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.

The purpose of this study was to evaluate the effect of a school-based fluoride mouthrinse program in a fluoridated community. Such an evaluation is important because the effect of such programs may decrease over time due to the widespread use of fluoride. Two elementary schools were chosen. One had a fluoride mouthrinse program: the other did not. The subjects were children in grades one and six. Their caries experience was examined using dft. dfs. DFT, and DFS scores. There were no statistically significant differences between the two schools. The program had no significant effect in the community studied.

OBJECTIVE: The objective was to assess the role of socio-demographic, dietary, behavioral, and environmental factors in Mutans Streptococci (MS) colonization in young children from low socio-income families. METHODS: This study involves secondary analyses of data collected from 6 to 24 months old children (N=129) enrolled in the Supplemental Nutrition Program at WIC, Iowa. They were followed for 18 months assessing different socio-demographic, dietary, behavioral, and environmental factors at 5 time-points. Total 3 clinical examinations were conducted at baseline, 9 months, and 18 months. Salivary samples collected during the examinations by semi-quantitative method, serve to determine the subjects' MS levels, who were grouped into either 1) No MS at any time during the study (n=58); 2) MS at baseline (n=35); or 3) Acquired MS during the study period (n=36). Prediction of the group membership (1or3) over the three time points is used as outcome for this study. This paper reports important findings from pairwise comparison of the three groups at baseline, 9 months and 18 months. RESULTS: Consumption of sugar-rich beverages and tooth-related factors like plaque and number of teeth were significantly (p<0.05) higher in Group 2 children, than the others at baseline. Group 2 also had the oldest children (mean age at baseline - 16.7 months) than Group 1 (10.8 months) and Group 3 (12.6 months). The effect of age was reflected in longitudinal comparison of group1 and 3 as well. Different behavioral and dietary factors were significant at different time-points, specific to that age-group under observation. Higher maternal education was found to be a protective factor, whereas tooth-related factors such as, history of caries and number of teeth, were risk factor in longitudinal analyses. CONCLUSION: Time measured as age of the child is the key factor in MS infection in youg children. Dietary, behavioral, environmental, and tooth related factors acquire importance depending on age of the child. Future longitudinal analyses will further explore these relationships.

This study is aimed to evaluate service-learning program's impact on senior dental students' attitude to community service at Virginia Commonwealth University (VCU) School of Dentistry. Experience gained through service-learning in dental school may positively impact dental students' attitude to community service that will eventually lead into providing care to the underserved. Two surveys were administered to 105 senior dental students. For the first survey (post-test), students reported their attitude to community service after the service-learning program completion. For the second survey (pre-test), students reported their attitude prior to the program retrospectively. Seventy six students responded to the post-test and fifty six students responded to the pre-test. A repeated-measure mixed-model analysis indicated that overall there was a change between pre-test and post-test. Scales of connectedness, normative helping behavior, benefits, career benefits, and intention showed a significant pre-test and post-test difference. A relationship between attitude to community service and student characteristics such as age, gender, ethnicity, and volunteer activity was also examined. Only ethnicity showed a significant difference. In conclusion, service-learning program at VCU School of Dentistry has positively impacted senior dental students' attitude to community service.

AUTHORS: Stella Chukwu DDS, Daniel Caplan, DDS, PhD, Michelle R. McQuistan, DDS, MS, Alice M. Horowitz, PhD, Christopher Squier PhD, Fang Qian, PhD TITLE: KNOWLEDGE OF RISK FACTORS FOR ORAL CANCER AMONG ADULT IOWANS OBJECTIVE: To gather baseline data from adult Iowans regarding their knowledge, opinions and practices about oral cancer (OC) prevention and early detection; with a focus on their knowledge of risk factors for OC. METHODS: A statewide, computer assisted random-digit dial telephone survey was conducted to gather information about OC prevention and early detection among Iowans age 18 and older. The survey contained 36 questions and lasted about ten minutes per respondent. Telephone numbers included landline and cell phone sampling lists provided by a private survey research firm. RESULTS: Of the 89 % of respondents that answered "yes" when asked if they had ever heard of OC, 54% had high OC risk factor knowledge; while of the eleven percent of those who said they had never heard of OC, 33% had high knowledge (p=0.003). Those that had an OC exam were more likely to have high OC risk factor knowledge (59%) compared with those that answered "no or don't know" to having had an OC exam (45%; p=0.002). Those that were "very or extremely" confident filling out medical forms were more likely to have high OC risk factor knowledge compared to respondents who were "not at all, slightly or moderately" confident filling out forms (54% vs. 45 %; p=0.097). CONCLUSIONS: The results suggest strongly that educational interventions are needed to increase knowledge of OC risk factors, early signs of OC, and the need to promote comprehensive OC examinations by healthcare providers. SOURCE OF FUNDING: Delta Dental of Iowa Foundation

