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Disease varies in different populations based on sociodemographic variables, and there is limited understanding of this interaction. The purpose of this methodological study was to determine the validity of the Oral Health Status Index, a disease-based index, on a Hispanic population by comparing it with the NIDCR epidemiological measures of disease, with the addition of demographic and behavioral variables. The epidemiologic data were collected according to the criteria defined by the NIDCR, including: a modified Decayed Missing Filled Surfaces Index, gingival inflammation, calculus, and destructive periodontal disease measures. The demographic and behavioral variables were gathered from 240 interviews with Hispanic adults in two community clinics. Bivariate analysis was used to determine relationships between the descriptive epidemiologic, demographic, and behavioral variables and the Oral Health Status Index (OHSI). There were statistically significant differences (p < 0.05) in mean OHSI scores among the demographic variables age, education, income, and place of birth; and the behavioral variables alcohol consumption, flossing, and acculturation. Multiple regression analysis with the OHSI as the dependent variable showed that the statistically significant (p < 0.001) epidemiologic predictors were: percentage of Decayed Teeth/Decayed, Filled Teeth; Number of Replaced Teeth/Missing Teeth; and millimeters of mesial attachment loss. These collectively explained 47.49% of the variance in the regression. The addition of demographic variables to the epidemiologic regression identified age (p < 0.05), gender (p < 0.01), and place of birth (p < 0.01) as significant predictors that explained an additional 4.12% of the variance, collectively bringing the total explained variance to 51.61%. The behavioral variables did not contribute significantly to predicting the OHSI regression score. The Oral Health Status Index in this study is validated by its correlation with both the epidemiologic measures and the demographic variables. This combination of variables separated the Hispanics into Mexicans and Central/South Americans. [ABSTRACT FROM AUTHOR]

Measures of perceived oral health represent subjective, individual perspectives of one's health. One measure commonly used is the single-item perceived oral health rating: How would you rate your overall oral health? These analyses examine the associations among age, ethnicity, and perceived oral health within the context of a comprehensive battery of 21 predisposing, enabling, and need variables. The study compares the adult data from three United States research locations of the International Collaborative Study of Oral Health Outcomes (ICS-II). Only social survey data were used for this analysis. The multiple regression model explains over 30% of the variance in perceived oral health, with R squares ranging from 0.324 for Indian Health Service sites to 0.391 for San Antonio. The most important significant predictors include ethnic group, education, perceived general health status, being edentulous or not having a partial denture, having no oral pain, fewer oral symptoms, and having one or more dental visits. The predictors of positive perceived oral health for the diverse groups highlight interesting age and ethnic differences. The only universal predictor for the middle-aged adults was having fewer oral symptoms. For the older adults, being edentulous or not having a partial denture was the only universal predictor. The findings suggest that perceived oral health may be a useful outcome measure in dentistry because of its relation to predisposing sociodemographics and dental utilization. [ABSTRACT FROM AUTHOR]

Personal characteristics (predisposing, enabling, and need) are described for the population-based samples of adults interviewed in the International Collaborative Study of Oral Health Outcomes (ICS-II) USA research locations. Differences in sample characteristics are compared by ethnic group (African-American, Native American, Hispanic, and White) and age cohort (35-44 and 65-74 years old) by means of Bonferroni multiple-means tests and Student's t tests. Differences in the personal characteristics of these diverse comparison groups abound. Bivariate results indicated that White adults from both age cohorts had higher socioeconomic levels, more positive self-rated health status, and greater proportions of individuals with dental benefits. Lakota adults from both age cohorts reported lower self-rated health status and were most likely to report total tooth loss. Hispanic persons were significantly less likely to report a usual source of dental care or dental benefits. Need for dental treatment (oral pain and oral symptoms index) was generally higher among Native American and Hispanic groups. It is critical that the differences highlighted between and among these groups be studied if appropriate strategies for improving the oral health of USA adults are to be determined. [ABSTRACT FROM AUTHOR]

Perceived oral health status has been shown to be associated with a variety of single clinical and self-reported indicators of oral health and oral health-related behaviors. A behavioral model is utilized which hypothesizes that perceived condition of natural teeth is predicted by multiple factors, including individual demographic and enabling characteristics, other health perceptions and orientations, actual levels of diseases and conditions, and self-defined need for treatment. The data are from the clinical examination and adult questionnaire of Phase 1 (1988-1991) of the Third National Health and Nutrition Examination Survey, which is based on a stratified multistage probability sample to produce nationally representative data for the civilian, non-institutionalized US population. Multivariate hierarchical regressions were used to assess perceived condition of natural teeth in two groups of dentate adults (those with a dental visit during the past 12 months, and those with a less recent dental visit). Self-defined treatment need made a significant, non-trivial contribution after other variables had been controlled. In both subpopulation models, the perception of general health and epidemiological indicators of oral health status were also significant factors. Socio-economic indicators did not contribute significantly in either regression. Understanding components of overall perceptions of oral health moves us closer to understanding oral health behaviors and oral-health-related quality of life. [ABSTRACT FROM AUTHOR]

