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Objectives To determine whether participants of a dental practice-based research network ( PBRN) differ in their level of oral health impact as measured by the Oral Health Impact Profile ( OHIP) questionnaire. Methods A total of 2410 patients contributed 2432 OHIP measurements (median age = 43 years; interquartile range = 28) were enrolled in four dental studies. All participants completed the Oral Health Impact Profile ( OHIP-14) during a baseline visit. The main outcome of this study was the level of oral health impact, defined as follows: no impact (' Never' reported on all items); low (' Occasionally' or ' Hardly ever' as the greatest frequency score reported on any item); and high (' Fairly often' or ' Very often' as the greatest frequency reported on any item). Polychotomous logistic regression was used to develop a predictive model for the level of oral health impact considering the following predictors: patient's age, gender, race, practice location, type of dentist, and number of years the enrolling dentist has been practicing. Results A high level of oral health impacts was reported in 8% of the sample; almost a third (29%) of the sample reported a low level of impacts, and 63% had no oral health impacts. The prevalence of impacts differed significantly across protocols ( P < 0.001). Women were more likely to be in the high oral impact group than in the no impact group compared to men ( OR = 1.46; 95% CI = 1.06-1.99). African Americans were more likely to report high oral impacts when compared to other racial/ethnic groups ( OR = 2.11; 95% CI = 1.26-3.55). Protective effects for being in the high or in the low-impact groups were observed among patients enrolled by a solo practice ( P < 0.001) or by more experienced dentists ( P = 0.01). A small but highly significant statistical association was obtained for patient age ( P < 0.001). In the multivariate model, patient's age, practice size, and gender were found to jointly be significant predictors of oral health impact level. Conclusions Patients' subjective report of oral health impact in the clinical setting is of importance for their health. In the context of a dental PBRN, the report of oral health-related quality of life ( OHRQo L) was different across four dental studies. The observed findings validate the differential impact that oral health has on the patients' perception of OHRQo L particularly among specific groups. Similar investigations to elucidate the factors associated with patient's report of quality of life are warranted. [ABSTRACT FROM AUTHOR]

Weng Y, Korte JE. Racial disparities in being recommended to surgery for oral and oropharyngeal cancer in the United States. Community Dent Oral Epidemiol 2012; 40: 80-88. © 2011 John Wiley & Sons A/S Abstract - Objectives: To investigate the impact of race on the likelihood of patients being recommended for surgery after a diagnosis of oral and oropharyngeal cancer. Methods: A total of 68 445 cases of oral and oropharyngeal cancer were extracted from the 1988 to 2005 Surveillance, Epidemiology, and End Results (SEER) database. County-level rurality data and income data were merged using the US Department of Agriculture Rural-Urban Continuum Codes dataset and US Census Bureau Small Area Income & Poverty Estimates dataset. We used logistic regression analyses to investigate the impact of race on being recommended to surgery for oral and oropharyngeal cancer, adjusting for demographic, socioeconomic, and clinical factors. Stratified analyses were further conducted by tumor site and rural/urban status. Results: Recommendation to surgery varied significantly by race, with black patients less likely than white patients to be recommended to surgery for their oral and oropharyngeal cancer. The racial difference in recommendation to surgery varied significantly by age, geography, and tumor subsite. Racial disparities are most evident in lip and buccal cancer from rural areas (OR, 4.4; 95% CI, 2.6-7.5); and least evident in oropharyngeal cancer from urban areas (OR, 1.2; 95% CI, 1.1-1.3). The magnitude of the racial disparity is attenuated with increasing age. Conclusions: We observed substantial racial disparities in surgery recommendation for oral and oropharyngeal cancer in the United States. Our results suggest the need to improve accessibility to better health care in racial minority groups, particularly in rural areas, and call for individual and institutional efforts to avoid physician bias related to the patient's sociodemographic characteristics in healthcare service. [ABSTRACT FROM AUTHOR]

