Oral health care services utilisation in the adult US population: Medical Expenditure Panel Survey 2006.

OBJECTIVES: To estimate the proportion of dental visits and to explore determinants of oral health care service (OHCS) utilisation among US civilian non-institutionalised adults. METHODS: Cross-sectional data from the 2006 Medical Expenditure Panel Survey (MEPS) were used to analyse adults' self-reported dental visits across potential risk factors (n = 22,721). MEPS uses a complex sample design including stratification, clustering, multiple stages of selection, and disproportionate sampling. These survey design complexities were taken into account for analysis in this study. The analysis was performed in SAS 9.2 and used chi-square tests and binary logistic regression. RESULTS: MEPS (2006) represented approximately 222 million non-institutionalised US adults. 42% (weighted) of this population reported a dental visit in the past 12 months. Dental visit numbers were observed to increase with age, with the 55-64-year-olds approximately 44% more likely than the 18-24-year olds to have visited the dentist in the past year. Hispanics were 48% less likely to report a dental visit compared to Non-Hispanic Whites. Respondents with public- or no- dental insurance were less likely to report a dental visit than persons with private dental coverage. CONCLUSIONS: Under half the US adult civilian non-institutionalised population reported a dental visit during 2006. To help address utilisation disparities, creative initiatives and systemic approaches aimed at groups currently utilising OHCS less often could be an important step towards oral health equity.

Peptide-based ELISAs are not sensitive and specific enough to detect muscarinic receptor type 3 autoantibodies in serum from patients with Sjogren's syndrome.

OBJECTIVES: The detection of autoantibodies to the muscarinic receptor type 3 (M3R) in the serum of patients with Sjögrens syndrome (SS) by ELISA is controversial. A study was undertaken to test whether modification of M3R peptides could enhance the antigenicity and increase the detection of specific antibodies using an ELISA. METHODS: A series of controlled ELISAs was performed with serum from 71 patients with SS and 37 healthy volunteers (HV) on linear, citrullinated and/or cyclised and multi-antigenic peptides (MAP) of the three extracellular M3R loops to detect specific binding. RESULTS: Significant differences (p<0.05) in optical density (OD) between serum from patients and HV were detected for a cyclised loop 1-derived peptide and the negative control peptide. Furthermore, there were no statistically significant differences between the frequency of positive patients (defined as OD >2SDs above the mean of the HV) and HV on any of the peptides tested. CONCLUSIONS: Binding of serum from patients with SS to M3R-derived peptides does not differ from binding to a control peptide in an ELISA and no significant binding to M3R-derived peptides was found in the serum from individual patients compared with HV. These data suggest that peptide-based ELISAs are not sufficiently sensitive and/or specific to detect anti-MR3 autoantibodies.

The presence of soluble c-erbB-2 in saliva and serum among women with breast carcinoma: a preliminary study.

The protein c-erbB-2, also known as Her2/neu, is a prognostic breast cancer marker assayed in tissue biopsies from women diagnosed with malignant tumors. Present studies suggest that soluble fragments of the c-erbB-2 oncogene may be released from the cell surface and become detectable in patients with carcinoma of the breast. Consequently, the purpose of this study was to assay the c-erbB-2 protein in the saliva and serum of women with and without carcinoma of the breast and to determine whether the protein possesses any diagnostic value. To determine the diagnostic utility of this oncogene, the soluble form of the c-erbB-2 protein was assayed in the saliva and serum using ELISA in three different groups of women. The three groups consisted of 57 healthy women, 41 women with benign breast lesions, and 30 women diagnosed with breast cancer. To compare the relative diagnostic utility of the c-erbB-2 protein, CA 15-3 was also measured. The CA 15-3 measurements served as a "gold standard" by which to compare the c-erbB-2 protein's diagnostic effectiveness. We found c-erbB-2 protein in the saliva and serum of all three groups of women. The salivary and serological levels of c-erbB-2 in the cancer patients, however, were significantly higher (P < 0.001) than the salivary and serum levels of healthy controls and benign tumor patients. Additionally, the c-erbB-2 protein was found to be equal to or to surpass the ability of CA 15-3 to detect patients with carcinoma. The results of the pilot study suggest that the c-erbB-2 protein may have potential use in the initial detection and/or follow-up screening for the recurrence of breast cancer in women.

