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This study assessed the relationship between interdental spacing patterns and caries experience in the primary dentition.Caries examinations were conducted amoung 356 children 4 to 6 years of age. At the time of the examinations, alginate impressions were obtained and poured in yellow stone. From the stone casts, each interdental area was categorized as: (1) space1 mm, (2) space1 mm, (3) no space, teeth in contact, or (4) no space, teeth overlapped. These categories were collapsed into presence or absence of space for each interdental site, and counted for each individual. Analyses assessed the relationships between interdental spacing and caries experience with separate analyses for anterior spacing, posterior spacing and total spacing.Children with more total interdental spaces had less decay experience and less untreated decay than children with fewer interdental spaces, and children with more molar spacing had less molar decay experience; however, these relationships were weak. Correlation analyses demonstrated significant relationships between number of decayed surfaces and total number of interdental spaces (r=-0.11, P=.04) and number of molar sites with interdental spaces (r=-0.13, P=.02). Multivariate analyses revealed the total number of interproximal spaces to be weakly associated with interproximal caries experience, but that fluoride exposure was a much stronger predictor.Absence of interdental spaces is weakly associated with greater decay experience in the primary dentition.

Fluoride continues to be the cornerstone of dental caries prevention in North America and throughout the world, and there are a variety of sources of fluoride that may contribute to the dietary intakes of fluoride. Although the severe effect of chronic exposures to high levels of fluoride--skeletal fluorosis--is extremely rare in North America, dental fluorosis has become more prevalent. To address the increase in dental fluorosis prevalence, recommendations have been made to reduce fluoride ingestion early in life. These recommendations have included the introduction of lower concentration fluoride dentifrice for use by young children, labeling of the fluoride concentration of bottled water, and revised fluoride supplement guidelines to reduce or eliminate their use. Because our knowledge is incomplete regarding the amount, duration, and timing of fluoride ingestion that can result in dental fluorosis, however, further research is clearly needed before definitive recommendations can be made regarding the use of fluorides, including recommended intakes of fluoride in the diet.

Dental caries continues to be a major public health problem in the US and other nations, particularly among younger children. Unfortunately, understanding of factors contributing to caries in this age group is incomplete and further studies are necessary. The purpose of this study was to assess factors related to extensive caries experience among children aged 4-7 years, including antibiotic use, dietary patterns, fluoride intakes, and tooth brushing habits.The case-control study was nested within a longitudinal cohort study of children's oral health. The larger cohort study collected data on fluoride intakes and behavioral factors, including antibiotic use and dietary patterns of children periodically from birth. A single dental examination was completed for each child at a time between the ages of 4-7 years. A case-control design was used to compare children with severe caries experience (6 or greater dmfs) to those with no caries experience. Cases (n = 39) included all who met the criteria and had sufficient longitudinal data (n = 39) while a control group was selected to have comparable mean age, exam dates, and an equal number of boys and girls.Backward elimination logistic regression controlling for demographic variables showed severe caries experience to be related to greater regular pop/other sugared beverage intake, greater frequency of starch foods, and greater frequency of eating occasions. Mother's education and fluoride intake from water were inversely related to severe caries experience. Antibiotic use was generally higher in the control group, but was not significantly different than in the severe caries group.Although we cannot rule out the possibility that antibiotics may be associated with increased or decreased caries risk, our data suggest that they play only a minor role in caries prevention compared to fluoride. Dietary sugar continues to be a significant risk factor for caries in the primary dentition.

Background. Understanding the determinants of adiposity in young children may be particularly critical for preventing adult obesity since the age at which body fatness reaches a postinfancy low point (typically 4–6 years) is inversely associated with obesity later in life. Methods. We examined cross-sectional associations among fatness, leanness, and physical activity in 467 children (range 4–6 years). Activity was measured using accelerometry and parental report of children's television (TV) viewing. Dual energy X-ray absorptiometry was used to quantify body composition. Results. Minutes spent in vigorous activity and TV viewing were the variables most consistently and most highly associated with adiposity. Children in the lowest quartile for vigorous activity had on average (absolute) body fat percentages that were 4% greater than those children in the highest quartile for vigorous activity. Body fat percentages for children in the highest category for TV viewing were on average 3% greater than those children who watched the least amount of TV. Conclusions. Low levels of vigorous physical activity and high levels of TV viewing are associated with fatness in young children during the adiposity rebound period. This suggests that increasing children's active play may be important in preventing obesity later in life.