Telford C, Murray L, Donaldson M, O'Neill C. An analysis examining socio-economic variations in the provision of NHS general dental practitioner care under a fee for service contract among adolescents: Northern Ireland Longitudinal Study. Community Dent Oral Epidemiol 2012; 40: 70-79. © 2011 John Wiley & Sons A/S Abstract - Objectives: To examine socio-economic variations in the use of publicly funded general dental practitioner care by adolescents under a fee for service arrangement. Method: Publicly funded general practitioner reimbursement data were linked to census and vital statistics data within the Northern Ireland Longitudinal Study. Data relate to 12 846 adolescents aged 11 or 12 in April 2003 included within the Northern Ireland Longitudinal Study (28% of the population). The main outcome measure was consumption of dental care between 2003/2004 and 2007/2008 by socio-economic status (as measured by National Statistics Socio-economic Classification of occupation and highest educational attainment of household reference person). Results: In multivariate analysis, socio-economic status was a significant determinant of dental care consumed. Those of the lowest socio-economic status, according to both occupation and highest educational attainment of household reference person, were less likely to have consumed orthodontics OR 0.76 (0.62, 0.95) and OR 0.79 (0.69, 0.91), respectively. Those of lower socio-economic status were, however, more likely to have undergone an extraction and restorative treatment and also consumed on average more treatment than those of higher socio-economic status. Conclusion: A demand-led service, in which practitioners are reimbursed in part on a fee for service basis, may create incentives that contribute to different patterns of utilization between social groups. Such a system may not be providing equal access for equal need and may widen existing socio-economic disparities in oral health among adolescents. [ABSTRACT FROM AUTHOR]

Aida J, Kuriyama S, Ohmori-Matsuda K, Hozawa A, Osaka K, Tsuji I. The association between neighborhood social capital and self-reported dentate status in elderly Japanese - The Ohsaki Cohort 2006 Study. Community Dent Oral Epidemiol 2011; 39: 239-249. © 2010 John Wiley & Sons A/S Little is known about the influence of social capital on dental health. The aim of the present cross-sectional study was to determine the association between neighborhood social capital, individual social networks and social support and the number of remaining teeth in elderly Japanese. In December 2006, self-administered questionnaires were sent to 31 237 eligible community-dwelling individuals (response rate: 73.9%). Included in the analysis were 21 736 participants. Five neighborhood social capital variables were calculated from individual civic networks, sports and hobby networks, volunteer networks, friendship networks and social support variables. We used multilevel logistic regression models to estimate the odds ratio (OR) of having 20 or more teeth according to neighborhood social capital variables with adjustment for sex, age, individual social networks and social support, educational attainment, neighborhood educational level, dental health behavior, smoking status, history of diabetes and self-rated health. The average age of the participants was 74.9 (standard deviation; 6.6) years, and 28.5% of them had 20 or more teeth. In the univariate multilevel model, there were statistically significant associations between neighborhood sports and hobby networks, friendship networks and self-reported dentate status. In the multivariable multilevel model, compared with participants living in lowest friendship network neighborhoods, those living in highest friendship network neighborhoods had an OR 1.17 (95% confidence interval, 1.04-1.30) times higher for having 20 or more teeth. There is a significant association between one network aspect of neighborhood social capital and individual dentate status regardless of individual social networks and social support. [ABSTRACT FROM AUTHOR]

