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Objective: This paper identifies differences in prevalence of established periodontitis and evaluates factors that might explain the differences between non-Hispanic African Americans (n=232) and whites (n=199) in the Detroit tricounty area. Methods: Subjects from a disproportionate probability sample of community-dwelling adults were interviewed regarding demographic, psychosocial and enabling factors, dental health-related behaviors, and other risk factors, and had comprehensive in-home dental examinations. Results: The overall prevalence of established periodontitis was 20.8 percent; African Americans exhibited a significantly higher prevalence than whites (29.8% vs 17.7%). The crude association between race and prevalence of established periodontitis was significant (odds ratio [OR]for African Americans=1.98; 95% confidence interval [CI]=1.17,3.34). After controlling for other covariates, we found the effect of race may be modified by dental checkup visit frequency: African Americans with dental checkups at least once a year had almost a fourfold higher odds of established periodontitis (OR=3.64;95% CI=1.43,9.24) than their white counterparts with dental checkups at least once a year (the referent group); while African Americans with a dental checkups once every two years or less often were more than fourfold less likely to have established periodontitis (OR=0.22; 95%CI=0.08, 0.59) than their white counterparts in the referent group. Conclusions: This analysis supports the disparity in periodontal health as part of the black: white health disparity when taking other factors into account. However, periodontal health disparities may be more complex than previously recognized, requiring greater understanding of factors related to dental care utilization in future studies evaluating this disparity.

Objectives: The goals of this investigation were (1) to evaluate the Oral Health Status Index in relation to demographic characteristics, socioeconomic status, and preventive behaviors of an adult population; and (2) to understand how individual index components performed as indicators of oral health status com- pared to the composite index. Methods: The Oral Health Status Index (OHSI) was used on a probability sample of adults, aged 18-93 years, living in the Detroit tricounty area. Data were collected on 509 subjects via in-home dental examina- tions. Bivariate and multivariate analyses were used to compare the OHSl and its components, including decayed, missing, and replaced teeth, free ends, and moderate and severe periodontal disease measures. Results: The mean OHSI score for subjects was 77.3 (SE= 1.83) with a range of -8.0 to 700.0. In regression analyses, OHSl scores were positively correlated with subjects' education level, self-rated oral health scores, and frequency of dental checkups and negatively correlated with age, nonwhite race, and smoking. Of the index components, missing teeth performed well as an indicator of oral health status. Missing teeth were positively correlated with age, nonwhite race, and smoking and negatively correlated with education level, self-rated oral health, and use of Medicaid. About 53 percent of variance in OHSl scores was explained by the multivariate models, compared to 46 percent for missing teeth. Conclusions: Choosing an indicator of oral health status likely will depend upon the characteristics of the population to be studied. As a composite measure of oral health status, the OHSlperformed acceptably; however, missing teeth, an index component, also worked well. Continued evaluation of the OHSl is warranted. (J Public Health Dent 1 997;57(4):233-42)

This study evaluated the effects of three modes of education on dentists' knowledge, attitudes, and use of pit and fissure sealants. A randomly selected group of dentists was invited to participate in a sealant education initiative. During a 12-month period, a total of 662 dentists either (1) attended continuing education courses, (2) received written materials and videotapes by mail, or (3) received only written materials by mail. A comparison group (n = 337) received no materials until after the education phase and evaluation had been completed. Pre- and postintervention surveys were used to measure changes in knowledge, attitudes, and sealant use. Response rates to the two surveys were 62 percent and 76 percent, respectively. Preintervention values for knowledge scores, an attitude scale, and sealant use were similar among the four groups. At followup, the three education groups had significantly higher knowledge scores than the comparison group. Attitude values for all but one group were not significantly different, and sealant use by all groups was identical. The numbers of respondents not using sealants declined slightly between surveys in the three education groups while rising slightly in the No-Education Group. Because program outcomes were similar to those of another sealant initiative, it can probably be concluded that continuing education will increase dentists' knowledge about sealants, but have little effect upon their attitudes or their use of the technique. The changes observed in this investigation may be due to the particular capacity for cognitive and affective changes of participants, characteristics of the technology being promoted, and external forces in the professional environment.

Objective: The objectives of this study were to investigate the prevalence of hepatitis B vaccine and use of infection control procedures by dental health care workers in Taegu, South Korea. Methods: Information was obtained with a mailed questionnaire sent to 300 private dental practices. Surveys were received from 177 dentists, 104 dental hygienists, and 46 dental assistants. All dental health care workers were asked to donate a blood sample for analysis of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs). Results: Vaccination against hepatitis B virus was reported by 63 percent of the respondents. About 40 percent of all participants answered that they were anti-HBs positive, while another 43 percent did not know their status. About 89 percent of dentists reported that they wore a mask with all patients, while hygienists (13.6%) and assistants (13.0%) were less likely to do so. Reported use of gloves (4.5%) and protective eyewear (14%) with all patients was extremely low in every group. Among the 56 dentists who were tested for HB V markers, 23 did not receive the vaccine against hepatitis B, and 13 percent (3 of 23) were positive for HBsAg as carriers. Conclusions: About 37 percent (120 of 327) of dental health care workers surveyed in this study in Korea did not receive the vaccine against HBV infection. Basic barrier techniques to prevent cross-contamination were not being used consistently. Nationwide guidelines for barrier techniques and hepatitis vaccinations should be developed and disseminated to dental personnel.

