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This paper reports the changed findings over a 40-year period on oral health knowledge, attitudes, and practices (KAP) of a very remote and rural population living the Jeremie region of Haiti. The far-sighted investigators of that original 1970 survey stated in their published 1972 paper that our "…findings are descriptive, but have to be accepted tentatively rather than definitively because time was short, transportation was difficult, and the small sample that had to be used could not random." They further insightfully stated their hopes that their "…results may be regarded as an anthropological cultural baseline from which to review further findings concerning Haitian dental beliefs." The two follow-up surveys in 1997 and 2010 using the same exact KAP questionnaire on the same population of rural Haitians living in the Jeremie region fulfilled the extraordinary vision of those two initial investigators, Dr. Wesley Young (a nationally renowned U.S. public health dental academician) and Paul Rundberg (then a dental student at the University of Kentucky).

Purpose This literature review summarizes the effectiveness of the seven leading root caries preventive agents and provides recommendations for use of those agents in clinical practice with older adults and vulnerable elderly. Method Studies were eligible if they assessed the effectiveness of either fluoride, chlorhexidine, xylitol, amorphous calcium phosphate, sealants, saliva stimulators, or silver diamine fluoride to prevent/control root caries in an English language articles between 1979 and 2010. Results In the 31 eligible studies, the most effective primary (1°) prevention agents had reductions in RC incidence ranging from 72% to nearly 200% as compared to a placebo while for secondary (2°) prevention, the best agents demonstrated arrest rates between 67 and 80%. Conclusion For 1° prevention of root caries the recommended “best choice” is a 38% Silver Diamine Fluoride solution professionally applied annually, while for the 2° prevention of root caries, the recommended “best choice” is a 22,500 ppm Sodium Fluoride varnish professionally applied every 3 months.

Objectives This study assessed the oral health status, dental utilization and dental needs of the homebound elderly (HBE) care patients within the Mount Sinai Visiting Doctor program. Methods Of the 334 eligible patients, 57% agreed to participate and 95.4% completed the clinical examinations, the Dental Utilization and Needs survey and Geriatric Oral Health Assessment Index conducted in each subject's home by a trained research team. Results Among 75% who were dentate subjects, 40% needed restorative dental care, 45.6% needed dental extractions, and 33% complained of current oral pain. Overall, 92.0% needed some type of dental care and 96% stated that they had not seen a dentist since they became homebound (mean number of years in program = 3.2 ± 2.58). Conclusion Findings show the oral health status of these homebound elderly was poor and their quality of life was significantly affected by the lack of basic dental care.

The purpose of this project was to describe dental students' use of lecture podcasts versus written lecture transcripts as learning aids under three different circumstances: studying for an exam, reviewing an attended lecture, and reviewing a missed lecture. Additional analyses were performed to see whether demographic differences (e.g., age, gender, language skills, and computer skills) or grade differences were associated with preferences for using podcast versus written lecture transcripts of class notes. Fifty-one percent (n=171) of the second-year dental students at the New York University College of Dentistry voluntarily participated in this survey. The major findings were that 1) a high percentage of students (70-92 percent) used one or both aids in all three utilization circumstances with a consistent preference for podcast use, especially when reviewing a missed lecture; 2) course grades were not associated with the preferred use of either lecture aid; and 3) over half the students listened to the podcasts at speeds that were one and one-half or two times faster than normal speech, especially younger students. Further studies are warranted to delve into the current student generation's preferred learning styles and the resultant learning outcomes associated with those preferences.

Summary This research project investigated the relationship between chewing gum and short-term learning, as prior studies had reported conflicting results. Incoming first-year dental students were assigned by stratified randomisation to either a group who chewed gum during lectures and examinations or a group that did not chew gum. The research subjects listened to a taped lecture on dental anatomy and then completed two examinations: (1) a test of specific knowledge which was a multiple-choice test on the dental anatomy lecture material; and (2) a test of generalised knowledge which was a standardised reading comprehension exam. Statistical analysis of the results showed that in a group of graduate students with a history of high academic performance, there was no difference in learning between research subjects who chewed gum compared with those who did not chew gum, as measured by performance on either test.

Aims: The Kungsholmen Elders Oral Health Study evaluated the oral health status of generally healthy, community-dwelling persons aged 80 years and over living in Stockholm, Sweden. This paper reports periodontal disease findings and evaluates the distribution by sociodemographic factors. Methods: Eligible persons were identified through the Kungsholmen Project, an ongoing, longitudinal, population-based study of older adults. A total of 121 study subjects received a periodontal examination. Results: The mean pocket probing depth was 2.6 mm and the mean clinical attachment loss was 3.7 mm. Gingival bleeding was common. Over half of all study participants met the criteria used for “serious periodontitis” (SP). In the best fit adjusted odds ratio (OR) model, males were 3.1 times more likely than females to have “SP” (OR=3.1, 95% CI 1.2, 8.0), a statistically significant observation. A sub-analysis of the differences in proportion of participants with SP revealed that the difference by sex also increased by age. Conclusions: These findings document the substantial and ongoing impact of periodontal disease in a sample of generally healthy, community dwelling older adults and underscore the importance of continued periodontal disease prevention and treatment in the oldest-old.