No description available.

Background: The Program of All-inclusive Care for the Elderly (PACE) is a program of care that enrolls nursing home eligible and offers them community-based long-term services and supports (LTSS). Many PACE enrollees are “dual eligibles” (DEs) meaning they qualify for Medicare and Medicaid services. Dental care is a unique feature of PACE among LTSS, as many LTSS do not include dental care, even though this population has difficulty in accessing these services. However, little is known about the delivery of dental care at PACE and how dental care and oral health promotion and prevention is being integrated into PACE. Thus, the purpose of this study is to describe the delivery and integration of dental care at PACE. Methods: Based on ten preliminary interviews and the PACE manual from the Centers for Medicare and Medicaid Services (CMS), a 56-question survey was developed to describe the delivery and integration of dental care at PACE across the country. In addition, the survey asked programs to rank their focus among five specialties (dentistry, mental health, optometry, audiology, podiatry), to determine if a program’s focus on dental care would influence the delivery and integration of dental services at PACE, and if this would lead the program to have a very high percentage of new and continuous enrollees with regular dental examinations. A publicly available contact list was obtained from CMS and the survey was distributed to all 124 PACE programs via email. Results: Respondents in this study represented 35 programs (28.2%) in 23 states (74.2%). Most programs had no limits for dental care, minimal waitlists, and provide most dental services without exclusions. This is evident by the 51.4% of programs that have no dental budget, 100% of programs providing preventive and basic restorative dental care, and nearly 100% offering advanced restorative services. Many programs also did not have a waitlist for non-emergent dental care. Few programs include a dentist in the routine operations of the PACE program, as evidenced by few programs having dentists conduct the dental assessment for the initial comprehensive assessment or having a dental director. A statistically significant association with a high percentage of reported utilization of dental examinations was detected with programs having a system for quality assurance for dental care (t=0.358, p=0.024), a protocol for a dental cleaning every 6-12 months (t=0.595, p<0.001), mandating a comprehensive dental examination (t=0.390, p=0.007), and providing preventive dental services onsite with built-in equipment (t=0.454, p=0.001). No factors were statistically associated with the focus ranking for dentistry among the other specialties. Conclusion: This study suggests that compared to nursing homes, PACE enrollees may have greater ability to receive dental care without limitations of the state adult Medicaid dental benefit. Dentistry also appears to be a high focus for some PACE programs. This study has begun to identify structures that support positive outcomes that can be used to develop best practices and guidelines for the delivery of dental care in PACE and other LTSS. Future studies are needed to better understand barriers and facilitators to the delivery of dental care and other specialty services.

Objective: To understand the association between dental insurance coverage and dental care utilization in Iowa children. Methods: The 2010 Iowa Child and Family Household Health Survey (IHHS) data was used to assess the association between dental insurance coverage and dental care utilization in Iowa children. Andersen’s model of health services utilization was used as a framework for determining the predictors of dental care utilization. Chi-square test was used for determining bivariate associations and Logistic regression analysis was used to determine factors associated with dental care utilization. Results: The results from the multivariable logistic regression model indicate that children with private dental insurance (p<0.001) and 4-9 years of age (p=0.005) were more likely to have a dental visit. Additionally, respondents who were always able to get dental appointments for their child (p<0.001), had a regular source of dental care for the child (p<0.001) and perceived dental need for their child (p<0.001), were more likely to report having a dental check-up for their child in the past 12 months. Conclusion: Dental insurance was significantly associated with having a dental visit in the past year in Iowa children 4-17 years of age. Some of the other predictors of dental care utilization were: having a regular source of dental care for the child, ease of getting dental appointment for the child, younger child’s age and having perceived dental need for the child.

