Maryland Residents'' Attitudes Toward AIDS and the Use of Dental Services

This project was conducted to examine the impact of Maryland residents' attitudes about AIDS on dental services utilization. A telephone survey of 1,477 households was conducted (response rate 68.9%). Less than 7 percent of the respondents volunteered a concern about contracting AIDS in the dental office. When asked directly, approximately 35 percent stated they would change dentists if their dentist were treating AIDS patients. Respondents who were most aware of the wide-spread treatment of AIDS patients by dentists were more likely to believe their dentist was treating AIDS patients. Also, they were less likely to report that they would leave the practice of dentists with AIDS or those who treated AIDS patients. It is critical for the public to be educated properly about the continued safety of the dental office and to receive accurate information about AIDS.     

The Dental Attitudes Questionnaire: comparing two response formats

In 1984 the Dental Attitudes Questionnaire, an instrument for assessing oral health care attitudes, was proposed. The DAQ has six content scales (Cynicism, Health Concern, Motivation, Oral Function, Social Aesthetic, Susceptibility) and two validity scales (Halo, Infrequency). The original items had an 'agree-disagree' format. We compared this dichotomous format with a six-point response format. Results obtained with the two-point scale did not meet acceptable psychometric criteria. The six-point scale resulted in acceptable item and subtest parameters and variance, internal reliability and test/retest reliability. For eight items, rewording was suggested. Future research is indicated.     

Self-disclosure Experience of People with HIV Infection in Dedicated and Mainstreamed Dental Facilities

Objectives : People infected with HIV choose dental care in dedicated or mainstreamed facilities. In this study, people with HIV were asked whether they sought care in dedicated or mainstreamed dental facilities, their reasons for choosing this source of care, their HIV disclosure experiences, and what, if any, consequences the disclosure had on access to dental care. Methods : Patients in a dedicated AIDS medical clinic ( n =84) responded to questions in a telephone survey. The sample was predominantly gay, white males with symptomatic HIV infection, from randomly chosen clinic appointments. Results : The study found that 67.6 percent of respondents who had seen a dentist since their HIV diagnosis chose mainstreamed dental facilities. The majority of study participants (70%) disclosed their HIV status. Of those subjects who chose disclosure, discrimination was minimal (2.7%). Conclusion : Results suggest support for public policy encouraging people with HIV to go to any dentist with whom they feel most comfortable and with whom they will receive the best possible care, regardless of whether the dentist practices in a dedicated or mainstreamed facility.     

The Rural Dental Health Program: Long-term Impact of Two Dental Delivery Systems on Children''s Oral Health

This paper addresses the long-term effect of two dental delivery systems established during the Rural Dental Health Program (RDHP) in 1975. At that time 725 children in grades K-2 were assigned randomly to an enriched dental health education program or regular health education program and to a SCHOOL- or COMMUNITY-based dental delivery system. Seven years after funding for RDHP ended, children originally assigned to the COMMUNITY group utilized more professional services and showed a higher level of dental knowledge than children assigned to the SCHOOL group. In addition, COMMUNITY-based children had, on average, twice as many sealed teeth. While the follow-up study did not reveal any statistically significant difference in the clinical oral health indices (DMFS, gingival index, calculus index, plaque index, periodontal probing depth, and orthodontic treatment priority index) the COMMUNITY-based children's higher level of professional dental service utilization, greater number of sealed teeth, and increased dental knowledge should lead to a higher level of oral health in the long run.     