Jung S-H, Watt RG, Sheiham A, Ryu J-I, Tsakos G. Exploring pathways for socio-economic inequalities in self-reported oral symptoms among Korean adolescents. Community Dent Oral Epidemiol 2011; 39: 221-229. © 2010 John Wiley & Sons A/S This study aimed to assess socio-economic inequalities in self-reported oral symptoms in Korean adolescents and to assess the association of health behaviours, psychosocial factors and material factors on social gradients in oral symptoms. Cross-sectional data were from the national 2007 Korean Youth Risk Behavior Web-based Survey (KYRBWS). Self-reported oral symptoms included toothache, bad breath, and fractured teeth. Self-assessed socio-economic status (SES) was selected as a measure of SES. To assess socio-economic inequalities in oral symptoms, we used logistic regression models for toothache, bad breath and fractured teeth, and ordinal logistic regression models for the aggregate variable on oral symptoms. We used models adjusting for socio-demographic factors (Model 1) and compared them to models additionally adjusting for health behaviours (Model 2), psychosocial factors (Model 3) and material factors (Model 4). A total of 78 834 students were invited to participate, and the response rate was 94.8% ( n = 74 698). We found that lower self-assessed SES was significantly associated with higher prevalence of each of the three self-reported oral symptoms. Social gradient in the prevalence of each oral symptoms persisted when adjusted for behavioural, psychosocial and material factors. The odds ratio (OR) for the aggregate variable on oral symptoms in the lower SES group was 2.25 (95% CI 2.04, 2.49), and the respective figures after adjusting for behavioural, psychosocial and material factors were 2.17 (95% CI 1.96, 2.39), 1.90 (95% CI 1.73, 2.10) and 2.26 (95% CI 2.04, 2.50). While adjusting for psychosocial factors decreased the OR in the aggregate variable on oral symptoms for lower SES groups, adjusting for health behaviours and material factors hardly changed the OR. There were clear social gradients in three self-reported oral symptoms (toothache, bad breath and fractured teeth) in Korean adolescents. Psychosocial factors explained part of the social inequalities in oral symptoms. Future longitudinal research is required to better address the pathways that explain socio-economic inequalities in oral symptoms during adolescence. [ABSTRACT FROM AUTHOR]

Preisser JS, Phillips C, Perin J, Schwartz TA. Regression models for patient-reported measures having ordered categories recorded on multiple occasions. Community Dent Oral Epidemiol 2011; 39: 154-163. © 2010 John Wiley & Sons A/S The article reviews proportional and partial proportional odds regression for ordered categorical outcomes, such as patient-reported measures, that are frequently used in clinical research in dentistry. The proportional odds regression model for ordinal data is a generalization of ordinary logistic regression for dichotomous responses. When the proportional odds assumption holds for some but not all of the covariates, the lesser known partial proportional odds model is shown to provide a useful extension. The ordinal data models are illustrated for the analysis of repeated ordinal outcomes to determine whether the burden associated with sensory alteration following a bilateral sagittal split osteotomy procedure differed for those patients who were given opening exercises only following surgery and those who received sensory retraining exercises in conjunction with standard opening exercises. Proportional and partial proportional odds models are broadly applicable to the analysis of cross-sectional and longitudinal ordinal data in dental research. [ABSTRACT FROM AUTHOR]

Liu Z, McGrath C, Hägg U. Associations between orthodontic treatment need and oral health-related quality of life among young adults: does it depend on how you assess them? Community Dent Oral Epidemiol 2011; 39: 137-144. © 2011 John Wiley & Sons A/S To determine the association between orthodontic treatment need (OTN) and oral health-related quality of life (OHRQoL). A cross-sectional study involving 273 young adults seeking orthodontic care. OHRQoL was assessed by the short-form Oral Health Impact Profile (OHIP-14) and United Kingdom oral health-related quality of life measure (OHQoL-UK). Study casts were assessed for OTN by: Dental Aesthetic Index (DAI), Index of Orthodontic Treatment Need (IOTN)-Aesthetic Component (IOTN-AC) and Dental Health Component (IOTN-DHC) and Index of Complexity, Outcome and Need (ICON). Variations in OHIP-14 and OHQoL-UK were determined with respect to OTN, and the magnitude of differences was calculated (effect size: ES). There were significant but weak correlations between occlusal indices scores and OHIP-14 scores ( P < 0.05, r < 0.3) and between occlusal indices scores and OHQoL-UK scores ( P < 0.05, r < 0.4). The magnitude of the statistical difference in OHQoL-UK scores was moderate to large with respect to OTN (ES: 0.36-0.87) and largest when DHC (ES = 0.87) and ICON (ES = 0.74) were used. The magnitude of the statistical difference in OHIP-14 scores was relatively lower (ES: 0.21-0.69), but also greatest when DHC and ICON were used to determine OTN (ES 0.69 and 0.50, respectively). Orthodontic treatment need was associated with OHRQoL. The magnitude of the statistical difference between those with and without an orthodontic treatment need was larger when OHRQoL was assessed using OHQoL-UK compared to OHIP-14. DHC and ICON were more useful indices in identifying greater differences in OHRQoL with respect to orthodontic treatment need. [ABSTRACT FROM AUTHOR]

