. The data suggests that young male dentists, who are responsible for 61% or more of their household income and are solo practitioners are the most likely to work full-time (32+ hours/week).

Little knowledge and contradictory results exist on the association of oral diseases with systemic diseases and with health predictors such as dental care utilization and health insurance. This research project aimed to examine 1) the association between Coronary heart disease (CHD) and periodontal disease using meta-analysis, 2) to examine the association between dental care utilization, health insurance coverage and periodontal disease with the prevalence of CVD, 3) the association between dental caries, periodontal disease and blood glucose level. For meta-analysis, literature searches were conducted using the PubMed computerized database (1966-2019), Cochrane Controlled Trials Register (1970-2019), EMBASE (1980-2019), and CINAHL (1982-2019). A systematic review of the literature identified fifteen prospective cohort studies and seven case control studies that meet the inclusion criteria. Maximum likelihood random effects analysis was used to compute the combining relative risk (RR) and odd ratio (OR). Data on periodontal disease, dental caries, dental care utilization, health insurance coverage, cardiovascular disease and blood glucose level were obtained from the National Health and Nutrition Examination Survey (2011–2014) for dentate community-dwelling persons 30 years of age and over. The outcome was cardiovascular disease (heart attack, hypertension, CHD, congestive heart failure and stroke) and glucose level (HbA1c and OGTT). The main independent variable was dental care utilization, insurance, periodontal disease and dental caries. Covariates included in the analysis were race/ethnicity, age, sex, income, education levels, body mass index, diabetes status, smoking status and alcohol drinking status. To obtain unbiased point estimates and correct variance estimation, proper sampling weights and statistical survey procedures were used. A-meta-analysis of the fifteen prospective cohort studies indicated that patients with periodontal disease are at 1.19 times increased the risk of having CHD compared to periodontally healthy patients (RR: 1.19, 95% CI (1.12 – 1.26)). The result of the seven case control studies, showed a significant association between periodontitis and CHD with odds ratio 2.37 (95% CI 1.72-3.28). In addition, lower dental care utilization and insurance were significantly increased the odd of developing CVD respectively; (OR 1.65, 95%CI 1.01–2.69, OR 1.52, 95% 1.09–2.11). Looking into the association between oral diseases and blood glucose level. Dental caries was significantly associated with increased the odd of high OGTT and HbA1c values respectively (OR 2.47, 95% 1.56-3.90, OR 1.37, 95% 1.14-1.64). However, periodontal disease was significantly associated with high HbA1c values only (OR 2.77, 95% 2.40-3.20). In conclusion, our analysis supports the association between periodontal disease and CHD. Additionally, using a large national representative sample, our analysis showed that health insurance and dental care utilization were significantly associated with the prevalence of CVD. Also, having either periodontal disease or dental caries increased the odds of poor glycemic control among US population.

The study introduced and evaluated the new Dental Providers’ Cross-Cultural KnowledgeTest (DP-CC-KT-50) designed to have utility to: 1) assess dental providers’ and dental students’ cross-cultural knowledge; 2) serve as a brief online e-health intervention for increasing the crosscultural knowledge of dental providers in training or currently in practice; and 3) provide an outline of topics to be covered in a cross-cultural curriculum for use in dental schools and continuing education for providers. Using the new tool, dental providers (N= 155) and dental students (N=337) were found to have a moderate level of knowledge; and, over 96% recommended the tool to others as a brief online e-health intervention, and as an outline providing topics for a cross-cultural curriculum for use in dental schools and continuing education for providers. Findings showed for both dental providers and dental students that the experience of taking the DP-CC-KT-50 with all “True” answers served as a brief online e-health intervention that resulted in: self-ratings for level of knowledge for the topics in the DP-CC-KT- 50 being significantly higher after taking it; self-ratings of self-efficacy for effectively delivering oral health care to diverse patients being significantly higher after taking it; and, a moderate positive impact for (a) being more open to, interested in, or motivated for providing oral health care to diverse patients, (b) having more understanding about the lives, experiences, and external societal influences on diverse patients, (c) having more empathy and compassion for diverse patients, and (d) shifting or changing some of their attitudes and beliefs about diverse patients. The DP-CC-KT-50 emerged as the most up-to-date and comprehensive tool for determining what providers and dental students know about cultural competence and cross-cultural oral health care service delivery with contemporary diverse patients; and for conducting research in this area. The DP-CC-KT-50 is recommended in research with nationally representative samples, and for assessment and research by dental schools as they pursue improvement in dental education. More immediately, the DP-CC-KT-50 is recommended for dissemination as a brief online e-health intervention to improve cross-cultural knowledge and self-efficacy for working with diverse patients—both within and beyond the dental profession.