Dentists and AIDS: a Survey of Knowledge, Attitudes, and Behavior in Italy

Objectives: Italy, together with Spain, is second only to France in the total number of AIDS cases” in Europe, with over 16,800 as of March 1993. The purpose of this study was to evaluate knowledge, attitudes, and behavior concerning AIDS and infection control among Italian dentists. Methods : A questionnaire was mailed to 1,000 dentists randomly selected from the Italian Dental and Maxilto-Facial Association's register of dentists. Results : Of the 715 dentists responding, 70.7 percent of dentists knew all the main risk groups able to transmit the infection and that semen is a biologic fluid potentially contaminated by HIV virus. This knowledge was greater if the number of patients per week was not higher than 55 and if the dentist had had a previous contact with an HIV-seropositive patient. Only a few (21.1%) knew all the oral manifestations of AIDS. Over 65 percent of the dentists indicated that they would treat HIV-seropositive patients (71.9%) or those with AIDS (66.8%). Dentists were more willing to care for an HIV-seropositive patient if they were involved in specialties with high blood contact, if they had a previous contact with an HIV patient, as the average number of patients per week increased, and if they did not consider saliva as a possible route of transmission of HIV. A small percentage of dentists who had the opportunity to treat patients at risk for AIDS (12.1%) or HIV seropositive (9.4%) refused to treat them. Willingness to treat was the most significant predictor of actual treatment of an infected patient. Only 24.4 percent routinely used all barrier techniques (gloves, masks, and protective eye-wear). Predictors of routine use of all barrier techniques were specialties with high blood contact, considering saliva a possible route of transmission of HIV infection, average number of patients per week fewer than 40, and number of years of practice. Conclusions : Educational efforts for improving knowledge and finding and implementing ways to motivate dentists to the correct and routine use of infection control procedures are needed.     

Socio‐economic inequality in oral health in childhood to young adulthood,despite full dental coverage

The aim of this cross‐sectional study was to assess differences in caries experience according to socio‐economic status (SES) in a health‐care system with full coverage of dental costs for children up to the age of 18 yr. In 2011 and 2014, by performing hurdle negative binomial models, we obtained data on 3,022 children and young adults aged 5, 8, 11, 14, 17, 20, and 23 yr, living in four cities in the Netherlands. At all ages between 5 and 23 yr, the percentages of children with caries‐free dentitions were lower and mean caries experience were higher in low‐SES than in high‐SES participants. In 5‐yr‐old children with dmft > 0, mean caries experience was 3.6 in those with low SES and 2.3 in those with high SES. In 23‐yr‐old participants, these estimates were 6.8 and 4.4, respectively (P < 0.05). Low‐SES children have a greater risk of more caries experience than high‐SES children. Thus, in a system with full free paediatric dental coverage, socio‐economic inequality in caries experience still exists. Dental health professionals, well‐child care doctors and nurses, general practitioners, and elementary school teachers should collaborate to promote oral health at the community level, with specific targeting of low‐SES families. We further need policy measures to curtail, at community level, the increasing availability and consumption of highly processed, carbohydrate‐rich foods, with particular attention for low‐SES families.     

The Missouri Elks Mobile Dental Program–Dental Care for Developmentally Disabled Persons

This article describes the origins, funding, organization, operation, utilization, and outreach program of a statewide mobile dental program for the disabled in Missouri. The article includes information based on analysis of productivity reports and patient records. Comparisons are made between the utilization by mentally retarded (MR) and other disabled patients (MCCS), their county of residence, and the location where service was provided (rural vs urban). The mean number of dental procedures provided per client was 7.3. More procedures (8.35) were provided to urban clients than rural clients (5.81). The utilization rate of urban MR clients was 63.9 percent, compared to 60 percent for rural MR clients. Other findings show 10.7 percent urban MCCS clients utilized the mobile dental program, versus 13.5 percent of the rural MCCS clients. The budgeted expenditures for providing care to this underserved group were $46,000 less than the estimated value of dental care provided in a private practice setting.     

Prevention of infective endocarditis and bacterial resistance to antibiotics: A brief review

The purpose of this statement is to debate the recommendations of the American Heart Association (AHA) for the prevention of infective endocarditis through an antibiotic prophylaxis protocol and its relation with bacterial resistance to antibiotics. Since dental infections involve biofilms that include several bacterial species (Gram‐negative and Gram‐positive), it is essential, from the dental point of view, to consider the frequency, magnitude, and duration of bacteremia associated with active dental infections before applying antibiotic prophylaxis. The actual guidelines for antibiotic prophylaxis should be revised according to recent evidence of bacterial resistance. Amoxicillin/clavulanic acid and moxifloxacin should be considered due to their effectiveness against bacteria associated with oral, GU, and GI infections and the low rates of antibiotic resistance associated with these antibiotics, instead of the actual protocol, which includes amoxicillin (2 g) or clindamycin (600 mg) administered an hour before the dental procedures. The breaking point to test the antibiotic bacterial resistance (ABR) had a wide range in the different studies that were analyzed, which could explain the widely varied ABR percentages reported for the various antibiotics used for antibiotic prophylaxis.     