Transdermal clonidine compared to placebo in painful diabetic neuropathy using a two-stage 'enriched enrollment' design.

Because a variety of mechanisms may generate pain in neuropathic pain syndromes, conventional clinical trial methods may fail to identify some potentially useful drugs; a drug affecting just a single mechanism may work in too few patients to yield a statistically significant result for the trial. To test a previous clinical observation that approximately one-quarter of patients with painful diabetic neuropathy appear responsive to clonidine, we conducted a formal clinical trial of transdermal clonidine in painful diabetic neuropathy patients using a 2-stage enriched enrollment design. In the first stage (study 1), 41 patients with painful diabetic neuropathy completed a randomized, 3-period crossover comparison of transdermal clonidine (titrated from 0.1 to 0.3 mg/day) to placebo patches. Twelve apparent responders from study I were entered into the 'enriched enrollment' second stage (study II), consisting of an additional 4 double-blind, randomized, 1-week treatment periods with transdermal clonidine and placebo. Study I showed that in the overall group of 41 patients, pain intensity differed little during clonidine and placebo treatment. In study II, however, the 12 apparent responders from study I had 20% less pain with clonidine than placebo (95% confidence interval (CI): 4-35% pain reduction; P = 0.015), confirming that their pain was responsive to clonidine. None of the 3 consistent clonidine responders who were tested with the alpha-adrenergic blocker phentolamine had relief of pain, suggesting that clonidine's pain relief is not mediated by a decrease in sympathetic outflow. A post-hoc analysis of many variables suggested that patients who described their pain as sharp and shooting may have a greater likelihood of responding to clonidine.(ABSTRACT TRUNCATED AT 250 WORDS)

Apparent anticipation and heterogeneous transmission patterns in familial Hodgkin's and non-Hodgkin's lymphoma: report from a study based on Swedish cancer database.

The goal of this study was to test whether there is genetic anticipation in Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). We analyzed 102 parent-child pairs with HD or NHL, based upon the Swedish Cancer Database. We identified 18 sib-pairs (2 HD and 16 NHL) and 102 parent-child pairs (13 HD/HD, 56 NHL/NHL, 25 HD/NHL, and 8 NHL/HD). The mean anticipation score was 27.6 years for all 102 parent-child pairs. The anticipation means were 13.8, 28.4, 19.8 and 35.8 years for these pair-type groups, respectively. These differences between the age of onset for each affected parent-child pair type were statistically significant. The anticipation level was more pronounced among the NHUNHL pairs than in the HD/HD pairs (difference = 12.6 years, p = 0.0003). These results allow us to conclude with confidence that there is an apparent genetic anticipation in familial HD and NHL in the Swedish population.

Analysis of clinical trials involving non-cavitated caries lesions.

Treatments to halt or reverse the progression of non-cavitated caries lesions are of increasing interest. Diagnostic technologies under development offer potential for the assessment of gradual progression and regression of such lesions. Many therapies directed at correcting demineralization-remineralization imbalance should, in principle, protect enamel similarly across lesion severities from initiation to near cavitation. If this is so, and if acceptable reproducibility and predictive validity can be demonstrated for a diagnostic of acceptable cost, then clinical trials of agents to prevent cavitation can become more efficient by the use of outcome indices that reflect, in addition to cavitation, the expansion and regression of non-cavitated lesions. However, to achieve such a benefit will require data analyses that fully exploit ordinal or continuous-scale outcome measures. We consider comparison of such measures of lesion status between treatment groups, with most attention to ordinal categorical data. Interim data from a clinical trial in Lithuanian children are used for illustration.

Periodontal status in the United States, 1988-1991: prevalence, extent, and demographic variation.