Objective: To examine levels of fluorosis among children in two Canadian communities exposed to flouride. Background: One community had discontinued flouride, the other had maintained it. Water supplies, however, were fluoridated for all the children when their esthetically important teeth were mineralized. Methods: We examined 8,277 children to assess Thystrup-Fejerskov Index (TFI) scores. Multivariate Poisson regression models were used to identify the relationship between TFI and water fluoride status, age, gender, SES, and dietary and fluoride exposure histories (supplements, rinses, toothpaste amount, tooth brushing frequency, and tooth brushing starting age). Parent(s) completed questionnaires. Results: Overall, levels of fluorosis were low to mild, with residents of the fluoridation-ended communities having marginally higher TFI scores than those of the still-fluoridated community. Females had higher TFI scores than males. Children aged 10 years or more had higher TFI scores than younger children. Consuming bottled water between birth and 6 months of age was protective. Exposure to fluoridation technologies was consistently associated with fluorosis experience. Children who began brushing with fluoride toothpaste between their first and second birthdays had higher TFI scores than those who began between their second and third birthdays, regardless of daily brushing frequency. Children who regularly used supplements had higher TFI scores than those who did not. Children with a college-educated father had higher TFI scores than those whose fathers had less education. Conclusions: Higher fluoride exposure slightly increased the likelihood that a child had a higher TFI score, especially when more fluoridation technologies were used at home.

Few studies in North America have assessed dental fluorosis of the primary dentition and few, if any, anywhere have assessed the relative importance in fluorosis etiology of fluoride intake during different time periods or from multiple sources. The purpose of this paper is to report on analyses relating estimated prenatal fluoride intake and fluoride intake during different parts of the first year of life to primary tooth fluorosis.As part of The Iowa Fluoride Study, subjects were recruited at birth and studied longitudinally. Trained examiners assessed dental fluorosis for children aged 4-7 years using the Tooth Surface Index of Fluorosis (TSIF) adapted for the primary dentition. Detailed parent questionnaires at childbirth were used to estimate prenatal fluoride intake and questionnaires sent at 6 weeks and 3, 6, 9, and 12 months were used to estimate fluoride intake during the first year of life (combined fluoride intake from water, food and beverage, supplements, and dentifrice). There were 504 children with prenatal and at least four of the five postnatal responses with complete data.Fluorosis prevalence was 12.1%, occurring primarily on the second primary molars. Receiver operating characteristic (ROC) curves and logistic regression were used to assess the importance of different time periods' fluoride intake. In bivariate analyses, fluoride intake during each time interval was individually significantly related to fluorosis occurrence. For multivariate analyses, the period from 6 to 9 months was most important individually (P = 0.0001), and no other period was jointly statistically significant.Results suggest that the middle of the first year of life is most important in fluorosis etiology for the primary dentition in this setting.

Breast milk is the recommended method of nutrition for newborns and infants. Several studies have investigated factors associated with the cessation of breast-feeding. This study assessed the associations between pacifier use, digit sucking, childcare attendance, and breastfeeding cessation among 1387 infants in the Iowa Fluoride Study.This was a longitudinal questionnaire survey. Mothers completed mailed questionnaires sent at infant ages 6 weeks, 3 months, and 6 months.Parents were recruited postpartum at 8 Iowa hospitals.Survival analysis (using Cox proportional hazards model) assessed the time covariate effects of pacifier use, digit sucking, and child care attendance on cessation of breastfeeding, while adjusting for other possible confounding variables (not planning to breastfeed, maternal smoking, infants' sex and antibiotic use, maternal and paternal age and education, and income group).Percentages of women who did any breastfeeding were 46%, 36%, and 27%, at 6 weeks, 3 months, and 6 months, respectively. Percentages using pacifiers were 81%, 71%, and 59%. Combinations of pacifier use and digit sucking for various levels of child care had statistically significant associations with cessation of breastfeeding, with the effect being strongest for pacifier users and digit suckers with no child care days (hazard ratio = 1.88; 95% CI, 1.36-2.62).Pacifier use and digit sucking were associated with cessation of breastfeeding, with results dependent on the level of childcare attendance. The strongest associations were found for those not attending childcare and for combined use of pacifier with digit sucking.