Veterans suffer from lower overall well-being than non-veterans due to their unique life course. This study aims to compare the impact of depression on oral health for veteran and non-veteran populations. Data from 11,693 adults (18 +) participating in the NHANES (2011-2018) were analyzed. Outcome variables were dichotomous (at/above mean) DMFT, MT, FT, and DT; the primary predictor variable combined depression screening outcome and veteran status (veteran/depressed, veteran/not depressed, non-veteran/depressed, non-veteran/not depressed). Covariates included socioeconomic factors, demographics, wellness factors, and oral health-related habits. Associations between outcome and predictor variables were assessed with a fully adjusted logistic regression analysis. Veterans, regardless of depression status, had more DMFT, FT, MT and DT compared to non-veterans. After controlling for covariates, veterans suffering from depression had higher odds of DT (1.5, 95% CI:1.0-2.4) compared to non-veterans without depression. In general, veterans who screened negative for depression had better oral health compared to all groups, with lower odd of DT (0.7, 95% CI:0.6-0.9) and more FT (1.4, 95% CI:1.1-1.7) compared to non-veterans with and without depression. This study found that veterans not only have higher odds of overall caries experience, but that veterans suffering from depression have higher odds of active caries compared to non-depressed veterans. Most veterans lack VA oral healthcare benefits and face challenges maintaining oral health on top of medical and mental health burdens. Our results add further urgency to increasing dental care access for this vulnerable population due to the exacerbation of unmet oral healthcare needs attributable to the mental health challenges veterans face.

The purpose of this study is to examine the relationship between dental and mental health. To dive deeper into seeing this connection, patients with sleep apnea will be asked to share their experiences with the treatments for sleep apnea and how it had affected their mental or dental health.

Frailty is defined as a biological syndrome marked by reduced physiological reserve and heightened vulnerability to stressors, leading to adverse health outcomes like dependency, functional impairment, cognitive decline, and mortality. While various conditions have been associated with frailty, oral health is one of them. However, the precise relationship and the underlying pathways through which oral health conditions may be associated with frailty remain unclear. Limitations such as small sample sizes, inadequate control for confounders, inconsistent results across studies, and variations in frailty assessment methods have contributed to the inconclusiveness of this relationship. Considering these limitations, this dissertation intends to address them by using a rigorous cohort with a robust design, which will allow for a larger sample size, appropriate confounder assessment, and the opportunity to create a practical frailty index (FI) using data from this cohort. This approach enables a comprehensive investigation of the association between clinical, functional, and microbiological oral health and frailty, both cross-sectionally and longitudinally (12 years of follow-up). Furthermore, this study aims to conduct an initial exploration of the mediating effects of inflammatory biomarkers in this relationship.Three specific aims were pursued to achieve this goal. Firstly, a systematic review was conducted to critically summarize the existing evidence on the association between poor oral health and frailty, assessed through any frailty index instrument. Subsequently, two analytical aims were undertaken to delve into the association between oral health and frailty. The initial analytical aim comprised two parts. The first part focused on creating and validating a population frailty index score using data from the Oral Infections and Vascular Disease Epidemiology Study (INVEST). The second part aimed to investigate, cross-sectionally, whether poor oral health independent of factors such as sex, age, occupation, educational level, marital status, and smoking is positively associated with frailty. Additionally, the study aimed to test the robustness and replicability of both the FI and the cross-sectional relationship, utilizing a smaller set of oral data from the Chilean National Health Survey conducted in 2016-2017. The second analytical aim was to explore the prospective association between oral health – assessed clinically, functionally, and microbiologically- and frailty, using the INVEST cohort with its 12 years of follow-up and repeated measures for the exposure, confounders and outcome. As a secondary aim, we explored the mediating effects of select inflammatory biomarkers in this relationship. The systematic review identified 11 studies that investigated the relationship between oral health and frailty, utilizing the FI as an instrument for assessing frailty. All these studies were cross-sectional, and the FI employed in them encompassed a range of deficits, varying from 32 to 76 items. The most frequently incorporated constructs in the frailty index were comorbidities, cognitive impairment, activities of daily living (ADL and/or IADL), functional limitations or abilities, anthropometry, depressive symptoms, and self-reported health status. In terms of the association between oral health and frailty, the review showed that a lower number of teeth, poor self-reported oral health, and experiencing chewing or oral cavity pain were associated with an increased likelihood of frailty, as indicated by any FI. Notably, no studies reported an association between periodontal disease, cavities, use of dental prostheses, and frailty. The second aim showed that within the U.S. population, functional oral health (assessed as the number of teeth and higher number of occlusive tooth pairs) was associated with frailty. Similarly, among the Chilean population aged 55 years and older, frailty was also associated with functional oral health (lower number of additional teeth, wearing dental prostheses, and not having a functional dentition). This study also showed that the inclusion of periodontal microbiota in the regression models improved the model’s fit, suggesting that this microbiota may play a role in the association between oral health and frailty. Finally, the third aim showed that after 12 years of follow-up, a higher incidence of frailty was associated with functional and clinical oral health. In fact, people who exhibited a lower number of additional teeth, had less than 21 teeth, wearing complete dental prostheses, and had periodontal disease had a higher incidence of frailty. Moreover, CRP, IL-6, and TNF- exhibited small, but not statistically significant, effects as potential mediators between oral health and frailty. These findings suggest the potential for further research to explore the action of other inflammatory biomarkers and pathways through which oral health may be associated with frailty.