This paper reports estimates of the periodontal status of US population derived from data from Phase 1 of the Third National Health and Nutrition Examination Survey conducted by the National Institute of Dental Research from 1988-1991. A total of 7,447 dentate individuals 13 years of age and older, representing approximately 160.3 million civilian non-institutionalized Americans, received a periodontal assessment. Measurements of gingival bleeding, gingival recession level, periodontal pocket depth, and calculus were made by dental examiners. Assessments were made at the mesiobuccal and mid-buccal sites of all fully erupted permanent teeth present in two randomly selected quadrants, one maxillary and one mandibular. All data were weighted and standard errors calculated by special software to adjust for the effect of sample design. Although over 90% of persons 13 years of age or older had experienced some clinical loss of attachment (LA), only 15% exhibited more severe destruction (LA > or = 5 mm). Prevalence of moderate and severe LA and gingival recession increased with age, while prevalence of pockets > or = 4 mm or > or = 6 mm did not. These data suggest that the increasing prevalence of LA with age is more associated with increasing prevalence of recession than with changes in the prevalence of pockets or age. The extent or number of affected sites with advanced conditions for loss of attachment, pocket depth, or recession was not large for any age group. Differences in prevalence of moderate and severe loss of attachment, moderate and deep pockets, and recession were found among gender and race-ethnicity groups. Females exhibited better periodontal health than males, and non-Hispanic whites exhibited better periodontal health than either non-Hispanic blacks or Mexican-Americans.

Mercury concentrations in urine and whole blood associated with amalgam exposure in a US military population.

Minute amounts of mercury vapor are released from dental amalgams. Since mercury vapor is known to be associated with adverse health effects from occupationally exposed persons, questions regarding the margin of safety for exposure to mercury vapor in the general population continue to be raised. To address this issue, one needs information regarding exposure to mercury vapor from dental amalgam fillings and its possible consequences for health in the general population. The NIDR Amalgam Study is designed to obtain precise information on amalgam exposure and health outcomes for a non-occupationally-exposed population of US adults. One hypothesis was that in a generally healthy population a significant association between amalgam exposure and Hg levels in urine and/or whole blood could be detected. The cohort investigated was an adult military population of 1127 healthy males. Their average age was 52.8 years, and their ages varied from 40 to 78 years. Ninety-five percent of the study participants were white males, and slightly over 50% had some college education. Five percent were edentulous. The dentate participants, on average, had 25 natural teeth, 36.9 decayed or filled surfaces (DFS), and 19.9 surfaces exposed to amalgam, with amalgam exposure varying from 0 to 66 surfaces. Their average total and inorganic urinary mercury concentrations were 3.09 microg/L and 2.88 microg/L. The average whole-blood total and inorganic mercury concentrations were 2.55 microg/L and 0.54 microg/L. Significant correlations were detected between amalgam exposure and the total (r = 0.34, p < 0.001) and inorganic 0.34 (r = 0.34, p < 0.001) urinary mercury concentrations on the original scale. Stronger correlations were found for total (r = 0.44, p < 0.001) and inorganic (r = 0.41, p < 0.001) urinary Hg on the log scale, as well as for creatinine-corrected total (r = 0.43, p < 0.001) and inorganic (r = 0.43, p < 0.001) urine concentrations. In whole blood, statistically significant, but biologically weak, correlations were detected for total (r = 0.09, p = 0.005) and inorganic (r = 0.15, p < 0.001) Hg concentrations, respectively. Based on these cross-sectional data, it is estimated that, on average, each ten-surface increase in amalgam exposure is associated with an increase of 1 microg/L mercury in urine concentration.

Interim report of the ad hoc committee for the consideration of statistical concerns related to the use of intra-oral models in submissions for product claims approval to the American Dental Association.

Subsequent to the American Dental Association Symposium on Intra-oral Studies, held in Chicago in September, 1990, the Council on Dental Therapeutics decided that further consideration should be given to statistical issues relating to intra-oral models. The authors accepted the request of Council staff to assist in the development of Guidelines concerning the validity, reliability, and combinability of data obtained from these models. The ensuing work in this area, which began in the fall of 1990 and has continued to date, has thus far focused on the tissue of validity. The purpose of the present paper is to provide the interested community at large with an update on the progress made thus far, and to provide some perspective as to where all of the work in this area may eventually be leading. It is anticipated that a more comprehensive and definitive report will be produced at the completion of this process.

Repeat measurements analysis of dental data.

The statistical analysis of trials in which individuals are evaluated repeatedly at several time points is examined. For the case in which correlations between observations follow a specified pattern, a conservative F test is applied to test for the effects of time and for the interaction between time and treatment groups.