The purpose of this study is to report the prevalence of having a dental visit and/or a topical fluoride treatment at the dental visit from birth to age 36 months from an observational, longitudinal study of a cohort of children followed since birth.Multiple questionnaires were sent to the families of children enrolled in a study of fluoride ingestion to ask parents if their child had had a dental (or dental hygiene) appointment and/or a fluoride treatment during the time interval since the previous mailed survey. Data were analyzed to determine the percentages of children who had at least one dental visit or at least one fluoride treatment by one, two or three years of age.Three hundred and forty parents completed all eleven questionnaires during the 36-month study period. Of these, 2% reported having taken their child for a dental visit by one year of age, 11% by two years of age and 31% by three years of age. Of those with a visit by three years of age, 19% received at least one fluoride treatment.Despite recommendations for early dental visits, only 31% of the children in this cohort had been seen by a dentist by the time they reached their third birthday and 19% of these had received a professional fluoride treatment.

This paper reports on the accuracy of tooth counts conducted In 22 subjects by 10 trained nurses as part of a large longitudinal study of a pharmacological agent. These nurses participated in a training course consisting of seminars, discussion, demonstrations, and practice examinations. Each of the nurses then counted the teeth of 22 subjects and recorded their findings independently. The counts of the nurses were compared with those of the dentists to assess the accuracy of the nurses' counts. We found that nurses and dentists were in perfect agreement for 86% of the patient counts conducted. Individual nurses' levels of agreement with dentists ranged from 73% to 100%, with pairwise kappa statistic values ranging from 0.70 to 1.00. In addition, both Pearson correlation and interclass correlation measures exceeded 0.98 for every comparison of dentist and nurse counts. The results of this study suggest that training nonden-tal health care workers may be an accurate and low-cost way of obtaining tooth loss data and other oral health measures, particularly when oral health data are collected as part of larger, multi-disciplinary studies.

Background: Dental caries remains the most prevalent chronic condition in children and a major contributor to poor general health. There is ample evidence of a skewed distribution of oral health, with a small proportion of children in the population bearing the majority of the burden of the disease. This minority group is comprised disproportionately of socioeconomically disadvantaged children. An in-depth longitudinal study is needed to better understand the determinants of child oral health, in order to support effective evidence-based policies and interventions in improving child oral health. The aim of the Study of Mothers’ and Infants’ Life Events Affecting Oral Health (SMILE) project is to identify and evaluate the relative importance and timing of critical factors that shape the oral health of young children and then to seek to evaluate those factors in their inter-relationship with socioeconomic influences. Methods/Design: This investigation will apply an observational prospective study design to a cohort of socioeconomically-diverse South Australian newborns and their mothers, intensively following these dyads as the children grow to toddler age. Mothers of newborn children will be invited to participate in the study in the early post-partum period. At enrolment, data will be collected on parental socioeconomic status, mothers’ general and dental health conditions, details of the pregnancy, infant feeding practice and parental health behaviours and practices. Data on diet and feeding practices, oral health behaviours and practices, and dental visiting patterns will be collected at 3, 6, 12 and 24 months of age. When children turn 24-30 months, the children and their mothers/primary care givers will be invited to an oral examination to record oral health status. Anthropometric assessment will also be conducted. Discussion: This prospective cohort study will examine a wide range of determinants influencing child oral health and related general conditions such as overweight. It will lead to the evaluation of the inter-relationship among main influences and their relative effect on child oral health. The study findings will provide high level evidence of pathways through which socio-environmental factors impact child oral health. It will also provide an opportunity to examine the relationship between oral health and childhood overweight.

