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Objective: To examine past-year dental visits among underserved, Hispanic farm-worker families using the Andersen Behavioral Model of Health Services Utilization, which posits that predisposing, enabling, and need factors influence care-seeking behavior., Methods: Oral health survey and clinical data were collected in 2006-2007 from families in Mendota, California (Fresno County) as part of a larger, population-based study. Generalized estimating equation logit regression assessed effects of factors on having a dental visit among adults (N = 326). Predisposing variables included sociodemographic characteristics, days worked in agriculture, self-rated health status, and dental beliefs. Enabling factors included resources to obtain services (dental insurance, income, acculturation level, regular dental care source). Need measures included perceived need for care and reported symptoms, along with clinically determined untreated caries and bleeding on probing., Results: Only 34% of adults had a past-year dental visit, despite 44% reporting a regular dental care source. Most (66%) lacked dental insurance, and nearly half (46%) had untreated caries. Most (86%) perceived having current needs, and on average, reported a mean of 4.2 dental symptoms (of 12 queried). Regression analyses indicated those with more symptoms were less likely to have a past-year dental visit. Those who would ask a dentist for advice and had a regular dental care source were more likely to have a past-year dental visit., Conclusions: The final model included predisposing, enabling, and need factors. Despite low utilization and prevalent symptoms, having a regular source of care helps break this pattern and should be facilitated.

There are many determinants of children's dental caries. We hypothesized that a mother's untreated caries was associated with increased likelihood of her children's untreated caries, after controlling for other factors. This population-based study was conducted in a rural, primarily Hispanic, California community. Interview and dental examination data for mother-child (children < 18 yrs old) dyads were analyzed. In a Generalized Estimation Equation (GEE) logit model for mothers (n = 179) and children (n = 387), maternal untreated caries was a statistically significant correlate of child's untreated caries, odds ratio (OR) = 1.76 (95%CI: 1.10, 2.70), adjusted for demographic factors. This relationship did not change when behavioral and dental utilization factors were added to the model, OR = 1.85 (95% CI: 1.12, 3.07). Maternal untreated caries almost doubled the odds of children's untreated caries and significantly increased child's caries severity by about 3 surfaces. Caries prevention and dental utilization programs for mothers and their children should be increased.

Introduction: Adolescent males in rural areas use smokeless tobacco (ST). We assessed the efficacy of a school-based nurse-directed ST intervention among rural high school males., Methods: Study high schools were randomly selected from a public high school list of California rural counties. Consenting high schools were stratified by school size and randomly assigned within strata to intervention or no-intervention groups. After gaining parental consent, male students completed baseline and 1-year follow-up questionnaires. The intervention included peer-led educational sessions and an oral exam by the school nurse who also provided brief tobacco cessation counseling. We used binary generalized estimating equation (GEE) models accounting for clustering within schools to test no difference between groups after adjusting for year in high school using both completers only and multiple imputation for those lost to follow-up. Subgroup analyses assessed Baseline Factor x Group interaction in GEE models., Results: Twenty-one rural counties (72%), 41 randomly selected high schools (56%), and 4,731 male students (50%) participated with 65% retention. Nonsmoking ST users in the intervention group were significantly more likely to stop using ST at follow-up than those in the no-intervention group; there was no intervention effect among baseline ST users who also smoked. A higher percentage of baseline nonsmoking ST users reported smoking at follow-up than baseline non-ST-using smokers who reported using ST., Discussion: A school-based nurse-directed ST cessation program was efficacious among rural nonsmoking ST-using high school males. The potential program reach holds significant public health value. Baseline ST use facilitated smoking at follow-up.

Introduction: In this prospective study, we compared differences in the diagnosis and treatment planning of impacted maxillary canines between 2 imaging modalities., Methods: Twenty-five consecutive impacted maxillary canines were identified from the pool of patients seeking orthodontic treatment. The first set of radiographs consisted of traditional 2-dimensional (2D) images including panoramic, occlusal, and 2 periapical radiographs. The second set comprised prints of 3-dimensional (3D) volumetric dentition images obtained from a cone-beam computed tomography (CBCT) scan. Seven faculty member completed a questionnaire for every impacted canine and diagnostic radiographic modality (2D and 3D)., Results: The data show that the judges produced different decisions regarding localization depending on the x-ray method. There were 21% disagreement (or discordance) in the perceived mesiodistal cusp tip position and 16% difference in the perceived labiopalatal position. In the perception of root resorption of adjacent teeth, there was 36% lack of congruence. Twenty-seven percent of the teeth that were planned to be left, recovered, or extracted with the 2D radiographs had different treatment plans when the judges viewed the 3D CBCT images (McNemar test, chi-square, 4.45; P = 0.035). The clinicians' confidence of the accuracy of diagnosis and treatment plan was statistically higher for CBCT images (P <0.001)., Conclusions: These results showed that 2D and 3D images of impacted maxillary canines can produce different diagnoses and treatment plans., (Copyright (c) 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Objectives: Early childhood caries (ECC) is very prevalent among young Hispanic children. ECC is amenable to a variety of preventive procedures, yet many Hispanic families underutilize dental services. Acceptability research may assist in health care planning and resource allocation by identifying patient preferences among efficacious treatments with the goal of improving their utilization. The purposes of this study were (a) to develop a culturally competent acceptability assessment instrument, directed toward the caregivers of young Hispanic children, for five preventive dental treatments for ECC and (b) to test the instrument's reliability and validity., Methods: An instrument of five standard treatments known to prevent ECC was developed, translated, reviewed by focus groups, and pilot tested, then tested for reliability The instrument included illustrated cards, brief video clips, and samples of the treatments and was culturally appropriate for low-income Hispanic caregivers. In addition to determining the acceptability of the five treatments individually, the treatments were also presented as paired comparisons., Results: Focus groups and debriefing interviews following the pilot tests established that the instrument has good face validity. The illustrated cards, product samples, and video demonstrations of the five treatments resulted in an instrument possessing good content validity. The instrument has good to excellent test-retest reliability, with identical time 1-time 2 responses for each of the five treatments 92 percent of the time (range 87 to 97 percent), and the same treatment of the paired comparisons preferred 75 percent of the time (range 61 to 90 percent)., Conclusions: The acceptability instrument described is reliable and valid and may be useful in program planning efforts to identify and increase the utilization of preferred ECC preventive treatments for target populations.

Objective: The objective of this study was to determine caregiver treatment acceptability and preferences for five preventive dental treatments for early childhood caries in young Hispanic children., Methods: We interviewed 211 parents/caregivers of Hispanic children attending Head Start programs regarding their acceptability of, and preferences for, five standard preventive dental treatments for young children. Treatments assessed were toothbrushing with fluoride toothpaste, fluoride varnish, and xylitol in food for children, and xylitol gum and chlorhexidine rinse for mothers. The interview assessment included presentation of illustrated cards with verbal description of treatment, photograph/video clip, and treatment samples. Parents rated the acceptability of each treatment (1-5 scale) and treatment preferences within each of 10 possible pairs. Individual treatment preferences were summed to create overall preference scores (range 0-4)., Results: All treatments were rated as highly acceptable, however, there were differences (range 4.6-4.9; Friedman chi-square = 23.4, P < 0.001). Chlorhexidine, toothbrushing, and varnish were most acceptable, not different from each other, but more acceptable than xylitol in food (P < 0.05). Summed treatment preferences revealed greater variability (means ranged 1.4-2.6; Friedman chi-square = 128.2, P < 0.001). Fluoride varnish (2.6) and toothbrushing (2.5) were most highly preferred, and differences between preferences for xylitol in food (1.4), xylitol gum (1.5), and chlorhexidine (2.1) were all significant (P < 0.001). Preferences for chlorhexidine were also significantly greater than those for the xylitol products (P < 0.001)., Conclusions: All five treatments were highly acceptable, however, when choosing among treatments overall, fluoride varnish and toothbrushing were favored over other treatments.