The prevalence of dental sealants in the US population: findings from NHANES III, 1988-1991.

Over the past decade, dental sealants have become recognized as an important adjunct to the use of fluorides in the prevention of dental caries. The most recent national survey of oral health in children conducted in 1986-1987 found that only 7.6% of children had any sealed teeth. As part of the oral health component of the 1988-1991 Third National Health and Examination Survey (NHANES III-Phase 1), the prevalence of dental sealants in children, adolescents, and adults was determined. The presence of dental sealants on posterior teeth (excluding third molars) and maxillary lateral incisors was recorded by visual and tactile methods during the dental caries examination. Findings in this paper are based on those examined persons having at least one sealable primary tooth for children aged 2-11 years (n=3,792); at least one sealable premanent tooth for persons aged 18 years and over (n=7,146). During 1988-1991, about 18.5% of US children and youth ages 5-17 had one or more sealed permanent teeth. A significantly higher percentage of non-Hispanic whites had sealants in comparison with their non-Hispanic black and Mexican-American counterparts (for all contrasts, p<0.001). As expected, molar teeth were the most frequently sealed tooth type. Only 1.4% of US children ages 2-11 had at least one sealed primary tooth. The prevalence of dental sealants decreased in the US adult population with increasing age; 5.5% of adults ages 18-24 had at least one sealed permanent tooth. Data collected from NHANES III-Phase 2 (1991-1994) will be analyzed to determine if the upward trend in sealant use continues.

Denture use and the technical quality of dental prostheses among persons 18-74 years of age: United States, 1988-1991.

For persons without all or some of their natural teeth in one or both arches, the use of a complete or partial denture and the quality of the denture used are important aspects of their oral health and functioning. This report of prosthodontic findings from the first three years of the 1988-94 National Health and Nutrition Examination Survey (NHANES III-Phase 1) provides estimates of denture use among the US civilian non-institutionalized population 18-74 years of age, as well as seminal information on the technical quality of dental prostheses nationwide. NHANES III-Phase 1 prosthodontic findings indicated that about one in five persons 18-74 years of age wears a removable prosthodontic appliance of some type. Overall, removable prosthodontic appliances are worn disproportionately more often by women than by men, and less frequently by whites than by blacks. Comparisons among race-ethnicity categories indicate that Mexican-Americans are less likely to use dentures than either of their non-Hispanic counterparts. Analyses of prosthodontic evaluation data indicated that approximately 60% of denture users have at least one problem with a denture. These findings from the oral component of NHANES III-Phase 1 provide clear indications that, despite increasing trends in tooth retention, dependence on removable prosthodontic appliances is still a reality of life for millions of Americans.

Effects of rinses with an acidic calcium phosphate solution on fluoride uptake, caries, and in situ plaque pH in rats.

The effects of oral rinses on enamel fluoride uptake, caries, and plaque pH in rats were investigated by use of (1) an acidic calcium phosphate solution (CPS) saturated with dicalcium phosphate dihydrate (DCPD) and (2) a 1% fluoride solution. Osborne-Mendel rats, 19 days of age, were randomly assigned to one of four mouth-rinse treatment groups, with the two consecutively administered rinses being: H2O-H2O; H2O-F; CPS-H2O; and CPS-F. The treatments were administered on days 1 through 4, and the animals were provided with a cariogenic challenge throughout the study. The groups treated with F exhibited significantly higher mean levels of enamel-bound F than did the non-F groups. Furthermore, CPS significantly increased uptake of F by enamel when used as an adjunct to the F treatment. The caries scores of the CPS-F and H2O-F groups were not statistically different; however, a strong negative correlation was observed between enamel F content and caries scores, indicating that as more F was incorporated into the teeth, less caries formation occurred. Despite the significant differences in enamel F and caries scores among some of the treatment groups, post mortem in situ plaque pH drop in response to a sucrose rinse showed no differences among these groups.

Periodontal disease in adolescents: some clinical and microbiologic correlates of attachment loss.