Objectives. Physical activity has a beneficial effect on bone development in circumpubertal children, although its effect on younger children is uncertain. In this cross-sectional study, we examined associations between physical activity and bone measures in 368 preschool children (mean age: 5.2 years, range: 4–6 years). Design. Physical activity was measured using 4-day accelerometry readings, parental report of children's usual physical activity, and parental report of children's hours of daily television viewing. Total body and site-specific bone mineral content and area bone mineral density (BMD) were measured by dual energy radiograph absorptiometry. Results. After adjustment for age and body size, accelerometry measures of physical activity and parental report of usual physical activity were consistently and positively associated with bone mineral content and BMD in both boys and girls (r = 0.15–0.28). Television viewing was inversely associated with hip BMD in girls (r = −0.15). The proportion of variance in bone measures explained by physical activity in linear regression models ranged fromr2 = 1.5% to 9.0%. In all of these models except total body BMD, at least 1 and often several of the physical activity variables entered as independent predictors. Activity variables most likely to enter the regression models were vigorous physical activity (as determined by accelerometry) and parental ranking of child's usual physical activity. Conclusions. Findings indicate that there are statistically significant and, perhaps important, associations between physical activity and bone measures during early childhood, well ahead of the onset of peak bone mass. This would suggest that intervention strategies to increase physical activity in young children could contribute to optimal bone development.

Objective: To compare permanent tooth surface–specific progression/reversal changes between fluoridation–ended (F–E) and still–fluoridated (S–F) communities in British Columbia, Canada, over a 3–year period. Methods: D1D2MFS examinations were contrasted for 2,964 schoolchildren in 1993/94 (grades 2, 3, 8 and 9) and 1996/97 (grades 5, 6, 11 and 12). Generalized Estimating Equation (GEE) models explored the relation between progression/reversal changes and fluoridation status, age, gender, socioeconomic status, and dietary/fluoride histories. Results: Within a scenario of low levels of caries overall, few children had multiple surfaces progressing. At least one smooth surface progressed in 31.4% of subjects; at least one pit–and–fissure (PF) surface progressed in 43.1% of subjects. At least one smooth surface reverted in 89% of subjects who had reversible stages; at least one PF surface reverted in 23.8% of subjects who had reversible stages. GEE (smooth) indicated that odds ratios of progression were twice as large in the F–E site compared to the S–F site, and slightly increased in older participants and in participants exposed to more fluoride technologies. GEE (PF) also indicated that progression was slightly more common in the F–E site; more frequent snacking and lower parental educational attainment had modest associations with increased progression in PF surfaces. For the two types of surfaces, GEE models demonstrated that unerupted surfaces were less likely to progress than sound surfaces. No associations were found between reversals and independent variables. Conclusion: Progressions were found to be weakly linked to socio–demographic factors; baseline surface statuses were better predictors of progression. Using the current definitions for disease transitions, F–E communities had more frequent progressions than a S–F community.

1Professor, Department of Prosthodontics and Dows Institute for Dental Research, University of Iowa, Iowa City, Iowa 52242 The Directors of Nursing (DON's) of all 428 nursing homes in the state of Iowa were sent a pre-tested questionnaire. The aim of the study was to examine the perceptions by nursing directors on the utility of a dental component of the Minimum Data Set (MDS) in identifying residents with dental problems in their facility. The return rate was 55.1% from the DON's. It was reported that 66.4% of the homes had a training program for the MDS and that in 38.0% of the homes there was only one person doing the assessments. The majority (76.0%) of the DON's stated that the MDS was useful in tracking residents and that it did help them to identify dental problems. When asked how often it was useful in the identification of dental needs, only 9% stated that it was often useful. Also, regarding frequency of dental appointments for the residents, a mean of 51.0% of residents were estimated to have received some dental care during the previous year (means of 33.2% at the facility, 22.4% at a dental office, and 0.4% in a hospital). If change is to occur, the dental profession must try to get the nursing home assessors to convince the nursing homes to use the oral/nutritional/dental sections of the MDS as they were intended under the OBRA regulations.

