Patterns and Correlates of Spit Tobacco Use among High School Males in Rural California

Objective: To assess patterns and correlates of spit [smokeless tobacco (ST)] use among high school males in rural California. Methods: An 18-item, self-administered questionnaire was used to assess ST use among young males in 41 randomly selected high schools in 21 rural counties in California. To ensure confidentiality, students were instructed to seal their completed questionnaire in an attached envelope prior to returning it to the questionnaire administrator. Results: Overall prevalence of ST use was 9.8 percent, significantly increasing with year in school from 5 percent among freshmen to 15 percent among seniors. ST use was highest among rodeo athletes at 42 percent compared with < 6 percent among nonathletes; ST use was significantly higher among smokers (32 percent) who were 2.5-30 times more likely to use ST compared with nonsmokers, depending on race/ethnicity as a result of a significant race/ethnicity  ×  smoking interaction of degree/magnitude. In addition, students who believed there was no, or slight risk of, harm from ST use were significantly more likely to use ST than students perceiving moderate or great risk, depending on race/ethnicity (odds ratios 3.6-13). Among all ST users, 40 percent used ST on at least 5 days in the previous week, 80 percent of those reporting a brand used the brand Copenhagen, and 41 percent (189) used ST within 30 minutes of waking. Conclusion: Dental public health practitioners, scholars, and policy-makers need to promote dental health through organized community efforts targeting high school male subgroups in rural areas that are at risk for ST-associated adverse health effects.     

What contributes to self‐rated oral health among community‐dwelling older adults? Findings from the ElderSmile program

Objectives: As part of ongoing efforts by the Columbia University College of Dental Medicine to devise community‐based models of health promotion and care for local residents, we sought to answer the following query: “What contributes to self‐rated oral health among community‐dwelling older adults?” Methods: The present study is cross sectional in design and centrally concerned with baseline data collected during community‐based screenings of adults aged 50 years and older who agreed to participate in the ElderSmile program in northern Manhattan, New York City. The primary outcome measure of interest is self‐rated oral health, which was assessed as follows: “Overall, how would you rate the health of your teeth and gums – excellent, good, fair, or poor?” Results: More than a quarter (28.5 percent) of ElderSmile participants aged 50 years and older reported that their oral health was poor. After adjustment for age (in years), place of birth, educational level, and dental insurance status in a logistic regression model, recent visits to the dentist (within the past year versus more than a year ago) contributed to better self‐rated oral health and non‐Hispanic Black race/ethnicity, dentate (versus edentulous) status, tooth decay as measured by decayed missing filled teeth, and severe periodontal inflammation contributed to worse self‐rated oral health in this population. Conclusions: Recent dental care contributed to better self‐rated oral health among community‐dwelling older adults living in northern Manhattan. Significant gradients were evident in the caries experience and periodontal inflammation of dentate adults by self‐rated oral health, suggesting that untreated oral disease contributes to poor self‐rated oral health.     

Dissatisfaction with dental care among mothers of Medicaid-enrolled children

Objectives: This paper is part of a larger study examining the impact of mothers’ having a regular source of dental care (RSDC) on utilization of dental care and oral health of their preschool children. We describe levels of satisfaction with care among mothers whose preschool children were enrolled in Medicaid in Washington State. We report mothers’ satisfaction related to having a RSDC by type of dental setting/office. Methods: Disproportionate stratified sampling by racial/ethnic group selected 11 305 children aged 3–6 in Medicaid in Washington State. Mothers (n = 4373) completed a mixed‐mode survey. Satisfaction with dental care was measured using the Dental Satisfaction Questionnaire (DSQ). Results: Overall mean DSQ was 57.1 ± 9.9 (range 18–89). A higher score indicates greater satisfaction. There was not evidence of a difference in dissatisfaction by race/ethnicity but Blacks and Hispanics were less satisfied with pain management than Whites. The majority of respondents agreed with the statement that ‘Dentists sometimes act rude to their patients.’ Satisfaction is higher for mothers who have a regular private dentist they see consistently versus having a regular dentist through a public or non‐profit clinic. Conclusions: The satisfaction with dental care for this population is low, and considerably lower than found in other studies for primary medical care. Steps need to be taken to increase dental satisfaction and access to private dental clinics, and to increase perceived quality and pain management of dental care in both private clinics and public/non‐profits serving low‐income populations.     