Dental public health: new opportunities--new responsibilities

Major changes affecting oral health in the United States have provided new leadership challenges for public health dentistry. Two new roles for dental public health are proposed: leadership in the incorporation of expanded public health skills into the education of every clinical dentist; and a broadening of the specialty in a manner similar to that of preventive medicine, involving the creation of subspecialties in public health dentistry, occupational environmental dentistry, and management policy dentistry. The current status of community dentistry departments in dental schools and programs of public health education for dental personnel in schools of public health are reviewed. Content is suggested for the incorporation of expanded public health skills into the education of every clinical dentist.     

Effects of School Dental Care Service in Hong Kong-primary teeth

The aim of this study was to describe the effects of the School Dental Care Service on the dental status of primary teeth, against the background of the water fluoridation program. A representative sample of Chinese children aged 6-12 yr was selected for a dental examination for caries and treatment needs. Thirty-two percent of the children aged 6-8 yr were caries free. The dmft indices for 6, 7, and 8-yr-olds were 2.8, 3.1, and 2.9 respectively, and the ratio of decayed to filled teeth declined from 3.2 at age 6 to 1.0 at age 9. The average child aged 6-8 yr needed treatment for caries on just fewer than two teeth. More teeth were in need of 1-surface fillings and such complex treatment as pulpotomy than other treatment types. It was concluded that 1) dental caries prevalence and severity in primary teeth of Hong Kong children continues to decline, 2) there has been an obvious improvement in dental fitness as a result of establishing the School Dental Care Service, 3) the risk to dental caries appears to be associated with the preschool time-frame and therefore 4) the dental service should redirect its attention to preschool children and 5) replace its restorative policy with a preventive policy.     

Oral Hygiene Instruction and Health Risk Assessment in Dental Practice

We studied oral hygiene instruction given to 109 patients in 19 Washington State dental practices to investigate the extent to which therapists targeted their efforts toward patients with high disease risk. Patients were examined prior to instruction and prophylaxes. Therapists' instructions were tape-recorded and their content analyzed: therapists' expectations were scored. There were no statistically significant associations between patients' initial plaque levels and the process/content of the oral hygiene instructions delivered. On average, therapists spent 9.4 minutes of each prophylaxis session discussing oral hygiene. Therapists were judged more genuine with those patients for whom they had higher expectations of compliance, i.e., those with less plaque and low disease risk. We conclude that dental practitioners were not employing effective risk assessment strategies in selection of patients most in need of intensive instructional efforts.     

Dental caries in schoolchildren in some Danish communities with and without school dental service

ABSTRACT The purpose of the investigation was to compare the caries prevalence (DMF-T) among 762 7th grade children, of whom one-hall had received regular school dental care throughout their school attendance and the other half had never received school dental care. The children were grouped according to social status in order to see if there was any difference in the caries prevalence between the social groups. The caries prevalence in children both with and without school dental service was high, 9.5 DMF-T and 10.5 DMF-T. The prevalence of untreated caries and secondary caries was lowest in the group with school dental service.     

