Correlates of dental visits among community-residing Latino elders: a public health alert.

OBJECTIVES: To examine oral service utilisation in a probability sample of community-residing Latino elders. BACKGROUND: Older Latinos are at a potential increased risk of oral diseases, given their higher prevalence of co-morbidities and lower rate of dental service utilisation. METHODS: A prevalence survey was conducted among a random sample of Latino (largely Puerto Rican) elders (n = 205; mean age = 75.8; SD ± 5.3) in New York City during 2001-2002. A systematic random sample was drawn from the Centers for Medicare and Medicaid Services Beneficiary tape files. Current use of oral health services and self-reported health conditions was obtained. Functional and cognitive impairment were assessed. RESULTS: Less than half of the sample reported a dental visit in the previous year. The average time since the last dental visit was 54 months (SD ± 84.5). Last year dental visit compliers were more likely to be unmarried, living alone, with higher levels of education, fewer health conditions and less impairment with activities of daily living. In multivariate analyses, problem-oriented behaviour, Medicaid beneficiary, education, living alone, chronic health conditions and mobility impairment explained 14% of the 'time since last dental visit' variance. CONCLUSIONS: Given that socio-demographic and level of functioning determinants appear to influence the frequency of dental visits, a multilevel approach to oral health promotion is imperative.

Oral disease experience of older adults seeking oral health services.

OBJECTIVE: The objective of this investigation was to describe the dental disease (dental caries and alveolar bone loss) experience in a sample of community-dwelling older adults who regularly utilize dental services in New York City. BACKGROUND: Public financing for dental care directed at older adults in the United States is minimal. Improved preventive methods, primarily the use of fluorides, have resulted in declines in tooth loss, and concomitant increase in risk for dental diseases among older adults. While the oral disease burden in institutionalized elderly and those unable to access services is well-documented, the dental care needs of older adults who access dental services are not well documented. MATERIALS AND METHODS: Radiographic and record review were used to determine prevalence of dental caries, alveolar bone loss, frequency of service utilization, and medical status in this cross-sectional investigation of a sample of older adults (N = 200) using dental services at Columbia University College of Dental Medicine. RESULTS: Only 9% of the sample was completely edentulous, the mean DMFT was 19.9 and mean alveolar bone loss was 3.6 mm. Missing and Decayed Teeth accounted for 57.8% and 6.5% of the total caries burden respectively. Missing Teeth and alveolar bone loss increased with increasing age, but there was no increase in Decayed Teeth. CONCLUSIONS: While access to and utilization of dental services may result in improved tooth retention, older adults who use dental services continue to have dental care needs, especially periodontal care needs.

Oral care needs, barriers and challenges among community dwelling elderly in New York State and northern Manhattan.

Older adults are living longer and retaining their teeth, resulting in a concomitant increase in the need for oral care services. Despite improvements in oral health among the elderly, there continue to be profound disparities by race/ethnicity, socioeconomic and dentate status. Furthermore, challenges, such as limitations in activities of daily living, poor wheel-chair accessibility of dental clinics, poor geographic distribution of providers, difficulty navigating the oral health system and fiscal limitations make access to, and utilization of, dental services difficult among older adults. While dialogue around national policy, especially incorporation of dental benefits for adults in Medicare and Medicaid, is imperative, local efforts in New York and Northern Manhattan show promise in addressing the oral health and health care of older New Yorkers.

Relationship Between Frequent Recreational Cannabis (Marijuana and Hashish) Use and Periodontitis in Adults in the United States: National Health and Nutrition Examination Survey 2011 to 2012.

BACKGROUND: Recreational use of cannabis, following its legalization in some countries, poses emergent oral and periodontal health concerns. The objective of this study is to examine the relationship between frequent recreational cannabis (FRC) (marijuana and hashish) use and periodontitis prevalence among adults in the United States. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) 2011 to 2012 were analyzed. Primary outcome (periodontitis) was defined using the Centers for Disease Control and Prevention/American Academy of Periodontology classification as well as continuous measurements of probing depth (PD) and clinical attachment loss (AL). Exposure of interest was self-reported cannabis use, defined as "FRC use" versus "non-FRC use." Bivariate and multivariable regression models were performed using the entire analytical sample (model 1) as well as those who had never used tobacco (never-users) (model 2). RESULTS: Of 1,938 participants with available cannabis use data and essential covariates, 26.8% were FRC users. Mean number of sites per participant with PD ≥4, ≥6, and ≥8 mm and AL ≥3, ≥5, and ≥8 mm was significantly higher among FRC users than among non-FRC users (mean difference in number of PD sites: 6.9, 5.6, and 5.6; P <0.05; mean difference in number of AL sites: 12.7, 7.6, and 5.6; P <0.05). Average AL was higher among FRC users than among non-FRC users (1.8 versus 1.6 mm; P = 0.004). Bivariate analysis revealed positive (harmful) association between FRC use and severe periodontitis in the entire sample (odds ratio [OR]: 1.7, 95% confidence interval [CI]: 1.3 to 2.4; P = 0.002) as well as in never-smokers (OR: 2.0, 95% CI: 1.2 to 3.5; P = 0.01). This association was retained in multivariable models adjusted for demographics (age, sex, race/ethnicity, and income level), alcohol and tobacco use, diabetes mellitus, and past periodontal treatment (model 1: adjusted OR [aOR]: 1.4, 95% CI: 1.1 to 1.9; P = 0.07; model 2: aOR: 1.9, 95% CI: 1.1 to 3.2; P = 0.03). CONCLUSION: FRC use is associated with deeper PDs, more clinical AL, and higher odds of having severe periodontitis.