Dental Care Visits among Dentate Adults with Diabetes and Periodontitis

Objectives: Two national surveys have shown that dentate adults with diabetes are less likely to visit a dentist than are those without diabetes; one survey showed this association only among women. We hypothesize that periodontal health among those with diabetes could explain this disparity. This report investigates the influence of periodontitis on the association between diabetes and dental care visits. It also tests whether disparities are limited to women. Methods: Data from the 1999‐2004 National Health and Nutrition Examination Survey were used. Covariates included age, sex, race/ethnicity, poverty status, education level, dental insurance, and periodontitis status. Weighted analyses were limited to dentate adults aged ≥25 years. Results: Overall, 56.8 percent of dentate adults with diabetes reported having a dental care visit in the preceding year compared with 64.7 percent for those without diabetes. In a multivariable model, diabetes status was significantly associated with having a dental care visit, independent of periodontitis status and covariates. Neither periodontitis status nor sex served as effect modifiers for the association between diabetes status and dental care visits. Conclusions: These data revealed that dental care visits for dentate adults with diabetes were unrelated to their periodontal health, suggesting that fear of periodontal therapy did not influence visit patterns. These data also showed that dental care visit disparities existed for all adults with diabetes, not just women. Future research should investigate whether factors that are indirectly related to diabetes status, such as competing costs, attitudes, and knowledge, are influencing dental care visit patterns among dentate adults with diabetes.     

The impact of a brief tobacco-use cessation intervention in public health dental clinics

BACKGROUND: Public health dental clinic patients use tobacco at disproportionately high rates. The purpose of this study was to evaluate a tobacco-use cessation program delivered via public health dental practitioners. METHODS: Two public health dental clinics participated in this quasiexperimental design study. First, all patients in one clinic who used tobacco (n = 178) received usual care. Next, the authors trained all practitioners to conduct a tobacco-use assessment and provide a brief cessation intervention. Subsequently, all patients in both clinics who used tobacco (N = 190) received the intervention. All enrolled patients had an income at or below the federal poverty level. The authors conducted follow-up assessments at six weeks and three and six months after enrollment. RESULTS: Differences in self-reported quitting by condition between participants in the two groups were significant across all endpoints. Patients in the intervention group were more likely to quit than those receiving usual care (15.5 versus 4.3 percent) and after 12 months (18.8 versus 4.6 percent). Controlling for enrollment differences between patients in the two groups (age, race/ethnicity, time to first cigarette after waking), the authors found that differences between groups were significant for quitting at three months (P < .05; odds ratio [OR] = 4.85; 95 percent confidence interval [CI] = 1.20, 19.60), and six months (P < . 01; OR = 5.25; 95 percent CI = 1.35, 20.36). CONCLUSIONS: The results of this study suggest the viability and effectiveness of delivering a tobacco intervention to low-income smokers via public dental practitioners. A randomized clinical trial is warranted. CLINICAL IMPLICATIONS: The potential reach of public health dental clinics is great. Because of the high percentage of tobacco-using patients in these clinics, the public health impact of a program such as the one reported here would be significant.     