Objective: This study compared the preventive oral health behaviors of African-Americans and whites. Methods: Face-to-face interviews were conducted with a probability sample of 384 African-American and 358 white adults living in the greater Detroit area. Questions focused on brushing, flossing, and dental visits. Results: More than 95 percent of both groups reported brushing daily; however, whites were more likely to brush all teeth, including parts that do not show. Frequency of flossing did not differ between groups. African-Americans, however, were less likely to floss all of their teeth. Whites were more likely than African-Americans to get dental check-ups at least once a year and much less likely to indicate they had never had a dental check-up. African-Americans tended to have less education and lower family income than whites and were more likely than whites to have Medicaid. Race differences in brushing thoroughness and annual check-ups were greatly reduced when income, education, and insurance were controlled statistically. Conclusion: African-Americans are less likely than whites to brush thoroughly, floss thoroughly, and get dental check-ups. These differences are partly traceable to differences in socioeconomic status and access to professional oral health care.

Objectives This investigation examined current practices of brushing, flossing, and periodic dental visits and their association with periodontal health status. Methods Data were collected using face-to-face interviews and 40-minute in-home dental examinations with a probability sample of adults 18 years of age or older, having at least one tooth, and living in housing units in the Detroit tricounty area. Complete examinations were performed on 319 individuals. Results On average, subjects reported brushing their teeth about twice a day. About one-third of the population reported flossing at least once a day. Loss of periodontal attachment was related to frequency of brushing while subjects who exhibited acceptable flossing ability had less plaque and calculus, shallower pocket depths, and less attachment loss. Subjects reporting a periodic dental visit at least once a year had less plaque, gingivitis, and calculus than subjects reporting less frequent visits. In regression analyses, brushing thoroughness, flossing ability and frequency, and dental visit frequency were predictors of lower plaque, gingivitis, and calculus scores. In turn, these scores were predictors of shallower pocket depths and less attachment loss. Conclusions Brushing, flossing, and periodic dental visits were correlated with better periodontal health. The behaviors appeared to be indirectly related to pocket depth and attachment loss through their associations with plaque, gingivitis, and calculus levels.

The planning and implementation of a community-based outreach program for older adults is described. Objectives of the program were to provide dental health education to older persons at their place of residence, to improve access to dental care for that population, and to increase the number of older adults treated at a dental facility administered by the Department of Community Dentistry, University of Michigan. Data collected during encounters with participants are reported to supplement the description of the program. In the first year, 98 older adults (mean age 71.3 years) participated in the outreach program which was directed by a dental hygienist. Of those persons whose initial encounter was with the outreach program, 47 percent eventually contacted the dental care facility and 36 percent completed treatment. Persons who elected to seek treatment average 3.9 encounters with the hygienist during the program; persons who did not seek treatment averaged 2.2 encounters. Strengths and weaknesses of the program are discussed.

A statewide mail survey of a stratified sample of 640 Michigan general dentists was conducted in 1983, with a response rate of 41 percent, n = 261. An analysis was performed to compare Medicaid and non-Medicaid providers. About half of all respondents reported that they were not seeing any Medicaid patients (Group 1); 29 percent reported that less than 10 percent of their patients were Medicaid-eligible (Group 2), and 22 percent reported that 10 percent or more of their patients were Medicaid-eligible (Group 3). Significant differences existed among the three groups for age of respondent, length of time in practice, and number of new patients seen each month. Respondents with greater percentages of Medicaid patients in their practices were more likely to be in group practice. Stratification of respondents by location suggested that rural providers were more likely than urban respondents to have some Medicaid patients in their practices. Over 40 percent of respondents from all groups reported themselves as being not busy enough. In 1984, more than one million persons in Michigan were eligible for Medicaid dental benefits, but only one-fourth of these individuals were recipients of dental care. Factors that may limit dentists' participation in the Medicaid program, despite the presence of a large eligible population and self-reported lack of business, are discussed.

A survey was conducted to identify and compare sealant knowledge and sources of sealant information of parents whose children had and had not received fissure sealants. The socioeconomic characteristics of these individuals were also compared. The sealant group was composed of the parents of children found to have a sealant on at least one permanent tooth during dental examinations of 2,036 elementary schoolchildren in southwestern Michigan. Another group of children was selected from the same population and matched to the children with sealants by child's age, sex, school location, and community. Surveys were returned by 210 of 260 sets of parents (81% response rate). Significant differences were found between the two groups with regard to parents' ages and levels of income. Parents of children with sealants had more correct information about the procedure and 74 percent of these individuals reported that the dental office was their primary source of information. For the group without sealants, 48 percent of respondents reported no source of sealant information. Findings suggest that dental personnel may strongly influence dissemination of information about sealants and utilization of this preventive procedure.

The dental health knowledge and sources of health information of 848 elementary schoolchildren (aged 9-12) in southwestern Michigan were assessed. Demographic parameters (education level, percent below poverty level, median income level) of the area were similar to state and national averages. The children were found to have some knowledge of caries and periodontal disease prevention, yet basic misconceptions were evident. More than one-third of the children thought that plaque should only be removed by a dentist. While 75 percent of the subjects knew that fluoride protected teeth from decay, only 4 percent of the children identified fluoridated water as the best source of this preventive agent. Knowledge of pit and fissure sealants was limited. Extent of correct dental knowledge was not related to age, sex, or mean DMFS scores. Children who answered the most questions correctly named parents and family as their source of information; dentist's office was the second most frequently mentioned source. Findings suggest a need to correct basic misinformation about dental health and to inform children about current efficacious preventive agents.