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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)

Objective : This study investigated knowledge, opinions, and experience regarding dental informatics and computers among first-year dental students (D1s) and fourth-year dental students (D4s). Design : First-year ( N = 95) and fourth-year ( N = 91) students in 1990 and first-year ( N = 97) and fourth-year ( N = 91) students in 1993 at a school of dentistry were surveyed. Measurements : Demographic characteristics and computer ownership were assessed. Knowledge was measured using an 18-item scale (range 0–18). Opinions were measured using a 13-item scale (range 13–65; alpha = 0.81). Experience was measured using a 28-item scale (range 28–140). Results : Response rates were all nearly 100%. Computer ownership by the D1s increased from 17.9% to 43.8% in the three years between surveys. Knowledge and opinions of the 1990 and 1993 D1s were similar, although the latter reported more experience with hardware and software. Experience with dental informatics applications was lacking in both groups. The 1993 D4s had completed more computer courses than had the 1990 D4s (2.3 vs 0.9), and demonstrated significantly more knowledge and experience. Opinion scores were nearly identical for these groups. The D4s in 1993 who had been D1s in 1990 had increased their knowledge of and experience with informatics applications during dental school. A difference in computer knowledge between the entering D1 males and females was observed in 1990, but was essentially gone by 1993 for the same individuals. Conclusions : Entering students had more computing knowledge and skill than their predecessors. Informatics knowledge and experience increased during dental school, and knowledge disparities between genders disappeared.

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: 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.