The Impact of Improved Oral Health on the Utilization of Dental Services

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153746/1/jddjde017017.pd

Factors Affecting the Cost of Fissure Sealants: A Dental Insurer's Perspective

The slow adoption of sealants into dental practice is attributed partly to the fact that few prepayment plans pay for sealants. An important concern of insurers is how a sealants benefit will affect premiums. In this analysis, caries rates for various surfaces and teeth, failure rates for both sealants and amalgam restorations, fees and copayments, interest rates, reimbursement policies for replacement and repair, and the passage of time were studied to assess the cost to an insurer of amalgam restorations versus sealants. The results indicate: 1. Sealants as a covered benefit for molars may not cause premiums to increase if fees and copayment levels are properly balanced. If caries in children continues to decline, however, higher premiums may be required if a sealant benefit is provided. 2. Sealants as a covered benefit for bicuspids are likely to require higher premiums. 3. The level of dental caries in the population should be monitored closely, because a further substantial decline in caries prevalence could diminish the economic argument for sealants.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65544/1/j.1752-7325.1986.tb03127.x.pd

Risk Factors for Total Tooth Loss in the United States; Longitudinal Analysis of National Data

The NHANES I Epidemiologic Follow-up Study (NHEFS) of 1982-84 collected longitudinal data from 10,523 individuals initially seen during the first National Health and Nutrition Examination Survey (NHANES I) of 1971-75. Among this additional data was information on the incidence of total tooth loss during the 10 years between the surveys, which could then be added to NHANES I data to identify risk factors. In this analysis, a series of bivariate analyses were carried out, followed by logistic regression analysis to assess the simultaneous effect of major variables. Results showed that 7.4 percent of dentate Americans aged 25-74 at NHANES I became edentulous over the next 10 years. In bivariate analyses, the incidence of edentulism was correlated with baseline measures of lower income and education status, poorer oral health, self-perceptions of poor general health and oral health, absence of a regular dentist, and a lower number of remaining teeth at baseline. No correlation was found with gender and geographic region, nor with self-reported diabetes and arthritis, and age was not a factor when the number of remaining teeth at baseline were taken into account. In a logistic regression model assessing the effect of these variables simultaneously, none of the demographic variables retained significance; the only variable statistically significant in both age groups was the number of teeth remaining at baseline. Other significant variables in younger persons were higher periodontal disease scores, perceived poor dental health, perceived need for extractions, history of smoking, and low ascorbic acid intake. Some of these variables were reflections of negative health behavior and attitudes rather than direct correlates. Principal findings from this study were the importance of early tooth loss in eventual edentulism and the virtual disappearance of gender and age as determinants of total tooth loss.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65639/1/j.1752-7325.1994.tb01173.x.pd

Estimating the Number of Dentists Needed in 2040

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153584/1/jddjde017021.pd

Time of Development of Occlusal and Proximal Lesions: Implications for Fissure Sealants

Analysis of surface and tooth-specific data from NHANES I and HHANES shows that the pattern of dental caries differs greatly from tooth to tooth and surface to surface. Occlusal caries precedes all other types, and increases most rapidly and to the highest levels in the molars. Caries on the proximal surfaces comes later. For sealants to be of value, they must reduce the need for restorations. Therefore, the value of sealants will be determined by the balance between high enough levels of potential caries on occlusal surfaces to give them something to prevent, and low levels of, or sufficiently delayed, proximal lesions to prevent the loss of the otherwise saved occlusal surface. The data presented demonstrate that as of the time of NHANES I, the number of permanent molars that could have had surfaces saved from restoration, at least for a number of years, appears to be sufficient to warrant widespread use of sealants on those teeth. More recent data (HHANES) suggest that the current decline in caries prevalence is likely to reduce the value of sealants in the short run because there are fewer occlusal lesions in young children, but may increase the value of sealants in the long run because proximal caries in older children and adults is also declining.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65756/1/j.1752-7325.1986.tb03119.x.pd