The aim of this study was to compare parental perceptions of oral health status and access to dental services by children in 34 special education and 16 mainstream public elementary school classes in San Mateo County, California. A self-administered parental survey was utilized and included questions about demographics, oral health, and dental utilization. The overall response rate was 58.8%. After adjusting for age and gender of the child, compared to mainstream, parents of students in special education classes were significantly more likely to report their children to have worse oral health (OR = 2.4, 95% CI 1.54, 3.67), be lacking a past year dental visit (OR = 1.96, 95% CI 1.01, 3.84), and have missed school days due to dental reasons (OR = 2.5, 95% CI 1.55, 4.17). Both groups rated their children's oral health inferior to the overall health rating (p < .001). The authors concluded that disparities exist between the two groups in parental perceptions of their children's oral health status and dental service utilization.

Purpose: The purpose of this study is to assess cortical thickness, height, and width with cone-beam computed tomography (CBCT), and determine the relationship of these parameters with age., Patients and Methods: A total of 113 subjects from the University of California at San Francisco Orthodontic Clinic with a CBCT scan were enrolled. Subjects were stratified by age in decades. Thickness of buccal and lingual cortices and mandibular height and width were evaluated in 5 regions (13 sites). A single factorial ANOVA was used to compare the parameters among age groups. P less than or equal to .05 was statistically significant., Results: There were 44 (38.9%) males; 69 females. For all groups, the thickest to the least thick cortical plates were: base of the mandible, lower buccal one third, upper lingual one third, upper buccal one third, and lower lingual one third. In all groups, the mandible increased in height as the midline was approached, and the width of the upper third of the mandible decreased from the second molar to the symphysis whereas the reverse occurred in the lower third. Comparison of the age groups showed that subjects 10 to 19 years old had thinner cortical plates than other age groups (P

Objective: To assess patterns and correlates of spit [smokeless tobacco (ST)] use among high school males in rural California., Methods: An 18-item, self-administered questionnaire was used to assess ST use among young males in 41 randomly selected high schools in 21 rural counties in California. To ensure confidentiality, students were instructed to seal their completed questionnaire in an attached envelope prior to returning it to the questionnaire administrator., Results: Overall prevalence of ST use was 9.8 percent, significantly increasing with year in school from 5 percent among freshmen to 15 percent among seniors. ST use was highest among rodeo athletes at 42 percent compared with <6 percent among nonathletes; ST use was significantly higher among smokers (32 percent) who were 2.5-30 times more likely to use ST compared with nonsmokers, depending on race/ethnicity as a result of a significant race/ethnicity x smoking interaction of degree/magnitude. In addition, students who believed there was no, or slight risk of, harm from ST use were significantly more likely to use ST than students perceiving moderate or great risk, depending on race/ethnicity (odds ratios 3.6-13). Among all ST users, 40 percent used ST on at least 5 days in the previous week, 80 percent of those reporting a brand used the brand Copenhagen, and 41 percent (189) used ST within 30 minutes of waking., Conclusion: Dental public health practitioners, scholars, and policy-makers need to promote dental health through organized community efforts targeting high school male subgroups in rural areas that are at risk for ST-associated adverse health effects.

Caries Detector staining reveals 4 zones in dentin containing caries lesions, but characteristics of each zone are not well-defined. We therefore investigated the physical and microstructural properties of carious dentin in the 4 different zones to determine important differences revealed by Caries Detector staining. Six arrested dentin caries lesions and 2 normal controls were Caries-Detector-stained, each zone (pink, light pink, transparent, apparently normal) being analyzed by atomic force microscopy (AFM) imaging for microstructure, by AFM nano-indentation for mechanical properties, and by transverse digital microradiography (TMR) for mineral content. Microstructure changes, and nanomechanical properties and mineral content significantly decreased across zones. Hydrated elastic modulus and mineral content from normal dentin to pink Caries-Detector-stained dentin ranged from 19.5 [10.6-25.3] GPa to 1.6 [0.0-5.0] GPa and from 42.9 [39.8-44.6] vol% to 12.4 [9.1-14.2] vol%, respectively. Even the most demineralized pink zone contained considerable residual mineral.

The efficacy of amalgam, Fuji-Plus, Geristore, and mineral trioxide aggregate (MTA) as intraorifice barriers was compared in a simulated saliva leakage model. Fifty teeth were divided into 4 experimental (n = 10 each) and 2 control groups (n = 5 each). Two millimeters of the materials was placed as intraorifice barriers and brought into contact with human saliva in a coronal reservoir. Bacterial leakage into the apical reservoir was assessed daily for 3 months. Geristore barriers leaked significantly more often (5/10) than Fuji-Plus (0/10, P < .05) at 60 days. The first Fuji-Plus sample leaked after 70 days; after 90 days, 3 (Fuji-Plus), 4 (MTA, amalgam), and 6 (Geristore) samples leaked. There were no significant differences between the experimental groups at that time point. Three-dimensional gap volumes in the barrier-dentin interface and the porosity of the barrier materials were compared by using micro-computed tomography (microCT). A measurable gap was evident in only 1 specimen with an MTA barrier. MTA was significantly less porous than Fuji-Plus and Geristore (P < or = .05), whereas amalgam was too radiopaque to allow microCT measurements. In conclusion, Fuji-Plus might be an effective intraorifice barrier (up to 70 days in vitro), but all 4 materials showed leakage in some specimens at 90 days.

Background: Reducing substance use and unprotected sex by HIV-positive persons improves individual health status while decreasing the risk of HIV transmission. Despite recommendations that health care providers screen and counsel their HIV-positive patients for ongoing behavioral risks, it is unknown how to best provide "prevention with positives" in clinical settings. Positive Choice, an interactive, patient-tailored computer program, was developed in the United States to improve clinic-based assessment and counseling for risky behaviors., Methodology and Findings: We conducted a parallel groups randomized controlled trial (December 2003-September 2006) at 5 San Francisco area outpatient HIV clinics. Eligible patients (HIV-positive English-speaking adults) completed an in-depth computerized risk assessment. Participants reporting substance use or sexual risks (n = 476) were randomized in stratified blocks. The intervention group received tailored risk-reduction counseling from a "Video Doctor" via laptop computer and a printed Educational Worksheet; providers received a Cueing Sheet on reported risks. Compared with control, fewer intervention participants reported continuing illicit drug use (RR 0.81, 95% CI: 0.689, 0.957, p = 0.014 at 3 months; and RR 0.65, 95% CI: 0.540, 0.785, p<0.001 at 6 months) and unprotected sex (RR 0.88, 95% CI: 0.773, 0.993, p = 0.039 at 3 months; and RR 0.80, 95% CI: 0.686, 0.941, p = 0.007 at 6 months). Intervention participants reported fewer mean days of ongoing illicit drug use (-4.0 days vs. -1.3 days, p = 0.346, at 3 months; and -4.7 days vs. -0.7 days, p = 0.130, at 6 months) than did controls, and had fewer casual sex partners at (-2.3 vs. -1.4, p = 0.461, at 3 months; and -2.7 vs. -0.6, p = 0.042, at 6 months)., Conclusions: The Positive Choice intervention achieved significant cessation of illicit drug use and unprotected sex at the group-level, and modest individual-level reductions in days of ongoing drug use and number of casual sex partners compared with the control group. Positive Choice, including Video Doctor counseling, is an efficacious and appropriate adjunct to risk-reduction efforts in outpatient settings, and holds promise as a public health HIV intervention., Trial Registration: Clinicaltrials.gov NCT00447707.