Dental expenditures and source of payment by race/ethnicity and other sociodemographic characteristics

OBJECTIVE: This study presents race/ethnic-specific distributions of dental expenditures and their sources of payment by socioeconomic characteristics among US working-age adults. METHODS: Data for persons aged 19-64 years from the 1987 National Medical Expenditure Survey (NMES) (n = 18,696) were used to calculate mean dental expenditures and their 95 percent confidence intervals. RESULTS: Dental expenditures were reported by 44.5 percent of participants. Non-Hispanic whites and persons with higher income were more likely to report dental expenditures than their counterparts. Among persons reporting expenditures, those with lower income had lower expenditures than higher-income persons. No differences in the amount of expenditures by race/ethnicity, sex, or employment status were observed. In all race/ethnic groups almost half the expenditures were paid out-of-pocket and one-third by dental insurance. CONCLUSION: While sociodemographic characteristics determined who had dental expenditures, they did not determine the amount or source of those expenditures.     

Racial and ethnic variation in the provision of dental procedures

OBJECTIVES: Most of the available information on racial/ethnic disparities in oral health is based on differences in sociodemographic variables related to dental disease burden, dental visits, and access to care. However, very little is known regarding racial/ethnic variation in the provision of dental procedures. This study examined trends in the provision of dental procedures and sought to determine whether there are racial/ethnic differences in the provision of dental procedures. METHODS: This is a retrospective observational study of patients treated at a dental training institution. Data for all patients 18 to 60 years of age in axiUm (electronic database) for 2001 to 2003 were analyzed. Data include demographic information, poverty status, insurance coverage, dental procedure, and race/ethnicity. Separate logistic regression models (by dental procedure category and year) were fitted while considering race/ethnicity, insurance coverage, poverty status, marital status, and age as possible covariates. RESULTS: The total number of dental procedures completed by providers increased by 14,000 between 2001 and 2003. African-Americans were significantly less likely to have restorative procedures [odds ratio (OR): 0.60, 95 percent confidence interval (CI): 0.42 to 0.86], (OR: 0.52, 95 percent CI: 0.38 to 0.73), (OR: 0.46, 95 percent CI: 0.36 to 0.58) in 2001, 2002, and 2003, respectively, than the White population. Significant differences in the use of other dental procedures (prosthodontics--removable) and oral surgery procedures by race/ethnicity were observed. CONCLUSIONS: Substantial racial/ethnic variation in the provision of dental procedures exists. This study presents findings beyond anecdotal information on racial/ethnic variation in the provision of dental procedures and requires further research to compile more detailed data.     

Alternative careers in pediatric dentistry: a survey of pediatric dental residents

Pediatric dentistry has enjoyed growing popularity in recent years, yet there remains a need for leadership in academe, research, and public health. In November 2008, the first Maternal and Child Health Bureau-sponsored regional Leadership in Pediatric Dentistry convocation was held at the Columbia University College of Dental Medicine. Seventy-two pediatric dentistry trainees from thirteen programs in the New York City area participated in interactive presentations and exercises. Of the sixty- seven participants who completed a pre-event survey, 93 percent stated they would likely or very likely pursue careers that involved, at least in part, private practice, 55 percent in care of children in Medicaid, 51 percent academics, 36 percent dental public health, and 12 percent research. Barriers related to finances, competence, or work environment/location were perceived by 83 percent for careers involving research, 73 percent for dental public health, 66 percent for providing care to children in Medicaid, 46 percent for academics, and 9 percent for private practice. Results of a pair of pre-event and post-event surveys completed by sixty-three attendees showed no change in reported likelihood to pursue a career alternative except for an increase in the likelihood of working in a practice that accepts Medicaid. The challenge before dental educators is to provide consistent and meaningful opportunities throughout training that encourage residents to consider all career options and to discover how their individual interests mesh with their clinical learning.     