Objectives: To examine whether caries or periodontitis is associated with cardiac arrhythmias in community-dwelling people aged 80 and older. Setting: Urban, community-based population in Stockholm, Sweden. Design: Cross-sectional. Participants: Eligible persons were identified through the Kungsholmen Project, which is an ongoing, longitudinal, population-based study of the oldest old. The present study included 125 dentate individuals. Measurements: Data from interviews, a medical examination, and an oral examination. The assessment of cardiac arrhythmia was based on a clinical examination by a physician or the Stockholm Inpatient Register. Active root caries, active coronal caries, and periodontitis were assessed using previously defined National Institute of Dental and Craniofacial Research diagnostic criteria. Results: The primary finding of the multivariate logistic regression analysis was that persons with three or more active root caries lesions had more than twice the odds of cardiac arrhythmias than persons without active root caries. The results did not notably change after adjusting for age, medications that reduce saliva, and number of teeth. Persons with one to two active coronal caries lesions had 2.8 times higher odds (95% confidence interval=1.1–7.0) of arrhythmia than persons without active coronal caries, but there was no greater risk for persons with three or more coronal caries lesions. There was no association between periodontal disease and arrhythmia. Conclusion: The findings indicate that there may be a link between active root caries and cardiac arrhythmias in the oldest old. Nevertheless, although a biological pathway is not obvious, it is plausible that both are simply markers of declining general health. The results suggest the need for further study of these relationships.

Objectives: The Kungsholmen Elders Oral Health Study (KEOHS) evaluated the oral health status of generally healthy, community-dwelling persons over the age of 80 living in Kungsholmen, Sweden. This ...

Objectives: This report presents, for the first time, findings on the vox populis as to who constitutes the “vulnerables in biomedical research.” Methods: The 3-City Tuskegee Legacy Project (TLP) study used the TLP questionnaire as administered via random-digit-dial telephone interviews to 1,162 adult Black people, non-Hispanic White people, and two Puerto Rican (PR) Hispanic groups: Mainland United States and San Juan (SJ) in three cities. The classification schema was based upon respondents' answers to an open-ended question asking which groups of people were the most vulnerable when participating in biomedical research. Results: Subjects provided 749 valid open-ended responses, which were grouped into 29 direct response categories, leading to a four-tier classification schema for vulnerability traits. Tier 1, the summary tier, had five vulnerability categories: 1) Race/ethnicity; 2) Age; 3) SES; 4) Health; and, 5) Gender. Black people and Mainland United States PR Hispanics most frequently identified Race/Ethnicity as a vulnerability trait (42.1 percent of Black people and 42.6 percent of Mainland United States. PR Hispanics versus 15.4 percent of White people and 16.7 percent of SJ R Hispanics) (P

Given the decline in dental caries incidence in preteens and young teenagers in the United States, a study of the incidence of dental caries in young adults (17–23 years) was conducted to provide a descriptive epidemiologic picture of this “new” natural history of dental caries in the late and post-teenage years. A retrospective study was performed analyzing the detailed dental records of the four-year college experience in the class of 1989, US Coast Guard Academy. Occlusal caries incidence, in the absence of associated proximal caries, was shown to be moderately common in molars (11.9%) and rare in pre- molars (0.8%). In contrast to previous studies' findings, demographic indicators, socioeconomic status indicators, and prior caries experience were poor predictors of occlusal caries incidence; targeting a universal sealant policy in this population therefore would be done best by tooth type rather than patient type. A preliminary costcomparison model, projected over a 40-month period, suggests that the cost of initiating a universal molar sealant policy in this population would be 92 cents per year per student greater than the cost of restoring occlusal caries in the presence of sound proximal surfaces. This cost comparison suggests that it would be advantageous to initiate such a policy.

There were 6181 cases of invasive intraoral squamous cell carcinoma accessioned by the Connecticut State Tumor Registry from 1935 to 1985. Cases were analyzed for age, sex, lesion site, and histologic differentiation. Crude, age-specific, and age-adjusted incidence rates plus birth cohort analyses were also calculated. It was found that incidence rates for both men and women increased over the 51-year period of study. For men, age-adjusted incidence rates (1970 United States standard) increased from 4.9/100,000 in 1935 to 1939 to 8.5/100,000 in 1980 to 1985; for women, rates increased from 0.5/100,000 to 3.3/100,000 for the same period. The male-to-female ratio for intraoral squamous cell carcinoma declined dramatically from 9.8 to 2.6 during the 51-year study period primarily because of the steep rate of increased incidence in women relative to that seen in men. The peak age of intraoral squamous cell carcinoma was the seventh decade. Age-specific analysis showed that the older the age group, the higher the incidence for both sexes. During recent years, there was evidence of slightly increased incidence in men younger than 40. The tongue was the most common site for intraoral squamous cell carcinoma, followed closely by the floor of the mouth. Moderately differentiated tumors were most common (54.3% of the total), followed by both well-differentiated cases (29.1%) and those that were poorly differentiated (16.6%).