Despite improvements in oral health status and clear links between oral and systemic health, oral health is not accorded the same importance in health care policy as is general health. This review of oral health disparities over the life span documents the results of this inequity. Dental concerns and unmet dental treatment needs, especially among vulnerable populations, are not well addressed in oral health policies. We offer examples of discrepancies between policy and needs and examples of successful interventions that integrate oral health care with informed policy.

Dental caries remains the single most common chronic childhood disease; without intervention, the prevalence and severity of caries increase into adulthood. Dental schools have begun to integrate caries risk assessment (CRA) and prevention counseling into the curriculum. We sought to assess the knowledge, attitudes, and intended behaviors of dental students regarding CRA and prevention counseling with children and adults. We also examined the extent to which these findings were influenced by the years of instruction that students received on these topics. We conducted a cross-sectional survey of dental students at the University of California, San Francisco. All first-year (D1) through fourth-year (D4) students were eligible to participate. Of the 322 eligible students, 290 (90 percent) participated. D4 students correctly answered a mean of 70.4 percent of the knowledge-based questions on CRA; the mean score among D1 students was 50.4 percent. Whereas 95 percent of D4 students identified themselves as confident in their ability to assess adult patients for caries risk, only 68 percent had such confidence with patients less than five years. To effectively prevent early childhood caries, dental schools should provide students with the skills necessary to be confident and willing to perform CRA and prevention counseling for all age groups.

Background: To determine the tobacco-related knowledge, attitudes, and practice behaviors among US pediatric dentists., Methods: A survey was conducted in 1998 among a national, random sample of 1500 American Academy of Pediatric Dentistry members. Chi-square tests and logistic regression with odds ratios (ORs) and 95% confidence intervals assessed factors related to pediatric dentists' tobacco control behaviors., Results: Response was 65% for the survey. Only 12% of respondents had prior tobacco prevention/cessation training. Of those untrained, 70% were willing to be trained. Less than two-thirds correctly answered any of four tobacco-related knowledge items. Over one-half agreed pediatric dentists should engage in tobacco control behaviors, but identified patient resistance as a barrier. About 24% of respondents reported always/often asking their adolescent patients about tobacco use; 73% reported always/often advising known tobacco users to quit; and 37% of respondents always/often assisting with stopping tobacco use. Feeling prepared to perform tobacco control behaviors (ORs = 1.9-2.8), a more positive attitude score (4 points) from 11 tobacco-related items (ORs = 1.5-1.8), and a higher statewide tobacco use prevalence significantly predicted performance of tobacco control behaviors., Conclusion: Findings suggest thatraining programs on tobacco use and dependence treatment in the pediatric dental setting may be needed to promote tobacco control behaviors for adolescent patients.

This article discusses caries management by risk assessment for children age 0-5. Risk assessment is the first step in a comprehensive protocol for infant oral care. The program includes opportunities to establish a "dental home" and provide guidance for improved health outcomes. Risk assessment forms, instructions for use, and guidance-related education points have been included. Collaboration among all health professionals regarding early and timely intervention to promote children's oral health and disease prevention is emphasized.

The Health Insurance Portability and Accountability Act of 1996 requires Notices of Privacy Practices (NPP) in plain (clear, concise, and easily understood) language. The objectives of this study were to test the readability of U.S. dental school NPPs; examine factors relating to readability; and develop a plain language NPP supplement. Readability statistics were Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL). Social capital measures of potential resources available to people in a civil society (e.g., perceived trust, perceived reciprocity, and per capita voluntary organization membership) along with lawyers per capita for each state were examined for potential relationships with readability levels. One-sample t-tests assessed plain language (FRE=60, FKGL=8), and analyses of variance compared groups. Spearman rank correlations (r(s)) compared social capital to readability. A plain language NPP supplement was developed. All fifty-six U.S. dental school NPPs were obtained (100 percent response). Forty-eight of fifty-six schools (86 percent) had website NPPs. FRE and FKGL were significantly more complex than plain language, overall (both p<0.0001, 95% CIs: FRE=37.6, 40.5; FKGL=11.2, 11.8) and by region (all p<0.014). Readability did not differ by region. Social capital measures moderately related to readability (0.18 < or = |r(s)| < or =0.39) with reciprocity being most related (FRE r(s)=0.36, FKGL r(s)=-0.39). U.S. dental school NPPs are more complex than "plain language."

This study was designed to assess, retrospectively using dental records, the impact on the management of dental caries of new caries risk assessment (CRA) forms and procedures introduced into a predoctoral dental school clinic. Of 3,659 patients with a new patient visit (NPV) and baseline exam (BE) in the two-year period of July 2003 through June 2005, 69 percent (n= 2,516) had a baseline CRA. "Visible cavitation or caries into dentin by radiograph" was significantly correlated to most items included in the CRA form, for example, "frequent between meal snack of sugars/cooked starch" (p<0.001), "inadequate saliva flow" (p=0.03), and "deep pits and fissures or developmental defects" (p<0.001). Fluoride toothpaste use (odds ratio, OR=0.7) was negatively related to cavitation risk while "readily visible heavy plaque on teeth" (OR=2.0), "frequent between meal snack of sugars/cooked starch" (OR=1.6), "interproximal enamel lesions or radiolucencies" (OR=11.8), and "white spots or occlusal discoloration" (OR=1.50) were positively related. CRA use at follow-up, the use of bacterial tests, antibacterial therapy, and specific patient recommendations were all very low. While the content and usefulness of the CRA procedures were validated, the study highlighted the difficulties of implementing such programs in educational establishments even with an extensive student didactic program and faculty training.

Objectives: To assess the effects of a single 10% povidone iodine application as an adjunct to extensive surgical procedures in the clinical treatment of children with early childhood caries., Methods: Twenty-two children scheduled for dental treatment under general anesthesia were randomized into either an intervention group (10% povidone iodine), or a control group (phosphate buffered saline). Either povidone iodine or phosphate buffered saline was applied to teeth and soft tissues after prophylaxis and all operative dental procedures, followed by 1.23% acidulated phosphate fluoride gel. Saliva samples taken at baseline, and after 1 hour, 3 weeks and 3 months were assayed for mutans streptococci, lactobacilli and total viable bacteria. Caries lesions were recorded at baseline and at one year., Results: Mutans streptococci and lactobacilli levels in the povidone iodine group were significantly reduced relative to baseline at 1 hour, 3 weeks and 3 months. At one year at least 60% of subjects had new caries lesions in each group, and there was no significant difference in caries increment between the two groups., Conclusions: Even prophylaxis, fluoride gel application and complete surgical treatment of caries at baseline were insufficient to prevent new caries in over 60% of the patients in these high caries risk infants. Although the one-time treatment with povidone iodine reduced mutans streptococci and lactobacilli levels for up to 3 months this therapy failed to additionally reduce future caries formation over one year, indicating that repeated antibacterial treatments will be needed to control high levels of cariogenic bacteria.