Objective: Decisions to extract a tooth may be among the most critical in dentistry. The aim of this study was to prospectivety investigate both clinical and nonclinical factors related to decisions to extract or retain teeth in private general dental practice. Methods: A convenience sample of 196 Iowa dentists in private general dental practice reported on 549 cases where decisions were made to extract or retain teeth as they occurred in their practices during a one-month period in May 1997. Bivariate and multivariate analyses were used to identify factors that differentiated between cases where a tooth (or teeth) was extracted and cases where an at-risk tooth was retained. Results: Of the 549 cases, 67 percent involved extraction, while the remainder involved alternatives to extraction. In comparing extraction cases to alternative treatment cases, we excluded 150 extraction cases because dentists reported that no alternative to extraction was available. Using Generalized Estimating Equations (GEE), we identified cost of treatment, presence of tooth mobility, poor prognosis of alternative treatment, and presence of gross caries as significant factors associated with extraction, while previous treatment of the tooth and concerns with patients' health were significantly associated with alternatives to extraction. Conclusions: For teeth at risk for extraction, cost, substantial periodontal disease, and several clinical factors were predictive of extraction.

Objective This study compared time required and 12-month retention for two methods of sealant placement: traditional acid-etch technique and air-abrasion technique without acid etch. Methods Sealants were placed on the permanent first molars of 84 children in grades 1-4 who were randomly assigned to treatment groups. All sealants were placed in a school setting by the same clinician. Chair time required for sealant placement was recorded, and retention rates were determined for each technique 12 months after placement. Results Mean chair time for placement of sealants on four first molars using the air-abrasion technique was significantly less than for the acid-etch technique (7:36 minutes vs 10:56 minutes). Fifty-eight children were available at 12-month follow-up; an examiner not involved in sealant placement and masked as to the technique used determined retention. Rates of complete retention for occlusal surfaces were not significantly different for the two techniques, although the rate for acid etch was higher than that for air abrasion (95% vs 87%). The complete retention rates for the acid-etch technique were significantly higher than air abrasion for buccal and distolingual surfaces. These rates were 65 percent and 58 percent, respectively, for acid etch and 6 percent and 28 percent, respectively, for air abrasion. Conclusion Although more research is needed to improve air-abrasion applications, it does not appear that air abrasion without acid etching offers a significant advantage over traditional sealant placement methods and, in fact, appears to be inferior to the acid-etch technique for use in public health settings.

Background The prevalence of fluorosis of the permanent teeth has increased during the past few decades in the United States and Canada. However, primary-tooth fluorosis has been largely overlooked, because it is often difficult to recognize. This article describes primary-tooth fluorosis, both as characterized in the literature and as seen clinically. Methods The authors review and summarize previous studies of primary-tooth fluorosis and discuss its etiology. In addition, the authors describe the condition, based on findings from the literature, and their own experiences in characterizing it as part of a longitudinal investigation of fluoride exposures, dental fluorosis and dental caries. Results Several studies indicate that primary-tooth fluorosis can be prevalent and severe in areas of very high water fluoride concentrations. In these areas, primary-tooth fluorosis is likely the result of both pre-and postnatal exposures. Studies have documented that primary-tooth fluorosis does occur in areas with optimal or suboptimal water fluoride concentrations, and that in these settings primary-tooth fluorosis is most likely caused by postnatal exposures and is seen most commonly in the primary molars. Primary-tooth fluorosis, however, is often more difficult to identify than fluorosis in permanent teeth, and clinicians may be unfamiliar with its characteristics and may not recognize its somewhat subtle appearance. Conclusion Primary-tooth fluorosis may be related to occurrence of fluorosis in the permanent dentition, so that its recognition by the clinician should raise awareness of possible increased risk for the permanent dentition. Clinical Implications The detection of primary-tooth fluorosis in a young child should prompt the clinician to carefully review the child's past fluoride exposures and current fluoride practices, as well as those of any younger siblings.

This investigation used retrospective methodology to examine the outcomes of previous dental treatment and the incidence of developing restorative and extraction needs, including dental caries, among nursing facility residents. Data were taken from treatment records of 48 dentate residents in 10 nursing facilities who received comprehensive dental treatment delivered through the Geriatric Mobile Unit (GMU) program operated by the University of Iowa College of Dentistry and were examined an average of 2.9 years after initial examination. Residents had a mean age of 84 years at the second exam, and 90% were female. About 18% of all previously placed restorations needed to be replaced, and an additional 11% of teeth that received a restoration needed to be extracted at follow-up. At follow-up, nearly 70% (33/48) of residents needed restorative care, while 44% (21/48) needed extractions. The mean incidence of teeth developing new treatment needs between the two visits was 2.7 teeth/person (14.9% of teeth) for restorative need and 1.1 teeth/person (6.6% of teeth) for extraction need. Results suggest that successful treatment outcomes can be achieved for nursing facility residents, but that dental disease and treatment needs develop at a high rate among these residents.