Jordan RA, Hetzel P, Franke M, Markovic L, Gaengler P, Zimmer S. Class III Atraumatic Restorative Treatment (ART) in adults living in West Africa - outcomes after 48 months. Community Dent Oral Epidemiol 2011; 39: 164-170. © 2010 John Wiley & Sons A/S This observational study assessed the effectiveness of class III restorations using the atraumatic restorative treatment (ART) approach in permanent anterior teeth over a 48-month period. Dental auxiliaries placed a total of 117 class III ART restorations in 2004, using a cosmetically improved glass-ionomer (Ionofil Plus; VOCO, Cuxhafen, Germany), in 67 patients with a mean age of 27.3 years in the rural Jahali Health Center, The Gambia. Independent examiners evaluated the restorations after 24 and 48 months using the clinical ART evaluation criteria. Seventy-six of the restorations could be observed over 48 months in 51 patients. After 48 months, 53 of 76 restorations were classified as clinically acceptable (without or with minor intervention (repair) needed), and 23 restorations were classified as insufficient. There was no statistical difference in a clustered performance rating between restorations placed in central and lateral incisors ( P = 1.0). The adoption of the ART approach to class III caries cavities made restorative dental care in anterior teeth available in a West African region. The long-term performance was comparable to other studies. Longitudinal clinical studies with greater populations are required to substantiate these results. [ABSTRACT FROM AUTHOR]

Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bönecker M, Raggio DP. Impact of oral diseases and disorders on oral health-related quality of life of preschool children. Community Dent Oral Epidemiol 2011; 39: 105-114. © 2010 John Wiley & Sons A/S The presence of oral diseases and disorders can produce an impact on the quality of life of preschool children and their parents, affecting their oral health and well-being. However, socioeconomic factors could confound this association, but it has not been yet tested at this age. To assess the impact of early childhood caries (ECC), traumatic dental injuries (TDI) and malocclusions on the oral health-related quality of life (OHRQoL) of children between 2 and 5 years of age adjusted by socioeconomic factors. Parents of 260 children answered the Early Childhood Oral Health Impact Scale (ECOHIS) (six domains) on their perception of the children's OHRQoL and socioeconomic conditions. Two calibrated dentists (κ > 0.8) examined the severity of ECC according to dmft index, and children were categorized into: 0 = caries free; 1-5 = low severity; ≥6 = high severity. TDI and malocclusions were examined according to Andreasen & Andreasen (1994) classification and for the presence or absence of three anterior malocclusion traits (AMT), respectively. OHRQoL was measured through ECOHIS domain and total scores, and poisson regression was used to associate the different factors with the outcome. In each domain and overall ECOHIS scores, the severity of ECC showed a negative impact on OHRQoL ( P < 0.001). TDI and AMT did not show a negative impact on OHRQoL nor in each domain ( P > 0.05). The increase in the child's age, higher household crowding, lower family income and mother working out of home were significantly associated with OHRQoL ( P < 0.05). The multivariate adjusted model showed that the high severity of ECC (RR = 3.81; 95% CI = 2.66, 5.46; P < 0.001) was associated with greater negative impact on OHRQoL, while high family income was a protective factor for OHRQoL (RR = 0.93; 95% CI = 0.87, 0.99; P < 0.001). The severity of ECC and a lower family income had a negative impact on the OHRQoL of preschool children and their parents. [ABSTRACT FROM AUTHOR]