Background: Dentists have a unique opportunity to address the problem of domestic violence (DV). The authors tested the effectiveness of a tutorial designed to educate dentists in identifying and responding to DV., Methods: The authors developed a brief interactive multimedia tutorial for dentists and recruited practicing dentists (N = 174) for a randomized, controlled trial. A 24-question instrument assessed participants' knowledge, attitudes and practice behaviors regarding DV at two time points. The control group took the tutorial before completing a posttest. The authors also administered a 20-question empathy scale., Results: The experimental group demonstrated significantly greater improvement in scores on most items, including knowledge, attitudes and behaviors, relative to control subjects (P < .01). Empathy scores did not show significant correlation with change scores on the DV assessment instrument., Conclusions: The tutorial is effective in helping dentists learn how to identify and help patients who are experiencing abuse., Clinical Implications: Broad dissemination of the tutorial about DV would introduce dentists to simple strategies for responding to patients who experience DV.

To determine the efficacy of fluoride varnish (5% NaF, Duraphat, Colgate) added to caregiver counseling to prevent early childhood caries, we conducted a two-year randomized, dental-examiner-masked clinical trial. Initially, 376 caries-free children, from low-income Chinese or Hispanic San Francisco families, were enrolled (mean age +/- standard deviation, 1.8 +/- 0.6 yrs). All families received counseling, and children were randomized to the following groups: no fluoride varnish, fluoride varnish once/year, or fluoride varnish twice/year. An unexpected protocol deviation resulted in some children receiving less active fluoride varnish than assigned. Intent-to-treat analyses showed a fluoride varnish protective effect in caries incidence, p < 0.01. Analyzing the number of actual, active fluoride varnish applications received resulted in a dose-response effect, p < 0.01. Caries incidence was higher for 'counseling only' vs. 'counseling + fluoride varnish assigned once/year' (OR = 2.20, 95% CI 1.19-4.08) and 'twice/year' (OR = 3.77, 95% CI 1.88-7.58). No related adverse events were reported. Fluoride varnish added to caregiver counseling is efficacious in reducing early childhood caries incidence.

Aims: To compare the clinical characteristics of diagnostic subtypes of temporomandibular disorders (TMD) based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) in terms of physical findings (Axis I) and psychosocial findings (Axis II) among Caucasian and African American young women. An ancillary goal was to assess the value of using self-reported TMD pain as a screening tool compared to RDC/TMD examinations., Methods: A biracial community sample (n = 830) of young women 19 to 23 years old was screened for facial pain with the Chronic Pain Grade questionnaire. Patients were considered to be putative cases of TMD if they reported facial pain present within the last 6 months; putative controls had no facial pain history or jaw symptoms. Women with facial pain more than 6 months ago and jaw symptoms (jaw symptom-past pain, JSPP group) were added. 129 women were clinically examined for TMD diagnosis for final confirmation of case-control status., Results: 41 of 43 Caucasian and 11 of 18 African American putative cases were confirmed as cases; 9 of 27 Caucasians, but 0 of 17 African Americans from the JSPP group were confirmed as cases. All 24 putative controls were confirmed as controls. Based on RDC/TMD Axis I, 80% of 61 cases were muscle-related diagnoses, 33% as disc-related diagnoses, and 48% as arthralgia/arthritis/arthrosis. Based on Axis I, there were no significant differences in diagnoses between African American and Caucasian women. Based on Axis II, cases had significantly greater depression (P = .002) and somatization with pain (P < .001) than controls as expected. African Americans had significantly greater somatization with pain than Caucasians (P = .020). There were no other significant racial differences., Conclusion: Among young women reporting facial pain, clinical TMD subtypes, pain impact, treatment utilization, and additional characteristics other than somatization with pain were similar between races. A high percentage of these young non-clinical cases presented severe depression and somatization.

The hypothesis tested in this study was that the self-etching system (Clearfil SE Bond, CSE) is less sensitive to surface moisture variability than the system that uses a separate acid-etching step (Single Bond, SB). Eighteen dentin specimens were bonded to composite using CSE or SB. Three different surface moisture conditions per bonding type (overwet, w; dry, d; and visibly moist, n [normal]) were applied prior to bonding dentin to composite. One cross section of each sample was analyzed with lines of nanoindentations crossing perpendicular to the bonding interface. An additional set of bonded samples was fixed and cross sectioned before the hybrid layer thickness was measured in scanning electron microscopy. The nanoindentations revealed significant differences in indentation modulus (E(i)) and hardness (H) for the hybrid layer comparing SBn, E(i) = 2.7(+/-1.6); H = 0.24(+/-0.1) GPa with SBd, E(i) = 0.9(+/-0.7); H = 0.9(+/-0.05) GPa, respectively, while CSE showed no differences among the groups. A significantly greater demineralized zone below the hybrid layer was found for SBd. The hybrid layer was wider for both CSEd and SBd. In conclusion the hypothesis was verified; CSE exhibited no significant changes of hybrid layer properties (E(i), H) at different hydration conditions, while SB had significant differences, especially after air-drying.

Objectives: This study examined the concentration of fluoride in whole saliva over time following the application of a fluoride varnish or a single rinse with a fluoride solution., Methods: A two-period, two-treatment randomized cross-over experimental trial with a 2-week washout period was used with 16 adult subjects. In the first period, eight subjects rinsed once with a 0.05% NaF solution and 8 subjects had 5.0% NaF varnish applied to facial and lingual surfaces of 20 teeth. Stimulated whole saliva was collected at baseline, 5 and 15 min, 1, 2, 4, 8, 12, 24, 32, 48, 56, 72, 80, 96, 104 h. After the washout period each subject was switched to the other treatment and saliva was collected at the same intervals. Salivary fluoride content was measured with the micro-diffusion method., Results: The NaF levels peaked at 5 min after application for both varnish (mean +/- SE 24.5 +/- 5.0 ppm) and rinse (3.2 +/- 0.8 ppm). Mean NaF levels returned to baseline, on average, within 2 h for the rinse and within 24 h for the varnish. The maximum fluoride levels were significantly greater (P < 0.01) with the varnish than with the rinse and remained above baseline levels for a longer duration., Conclusions: Salivary fluoride levels with the rinse returned to baseline, on average, in 2 h while they remained elevated for, on average, 24 h with the varnish. Salivary fluoride levels from the varnish were found to be comparable with those in previous studies for 1.1% neutral NaF.