This study evaluated the replicability of clinical measurements under careful calibration of multiple dentists and how the replicability can relate to their use as selection criteria in guidelines for prescribing dental radiographs. For 48 consenting patients, three dentists clinically examined each patient and recorded the presence of all clinical findings using standardized selection criteria. The examinations were performed independently of each other, but with periodic conferences of the dentists to clarify general measurement criteria. The degree of agreement among the dentists is described by the interrater agreement kappa for several standard clinical indications such as rating of caries, periodontal disease, and tooth mobility. Almost perfect agreement was obtained for tooth status, restoration size, and restoration material. Moderate agreement resulted for measures of caries, defective restoration presence, and gingival recession presence. Only fair agreement was obtained for other periodontal disease measures. The relationship between extent of agreement and guidelines' results was examined for the FDA Guidelines. The differences among the dentists' clinical measurements resulted in considerable differences among the radiographs that were selected by the FDA Guidelines' criteria. Even so, the missed disease rates for 490 patients in a larger study of the FDA Guidelines' efficacy were very low and did not vary greatly among the three dentists. We conclude that guidelines' criteria can be quite robust to variation from dentists' clinical measurement differences, as seen from the FDA Guidelines applied under the idealized setting where the dentists are periodically recalibrated through group discussions of the clinical measurements' definitions and interpretations. [ABSTRACT FROM AUTHOR]

The diagnosis of periodontitis is generally made on the basis of a clinical examination supported by radiographic evidence of bone loss. Recent guidelines promulgated by the US Food and Drug Administration recommend that periapical radiographs be ordered on the basis of clinical signs and symptoms indicating the probable presence of disease. This study evaluated the effectiveness of the FDA Guidelines for ordering radiographs for new adult dental patients as related to assessment of the periodontal condition of the patient. We examined 490 patients and determined the periapicals needed to supplement the posterior bitewings based upon the patient's clinical findings. We measured the reduction in the number of radiographs ordered as well as the extent of missed alveolar and furcation bone loss resulting from the use of the selected set of radiographs compared with a complete set. Four hundred thirty-three subjects had at least one clinical sign of periodontitis present in their mouths, and 264 demonstrated radiographic evidence of alveolar bone loss. Of the 460 subjects on whom periodontal probing was conducted, two-thirds demonstrated periodontal probing depths in excess of 3 mm; almost half showed evidence of bleeding upon probing. Individuals with clinical signs of periodontitis had, on average, 10 periapicals ordered-more than twice the number as those with no sign of periodontitis. Of the 2,415 teeth with radiographic findings of proximal or furcal bone loss, 152 sites of bone loss (6%) were missed when the selected set of films plus the posterior bitewings was used. [ABSTRACT FROM AUTHOR]

Decisions to replace existing restorations are often based on clinical findings of margin discrepancies and other restoration defects. Previous studies have suggested that such findings do not correlate well with the actual presence of secondary caries, and that treatment should be deferred until caries is clinically or radiographically evident. The purpose of this study was to assess the frequency with which clinically defective restorations are associated with radiographic secondary caries. As part of a study to assess the efficacy of guidelines for the ordering of dental radiographs, 6285 restored teeth in 490 subjects were examined clinically and radiographically by three calibrated investigators. Specific criteria were used to determine whether restorations were intact or defective. Of the total, 822 teeth (13%) were judged to have clinically defective restorations. Of these, 113 teeth (14%) had radiographic secondary caries. Of the 5463 teeth with intact restorations, 5% had radiographic secondary cares. We found that the likelihood of radiographic secondary caries was nearly three-fold higher for defective restorations than for intact restorations. The large percentage (86%) of defective restorations with no radiographic secondary caries suggests, however, that replacement of all defective restorations due to risk of secondary caries may constitute overtreatment. The use of defective restoration status and presence of radiographic secondary caries as a combined criterion for replacement may potentially reduce such overtreatment. The prevalence of secondary caries under defective restorations should be determined clinically so that the usefulness of combining the criteria of defective restoration with those of radiographic secondary caries can be evaluated. [ABSTRACT FROM AUTHOR]

It is commonly acknowledged that the United States' health-care system produces some of the finest care in the world for some people but fails to meet the needs of others. The Institute of Medicine (IOM) issued six aims for a redesigned health-care system, that it be: safe, effective, patient-centered, timely, efficient, and equitable. The purpose of this paper is to use an ongoing community-based study to illustrate current problems in the provision of oral health services that could be addressed through information technology. Appropriate use of information technology can assist dental schools and clinics in community-based clinical outcomes research needed to assemble the evidence base for improving oral health care. This conference serves as an important steppingstone to establish a means for information technology to improve the community's oral health. [ABSTRACT FROM AUTHOR]