Several studies have reported the prevalence of medical conditions or investigated the relationships between the oral health status and general health conditions in the elderly. However, the relationship between medical conditions and oral health among the elderly is not well-described. Previous studies have not clearly identified a consistent association between medical conditions and oral health, specifically edentulism and tooth loss. The purpose of this study was to investigate the relationships between medical conditions and oral health, as assessed by edentulism and missing teeth, in an institutionalized elderly population. A systematic sample (n = 175), stratified by age and sex, was drawn from nursing home patients treated by the University of low' as Geriatric Mobile Unit (GMU) team. Data were extracted from GMU dental records, regarding history of medical conditions, medications, dental history, dentate status, and tooth-by-tooth conditions. Mean numbers of missing teeth were significantly higher among those who had a history of atherosclerotic vascular disease, heart failure, ischemic heart disease, and joint disease. Subjects who had a history of atherosclerotic vascular disease, heart failure, ischemic heart disease, and joint disease were more likely to be edentulous than subjects who did not have a history of those diseases. The biological basis for these relationships between dentate status and systemic medical conditions is unclear and warrants further study.

Original Article Bottenberg P, Declerck D, Ghidey W, Bogaerts K, Vanobbergen J, Martens L. Prevalence and determinants of enamel fluorosis in Flemish schoolchildren. Caries Res 2004;38(1):20-8. Level of Evidence 2b Question What are the relationships between exposures to various fluoride sources and dental fluorosis? Source of Funding Industry: Lever-Elida, Brussels Type of Study/Design Cohort study (or could be considered Prevalence/Cross Sectional Study)

Nurses' aides provide the majority of direct care for nursing facility residents. This study investigated aides' self-reported oral care activities and personal, job, organizational, and resident factors associated with oral care. A 30-item questionnaire was completed by 488 aides, and interviews were conducted with 65 of these aides. Aides were performing oral care activities for residents. Associations between some of the four groups of factors proposed and aides' oral care provision were found. Aides' attitudes toward oral care, lack of time and staff to complete oral care, and behavioral and physical difficulties with residents may have affected the time spent by these aides in providing oral care. The study highlighted the need for further investigation and assessment of (1) aides' CNA training courses and (2) continuing oral health educational interventions in nursing facilities. Personal interview were found to be a useful qualitative instrument for conducting dental research in nursing facilities. Further investigation is needed of interviews and other methodologies, such as observation, to supplement self-report as a measure of aides' oral care activities.

Objectives: Concerns have been raised recently about whether a substantial amount of dental fluorosis is resulting from the increased use of fluoride from various sources. The purposes of this study were to determine the prevalence and severity of dental fluorosis in a sample of pediatric patients seeking dental treatment in a university pediatric dental clinic and to evaluate sources of fluoride as risk factors for dental fluorosis. Methods: A convenience sample of 157 children aged 8 to 17 years were examined for dental fluorosis using the Tooth Surface Index of Fluorosis (TSIF). Fluoride history questionnaires assessing previous exposure to fluoride during the first eight years of life were completed by the children’s parents. Fluoride exposures were compared among 54 cases and 54 matched controls using a case-control retrospective design. Results: Fluorosis was found in 72 percent of the children, but was generally quite mild. The risk of fluorosis was significantly greater for children who had greater exposure to fluoridated water and who used larger amounts of fluoridatedtoothpaste up to age eight. Conclusions: This study provided evidence that increased use of fluoride toothpaste may be a risk factor for dental fluorosis. The results suggest prudent use of dentifrice by young children to minimize the risk of fluorosis. [J Public Health Dent 1995;55(3): 154-91