The cephalogram is the standard used by orthodontists to assess skeletal, dental, and soft tissue relationships. This approach, however, is based on 2-dimensional (2D) views used to analyze 3-dimensional (3D) objects. The purpose of this project was to evaluate and compare a 3D imaging system and traditional 2D cephalometry for accuracy in recording the anatomical truth as defined by physical measurements with a calibrated caliper. Thirteen skeletal landmarks were located by both radiographic methods on 9 dry human skulls. Intraclass correlation (0.995), variance (0.054 mm(2)), and standard deviation (SD) (0.237 mm) were averaged over 76 measurements and derived from precision calipers to establish these physical measurements as a reliable gold standard to make comparisons of the 2D and 3D radiographic methods. The results showed great variability of the 2D from the gold standard, with the range varying from -17.68 mm (underestimation of Gn-Zyg R) to +15.52 mm (overestimation of Zyg L-Zyg R). In contrast, the 3D method (Sculptor, Glendora, Calif) indicated a range of the SD from -3.99 (underestimation) mm to +2.96 mm (overestimation). The 3D evaluation was much more precise, within approximately 1 mm of the gold standard. These results indicate that, when the actual distance is measured on a human skull in its true dimensions of 3D space, the Sculptor program, by using a 3D method, is more precise and 4 to 5 times more accurate than the 2D approach. Evaluating distances in 3D space with a 2D image grossly exaggerates the true measure and offers a distorted view of craniofacial growth. There is an inherent problem of representing a linear measure occupying a 3D space with a 2D image.

The University of California, San Francisco School of Dentistry wanted to determine if a predental school manual dexterity test predicts: 1) subsequent grades in preclinical restorative courses, and 2) faculty perceptions of satisfactory performance in these skills that would indicate the student is ready to advance to the clinic. The study population was comprised of all 244 applicants admitted to UCSF School of Dentistry's D.D.S. program from Classes of 2000 to 2002 and who matriculated into the program. The manual dexterity test (MDT) consisted of a two-hour block-carving test. Three preclinical faculty, three clinical faculty, and two basic science faculty graded the blocks. Even after instruction and calibration, faculty varied greatly in their grading (intra-rater reliability kappa statistics ranging from 0.34 to 1.00). Two of three preclinical raters gave No Passes for the MDT in 9.8 percent of the incoming, first-year dental students. Of these twenty-three students, only four (17 percent) were in the lower 10 percent of their classes according to their five preclinical restorative laboratory courses after two years, and four (33 percent) were among the twelve students the three preclinical laboratory directors identified as laboratory cautions. The MDT did not significantly (p=0.342) predict students in the bottom 10 percent after five restorative preclinical laboratory courses, above and beyond current admissions criteria. Among current admissions criteria, PAT score was the only item at least moderately correlated with preclinical average percentile class rank (Spearman correlation = 0.34). In conclusion, the MDT did not appear to add information to the current admissions criteria.

Self-etching primers (SEP), used for adhesion of resin restorations, contain an acidic monomer that is not rinsed off after application; therefore, residual acid could further demineralize dentin, jeopardizing adhesion. This study evaluated whether dentin demineralization continues after a 20-s application of a SEP and also after polymerization of the adhesive. Surface recession was measured, using atomic force microscopy (AFM), between the masked surface and dentin etched with SEP (Clearfil SE Bond) or phosphoric acid (pH 1.94) immediately, 5 min, 2 h or 12 h after application. AFM-based nanoindentations were performed to determine mechanical property profiles across resin-bonded interfaces of two sequence groups: SG 1, where the adhesive was applied and polymerized immediately after application of the primer and specimens were immersed in Hank's solution after 5 min, 2 h and 12 h; or SG 2, where specimens were placed in an incubator before the application of the adhesive, for the same time periods. Significant surface recession occurred over time for all groups, except for SEP before desiccation. Nanoindentations yielded decreased hardness and elastic modulus below the hybrid layer after application of the initial primer, even after polymerization of the adhesive. The results reveal a demineralized dentin zone below the hybrid layer formed by the SEP, not fully protected by the adhesive, which could jeopardize bond strength.

Bonded amalgams were used as pit-and-fissure sealants without mechanical preparation. They were compared with resin-based pit-and-fissure sealants for retention over a 5-year period. Clinical examinations at 6 months, 1 year, 2 years, and 5 years revealed no difference between the two techniques. Although amalgam sealants may not be practical by themselves, they can be used to seal pits and fissures surrounding very conservative preparations, in the "preventive amalgam restoration." Conventional amalgam retentive features and 90-degree cavosurface margins may not be necessary when bonding is used with amalgam.

Background: The purpose of this study was to evaluate the impact of a brief, interactive multimedia tutorial designed to prepare dentists to recognize and respond to domestic violence., Methods: The authors randomly assigned dentists and dental students to one of three groups: a control group or one of two experimental groups in a modified Solomon four-group design., Results: One hundred sixty-one dental students and 13 dentists completed the multimedia tutorial. At the posttest, subjects in both experimental groups demonstrated significantly better scores than did subjects in the control group on most items. The two experimental groups (pretest and posttest, posttest only) did not differ significantly from each other., Conclusion: An engaging, interactive tutorial presenting a simplified model for ways in which dental professionals can recognize and respond to domestic violence significantly improved dental students' knowledge of, and attitudes toward, the topic., Clinical Implications: Clinicians may improve the care they provide to patients by accessing this brief tutorial and following the lessons contained in it.

Knowledge Discovery and Data Mining (KDD) have become popular buzzwords. But what exactly is data mining? What are its strengths and limitations? Classic regression, artificial neural network (ANN), and classification and regression tree (CART) models are common KDD tools. Some recent reports (e.g., Kattan et al., 1998) show that ANN and CART models can perform better than classic regression models: CART models excel at covariate interactions, while ANN models excel at nonlinear covariates. Model prediction performance is examined with the use of validation procedures and evaluating concordance, sensitivity, specificity, and likelihood ratio. To aid interpretation, various plots of predicted probabilities are utilized, such as lift charts, receiver operating characteristic curves, and cumulative captured-response plots. A dental caries study is used as an illustrative example. This paper compares the performance of logistic regression with KDD methods of CART and ANN in analyzing data from the Rochester caries study. With careful analysis, such as validation with sufficient sample size and the use of proper competitors, problems of naïve KDD analyses (Schwarzer et al., 2000) can be carefully avoided.

Objectives: This paper explores the role of race/ethnicity in the occurrence of early childhood caries (ECC) among California Head Start (HS) and non-HS preschool children., Methods: Using oral examination and questionnaire data from the 1993-94 California Oral Health Needs Assessment of Children, we computed the prevalence of ECC using various definitions and fitted logistic regression models to explore the effect of race/ethnicity on ECC, separately for HS and non-HS children, adjusting for bedtime feeding habits and other covariates., Results: Among 2,520 children, the largest proportion with a history of falling asleep sipping milk/sweet substance was among Latinos/Hispanics (72% among HS and 65% among non-HS) and HS Asians (56%). HS Asians and Latinos/Hispanics had the largest prevalence of ECC (30%-33%) and untreated caries (49%-54%). The estimated risk for ECC was more than three times higher in HS Asians compared to HS whites and among non-HS African Americans and Asians compared to non-HS whites controlling for socioeconomic status variables. The risk of ECC was also significantly higher among children who fell asleep while sipping milk or any sweet substance compared to those who did not., Conclusion: Studies of the cultural/behavioral patterns that may be specific to ethnic subgroups with the highest risk for ECC seem essential to the development of effective prevention strategies.