All cases of oral cancer (N = 9708) recorded by the Connecticut Tumor Registry from 1935 to 1985 were analyzed for time-trend patterns within 10-year age-groups. Crude, age-specific, age-adjusted incidence rates and birth cohort analyses were calculated. The average annual age-adjusted incidence rate was 12.9/100,000 for men and 2.9/100,000 for women (1970 US standard million population). The male age-adjusted incidence rate decreased 33% from the late 1930s to the early 1980s. The female age-adjusted incidence rate exhibited a threefold steady increase over this same time period. The male/female ratio for oral cancer incidence declined dramatically from 10.4 to 2.7 for the age-adjusted rate, nearly a fourfold decrease during the 51- year period. Birth cohort analyses for women indicated a marked increase in oral cancer incidence for the birth cohort of 1900, which was sustained in the birth cohorts that followed. Birth cohort analyses for men revealed a decline in oral cancer incidence for birth cohorts born after 1910. The highest incidence rates were found in the urban counties and the lowest in the rural areas.

This analysis of a caries index, proposed in 1966 to WHO as a simplified method of measurement, as tested on a 16- to 45-year-old population who were seeking dental care at the University of Minnesota School of Dentistry revealed several weaknesses associated with the index. An analysis of the external validity of this index, a comparison with subjects' DMFS scores, revealed a correlation coefficient of 0.71. Although the index purports to measure the prevalence and severity of dental caries by dividing the dentition into five zones representing increasing severity of dental caries experience, an analysis of this index's internal validity, i.e. whether these five zones truly represent a rank-order scale of severity, revealed misclassification rates of from 21 % for the total population up to 44 % for a subgroup. When zones were recombined to reduce the misclassification rates, the descriptive capabilities of the index were greatly reduced as most subjects were then classified in only one or two of the zones.

There is disagreement as to whether clinical methods of caries diagnosis will produce reliable results in skeletal material, and studies vary greatly in the extent to which such methods are employed. The purpose of this study is, therefore, to evaluate the interobserver reliability of visual, tactile, and radiographic methods of scoring dental caries in ancient populations. Thirty-three individuals from a Mogollon skeletal sample were scored on three occasions by pairs of examiners. The first exam employed visual criteria alone. In the second exam, visual methods were supplemented with the dental explorer. For the third exam, mesial and distal surfaces were scored from “intraoral” radiographs. Examiners worked independently, but did calibrate on material from clinical populations prior to the second and third exams. Exams were conducted on a “blind” basis, and analysis was delayed until all exams were completed. Caries scores were expressed as a percentage of total surfaces present per individual. Repeat-measures ANOVA and intraclass correlation coefficients (ICC) were used to estimate interobserver reliabilities. For visual scores, ICC = 0.97, and there is no significant difference between examiners (P = 0.897). For visual plus explorer scores, ICC drops to 0.90, and there is a significant difference between examiners (P = 0.003). For the radiographs, ICC = 0.86, and there is no significant difference between observers (P = 0.117). These results suggest that clinical methods are less reliable in skeletal populations. Probable sources of error include postmortem dehydration of carious dentin, confusing radiolucencies engendered by worn or fractured enamel, and inadequate radiologic standards for root caries. These problems can be avoided through reliance on visual criteria.

A questionnaire was sent to all 60 U.S. dental school deans to obtain their opinions concerning future faculty training requirements and job opportunities. Two rounds of mailings produced a 95 percent response rate. The deans expressed a greater need for faculty in clinical fields than in the basic sciences but they strongly indicated that the majority of future clinical faculty would have to possess the training and skill necessary to conduct independent research. Additionally, the deans indicated a preference for faculty jointly trained in two disciplines, wither two clinical fields or a clinical and basic science field. An analysis of current data on the number of dentists in formal research training programs was compared with the deans9 estimation of projected faculty openings. This analysis led to the conclusion that there is a significant undersupply of dentists trained jointly in two disciplines who are capable of independent research. In the absence of corrective action, an opportunity to strengthen dental faculties and dental research will be lost.

This paper discusses a variety of considerations associated with the clinical identification of root caries. While focusing upon this clinical identification process from the perspective of the clinical researcher, the differing diagnostic needs between the clinical researcher and the dental practitioner are frequently addressed. The topic of the identification of untreated root caries lesions includes a presentation of both existing definitions and a proposed set of diagnostic criteria. The presentation of the topic on the identification of arrested and treated root caries lesions emphasizes the diagnostic challenge that will occur due to the newly introduced chemotherapeutic treatments that have been proposed for the control of root caries. The influence of varying examination conditions, techniques and instruments on the reliability and validity of the clinical identification of root caries are also considered. Finally, a preliminary set of clinical research diagnostic conventions, which would both aid the researcher in “grey zone decisions” and enhance comparability of findings across studies, are proposed.