Marlow NM, Slate EH, Bandyopadhyay D, Fernandes JK, Salinas CF. An evaluation of serum albumin, root caries, and other covariates in Gullah African Americans with type-2 diabetes. Community Dent Oral Epidemiol 2011; 39: 186-192. © 2010 John Wiley & Sons A/S Associations between dental conditions and overall health have been previously reported. Investigators have also shown significant inverse relationships between serum albumin (a general health status marker) and root caries. This relationship was explored among a study population of Gullah African Americans (who have a considerably lower level of non-African genetic admixture when compared to other African American populations) with type-2 diabetes (T2DM) and self-reported history of normal kidney function ( N = 280). Root caries indices were defined as total decayed and/or filled root surfaces. The coronal caries index [total decayed, missing, and/or filled coronal surfaces (DMFS)], level of glycemic control, total number of teeth, and other covariates were also evaluated. Logistic regression models were used to evaluate the associations between these factors and hypoalbuminemia (serum albumin concentrations <4 g/dl). Serum albumin concentrations ranged 2.4-4.5 g/dl (mean = 3.8, SD = 0.3), with 70.4% exhibiting hypoalbuminemia. Root caries totals ranged 0-38 (mean = 1.3, SD = 4.5) surfaces decayed/filled, while total teeth ranged 1-28 (mean = 19.4, SD = 6.2). DMFS totals ranged 2-116 (mean = 55.2, SD = 28.0). We failed to detect significant associations for root caries; however, the final multivariable logistic regression models showed significant associations between hypoalbuminemia and total teeth [odds ratio (OR) = 0.93, P = 0.01], poor glycemic control (OR = 2.49, P < 0.01), elevated C-reactive protein (OR = 1.57, P < 0.01), glomerular filtration rates ≥60 (OR = 0.31, P = 0.03), and age (OR = 0.97, P = 0.03). Previously reported inverse relationships between serum albumin and root caries were not evident in our study population. We propose that these null findings are because of the considerably lower level of root caries as well as other differing characteristics (including oral health status, the chronic presence of T2DM, and predominantly younger age) within our study population compared to these previously assessed groups. [ABSTRACT FROM AUTHOR]

Ferracane J, Hilton T, Korpak A, Gillette J, Speed McIntyre P, Berg J, Northwest PRECEDENT. Use of caries prevention services in the Northwest PRECEDENT dental network. Community Dent Oral Epidemiol 2011; 39: 69-78. © 2010 John Wiley & Sons A/S This cross-sectional study assessed the use of caries preventive services by Northwest PRECEDENT dental network practitioners and compared the caries experience of patients who received such services in the past 12 months with those who had not. An oral health survey was conducted on approximately 20 patients seen by each of 97 private practice dental practitioners in the network. Eligible patients (total of 1877 aged 3-92) were randomly assessed for the occurrence of one or more new caries lesions as well as having received the following preventive services within the past 12 months: fluoride varnish or gel, sealant in molar or premolar, and prophylaxis. Patients were stratified by gender and age (1-17 years old, 18-64 years old, and 65+ years old). Logistic regression was used to investigate the association between the practitioner characteristics and the use of preventive services, as well as the preventive services and the presence of a new caries lesion in the past 12 months. The percent of patients in age category 1-17 years old/18-64 years old/65+ years old receiving each preventive treatment varied as follows: 95%/85%/81% for prophylaxis, 87%/24%/22% for fluoride, and 27%/2%/0% for sealant. There was a very limited association between the use of a specific preventive service and practitioner gender, and no significant association between use of services and practice location (rural, urban or suburban). There was a significant association between greater use of sealants for dentists with 0-15 years of practice experience as compared with those having more than 25 years of experience. For the 1-17 -year-old age group, boys had about 1.7 times the odds of having a new lesion than girls in the past 12 months, and patients receiving a sealant had 1.9 times the odds of having a new caries lesion. In the 18-64 -year-old group, receiving a prophylaxis in the past 12 months was significantly associated with lower odds for having a new lesion (odds ratio = 0.57). This study reports that aside from prophylaxis, which more than 85% of the patients had received, about one-third of the patients overall received preventive services consisting of either sealants or some type of fluoride treatment in private dental practices in the Northwest PRECEDENT network. [ABSTRACT FROM AUTHOR]