Objectives: To investigate the color and microhardness changes of five chemically- and five light-curing composites as a function of accelerated aging from light exposure., Materials and Methods: From each material five composite specimens were embedded in epoxy resin prior to determining the Knoop microhardness of the surface. For analyzing the color DeltaE*=f((L*a*b*)) with a spectrophotometer, three discs per composite were prepared. After measuring the baseline for hardness and color the same specimens were exposed to a xenon arc light and water in a Weather-Ometer machine for a total radiant energy of 150 kJ/m2 and 122 h. The microhardness and the color were again determined following the aging treatment., Results: Each material showed a significant increase in hardness after aging treatment (p<0.05). Comparing the hardness changes (in %) of the light-cured materials with the chemically cured materials, no significant difference could be found. Perceptible color differences could be observed for all the materials. Three brands showed small differences with DeltaE*=1.6-2.2, while four composites had DeltaE* ranging from 6.2 to 15.5. A significant correlation between hardness values and color changes could not be established., Clinical Significance: The findings suggest that, since light-curable materials showed significantly more resistance to color changes after accelerated aging by light and water than chemically-cured materials, they may be more esthetically acceptable. Color changes were not correlated with surface hardness changes of the materials after aging.

The goals of this cross-sectional study were to characterize and compare demographic, behavioral, and environmental factors potentially associated with early childhood caries (ECC) and to assess salivary levels of mutans streptococci (MS) and lactobacilli (LB) in underserved, predominantly Hispanic children. One hundred forty-six children aged 3 to 55 months with a range of caries experience were identified and examined. ECC was primarily associated with the presence of MS and lack of access to dental care. Salivary MS levels among young children with ECC were higher than would be expected in a dentally healthy population, but lower than levels reported among older children at high risk for caries. After adjustment for age, children with log10 MS > or = 3.0 or log10 LB > or = 1.5 were about five times as likely (OR=4.9, 95% CI=2.0, 12.0) to have ECC than those with lower bacterial levels. This study demonstrated a significant association between relatively low cariogenic bacterial levels and dental caries in infants and toddlers. Antibiotic use, exposure to lead, and anemia were not significantly associated with the number of decayed and filled surfaces or decayed and filled teeth. ECC correlated significantly with child's age and lack of dental insurance of the children, as well as inversely with both family income and the educational level of the mother of the child.

Background: The diagnosis of progressing periodontal disease typically relies on retrospective methods that detect changes in the amount of periodontal breakdown. Fibronectin (FN) fragments are found in vivo in association with periodontal disease, and specific FN fragments compromise periodontal ligament cell functions in vitro. The overall goal of this cross-sectional study was to determine whether specific FN fragments are present in gingival crevicular fluid (GCF) and can be used as markers for periodontal disease status. The eventual goal is to test these FN fragments in a longitudinal study as potential markers of disease activity., Methods: GCF was collected from 94 subjects with untreated periodontitis from clinically healthy, mild/moderate periodontitis, and severe periodontitis sites. Sites were defined on the basis of clinical criteria, including gingival bleeding index, probing depth, and clinical attachment level. Western immunoblotting was used to detect FN fragments in GCF using antibodies to specific FN domains, including the collagen/gelatin-, central cell-, and carboxyl terminal heparin-binding domains, plus the CS-1 site on the alternatively spliced V region and the EIIIA region. FN fragments identified by immunoblotting and analyzed by NIH image software were scored based on pixel intensity and an ordinal grade scale., Results: We identified several fragments highly associated with severe periodontitis sites, including 40-kDa, 120-kDa, and 68-kDa fragments., Conclusions: This study demonstrates that specific FN fragments are markers for periodontal disease status and supports the role of FN fragments as potential components in the pathogenesis of periodontal disease.

This study investigated dimensions of chronic pain and temporomandibular disorders (TMDs) in a census tract sampling of African-American and Caucasian young women enrolled (from racially congruent households) at ages 9-10 in the longitudinal multicenter National Heart Lung and Blood Institute's Growth and Health Study (NGHS). The present study, which examined participants at the California clinical NGHS center when they were 19-23 years old, investigates five commonly reported chronic pains: back, head, face/jaw, abdomen, and chest. Chronic pain grade (CPG) status based on pain self-reports (frequency, duration, severity, and interference with usual activities) is reported for each of the five pain sites. Results show that chronic pain is common in this population of young women, although based on the CPG severity scores, only a small percentage is dysfunctional. Racial differences were not found for back, head, abdomen or chest pains. However, significant racial differences were found regarding facial pain and symptoms related to TMDs above and beyond socioeconomic status (SES) (lifetime prevalence: adjusted odds ratio (aOR)=2.14 and 95% confidence interval (CI)=1.40-3.31; 6 month period prevalence: aOR=2.03 and 95% CI=1.16-3.64). Not only were facial pain and jaw symptoms reported more frequently by Caucasians compared to African-Americans controlling for SES, but they were also reported to have an earlier onset.

This paper reviews five randomized controlled trials of brief spit (smokeless) tobacco (ST) cessation treatment by dental professionals consisting of oral cancer screening, cessation advice, self-help materials, and brief cessation counseling by a dental hygienist. In addition, original two-year findings from a randomized controlled trial to determine the effect of a dental-directed, peer-assisted ST intervention among high school baseball athletes in rural California (n=1084) are reported. In the latter study, results show sustained quitting at two years of 23 percent (32/141) in the intervention group and 13 percent (21/166) in the control group (OR=2.0, 95% CI 1.1-3.9) with subjects lost-to-follow-up considered non-quitters. The evidence presented supports the efficacy of oral screening and brief cessation counseling by dental professionals to promote ST cessation in the dental office or in athletic facilities. In addition, recommendations for policy and future research are presented.

Background: Physicians routinely confront patient risk behaviors once considered private, including tobacco use, alcohol abuse, and HIV/STD-risk behavior. We compared physicians' behaviors and beliefs on screening and intervention for domestic violence with each other risk., Methods: Survey of nationwide, random sample of 610 primary care physicians from the American Medical Association Physician Masterfile., Results: Fewer primary care physicians screened for domestic violence than for other risks (p <0.001); once domestic violence was identified, however, physicians intervened with equal or greater frequency than for other risks. Fewer believed that they knew how to screen or intervene for domestic violence compared with other risks, and significantly fewer believed that domestic violence interventions were successful compared with interventions for tobacco and HIV/STD risks (Bonferroni adjusted p<0.001)., Conclusions: Lower domestic violence screening rates may reflect physicians' beliefs that they do not know how to screen or intervene, and that interventions are less successful for domestic violence than for other risks. We may improve screening rates by educating physicians that a simplified role, as for other risks, can be effective for domestic violence.

Dentin structure and properties are known to vary with orientation and location. The present study explored the variation in the ultimate tensile strength (UTS) of dentin with location in the tooth. Hourglass specimens were prepared from dentin located in the center, under cusps, and in the cervical regions of human molar teeth. These were tested in tension at various distances from the pulp. Median tensile strengths ranged from 44.4 MPa in the inner dentin near the pulp, to 97.8 MPa near the dentino-enamel junction (DEJ). This increase in the median UTS with distance from the pulp to the DEJ was statistically significant (P <.001). Of particular importance was the observation that the UTS measurements followed a Weibull probability distribution, with a Weibull modulus of about 4.5. The Weibull behavior of the UTS data strongly suggests that the large variances in fracture strength data result from a distribution of preexisting defects in the dentin. These findings justify a damage-mechanics approach to studies of dentin failure., (Copyright 2002 Wiley Periodicals, Inc.)

