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Objective: This paper identifies differences in prevalence of established periodontitis and evaluates factors that might explain the differences between non-Hispanic African Americans (n = 232) and whites (n = 199) in the Detroit tricounty area., Methods: Subjects from a disproportionate probability sample of community-dwelling adults were interviewed regarding demographic, psychosocial and enabling factors, dental health-related behaviors, and other risk factors, and had comprehensive in-home dental examinations., Results: The overall prevalence of established periodontitis was 20.8 percent; African Americans exhibited a significantly higher prevalence than whites (29.8% vs 17.7%). The crude association between race and prevalence of established periodontitis was significant (odds ratio [OR] for African Americans = 1.98; 95% confidence interval [CI] = 1.17,3.34). After controlling for other covariates, we found the effect of race may be modified by dental checkup visit frequency: African Americans with dental checkups at least once a year had almost a fourfold higher odds of established periodontitis (OR = 3.64; 95% CI = 1.43, 9.24) than their white counterparts with dental checkups at least once a year (the referent group); while African Americans with a dental checkups once every two years or less often were more than fourfold less likely to have established periodontitis (OR = 0.22; 95% CI = 0.08, 0.59) than their white counterparts in the referent group., Conclusions: This analysis supports the disparity in periodontal health as part of the black:white health disparity when taking other factors into account. However, periodontal health disparities may be more complex than previously recognized, requiring greater understanding of factors related to dental care utilization in future studies evaluating this disparity.

Objective: This study compared the preventive oral health behaviors of African-Americans and whites., Methods: Face-to-face interviews were conducted with a probability sample of 384 African-American and 358 white adults living in the greater Detroit area. Questions focused on brushing, flossing, and dental visits., Results: More than 95 percent of both groups reported brushing daily; however, whites were more likely to brush all teeth, including parts that do not show. Frequency of flossing did not differ between groups. African-Americans, however, were less likely to floss all of their teeth. Whites were more likely than African-Americans to get dental check-ups at least once a year and much less likely to indicate they had never had a dental check-up. African-Americans tended to have less education and lower family income than whites and were more likely than whites to have Medicaid. Race differences in brushing thoroughness and annual check-ups were greatly reduced when income, education, and insurance were controlled statistically., Conclusions: African-Americans are less likely than whites to brush thoroughly, floss thoroughly, and get dental check-ups. These differences are partly traceable to differences in socioeconomic status and access to professional oral health care.

Objectives: The goals of this investigation were (1) to evaluate the Oral Health Status Index in relation to demographic characteristics, socioeconomic status, and preventive behaviors of an adult population; and (2) to understand how individual index components performed as indicators of oral health status compared to the composite index., Methods: The Oral Health Status Index (OHSI) was used on a probability sample of adults, aged 18-93 years, living in the Detroit tricounty area. Data were collected on 509 subjects via in-home dental examinations. Bivariate and multivariate analyses were used to compare the OHSI and its components, including decayed, missing, and replaced teeth, free ends, and moderate and severe periodontal disease measures., Results: The mean OHSI score for subjects was 77.3 (SE = 1.83) with a range of -8.0 to 100.0. In regression analyses, OHSI scores were positively correlated with subjects' education level, self-rated oral health scores, and frequency of dental checkups and negatively correlated with age, nonwhite race, and smoking. Of the index components, missing teeth performed well as an indicator of oral health status. Missing teeth were positively correlated with age, nonwhite race, and smoking and negatively correlated with education level, self-rated oral health, and use of Medicaid. About 53 percent of variance in OHSI scores was explained by the multivariate models, compared to 46 percent for missing teeth., Conclusions: Choosing an indicator of oral health status likely will depend upon the characteristics of the population to be studied. As a composite measure of oral health status, the OHSI performed acceptably; however, missing teeth, an index component, also worked well. Continued evaluation of the OHSI is warranted.

Canonical correlation analyses of a previous dental survey suggested that dental checkups, flossing, and tooth brushing could all be predicted from a single equation. Most theories and research about the influence of beliefs on behavior, however, suggest different behaviors will be best predicted by different behavior-specific measures. The current survey investigated influences on brushing, flossing, and dental checkups in a probability sample of adults in the Detroit tri-county area. Both behavior-specific variables, such as perceived benefits and costs of flossing, and general variables, such as gender, were included as predictors. Canonical correlation analysis indicated three equations were needed to predict the three oral health behaviors. Flossing frequency, for example, was best predicted by confidence in flossing ability and beliefs about the benefits of and barriers to flossing. The results suggest that even these closely related behaviors are best predicted using separate equations that include mostly behavior-specific predictors.

The Dental Emergency Assistance Program is a collaboration between Michigan dentists and a United Way agency. The program's goal is to provide timely, accessible dental care to underserved people in a large metropolitan area. The authors analyzed the program's 1993 activities to determine sources of patient referrals, patients' demographic characteristics, and the types and value of services provided by participating dentists. The evaluation indicated that the Dental Emergency Assistance Program was successfully addressing the emergency dental needs of an underserved portion of the community.