In order to facilitate effective tobacco cessation services within dental school clinics, it is necessary to understand the perceived barriers encountered by dental students while providing these services. The aim of this study was to identify which factors fourth year dental students perceive to be associated with barriers to providing tobacco intervention services. A written survey was developed and completed by the incoming fourth year dental students at the University of Iowa College of Dentistry in 2008. The survey assessed the perceived barriers to providing tobacco intervention services and related factors. Descriptive, bivariate and logistic regression analyses were conducted. The response rate was 97 percent. Some of the most frequently reported barriers included: patient's resistance to tobacco intervention services (96%), inadequate time available for tobacco intervention services (96%) and forgetting to give tobacco intervention advice (91%). The following variables were significantly (p<0.05) related to greater perceived barriers in providing tobacco intervention services: lower "adequacy of tobacco intervention curriculum coverage of specific topics covered over the previous three years" and "perceived importance of incorporating objective structured clinical examination teaching method for learning tobacco intervention." Students could benefit from additional didactic training and enhanced clinical experience in order to facilitate effective intervention services in the dental school.

Oral diseases including dental caries and periodontal disease are among the most prevalent and costly diseases in Australia today. Around 5.4% of Australia’s health dollar is spent on dental services totalling around $2.6 billion, 84% of which are delivered through the private sector (AIHW 2001). The other 16% is spent providing public sector services in varied and inadequate ways. While disease rates among school children have declined significantly in the past 20 years the gains made among children are not flowing on to adult dentitions and our aging population will place increasing demands on an inadequate system into the future (AHMAC 2001). Around 50% of adults do not received regular care and this has implications for widening health inequalities as the greatest burden falls on lower income groups (AIHW DSRU 2001). The National Competition Policy agenda has initiated, Australia-wide, reviews of dental legislation applying to delivery of services by dentists, dental specialists, dental therapists and hygienists and dental technicians and prosthetists. The review of the Victorian Dentists Act 1972, was completed first in 1999, followed by the other Australian states with Queensland, the ACT and the Northern Territory still developing legislation. One of the objectives of the new Victorian Act is to ‘…promote access to dental care’. This study has grown out of the need to know more about how dental therapists and hygienists might be utilised to achieve this and the legislative frameworks that could enable such roles. This study used qualitative methods to explore dental health policy making associated with strategies that may increase access to dental care using dental therapists and hygienists. The study used a multiple case study design to critically examine the dental policy development process around the Review of the Dentists Act 1972 in Victoria; to assess legislative and regulatory dental policy reforms in other states in Australia and to conduct a comparative analysis of dental health policy as it relates to dental auxiliary practice internationally. Data collection has involved (I) semi-structured interviews with key participants and stakeholders in the policy development processes in Victoria, interstate and overseas, and (ii) analysis of documentary data sources. The study has taken a grounded theory approach whereby theoretical issues that emerged from the Victorian case study were further developed and challenged in the subsequent interstate and international case studies. A component of this study has required the development of indicators in regulatory models for dental hygienists and therapists that will increase access to dental care for the community. These indicators have been used to analyse regulation reform and the likely impacts in each setting. Despite evidence of need, evidence of the effectiveness and efficiency of dental therapists and hygienists, and the National Competition Policy agenda of increasing efficiency, the legislation reviews have mostly produces only minor changes. Results show that almost all Australian states have regulated dental therapists and hygienists in more prescriptive ways than they do dentists. The study has found that dental policy making is still dominated by the views of private practice dentists under elitist models that largely protect dentist authority, autonomy and sovereignty. The influence of dentist professional dominance has meant that governments have been reluctant to make sweeping changes. The study has demonstrated alternative models of regulation for dental therapists and hygienists, which would allow wider utilisation of their skills, more effective use of public sector funding, increased access to services and a grater focus on preventive care. In the light of theses outcomes, there is a need to continue to advocate for changes that will increase the public health focus of oral health care.