A study is presented which examined material and sociodemographic factors influencing oral health practices and experiences of six-year-old Pacific children in New Zealand. The study is based on a cohort of infants born at Middlemore Hospital in Auckland, interviews with their mothers, and an analysis of their ethnicity and level of acculturation. Other variables assessed by the researcher are educational background, duration of breastfeeding, frequency of toothbrushing and tooth brushing supervision.

Dorri M, Sheiham A, Watt R. The influence of peer social networks on toothbrushing behaviour in Iranian adolescents in Mashhad. Community Dent Oral Epidemiol 2010; 38: 498-506. © 2010 John Wiley & Sons A/S This study aimed to assess the association between the quality and quantity of peer social networks and toothbrushing behaviours of Iranian adolescents in Mashhad. The second objective was to examine whether peer social networks go some way to explain the sex difference in toothbrushing behaviours in Iranian adolescents in Mashhad. A representative stratified random sample of 1132 sixth grade Iranian students in Mashhad, with an average age of 12.4 (SD = 0.8) years, answered a 37-item questionnaire. The questionnaire had items on sociodemographic characteristics (age, sex and parents' education level), education achievement (last year's final average mark), frequency of toothbrushing behaviours and peer social networks (number of close friends, frequency of meeting friends, club membership and quality of peer groups). Binary logistic regression analysis was employed to test the association between toothbrushing frequency and peer social networks. Adolescents who met their friends moderately often and had stronger ties with their friends were more likely to brush their teeth twice or more a day; P = 0.05 and P < 0.001, respectively. Club membership and number of close friends were not associated with toothbrushing frequency. Girls were significantly more likely to brush their teeth twice or more a day. They had weaker peer social networks than boys ( P < 0.001). When adjusted for sex and father's education level, all peer social networks variables were significantly associated with toothbrushing frequency. However, the interaction between sex and peer social networks variables was not significant. Peer social networks are related to toothbrushing frequency among Iranian adolescents in Mashhad but do not explain the differences in toothbrushing frequency between sixth grade Iranian boys and girls. [ABSTRACT FROM AUTHOR]

Vermaire JH, Hoogstraten J, van Loveren C, Poorterman JHG, van Exel NJA. Attitudes towards oral health among parents of 6-year-old children at risk of developing caries. Community Dent Oral Epidemiol 2010; 38: 507-520. © 2010 John & Wiley & Sons A/S Parental attitudes are likely to play a role in achieving and maintaining a desired level of oral health in children. To be useful in individually delivered caries prevention programmes, parental attitudes should be identified at individual level. Q-methodology has been proved successful in identifying attitudes in a wide range of disciplines but in dentistry Q-studies are scarce. In this study Q-methodology was used to identify parents' prevailing attitudes towards the oral health of their children. Thirty-nine parents ranked 37 statements regarding the dental health behaviour they apply to their 6-year-old child. They later explained their rankings during a short interview. In Q-methodology, rather than reporting one average composite attitude and opinion, various combinations of opinions and attitudes concerning these statements are identified using by-person factor analysis. Based on their beliefs, attitudes and cognitions, five categories of parents were found: (i) conscious and responsible, (ii) trivializing and fatalistic, (iii) appearance-driven and open-minded, (iv) knowledgeable but defensive and (v) conscious and concerned. Q-methodology appears to be a fruitful way to structure the complexity of parents' opinions and attitudes towards their children's dental health. It appears that Q-methodology provides comprehensive clusters of individual attitudes, based on various levels of responses to a wide range of questions. The five identified profiles may be useful in developing tailor-made prevention strategies in caries prevention. [ABSTRACT FROM AUTHOR]