The influence of the volume of dental treatment on change in self‐reported oral health

Objectives: To find an association between self‐reported change in oral health and dental treatment volume. Methods: Baseline data were obtained from the Tasmanian component of the National Survey of Adult Oral Health 2004‐06 and 12‐month follow‐up data from service use logbooks and mail self‐complete questionnaires. The global oral health transition statement indicated change in oral health. Many putative confounders were analyzed and Poisson regression with robust variance estimation was used to calculate the prevalence ratios and 95 percent confidence intervals for bivariate‐ and multivariate‐adjusted relationships. Results: One‐eighth (12.4 percent) of the participants reported that their oral health had improved. Over half visited a dentist (n = 176, 52.6 percent), of whom 105 received less than six dental services and 71 received six or more dental services. Baseline oral disease (P = 0.01), having a treatment need (P < 0.01), usually visiting a dentist for a problem (P < 0.05), and having a lot of difficulty paying a $100 dental bill (P = 0.01) were significantly associated with the same or worsening oral health. The regression model indicated that having six or more dental services (P < 0.01) was significantly associated with improvement in oral health, indicating a threshold effect. Usually visiting a dentist for a check‐up was significantly associated with improvement in oral health (P < 0.01). Conclusion: Having six or more dental services was significantly associated with a greater self‐reported improvement in oral health than having less than six dental services. The greater prevalence ratios with increasing dental service volume suggested a threshold effect.     

Periodontal-systemic disease education in United States dental hygiene programs

The relationship between periodontal disease and systemic disease has gained much attention in recent years in the dental profession and from national health care agencies. Two third-party providers are now modifying their dental reimbursements for patients who have periodontal disease and are pregnant or have cardiovascular disease. However, there are few reports in the dental or dental hygiene literature about how students are taught this information and how it is incorporated into the didactic and clinical aspects of the curriculum. A thirty-item survey and cover letter on these subjects were emailed to the directors of the 286 accredited dental hygiene programs in the United States in 2007. The response rate was 63 percent. According to these responses, the three most emphasized topics regarding oral-systemic disease are diabetes, tobacco use, and cardiovascular disease. Most programs (90 percent) use journal articles for instructional content, and 87 percent use the American Academy of Periodontology website for reference. Only 4 percent have content taught jointly with nursing, medical, or allied health students. The majority of directors (87 percent) indicated they could use more evidence-based educational materials to help teach the concepts to students. Only 9 percent of survey respondents thought that nurses and physicians are knowledgeable about the relationship of oral health to systemic disease. The findings indicate that dental hygiene program directors are confident about the education on oral-systemic content provided to their dental hygiene students, but would like additional evidence-based materials to help their students learn this topic.     

Oral health-related quality of life among low-income adults living with HIV

Objectives: To explore oral health‐related quality of life and its correlates among low‐income human immunodeficiency virus (HIV)‐positive patients receiving primary HIV care. Methods: Data were from a randomized experimental trial evaluating an intervention to increase use of oral health services by low‐income HIV‐positive adults. Interviews were conducted in English or Spanish among 594 adults receiving HIV medical care but not dental care. Oral health‐related quality of life was measured with the 49‐item Oral Health Impact Profile (OHIP‐49). Primary predictor variables included measures of HIV disease: duration of HIV infection, CD4 cell count, and HIV viral load. Other predictors included sociodemographic and behavioral factors. Results: Overall, 62.6 percent of participants had experienced at least one oral health impact very often or fairly often in the 4 weeks preceding the survey, with a mean of 5.8 impacts. The mean number of impacts was significantly higher for women, the unemployed, those living in temporary housing, and current smokers. Neither the prevalence nor the mean number of impacts differed significantly by duration of HIV infection, CD4(+) T lymphocyte cell count, or HIV viral load. In bivariate analysis, women had higher mean OHIP‐49 scores than men overall (62.6 versus 50.5, P < 0.05) and for most subscales, indicating that women experienced more oral health impacts. In the final multivariate model, significant correlates of OHIP‐49 were sex, race/ethnicity, living situation, and smoking status. Conclusions: Oral health impacts are prevalent among adults in South Florida living with HIV, particularly among women, cigarette smokers, those in prison or other institutional settings, and certain racial and ethnic groups.     