Dental care of infectious patients in Denmark, 1986–1993: theoretical considerations and empirical findings

Abstract Changes in infection control and behavior and attitudes towards HIV-infected patients from 1986 to 1992/93 were studied among a random sample of 335 Danish dentists; previous studies among random samples of Danish dentists served as references. 249 (74.3%) returned a mailed questionnaire together with a time, steam, temperature (TST) control indicator strip processed in their steam autoclaves. 3.4% of the autoclaves had not sterilized properly, which was an insignificant decrease compared to 1986. Overall, infection control had improved since 1986. In 1992/93 17.3% of dentists surveyed reported use of gloves always: in 1986 0.8% did so. Many (60.2%) reported at least one needlestick or cut accident within the last year. The number of dentists who were willing to treat HIV-infected patients and the number of clinics that found they could treat infectious patients safely had increased from 56.1%, to 78.7%, and from 43.0% to 66.8%, respectively. Other attitudinal dimensions, for example views on secrecy of HIV test results and HIV screening policy, had not changed. A conceptual model based on the theory of reasoned action formed the framework for multiple logistic regression analysis with two different outcomes: Willingness to treat HIV-infected individuals and Treatment of HIV-infected patients. In particular, expected staff problems turned out to have a high explanatory value (odds ratio = 18.2) if HIV-infected patients were received. In both models Certainty about hygienic precautions had some explanatory value. The findings may give some clues about how to plan and implement future continuing education on infection control and attitudinal and behavioral aspects of caring for infectious patients.     

The Development and Practice of Social Dentistry in Germany

The traditions of social dentistry in Germany represent early forms of dental public health development. It was promoted in dental care facilities where salaried dentists delivered services to target groups, i.e., schoolchildren and sickness fund members. They enabled larger numbers of patients to receive dental care, especially those of lower class origin who otherwise would have remained untreated because of lack of financial resources or scarcity of manpower. School dental clinics not only delivered dental treatment, but also distributed oral hygiene and nutritional information to school-aged children. Social dentistry in the prefluoride era in Germany pursued an egalitarian and social-class oriented concept of dental care delivery, aiming at compensating the detrimental effects that the private practice-based, fee-for-service financed dental care system had produced in the lower classes of the population. The impact of the Nazi regime nearly abolished the institutions of social dentistry. They never were restored in West Germany after World War II. In East Germany dental care had been organized according to traditions of social dentistry, i.e., delivering services in dental treatment centers. Since the unification of the two German states, the institutions of dental care delivery in former East Germany have been restructured to fit the private practice-based model of former West Germany, eliminating most of the social dentistry institutions in the country.     

Dental case manager encounters: the association with retention in dental care and treatment plan completion

Little is known about dental case managers as few programs have been scientifically evaluated. The goal of this study was to explore the impact of dental case manager on retention in dental care and completion of treatment plans, while specifically exploring the number of dental case manager encounters. Fourteen programs enrolled people with HIV/AIDS (PLWHA) in dental care and a longitudinal study between 2007 and 2009. The 758 participants had a total of 2715 encounters with a dental case manager over twelve months: 29% had a single encounter; 21% had two; 27% had 3–4 and; 23% had 5–29 encounters. Adjusting for baseline characteristics, participants receiving more encounters were significantly more likely to complete their Phase 1 treatment plan, be retained in dental care, and experience improvements in overall oral health status. Organizations considering efforts to improve the oral health of vulnerable, hard‐to‐engage populations should consider these findings when planning interventions.     

Academic Dental Public Health Diplomates: Their Distribution and Recommendations Concerning the Predoctoral Dental Public Health Faculty

Objectives : The purpose of this study was to assess the representation of academically based diplomates of the American Board of Dental Public Health (ABDPH) and to identify their perceptions on the training of dental public health predoctoral faculty. Methods : Data were collected by a mailed, self-administered, 13-item questionnaire. The population was the 48 diplomates of the ABDPH as of March 1997 associated with academic institutions. Results : Twenty of the 55 US dental schools had a diplomate of the ABDPH with a mean of 1.8 diplomates per school with a diplomate. An average of 4.5 full-time faculty members per school were associated with teaching dental public health. A master's degree in public health (MPH) was the most frequently suggested educational requirement for dental public health faculty. Continuing education courses were training needs perceived for dental public health faculty. The lack of time, money, and incentives, along with perceived rigidity of requirements for board certification, were reported as major barriers for faculty becoming dental public health board certified. Conclusion : Numerous challenges confront the development of a strong dental public health presence in US dental schools. These challenges include, among others, insufficient numbers of academic dental public health specialists and insufficient motivations to encourage promising candidates to pursue specialty status.