Objectives: This investigation examined current practices of brushing, flossing, and periodic dental visits and their association with periodontal health status., Methods: Data were collected using face-to-face interviews and 40-minute in-home dental examinations with a probability sample of adults 18 years of age or older, having at least one tooth, and living in housing units in the Detroit tricounty area. Complete examinations were performed on 319 individuals., Results: On average, subjects reported brushing their teeth about twice a day. About one-third of the population reported flossing at least once a day. Loss of periodontal attachment was related to frequency of brushing while subjects who exhibited acceptable flossing ability had less plaque and calculus, shallower pocket depths, and less attachment loss. Subjects reporting a periodic dental visit at least once a year had less plaque, gingivitis, and calculus than subjects reporting less frequent visits. In regression analyses, brushing thoroughness, flossing ability and frequency, and dental visit frequency were predictors of lower plaque, gingivitis, and calculus scores. In turn, these scores were predictors of shallower pocket depths and less attachment loss., Conclusions: Brushing, flossing, and periodic dental visits were correlated with better periodontal health. The behaviors appeared to be indirectly related to pocket depth and attachment loss through their associations with plaque, gingivitis, and calculus levels.

Current recommendations for periodontal health maintenance emphasize toothbrushing, flossing and periodic dental checkups. The purposes of this study were to examine (1) the effects of these practices on periodontal health and (2) the relationships of demographic and socioeconomic variables with these behaviors and with periodontal health. Adults (n = 319) in the Detroit, Michigan tri-county area were asked how frequently they performed the 3 preventive behaviors. Levels of plaque, gingivitis, calculus, and periodontal attachment were then assessed during in-home dental examinations. There were no statistically significant differences in these health measures between those with acceptable and unacceptable brushing behavior. About 20% of the subjects reported acceptable flossing behavior, and these individuals had significantly less plaque and calculus than other participants. Over 3/4 of subjects reported having a dental checkup at least 1 x a year, and these persons were found to have significantly less plaque, gingivitis, and calculus compared to less frequent attenders. Acceptable brushing behavior was not associated with any particular demographic or socio-economic characteristic, while differences in acceptable flossing behavior were found among age groups. Frequencies of yearly dental checkups varied significantly within every demographic and socioeconomic characteristic.

A survey was conducted to identify (a) factors that influence preventive dental behaviors and (b) target groups for interventions. Data were collected in face-to-face interviews with a probability sample of 662 dentate adults living in the Detroit tricounty area. The interviews included questions about demographic and socioeconomic variables and about three preventive behaviors: brushing, flossing, and preventive dental visits. All behaviors were positively associated with socioeconomic status. Females were more likely than males to perform each of the behaviors at the recommended frequency. The behaviors were only weakly associated with age. Whites were more likely than nonwhites to make regular dental visits, but frequency of brushing and flossing did not vary substantially across racial groups. The impact of race on frequency of dental visits was reduced when socioeconomic status was statistically controlled. Findings suggest that socioeconomic status, race, and sex remain important considerations when planning dental health education or other interventions.

This study evaluated the effects of three modes of education on dentists' knowledge, attitudes, and use of pit and fissure sealants. A randomly selected group of dentists was invited to participate in a sealant education initiative. During a 12-month period, a total of 662 dentists either (1) attended continuing education courses, (2) received written materials and videotapes by mail, or (3) received only written materials by mail. A comparison group (n = 337) received no materials until after the education phase and evaluation had been completed. Pre- and postintervention surveys were used to measure changes in knowledge, attitudes, and sealant use. Response rates to the two surveys were 62 percent and 76 percent, respectively. Preintervention values for knowledge scores, an attitude scale, and sealant use were similar among the four groups. At followup, the three education groups had significantly higher knowledge scores than the comparison group. Attitude values for all but one group were not significantly different, and sealant use by all groups was identical. The numbers of respondents not using sealants declined slightly between surveys in the three education groups while rising slightly in the No-Education Group. Because program outcomes were similar to those of another sealant initiative, it can probably be concluded that continuing education will increase dentists' knowledge about sealants, but have little effect upon their attitudes or their use of the technique. The changes observed in this investigation may be due to the particular capacity for cognitive and affective changes of participants, characteristics of the technology being promoted, and external forces in the professional environment.

A statewide mail survey of a stratified sample of 640 Michigan general dentists was conducted in 1983, with a response rate of 41 percent, n = 261. An analysis was performed to compare Medicaid and non-Medicaid providers. About half of all respondents reported that they were not seeing any Medicaid patients (Group 1); 29 percent reported that less than 10 percent of their patients were Medicaid-eligible (Group 2), and 22 percent reported that 10 percent or more of their patients were Medicaid-eligible (Group 3). Significant differences existed among the three groups for age of respondent, length of time in practice, and number of new patients seen each month. Respondents with greater percentages of Medicaid patients in their practices were more likely to be in group practice. Stratification of respondents by location suggested that rural providers were more likely than urban respondents to have some Medicaid patients in their practices. Over 40 percent of respondents from all groups reported themselves as being not busy enough. In 1984, more than one million persons in Michigan were eligible for Medicaid dental benefits, but only one-fourth of these individuals were recipients of dental care. Factors that may limit dentists' participation in the Medicaid program, despite the presence of a large eligible population and self-reported lack of business, are discussed.

The planning and implementation of a community-based outreach program for older adults is described. Objectives of the program were to provide dental health education to older persons at their place of residence, to improve access to dental care for that population, and to increase the number of older adults treated at a dental facility administered by the Department of Community Dentistry, University of Michigan. Data collected during encounters with participants are reported to supplement the description of the program. In the first year, 98 older adults (mean age 71.3 years) participated in the outreach program which was directed by a dental hygienist. Of those persons whose initial encounter was with the outreach program, 47 percent eventually contacted the dental care facility and 36 percent completed treatment. Persons who elected to seek treatment average 3.9 encounters with the hygienist during the program; persons who did not seek treatment averaged 2.2 encounters. Strengths and weaknesses of the program are discussed.