The influence of several clinical and microbiological variables on the site-specific risk of attachment loss was studied in Navajo Indian adolescents aged 14-19. Diagnoses were made at mesio-buccal sites of the four first permanent molars. Case-control analytical methods were used, with A. actinomycetemcomitans, B. gingivalis, and B. intermedius considered the "risk" variables, and with calculus, gingival bleeding, age, and gender treated as possible confounders. The presence of B. intermedius significantly increased the likelihood that attachment loss would be diagnosed at a site (odds ratio = 2.86). However, this association was confounded by calculus and gingival bleeding; when either or both were present, the effect of B. intermedius was markedly weaker. Step-wise multiple logistic regression analyses showed that, of the variables considered, the combination of calculus, gingival bleeding, and B. intermedius gave the most parsimonious explanation of the presence of attachment loss. The chance that attachment loss would be diagnosed was increased five times when calculus was present, 16.5 times in the presence of both calculus and gingival bleeding, and 37 times when these variables plus B. intermedius were observed at a particular site.

Comparison of tooth surface-specific dental caries attack patterns in US schoolchildren from two national surveys.

The 1979-1980 and the 1986-1987 National Institute of Dental Research (NIDR) surveys of school-aged children revealed that virtually all tooth surfaces experienced a decrease in caries prevalence during the inter-survey period. Overall, there was a 28% decrease in the proportion of tooth surfaces attacked by caries for the primary dentition between the two surveys. The decrease for primary incisors was numerically small (5 surfaces per thousand surfaces at risk) and not statistically significant, whereas decreases in the canines and primary molars were considerably larger (23 surfaces per thousand) and statistically significant. For the permanent dentition, the overall decrease in the proportion of surfaces attacked was 35% during the 1979-87 period. Differences between the two surveys in the proportions of surfaces with caries were largest for pit and fissure surfaces (56 surfaces per thousand), followed by those for posterior approximal surfaces (14 surfaces per thousand) and all other smooth surfaces (5 surfaces per thousand). Almost all of these differences were statistically significant, except for some surfaces which experienced very few caries.

Effects of sequential calcium phosphate-fluoride rinses on dental plaque, staining, fluoride uptake, and caries in rats.

Oral rinses which included (1) an acidic calcium phosphate solution containing 0.7 M Ca, 1.9 M PO4, and saturated with respect to CaHPO4 . 2H2O, and with a pH of 2.0, followed by (2) a 0.52 M fluoride solution, from NaF or SnF2, were provided to rats once daily for seven days. The investigation consisted of two studies: In the first study, the amounts of dental plaque on the tooth surfaces and fluoride concentrations in the outer enamel were assessed seven days after the last treatment; in the second study, the extent of dental caries was evaluated seven weeks after the last treatment. All rinse sequences containing fluoride provided significant caries protection. The acidic calcium phosphate treatment markedly enhanced the ability of the enamel to acquire fluoride without change of surface morphology. Only the rinse sequences that included stannous fluoride showed significant plaque suppression.

An international collaborative study of laboratory methods for assessing abrasivity to dentin.

An International Collaborative Study was conducted in which one surface profile and two radiotracer methods for assessing abrasivity of dentifrices on human dentin were compared. The study consisted of two phases: an open phase in which participating laboratories used the method they routinely practiced; and a controlled phase in which an expert team for each method performed the abrasion tests using all three methods. Four test pastes of known abrasivity were evaluated by each method. Similar abrasivity values for the test pastes were obtained with the radiotracer methods, whereas the surface profile method produced significantly different values. The precision levels of the radiotracer methods were similar, and both were superior to those obtained by the surface profile method. The time needed to perform the tests by the ADA radiotracer method was significantly less than that needed by the other methods. These findings suggest that the ADA radiotracer method will be useful in assessing abrasivity of dentifrices.

An overview of the oral health component of the 1988-1991 National Health and Nutrition Examination Survey (NHANES III-Phase 1).

As part of a Federal consortium, the National Institute of Dental Research's (NIDR) Division of Epidemiology and Oral Disease Prevention (DEODP) staff and consultants collaborated with the National Center for Health Statistics (NCHS) to conduct a national oral health examination as a component of the 1988-94 National Health and Nutrition Examination Survey (NHANES III). The Phase 1 took place between October 18, 1988, and October 24, 1991, at 44 survey locations; Phase 2, between September 20, 1991, and October 15, 1994, at 45 sites. This article provides general background information on the NHANES III and its oral health examination component which pertains to all six years of the full survey. It also focuses on particular aspects of the first three years of the survey (NHANES III-Phase 1)--the database for the articles in this peer-reviewed Special Issue--and provides the essential context for the substantively oriented analyses of the Phase 1 database which are presented in the articles which follow this overview.