Sugar consumption and caries risk in schoolchildren with low caries experience

– This paper assesses the risk from sugar consumption in a population of schoolchildren with low caries experience. It relates eight different measures of sugar consumption to the occurrence of any DMFS increment, and, separately, to approximal and pit-and-fissure DMFS. The data are from a 3-yr longitudinal study of 429 children, initially aged 11–15, residing in non-fluoridated rural communities in Michigan, USA. All children completed at least three dietary interviews, were present for baseline and final dental examinations, and had a parent or guardian provide questionnaire information on residence history, use of fluoride and dental services, and family history. Results indicated that a higher proportion of total energy intake from sugars increased the probability of caries on all surfaces, and a higher total intake of sugars was also associated with total caries increment. No relationship, however, was found between DMFS increment and the frequency of eating high sugar foods. Each additional 5 g of daily sugars intake was associated with a 1% increase in the probability of developing caries, and those whose energy intake from sugars was 1 SD above the mean had 2.0 times the risk of developing approximal caries than did children whose energy intake from sugars was 1 SD below the mean.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74862/1/j.1600-0528.1995.tb00218.x.pd

Letters to the Editor

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66363/1/j.1752-7325.1998.tb02993.x.pd

Periodontal disease, tooth loss, and oral hygiene among older Americans

– Recent research has suggested that susceptibility to destructive periodontal disease may not be as universal as was previously thought. This report analyzes data from a representative national sample of 11 338 American adults aged 25–74, examined in a national survey in 1971–74. Results showed that 46.1% of those aged 65–74 were edentulous, but half of the dentate persons in that age group were diagnosed as free of destructive periodontal disease. Periodontal (PI) and oral hygiene (OHI-S) index scores in this group were significantly better in those persons who had lost fewest teeth. When persons aged 65–74 who retained 25 or more teeth were compared with younger adults who also had 25 or more teeth, OHI-S and CI scores were similar. H is hypothesized that maintenance of oral hygiene levels corresponding to OHI-S scores of 0.3–0.6, and calculus levels corresponding to CI scores of 0.1–0.2, is sufficient to maintain a dentition free of periodontal disease throughout life. Slightly higher OHI-S levels (0.7–1.3) and CI levels (0.3–0.6) might be compatible with acceptably low levels of periodontal disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72103/1/j.1600-0528.1985.tb01684.x.pd

Validity of Two Methods for Assessing Oral Health Status of Populations

Objective : This investigation assessed two methods for estimating epidemiologic indicators of oral health status among children: (1) a visual-only screening, performed independently by a dental hygienist and a registered nurse; and (2) a parent- or guardian-completed questionnaire. The indicators included dichotomous variables measuring dental caries and treatment needs, presence of sealants, injuries to the anterior teeth, and dental fluorosis. Methods : Following training and calibration, data were collected over an eight-day period in April 1994 among 632 elementary schoolchildren (aged 5 to 12 years) in Monticello, Georgia. Both screening and questionnaire findings were compared pairwise with results from visual-tactile examinations done by a dentist. Validity, represented by sensitivity, specificity, and predictive values, was assessed for screening results from the dental hygienist, the nurse, and the parent-completed questionnaire. Results : Validity was high for screening for caries and treatment needs (>90% for sensitivity, specificity, and predictive values in a sample having 30% to 40% prevalence). Less valid data — mainly an effect of false negatives — were obtained for fluorosis, injuries, and presence of sealants. No significant difference in validity was observed between the nurse and the dental hygienist. One-third of respondents to the questionnaire did not know if their children needed fillings (a proxy for untreated decay) or had received sealants; only knowledge of restorations was comparable to results from screening. Intraexaminer reliability for the two screeners ranged from 85 to 100 for percent agreement and 0.70 to 0.93 for kappa scores. Conclusions : Screening by dental hygienists or nurses can provide valid data for surveillance of dental caries and treatment needs. Training for visual assessment of fluorosis and injuries must be improved to diminish the proportion of false negatives. A parent-completed questionnaire is less effective than visual screening for evaluating oral health status in children.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66163/1/j.1752-7325.1997.tb02977.x.pd

Development of an Oral Health Survey: Columbus, Ohio

This article describes the method used to develop and implement a local oral health survey (Columbus, Ohio) conducted in 1986. With the shift in the national dental disease pattern in the past decade, local oral health information is essential for program planning purposes. A collaborative effort by a city health department, a state health department, a dental school, and a school of public health demonstrated how this group worked harmoniously in a relatively inexpensive venture to determine the oral status of various age groups (grades 1–2, grades 6–7, age 35–44, and age 65 +). This information provided part of the framework for a five-year dental plan at the Columbus Health Department. The survey design will serve as a basis for conducting a similar survey statewide. Modifications of existing oral health survey instruments are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65714/1/j.1752-7325.1988.tb03177.x.pd