Differential item functioning related to ethnicity in an oral health‐related quality of life measure

International Journal of Paediatric Dentistry 2010; 20: 435–441 Objective. To assess whether an oral health‐related quality of life (OHRQoL)measure showed differential item functioning (DIF) by ethnicity. Methods. A simple random sample of 12‐ and 13‐year‐old schoolchildren enrolled in the Taranaki District Health Board’s school dental service, New Zealand. Each child (n = 430) completed the Child Perception Questionnaire (CPQ_11‐14) in the dental clinic waiting room, prior to a dental examination. The dataset included age, gender, ethnicity, and deprivation status. The general principle of the analytic plan was that equal scores from each CPQ_11‐14 item were expected from both non‐Mäori and Mäori groups regardless of their ethnic group. Ordinal logistic regression was performed. The dependent variables were the CPQ_11‐14 items. The ethnicity group and each CPQ_11‐14 domain score were the independent variables. Non‐uniform DIF was assessed through adding an interaction term for each CPQ_11‐14 sub‐scale. Results. Non‐uniform DIF was found in two items, one in the Functional Limitations sub‐scale and another in the Social Well‐being sub‐scale. Uniform DIF was found in one item of the Emotional Well‐being sub‐scale. Conclusion. Both non‐uniform and uniform DIF by ethnicity was found in three of 37 items of the CPQ_11‐14 questionnaire, showing it is important to perform DIF analysis when applying OHRQoL measures.     

Self-reported oral health perceptions of Somali adults in Minnesota: a pilot study

Abstract: Objective: To assess self‐reported oral health perceptions and associated factors in an adult Somali population living in Minnesota, USA. Methods: We analysed data from a cross‐sectional study of Somali adults aged 18 to 65+ years attending a dental school clinic for care. A comprehensive oral examination was performed by the dental school outreach team on all patients who attended a 2‐week designated Somali dental clinic. Adults who consented were given an oral health questionnaire to collect information on sociodemographics, marital status, language preference and self‐rated oral and general health. We performed summary statistics and differences between proportions using Fisher’s exact test and a comparison of means using one‐way anova or a two‐sample t‐test. Results: The sample consisted of 53 adults, 75% of whom were females. About 49% of subjects reported poor/fair oral health and 38% reported poor/fair general health. Seventy‐four percent rated their access to dental care as poor/fair and 83% reported that they did not have a regular source of dental care. Self‐rated oral health was significantly associated with marital status (P < 0.05) and self‐rated general health (P < 0.01) using Fisher’s exact test. Conclusion: A substantial proportion of Somali adults rated their oral health and access to dental care as poor/fair. These findings suggest that this population would benefit from improved access to oral health care and culturally appropriate oral health education and promotion programs.     

Older peoples' perceptions of oral health: 'it's just not that simple'

Abstract: Objectives: Little is known about older persons’ perceptions of oral health and oral health care. The purpose of this study was to explore the viewpoint of older adults’ regarding their oral health care practices. Methods: A qualitative interpretive methodology was employed comprising three analytic levels: coding of data into concepts, analysis of concepts into themes, followed by an in‐depth analysis of relationships within concepts and between themes. In‐depth individual interviews were conducted with 19 participants aged 65 to 87 years. Results: Older people’s decision to access oral health care involves complex and personally meaningful strategies. A dental visit surfaces hopes and fears based on past and present experiences. Mouth and teeth are not merely objects of dental care; they represent a person’s social and relational self. Age‐related changes challenge the relational self as represented in societal ideal images of youth and perfection (the perfect smile). This study highlights older peoples’ resilience and determination when faced with the dilemmas in accessing oral health care – it costs, personally as well as financially. Contrary to the assumption that older peoples’ oral health status is related to neglect, rather for many, it is the result of the intersection of their history with technological advances. Conclusions: These findings challenge oral health care practitioners to be sensitive to the contexts affecting their older client’s oral health care status. They do not ‘just go’ to the dentist; they bring with them their past dental experiences and their hopes for the future. It matters how one is treated at this vulnerable time.     