Coronal and root caries in the dentition of adults in the United States, 1988-1991.

Dental public health policy planning requires accurate and current information about the extent of caries in the United States population. These data are available from the caries examination from Phase 1 of the Third National Health and Nutrition Examination Survey, which found that 94% of adults in the United States show evidence of past or present coronal caries. Among the dentate, the mean number of decayed and filled coronal surfaces per person was 21.5. Dentate females had a lower number of untreated coronal tooth surfaces with caries (1.5), but a higher mean number of treated and untreated surfaces per person (22.7) than males, with scores of 2.1 and 20.2, respectively. Estimates for race-ethnicity groups were standarized by age and gender to control for population differences among them. Dentate non-Hispanic blacks (11.9) and Mexican-Americans (14.1) had half the number of decayed and filled coronal surfaces as non-Hispanic whites (24.3), but more untreated surfaces (non-Hispanic whites, 1.5; non-Hispanic blacks, 3.4; Mexican-Americans, 2.8). Mexican-Americans were most likely to be dentate, had the highest average number of teeth, and had 25% fewer decayed, missing, and filled coronal surfaces (37.6) than non-Hispanic blacks (49.2) and non-Hispanic whites (51.0). Root caries affected 22.5% of the dentate population. Blacks had the most treated and untreated root surfaces with caries (1.6), close to the value for Mexican-Americans (1.4). The score for non-Hispanic whites was 1.1. Untreated root caries is most common in dentate non-Hispanic blacks (1.5), followed by Mexican-Americans (1.2), with non-Hispanic whites (0.6) having the fewest untreated carious root surfaces. Race-ethnicity groups were disparate with respect to dental caries; effort is needed to treat active caries common in some population subgroups.

Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994.

BACKGROUND: The aim of this study was to assess the prevalence and extent of gingival recession, gingival bleeding, and dental calculus in United States adults, using data collected in the third National Health and Nutrition Examination Survey (NHANES III). METHODS: The study group consisted of 9,689 persons 30 to 90 years of age obtained by a stratified, multi-stage probability sampling method in 1988 to 1994. The weighted sample is representative of U.S. adults 30 years or older and represents approximately 105.8 million civilian, non-institutionalized Americans. Gingival recession, gingival bleeding, and dental calculus were assessed at the mesio-buccal and mid-buccal surfaces in 2 randomly selected quadrants, one maxillary and one mandibular. Data analysis accounted for the complex sampling design used. RESULTS: We estimate that 23.8 million persons have one or more tooth surfaces with > or = 3 mm gingival recession; 53.2 million have gingival bleeding; 97.1 million have calculus; and 58.3 million have subgingival calculus; and the corresponding percentages are 22.5%, 50.3%, 91.8%, and 55.1% of persons, respectively. The prevalence, extent, and severity of gingival recession increased with age, as did the prevalence of subgingival calculus and the extent of teeth with calculus and gingival bleeding. Males had significantly more gingival recession, gingival bleeding, subgingival calculus, and more teeth with total calculus than females. Of the 3 race/ethnic groups studied, non-Hispanic blacks had the highest prevalence and extent of gingival recession and dental calculus, whereas Mexican Americans had the highest prevalence and extent of gingival bleeding. Mexican Americans had similar prevalence and extent of gingival recession compared with non-Hispanic whites. Gingival recession was much more prevalent and also more severe at the buccal than the mesial surfaces of teeth. Gingival bleeding also was more prevalent at the buccal than mesial surfaces, whereas calculus was most often present at the mesial than buccal surfaces. CONCLUSIONS: Dental calculus, gingival bleeding, and gingival recession are common in the U.S. adult population. In addition to their unfavorable effect on esthetics and self-esteem, these conditions also are associated with destructive periodontal diseases and root caries. Appropriate measures to prevent or control these conditions are desirable, and this may also be effective in improving the oral health of the U.S. adult population.