Wide variations in fluoride intake among children make estimating fluoride intake difficult. This paper discusses the various sources of fluoride intake among children, beginning with a review of the fluoride concentrations of water and other beverages, foods, and therapeutic fluoride products. A review of previous studies' estimates of fluoride intake from diet, dentifrice, fluoride supplements, fluoride mouthrinses, and gels, as well as total fluoride intake also is presented. Then, estimates of fluoride intake among young children of different age groups are summarized, and examples demonstrating the high level of variability of fluoride intake, both from individual sources and in total, are presented. Lastly, this paper discusses the implications of our current level of knowledge of children's fluoride intake, and presents recommendations for the use of fluoride for children in light of this current knowledge. The major recommendations are that: (1) the fluoride content of foods and beverages, particularly infant formulas and water used in their reconstitution, should continue to be monitored closely in an effort to limit excessive fluoride intake; (2) ingestion of fluoride from dentifrice by young children should be controlled, and the use of only small quantities of dentifrice by young children should be emphasized; and (3) dietary fluoride supplements should be considered a targeted preventive regimen only for those children at higher risk for dental caries and with low levels of ingested fluoride from other sources.

Original article Jackson RD, Brizendine EJ, Kelly SA, Hinesley R, Stookey GK, Dunipace, AJ. The fluoride content of foods and beverages from negligibly and optimally fluoridated communities. Community Dent Oral Epidemiol 2002;30:382-91. Level of evidence None Purpose To summarize the distribution of fluoride content of foods and beverages in 1 fluoridated and 1 nonfluoridated community and to estimate, on the basis of these data, the mean daily dietary fluoride intake of 3- to 5-year-old children Source of funding National Institute of Dental and Craniofacial Research Type of study/design Cross-sectional

Research suggests that adolescent S T users are open to advice about quitting. We surveyed 821 Iowa teenage boys to establish patterns of smokeless tobacco use, occurrence of oral lesions and the effect of lesions on attitudes about quitting, current use and plans for future use. Results suggest that young ST users who currently have a lesion or have experienced lesions may be particularly receptive to discussion of quitting options and other information about ST health effects. Dentists and other oral health professionals should initiate ST intervention when establishing a lesion history or on discovering a lesion at examination.

Oral hygiene care levels in lowa intermediate care facilities This study was undertaken to improve understanding of current oral hygiene care practices in intermediate care facilities. Questionnaires were sent to directors of nursing of all licensed intermediate care facilities in Iowa. Results show that an estimated 57% of residents needed direct oral hygiene assistance. In all intermediate care facilities, the majority of direct oral hygiene care was provided by aides. Oral hygiene care was often not provided at an optimal level, and the main reasons reported for this lack of care were uncooperative residents (82%), lack of perceived need by aides (68%), and inadequate time/personnel(49%). Development and promotion of oral hygiene care programs in intermediate care facilities must take into consideration the realities and problems involved. Otherwise, efforts to introduce or implement new or improved care programs will fail.

Many care-dependent elderly individuals live in nursing homes and must depend on nursing home aides for oral hygiene care. It is generally agreed that the level of oral hygiene care among care-dependent nursing home residents is less than optimal. Two reasons are time constraints and the difficulty involved in brushing other individuals' teeth. The identification of effective and efficient plaque-removal devices for use by care-providers should make it easier for nursing home aides to incorporate effective oral hygiene care into their daily routines. This pilot study was undertaken to determine the relative effectiveness of four plaque removal devices with different basic designs when used by a non-professional care-provider on 10 healthy volunteers. A brush with curved bristles on the lateral aspect of the brush head and short straight bristles in the center (Collis-curve) and an electric toothbrush with tufts that rotate reciprocally (Interplak) were the most effective, a conventional brush (Oral-B) was somewhat less effective, and a disposable foam brush (Abco) was least effective and similar to the prebrushing plaque score (baseline). All the volunteers reported that the Collis-curve was the most comfortable brush, and the care-provider reported that it was the easiest to use.

This paper reports on the comparison of 104 patient-provided medical histories and those provided by the patients' physicians. Patient-provided histories were obtained using a written health questionnaire with verbal follow-up. At the level of specific medical conditions, patients and physicians agreed only about half of the time, whereas there was better agreement by systemic disease category (average agreement 77%). Both patients and physicians reported systemic conditions not reported by the other, indicating that neither patients nor physicians can be relied on as the sole source of medical history information. Whenever there is a complex medical history or uncertainty about the completeness of the patient's knowledge and reporting of their medical history, contacts with the patient's physician(s) are indicated.