Income, dental insurance coverage, and financial barriers to dental care among Canadian adults

Objectives: To explore the issue of affordability in dental care by assessing associations between income, dental insurance, and financial barriers to dental care in Canadian adults. Methods: Data were collection from a national sample of adults 18 years and over using a telephone interview survey based on random digit dialing. Questions were asked about household income and dental insurance coverage along with three questions concerning cost barriers to accessing dental care. These were: “In the past three years . . . has the cost of dental care been a financial burden to you? . . . have you delayed or avoided going to a dentist because of the cost? . . . have you been unable to have all of the treatment recommended by your dentist because of the cost?” Results: The survey was completed by 2,027 people, over half of which (56.0%) were covered by private dental insurance and 4.9 percent by public dental programs. The remainder, 39.1 percent, paid for dental care out‐of‐pocket. Only 19.3 percent of the lowest income group had private coverage compared with 80.5 percent of the highest income group (P < 0.001). Half (48.2%) responded positively to at least one of the three questions concerning cost barriers, and 14.8 percent responded positively to all three. Low income subjects (P < 0.001) and those without dental insurance (P < 0.001) were most likely to report financial barriers to care. While private dental insurance reduced financial barriers to dental care, it did not entirely eliminate it, particularly for those with low incomes. Those reporting such barriers visited the dentist less frequently and had poorer oral health outcomes after controlling for the effects of income and insurance coverage. Conclusions: Canadian adults report financial barriers to dental care, especially those of low income. These barriers appear to have negative effects with respect to dental visiting and oral health outcomes. For policy, appropriateness will be key, as clarity needs to be established in terms of what constitutes actual need, and thus which dental services can then be considered a public health response to affordability.     

Adequacy of Oral Health Information for Patients with Diabetes

Objective: We investigated the perception of dental hygienists regarding their adequacy of providing diabetics with diabetes‐related oral health preventive education. Methods: A one‐page questionnaire printed on both sides was mailed to 2,237 licensed registered dental hygienists with a South Carolina (SC) mailing address. In addition to the dental hygienists' background and practice characteristics, their perception of adequacy for educating patients with diabetes on various diabetes‐related oral health topics and reasons for inadequate coverage of materials were queried in the survey. Results: After two follow‐up mailings, 995 completed and usable surveys were returned. An average of 93.6 percent of respondents indicated that they adequately covered topics of oral hygiene and general oral health issues. However, about 60 percent of respondents reported not covering all essential materials related to oral health when educating diabetic patients. The three most common reasons were: a) insufficient time (60.1 percent); b) patient disinterest (41.2 percent); and c) insufficient information on oral care and diabetes (39.7 percent). Respondents reporting insufficient information were less likely to adequately address the effect of periodontal disease on diabetes (P < 0.001), effect of uncontrolled diabetes on periodontal disease (P < 0.001), and dry mouth management (P = 0.03). Conclusion: This study indicates that SC dental hygienists do not routinely provide patient education on diabetes‐related oral health and healthy lifestyle topics. Lack of time, patient disinterest, and insufficient information were the three main reasons for respondents not covering these essentials. A practical method for improving dental hygienists' comprehensive service to patients with diabetes is to offer them more continuing education on diabetes and oral health to supplement their knowledge, skills, and confidence to educate this growing population.     

Oral health and health care for older adults: A spatial approach for addressing disparities and planning services

The purpose of this paper was to examine the geographic distribution of New York City adults aged 65 and older by race/ethnicity and poverty status. Also analyzed was seniors' access to dental care as defined by the location of dental providers and their proximity to the subway system lines in Manhattan and the Bronx. ArcGIS software was used to create a geographic information system (GIS) incorporating relevant data from a variety of sources. Individual and overlay maps were then produced to examine the aims of this analysis. Data showed that Black race, Hispanic ethnicity, and poverty status tend to co‐occur spatially among seniors in Northern Manhattan and the South Bronx. Further, a spatial/transportation barrier may inhibit access to dental care for seniors who reside in these areas. By presenting multiple layers of local information juxtaposed, GIS can help provide directions for planning oral health service delivery for seniors.