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.D.S.)--University of Hong Kong, 1988. / Also available in print.

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.

published_or_final_version / Dentistry / Master / Master of Dental Surgery

The 2000 U.S. Surgeon General’s report identified oral health as a priority health concern and recognized that oral health is integral to general health. A serious and widespread oral health problem is dental caries, a chronic infectious, transmissible disease of the oral cavity. While adverse short-term consequences of dental caries such as pain and further infection are well known and long-established, long-term consequences are not as generally recognized and accepted. However, evidence for these short-term consequences has spurred discussion of potential long-term consequences as well; in particular, negative effects on early childhood weight. An established literature examining the hypothesis that severe early childhood caries has an adverse effect on early childhood weight suggests that severe caries may lead to less attained weight and less weight gain. Additionally, the literature posits hypotheses about potential causal pathways through chronic inflammation, diet, and/or sleep disturbances, which the literature claims stem from pain and infection. However, there are no studies that formally conduct meditational analyses and furthermore, the present body of literature does not even adequately test the main effect because the evidence base suffers from methodological issues that make it difficult to rule out alternative explanations for the positive associations that have been found. The overarching goal of this dissertation is to better understand the relationship between oral health and general health by examining if a common oral disease, severe early childhood caries, a specific variant of dental caries, has adverse effects on early childhood weight using a causal framework perspective to address the limitations and gaps in the literature. This dissertation consists of three papers that examine the theory that severe caries negatively affects weight attainment and weight gain in children. The first paper, a systematic review, synthesizes and critically appraises the literature on the negative effects of severe early childhood caries on early childhood weight to identify what is known about the relationship and the gaps in the literature to inform the subsequent empirical tests of the hypothesis. The second and third papers empirically test the hypothesis. The second paper examines if severe early childhood caries leads to less attained weight and less weight gain in children and if treatment for severe caries mitigates the problem. The third paper will examine hypotheses about mediation of the association. The systematic review shows that despite reasonable consistency of findings across the literature examining the negative effect of severe early childhood caries on early childhood weight, the studies are not conclusive due to the possibility of reverse causation and the potential for residual confounding. The findings in paper 2 only partially support the a priori hypotheses, as associations were not consistent across different comparison groups in the analysis. The mediation hypotheses tested in paper 3 were also not fully supported due to null findings in a link within the causal pathway. Future studies should attempt to build on the findings of this longitudinal examination of the hypothesis by directly addressing the issues identified in the literature review, examining gradations of caries exposure, and improving measurement of the mediators.

Dental hygiene students may struggle in dental hygiene curriculum in regards to hand function. Currently, this is not an aspect dental hygiene programs screen for or have protocol in place to help students. The research in the study examined if hand function could improve with hand function exercises and if exercises improved instrumentation scores. During a 6-week pilot study, an occupational therapist tested the hand function of a cohort of dental hygiene students. The results were recorded and the students began a 6-week hand function exercise regimen. After 6 weeks the same evaluations were preformed and the pre- and posttest data were compared. Statistical tests showed a significant improvement in hand function. After the hand function testing was complete, the scores of the cohort on the periodontal probe and 11/12 explorer were compared to students in the previous 5 cohorts. No significant improvement was made on the instrumentation scores.

Excerpt: According to the United States Centers for Disease Control and Prevention (CDC), approximately 20 million Americans are currently infected with human papillomavirus (HPV), and another 6 million will become newly infected each year.

Objective: To investigate and determine periodontal treatment needs by the use of the Community Periodontal Index of Treatment Needs (CPITN) of a Medicaid expansion population in the state of Iowa (DWP) in comparison with patients insured by the traditional Medicaid State Plan, patients with private dental insurance, and self-pay patients, while evaluating for systemic health conditions and socio-behavioral factors. Methods: A secondary data analysis of electronic health records (EHR) from the University of Iowa College of Dentistry was completed and analyzed. Univariate and bivariate analyses were conducted. Logistic regression models were used to analyze relationships between predictors and periodontal treatment need. Results: Out of the study population, 54% were indicated for scaling and root planing (SRP). Predictors of indicating the need for SRP treatment were found to be: Age (p< .0001), gender (p< .0001), medical diagnosis of diabetes (p=.031), smoking status (p< .0001), and not receiving regular dental check-ups (p< .0001). Discussion: Our findings are consistent with common periodontal disease predictors found in the literature. Interestingly, insurance status was not a significantly associated predictor of periodontal treatment needs. However, approximately 50% patients with all insurance types were indicated for SRP. Implications: DWP patients must earn benefits by maintaining dental appointments. This earned benefits approach delays periodontal treatment as patients must earn this procedure, potentially leading to deteriorating periodontal health. Further assessment of periodontal burden in the DWP population should be conducted and potential program structure evaluated.