Citric acid etchants with ferric chloride (10-3) promote adhesion and are effective etchants. We used atomic force microscopy (AFM) to determine the dentin etching characteristics of 10% citric acid etchant with various additions of ferric chloride. AFM was used to measure the surface recession and morphology of dentin etching for a variety of 10% citric + Fe-Cl etchants. Commercial 10-3 was used as the control. Dentin disks were prepared and partially masked during etching so that the unetched dentin served as a reference. AFM images of the same samples were taken at each of the seven experimental steps using 10% citric acid with various quantities of ferric chloride ranging from 0 to 3% (denoted 10-0, 10-1, 10-1.8 and 10-3, respectively) which altered the pH from 1.63 to 0.42. Changes in depth (nm) relative to the reference height for intertubular dentin were determined after etching 15 s; clinical air drying, rewet for 1-5 min; desiccation for 24 h; rehydration for 24 h. Differences of log(depth change) were tested with mixed effects cell mean models. Overall differences were significant (P < 0.001). Significant differences were found between etchants and the extent of collapse on drying was dependent on pH and Fe-Cl content. Following long-term rehydration, samples recovered, but those with 0 or 1% Fe-Cl did not recover as completely (P < 0.01). Etching and collapse depended on Fe-Cl content. The collapse was nearly reversed on rehydration. Ten per cent citric acid with ferric chloride did not prevent the collapse of etched dentin. Ferric chloride additions reduced pH and increased the collapse of dentin on drying for either brief or prolonged periods. Brief rewetting can reverse the effect of brief air drying. For fully desiccated samples the effect was not reversed after 30 s, but was largely or completely reversed at 24 h in solution depending on Fe-Cl content.

Objectives: This study determined recession rates of peritubular dentin and intertubular dentin in citric acid solution (0.018M, pH=2.5) for caries-affected transparent dentin, one of the major components of dentin substrate as altered by caries, with comparisons made with non-carious dentin., Methods: Transparent dentin was identified by sagittally sectioning five obviously carious teeth. Sections were then cut through the transparent dentin area perpendicular to the course of the dentinal tubules. Polished dentin samples of the transparent dentin and non-carious dentin were prepared with an internal reference layer and studied at specific intervals for citric acid etching in an atomic force microscope (AFM)., Results: At baseline, transparent dentin was identified by dentinal tubules that were largely occluded with mineral deposits that on etching proved to be acid resistant. Peritubular dentin etched rapidly and linearly over time until it could no longer be measured, yielding etching rates for transparent dentin that could not be distinguished from normal dentin. The normal and transparent intertubular dentin surfaces began etching at nearly the same rate, but then surface recession stabilized after less than 1 microm depth change for both dentin types., Significance: Most previous studies have focused on demineralization and bonding to normal dentin, although many bonding procedures involve altered dentin substrates, such as those modified by caries. In this study, peritubular and intertubular dentin from normal and caries-affected dentin exhibited similar behavior. The major difference was the presence of acid resistant mineral in most of tubule lumens in the transparent dentin.

The dentinoenamel junction (DEJ) is a complex and poorly defined structure that unites the brittle overlying enamel with the dentin that forms the bulk of the tooth. In addition, this structure appears to confer excellent toughness and crack deflecting properties to the tooth, and has drawn considerable interest as a biomimetic model of a structure uniting dissimilar materials. This work sought to characterize the nanomechanical properties in the region of the DEJ using modified AFM based nanoindentation to determine nanohardness and elastic modulus. Lines of indentations traversing the DEJ were made at 1-2 microm intervals from the dentin to enamel along three directions on polished sagittal sections from three third molars. Nanohardness and elastic modulus rose steadily across the DEJ from bulk dentin to enamel. DEJ width was estimated by local polynomial regression fits for each sample and location of the mechanical property curves for the data gradient from enamel to dentin, and gave a mean value of 11.8 microm, which did not vary significantly with intratooth location or among teeth. Nanoindentation was also used to initiate cracks in the DEJ region. In agreement with prior work, it was difficult to initiate cracks that traversed the DEJ, or to produce cracks in the dentin. The fracture toughness values for enamel of 0.6-0.9 MPa . m(1/2) were in good agreement with recent microindentation fracture results. Our results suggest that the DEJ displays a gradient in structure and that nanoindenation methods show promise for further understanding its structure and function., (Copyright 2000 John Wiley & Sons, Inc.)

Atomic force microscopy (AFM) has been used to determine microstructural changes, etching rates of peritubular dentin, and intertubular dentin recession during demineralization in dilute acidic solutions. These studies have not included many forms of altered dentin, including noncarious sclerotic root dentin associated with Cl V (abfraction) lesions. We sought to determine microstructural changes and recession rates during demineralization in citric acid (pH 2.5, 0.018M) for the transparent/sclerotic zone. Highly polished dentin disks were prepared from teeth with noncarious C1 V lesions (n = 3) and compared with normal root dentin (n = 3). Samples were etched at 5-s intervals for 1 min and at longer intervals up to 30 min. The depth changes in various portions of the dentin with respect to the reference layer were measured and changes in microstructure observed in solution in the wet cell of the AFM. In sclerotic dentin, most tubule lumens were occluded with crystalline deposits that etched more slowly than the other dentin components, but etching rates could not be determined due to their irregular geometry. The intertubular dentin recession quickly reached a plateau after a depth change of <1 microm for all dentin types, in agreement with prior work. Mixed linear regression models indicated an important difference between the etching of sclerotic intertubular dentin and that of non-sclerotic root dentin that became apparent after 600 s (p = 0.037). The sclerotic intertubular dentin underwent less depth change at the plateau (558 nm) compared to normal root dentin (744 nm). In addition, normal root dentin underwent significantly greater recession than coronal dentin (p = 0.002). The results of this study indicate that intertubular sclerotic dentin from Cl V lesions etches differently than normal root dentin, and this may help explain the difficulties in restoring such lesions with current bonding procedures., (Copyright 2000 John Wiley & Sons, Inc.)

Purpose: To determine the etching characteristics of 10% citric acid etchant with 3% ferric chloride (10-3) compared with related etchants without ferric chloride (10-0), or one of similar pH (36% citric acid)., Materials and Methods: Atomic force microscopy (AFM) was used to measure the surface recession and morphology of dentin. AFM images were taken of the same samples at seven steps of an etching and drying procedure using 10-3 (pH = 1.09), 10-0 (pH = 1.87) or 36% (pH = 1.08) citric acid solutions: at baseline, after etching 15 s, after 5-s air-drying, after rewetting, after 24-hr desiccation, after 30 s rewetting and after 24 hrs rewetting in filtered and purified water., Results: 10-3 etched surfaces receded more than either 10-0 or 36% etched surfaces, and underwent greater collapse on 5-s air-drying. On rewetting all surfaces re-expanded to near their as-etched level. Following prolonged desiccation (24 hrs) all samples collapsed to the level seen after brief air-drying. 30-s rewetting did not restore the surface, but re-expansion of the collapsed collagen matrix was seen at 24 hrs.