Dental caries experience in northern Manhattan adolescents.

OBJECTIVE: The study sought to document dental caries among adolescents residing in northern Manhattan, New York, by race, sex, and community. METHODS: Clinical and demographic data were collected from children aged 12-17 years at five school-based dental clinics in northern Manhattan. Data on dental caries were collected by calibrated examiners using the National Institute of Dental and Craniofacial Research criteria for oral examinations. RESULTS: A total of 566 children participated in the study. They were predominantly Hispanic (64%) or African American (28%). Compared to data from the National Health and Nutrition Examination Survey III, mean DMFT (3.36 vs 2.53; P<.01) and the prevalence of untreated disease (36% vs 16%; P<.01) were significantly higher for northern Manhattan adolescents. Of the adolescents evaluated, 13 percent had at least one severely carious tooth with pulpal involvement that required either extraction or endodontic therapy. CONCLUSIONS: Adolescents in northern Manhattan have higher caries prevalence and higher levels of untreated caries than their national counterparts. Carious lesions progress to pulpal involvement in a high percentage of northern Manhattan children and require extraction or root canal therapy as treatment. There is an urgent need for affordable and available dental primary care services targeted to economically disadvantaged communities.

A competency-based framework for training in advanced dental education: experience in a community-based dental partnership program.

While goals and objectives are useful to assess programmatic outcomes, they are not able to evaluate individual trainees' performance and/or corrective actions needed to improve performance. As a result, competency-based evaluation is increasingly being used to assess trainee performance at both the doctoral and postdoctoral levels. However, the translation of broadly stated competency statements into evaluable action statements continues to pose a challenge, especially in nontechnical domains such as the assessment and integration of cultural and sociodemographic variables in the development and execution of treatment plans. This article describes a process used to develop a competency-based framework that includes specific evaluable action statements to assess the performance of Advanced Education in General Dentistry (AEGD) residents providing dental care services to medically compromised patients in a community-based partnership program. Although the resultant framework may not itself be generalizable across training programs, the process described to develop the framework can be used by those individuals involved in evaluating students and/or residents in training programs.

Assessing the oral cancer risk of South-Asian immigrants in New York City.

Increasing immigration from South Asia, where oral cancer is one of the most common cancers in adults, suggests that this disease will probably pose a serious public health problem in the United States. According to the 2000 Census, there are approximately 1.9 million South Asians in the U.S., and their access to dental care is limited. The morbidity and mortality associated with oral cancer can be reduced by primary prevention and early detection. South Asians are not a homogenous group, and areca, and important risk factor for oral cancer, has religious and cultural significance in some South Asian communities. In order to develop culturally relevant preventive and educational interventions, it is important to assess risk behaviors according to ethnic and religious subgroup identity. In this report, the author provides an overview of oral cancer risk factors among South-Asian immigrants in the U.S., and describes a recently funded pilot study designed to assess oral cancer risk behaviors in South Asian seniors. The data collected will be used to develop risk profiles of South Asian religious and ethnic sub-groups. It is hoped that medical and dental providers will be able to use the risk profiles to target early-detection and risk-reduction services in this population.

Oral disease burden and dental services utilization by Latino and African-American seniors in Northern Manhattan.

Although oral diseases are among the most common chronic conditions affecting older adults, utilization of dental services by the elderly, especially minority elderly is low. This pilot study determined whether there are racial/ethnic differences in oral disease burden, perceived oral health-related quality of life, perceived need for dental services and dental services utilization between African-American and Latino seniors in Northern Manhattan. Subjects received an oral examination and a face-to-face survey to assess oral health status, perceived need, perceived oral health-related quality of life, and utilization of dental services. The data suggest that in both populations, oral disease burden is high and utilization of dental services is problematic--34.0% of the subjects were edentulous and average time since last dental visit was 40.1 months. The average DMFT was 23.8; 81.6% of the dental caries experience was accounted for by Missing Teeth, and there were significant differences in total caries experience, and Missing and Filled Teeth between African-American and Latino seniors. Although there were no racial/ethnic differences in the utilization of dental services, dentate individuals were more likely to have had a more recent dental visit (31.0 months) than edentulous individuals (57.7 months). The high proportion of Missing Teeth suggests that interventions aimed at improving the oral health of this population must target individuals at a younger age.