Survey dental examinations were conducted in 262 dentate elderly people aged 70 and older and residing in two rural Iowa counties. Over 60 percent of the elderly in these countries were dentate. Buccal and mesial sites of all teeth were assessed for gingival recession, pocket depth, and attachment loss. Mean loss of periodontal attachment was 2.1 mm, and was slightly greater in older age groups and in men. More gingival recession was found on buccal sites and deeper pocketing was found on mesial sites regardless of age group, sex, or tooth type. However, the clinical magnitude of these differences was small. The prevalence of advanced periodontal breakdown was relatively low, with less than 15 percent of the subjects having at least one site with attachment loss of 7 mm or more. However, moderate periodontal breakdown was highly prevalent in this older population.

We examined the association of candidate gene polymorphisms with bone mineral density (BMD) and bone mineral content (BMC) in a cohort of 428 healthy non-Hispanic white children participating in the Iowa Bone Development Study, a longitudinal study of determinants of bone accrual in childhood. BMD and BMC measurements of the hip, spine and whole body were made using a Hologic 2000 Plus densitometer in 228 girls and 200 boys ages 4.5-6.5 years. Genotypes at 14 loci representing eight candidate genes [type I collagen genes (COL1A1 and COL1A2), osteocalcin, osteonectin, osteopontin, vitamin D receptor (VDR), estrogen receptor (ER), androgen receptor (AR)] were determined. Gender-specific and gender-combined prediction models for bone measures that included age, weight, height (and gender) were developed using multiple linear regression analysis. COL1A2 and osteocalcin genotypes were identified as having the strongest and most consistent association with BMD/BMC measures. Osteonectin, osteopontin and VDR translation initiation site polymorphisms were associated with some individual bone measures, but none of the associations was as consistent as those identified for the COL1A2 and osteocalcin genes. No association was identified with COL1A1 (RsaI and Sp1), VDR (BsmI) and ER polymorphisms (PvuII, XbaI, TA) and BMD/BMC. However, we identified significant gene-by-gene interaction effects involving the ER and both VDR and osteocalcin, which were associated with BMD/BMC. Our data suggest that genetic variation at multiple genetic loci is important in bone accrual in children. Moreover, the combination of genotypes as several loci may be as important as a single genotype for determining BMD and BMC.

Interprofessional contact and consultation among dentists, physicians, and pharmacists can help to optimize patient care. Because pharmacists are readily accessible to the public, their influence is essential for the appropriate prescribing and continued use of systemic fluoride supplements.Pharmacists should be familiar with various aspects of fluoride therapy, such as mechanisms of caries inhibition, dosages associated with acute and chronic toxicity, and recommended daily dosage levels. The impact of breastfeeding, multiple sources of water intake, and changing age of the patient must be considered in determining proper systemic fluoride dosage.Pharmacists should consult with both physicians and dentists to coordinate water fluoride assay and prescribing responsibilities. They also can help to educate both prescribers and patients. Because of frequent patient contact and access to medication records, pharmacists can encourage and monitor patient compliance. Fluoride prescriptions and results of water fluoride assays should be documented on the patients' computerized or card profiles. In addition, pharmacists can counsel patients about the fluoride ion content of various home-use products and make recommendations to ensure that an optimal level of fluoride ingestion is maintained.

Deficiencies have been identified in dentists' knowledge about and use of proper protocol in systemic fluoride supplementation and water fluoride assay. Although AADS curriculum guidelines include systemic fluoride supplementation, little is known about actual predoctoral dental and dental hygiene curricula in this area. This study used a mail survey format to investigate dental and dental hygiene curricula concerning systemic fluoride supplementation. The majority of pertinent topics were reported to be included in most program curricula. However, the majority of programs reported no opportunities for students to apply the lecture material presented. Clinical evaluation of the fluoride supplement needs of all child patients is recommended. Student experience should be enhanced by the use of simulated experiences, especially in urban dental and dental hygiene programs. The dentist/dental hygienist team approach should be encouraged.