Objectives: Tooth extraction initiates a cascade of events that often leads to local anatomic changes in the alveolar ridge. Ridge preservation is a surgical approach aimed at minimizing hard and soft tissue volume loss. There have been contradicting reports on the efficacy of socket grafting for alveolar ridge preservation. Interestingly, there is a paucity of adequately powered randomized controlled clinical trials. The purpose of this study was to assess the effect of the application of a socket grafting technique on alveolar ridge dimensional changes following tooth extraction. Methods: Healthy patients requiring the extraction of one single-rooted tooth on either arch, from second premolar to second premolar, excluding mandibular incisors, and who met the eligibility criteria were recruited. Patients were then randomly assigned to either the control group, consisting of tooth extraction alone, or the experimental group, which consisted of extraction and simultaneous ridge preservation using an allograft bone material to fill the socket and a dense polytetrafluoroethylene membrane (dPTFE) to seal it. Cone beam computed tomography (CBCT) was obtained immediately prior to extraction (baseline) and at 14 weeks. Linear measurements with the use of a tooth-supported stent were obtained immediately after extraction (baseline) and at 14 weeks. Linear and volumetric measurements were made using data obtained from the CBCTs. Masked, calibrated examiners performed all radiographic measurements. Measurements obtained included buccal keratinized tissue width, buccal and lingual plate height and width, alveolar ridge horizontal width (CBCT); and alveolar ridge volume changes. Digital planning of dental implants was performed in the ideal restorative location and need for additional grafting was virtually determined. The primary outcome of interest was volumetric reduction of the alveolar ridge at 14 weeks. Linear mixed model statistical analyses were used to compare the mean change in the measurements between the grafted and control groups. Results: A total of 59 subjects were recruited, of which 53 patients (27 control and 26 experimental) completed the study. No statistically significant difference was found between the two groups at baseline for any of the parameters analyzed. At the 14 week follow-up appointment there was an average loss in height of the buccal plate of 1.17 mm and 0.61 mm for the control (CG) and experimental (ARP) groups, respectively, showing statistical significance (p=0.012). The lingual plate height was reduced 0.7 mm in CG and 0.47 mm in ARP with no statistical significance (0.075). A linear loss in the buccal-lingual dimension of the alveolar ridge was noted radiographically in both groups, 1.68mm in CG and 1.07mm in ARP, which demonstrated a statistical significant difference between them (p=0.023). Volumetric analysis demonstrated a mean volume loss of 15.83% in the CG showing statistical significance from the 8.36% loss shown in the ARP group. This difference demonstrates a clinical significance when virtual planning of implant placement in the ideal restorative location revealed the need for additional grafting at 13/27 or 48% of CG and 3/26 or 11% of ARP sites. Additionally, a very robust, statistically significant correlation was noted between buccal bone plate width and reduction of alveolar bone volume after 14 weeks of healing (p< 0.0001). A multivariate regression analysis revealed that within the control group a buccal plate <1mm lead to >10% volumetric reduction, while the same reduction in the graft group was only seen when the buccal plate was less that 0.6mm. Conclusions: In this study, a novel volumetric analysis of alveolar ridge reduction after tooth extraction was performed, which demonstrated that socket grafting for alveolar ridge preservation does provide a therapeutic benefit. This finding was associated to a decreased probability of requiring additional grafting at the implant site. The thickness of the buccal plate at the time of extraction appears to be a valuable factor to predict the amount of resorption that will take place, meaning that more resorption should be expected, as the buccal plate gets progressively thinner.

Objective: To determine risk factors for cavitated caries incidence and extent of cavitated caries among adolescents. Methods: Three hundred and three Iowa Fluoride Study (IFS) subjects met inclusion criteria for interval between dental examination and the responses from the IFS (ages 13.5 to 17.0) and the Block Kids Food Frequency (ages 13.0 to 17.0) questionnaires, respectively. The analyses focused on the outcome variables of net cavitated caries incidence and net cavitated caries increment counts, respectively. The independent IFS questionnaire variables related to demographics, fluorides, oral hygiene, beverage intakes, dental visits, sealants and previous caries incidence variables, respectively, whereas, Block's questionnaire variables related to intakes of solid foods and beverages, respectively. Two sets of analyses, logistic and negative binomial regression analyses, were conducted to assess the associations between risk factors and net cavitated caries incidence and increment counts from 13 to 17, respectively. Results: In multivariable logistic regression analyses, significant (p<0.05) negative associations were found between age 13 to 17 net cavitated caries incidence and greater frequency of consumption of vegetables, greater brushing frequency and greater frequency of sugar-free beverage consumption. Additionally, significant (p<0.05) positive associations were found between age 13 to 17 net cavitated caries incidence and both net cavitated caries incidence from 9 to 13 and frequency of consumption of solid-foods in the combined category of presumed moderate cariogenicity. The significant interaction effect showed that the effect of the presence/ absence of sealants varied for girls vs. boys. In multivariable negative binomial analyses assessing the association between net cavitated caries increment count from 13 to 17 and risk factors, significant (p<0.05) positive associations were found with greater intake of foods predominant in starch, presence of sealants, greater baseline age, cavitated caries increment count from 9 to 13, and greater frequency of consumption of foods predominant in added sugar, respectively. Significant (p<0.05) negative associations were found between net cavitated caries incidence and greater frequency of consumption of foods predominant in fiber and natural sugar and greater daily fluoride intake from water. However, daily fluoride intake from water was not statistically significant with the significant interaction effect included between baseline age and net cavitated caries increment count from 9 to 13 (dichotomized as Y/N). Conclusion: Presence of sealants, frequency of consumption of vegetables and previous cavitated caries incidence from 9 to 13 were associated with outcomes of incidence and extent of cavitated caries observed among IFS adolescents. The differences in findings for risk factors for incidence and extent of cavitated caries are due in part to the nature of the outcome variables (count vs. dichotomous), emphasizing the need to consider both outcomes in future studies of adolescent caries.