Investigators in dental public health often use strategies other than simple random sampling to identify potential subjects; however, their statistical analyses do not always take into account the complex sampling mechanism. Often it is not clear whether a given strategy requires adjustment for stratification and/or cluster sampling of observations. We propose that the need for such adjustment depends on the primary study objective. As a general rule, we recommend that if the study goal is to estimate the magnitude of either a population value of interest (e.g., prevalence), or an established exposure-outcome association, adjustment of variances to reflect complex sampling is essential because obtaining appropriate variance estimates is a priority. However, if the study goal is to establish the presence of an association, especially in a preliminary investigation of novel conditions or understudied populations, obtaining appropriate variance estimates may not be of primary importance; hence, adjustment of variances for complex sampling is not always required, but often is recommended. This paper describes several types of complex sampling designs, methods of adjusting for complex sampling strategies, examples illustrating the effect of adjustment, and alternative approaches for analysis of complex samples.

The 3 human salivary cystatins S, SA and SN are multifunctional proteins that possess a cysteine protease inhibitory property, but their ability to act as such is very different (SN > SA >> S). One form, S, also appears to possess antibacterial properties towards the bacterium Porphyromonas gingivalis, often associated with periodontal diseases. In this study we measured the total cystatin inhibitory activity and the levels of each salivary cystatin in the whole saliva of 8 periodontally diseased patients and 2 groups of control subjects (n = 6 and n = 10). The total cystatin inhibitory activity and the total salivary cystatin concentration in the periodontally diseased patients were found to be lower than the controls (p < or = 0.005). The concentration of S was depleted to levels that would not allow it to be an effective antibacterial agent, and the concentration of SA, although depleted in some cases, was still present at sufficient levels to allow it to act as an effective physiological inhibitor of cathepsin L. The concentration of cystatin SN was also depleted in the periodontally diseased patients, but was still present in sufficient quantities to act as an effective physiological cysteine protease inhibitor of cathepsins H and L. In comparison, the concentration of all 3 salivary cystatins in the control subjects were sufficient to enable these proteins to be both effective physiological cysteine protease inhibitors and antibacterial agents.

Objectives: This study sought to determine the population effects of both classroom-based and risk-based interventions designed to reduce cardiovascular disease risk factors in children., Methods: Elementary school children (n = 2109; age range: 7-12 years) were randomized by school to a classroom-based intervention for all third and fourth graders, a risk-based intervention only for those with 1 or more cardiovascular disease risk factors, or a control group. The 8-week interventions involved both knowledge--attitude and physical activity components., Results: School-level analyses showed that physical activity in the risk-based group and posttest knowledge in the classroom-based group were significantly higher than in the control group. With regard to trends shown by individual-level analyses, cholesterol dropped more in the classroom-based than in the control group, and skinfold thickness decreased 2.9% in the classroom-based group and 3.2% in the risk-based group (as compared with a 1.1% increase in the control group)., Conclusions: Both classroom-based and risk-based interventions had positive effects on physical activity and knowledge, with trends toward reduced body fat and cholesterol. However, the classroom-based approach was easier to implement and evidenced stronger results than the risk-based intervention.

Objective: Because pain is the most commonly reported symptom of patients presenting to temporomandibular disorders clinics, it is important to identify factors that modify the perception or reality of such pain. The purpose of this study was to investigate the hypothesis that a patient with a history of trauma and/or non-temporomandibular joint surgery might be sensitized to pain and might report increased pain levels if a temporomandibular disorder later developed., Study Design: This was a retrospective study of 778 consecutive patients seen over a 1-year period in an Orofacial Pain Clinic. Study parameters included gender, lifetime number of self-reported traumas, lifetime number of non-temporomandibular joint operations, and location, intensity, frequency, and type of temporomandibular disorder-related pain., Results: There were significantly more women than men in the study (609 to 169). There was no relationship between numbers of previous traumas and non-temporomandibular joint operations and types of temporomandibular disorder. However, there were statistically significant relationships between the severity of facial pain and the frequency of facial pain as well as between the severity and frequency of joint pain and the number of traumas. There were also statistically significant associations between the severity and frequency of facial pain and the number of non-temporomandibular joint-related surgical procedures that the patient had undergone., Conclusions: There is a relationship between a patient's reported history of trauma and/or non-temporomandibular joint-related operations and the severity and frequency of facial and temporomandibular joint pain, should it develop. It is possible that such traumas and operations sensitize the patient in such a way that the pain of subsequent temporomandibular joint disorders is heightened.

Statement of Problem: Techniques for bonding denture teeth to an acrylic resin denture base remain empirical, with little consensus from the literature, among clinicians, or among dental laboratories., Purpose: This study evaluated the failure load of acrylic resin teeth bonded to 2 high impact acrylic resins., Methods and Material: The ridge lap portion on 120 identical denture teeth were modified with 3 variables: (1) placing a diatoric, (2) using monomer to prewet the denture tooth, and (3) breaking the glaze. Variables were combined to form 6 groups of 10 teeth each, and processed with Lucitone 199 (Lucitone) or SR-Ivocap (Ivocap) acrylic resin. Data analysis included the use of a heterogeneous variance linear regression model., Results: Mean (+/- SD) failure load ranged between 10.25 +/- 1.48 Kg to 28.43 +/- 11.05 Kg for the 6 Ivocap groups and 16.63 +/- 5.87 Kg to 28.05 +/- 5.35 Kg for the Lucitone groups. For Lucitone 199 acrylic resin, the highest failure loads resulted when the ridge lap was left with an intact glaze and did not have a diatoric, with no significant influence from the use of monomer. For Ivocap resin, the highest failure loads resulted when the ridge lap had a diatoric but did not have monomer placed, with no significant influence from glaze., Conclusion: Failure load of bonding highly cross-linked denture teeth to SR-Ivocap or Lucitone 199 acrylic resin was significantly influenced by modifications to the ridge lap before processing.

Unlabelled: Tooth loss diminishes oral function and quality of life, and national health targets aim to reduce population levels of tooth loss., Objectives: The purpose of this study was to determine tooth loss incidence and predictors of tooth loss among older adults in South Australia., Methods: Data were obtained from a cohort study of a stratified random sample of community-dwelling dentate people aged 60+ years. Interviews and oral examinations were conducted among 911 individuals at baseline and among 693 of them (76.1%) 2 years later. Incidence rates and relative risks were calculated for population subgroups and multivariate logistic regression was used to construct risk prediction models. A method was developed to calculate 95% confidence intervals (95% CI) for relative risks (RR) from logistic regression models using a Taylor series approximation., Results: Some 19.5% (95% CI = 15.4-23.6%) of people lost one or more teeth during the 2 years. Men, people with a recent extraction, people who brushed their teeth infrequently, smokers and people born outside Australia had significantly (P < 0.05) greater risk of tooth loss. Baseline clinical predictors of tooth loss included more missing teeth, retained roots, decayed root surfaces, periodontal pockets and periodontal recession. In a multivariate model that controlled for baseline clinical predictors, former smokers (RR = 2.55, 95% CI = 1.48-4.40) and current smokers (RR = 2.06, 95% CI = 0.92-4.62) had similarly elevated risks of tooth loss compared with non-smokers., Conclusions: The findings from this population suggest that a history of smoking contributes to tooth loss through mechanisms in addition to clinical disease processes alone.