Oral health knowledge levels of Hispanics in Iowa.

BACKGROUND: Hispanics disproportionately experience preventable oral health conditions in the United States. This study aimed to determine the oral health knowledge (OHK) of Hispanic adults in Iowa to identify potential gaps in knowledge. METHODS: This cross-sectional study included a convenience sample of self-identifying Hispanic adults. Data pertaining to oral health literacy and demographic, cultural, and dental characteristics were collected. OHK was assessed with the Conceptual Measure of Oral Health Knowledge, and it was categorized as low or high. Bivariate analyses and multiple logistic regression models were conducted to identify the variables related to OHK (P < .05). Institutional review board approval was obtained. RESULTS: Three hundred thirty-eight participants completed the questionnaire, 68% of participants completed the questionnaire in Spanish, and 51% of all participants had low OHK. Participants were less likely to correctly answer questions pertaining to children's oral health, periodontal disease, and oral cancer. Low OHK was associated with having less than 12th grade education, lack of dental insurance, and preference for a Spanish-speaking oral health care provider. CONCLUSIONS AND PRACTICAL IMPLICATIONS: OHK appears to be low in this population. Increasing OHK may help decrease oral health disparities and improve oral health outcomes. Furthermore, it is important that oral health care providers have an understanding of barriers that can impede patients' understanding of the health care system. Specifically, minority populations, such as Hispanics, may have a harder time because of certain cultural differences that exist among this ethnic group.

Oral Health Literacy and Measures of Periodontal Disease.

BACKGROUND: Existing evidence demonstrating a relationship between health literacy (HL) and periodontal health is insufficient to identify how providers can help patients manage periodontal disease. This study assesses associations between HL measures (word recognition, numeracy, and conceptual knowledge) and signs of periodontal disease. METHODS: This study included 325 new patients at a dental school clinic and employed an oral HL (OHL) survey, full-mouth radiographs, and clinical examination. Evaluations included the relationship between each HL measure versus number of teeth, bleeding score, plaque score, and periodontal severity with linear and ordinal logistic regression models before and after adjusting for covariates. RESULTS: Among HL measures, the Newest Vital Sign demonstrated a significant relationship with number of teeth and the Short Test of Functional Health Literacy in Adults showed a significant association with plaque score. The short Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALMD-20) showed participants who performed in the highest quartile had nearly two additional teeth, over 5.5% fewer bleeding sites, and nearly 9% fewer teeth with plaque after adjustment for demographic variables, smoking, and diabetes mellitus (DM). Participants who scored in the highest quartile of the Comprehensive Measure of Oral Health Knowledge (CMOHK) had nearly 9% less plaque. CONCLUSIONS: Two OHL instruments (REAMLD-20 and CMOHK) provided statistical associations with clinical measures of periodontal health at a level that could be considered of moderate clinical relevancy. Findings suggest dentists may wish to assess familiarity of their patients with dental terminology and knowledge of periodontal disease to provide education on oral hygiene, smoking, and DM.

A genome-wide association study of myasthenia gravis.

IMPORTANCE: Myasthenia gravis is a chronic, autoimmune, neuromuscular disease characterized by fluctuating weakness of voluntary muscle groups. Although genetic factors are known to play a role in this neuroimmunological condition, the genetic etiology underlying myasthenia gravis is not well understood. OBJECTIVE: To identify genetic variants that alter susceptibility to myasthenia gravis, we performed a genome-wide association study. DESIGN, SETTING, AND PARTICIPANTS: DNA was obtained from 1032 white individuals from North America diagnosed as having acetylcholine receptor antibody-positive myasthenia gravis and 1998 race/ethnicity-matched control individuals from January 2010 to January 2011. These samples were genotyped on Illumina OmniExpress single-nucleotide polymorphism arrays. An independent cohort of 423 Italian cases and 467 Italian control individuals were used for replication. MAIN OUTCOMES AND MEASURES: We calculated P values for association between 8,114,394 genotyped and imputed variants across the genome and risk for developing myasthenia gravis using logistic regression modeling. A threshold P value of 5.0×10(-8) was set for genome-wide significance after Bonferroni correction for multiple testing. RESULTS: In the overall case-control cohort, we identified association signals at CTLA4 (rs231770; P=3.98×10(-8); odds ratio, 1.37; 95% CI, 1.25-1.49), HLA-DQA1 (rs9271871; P=1.08×10(-8); odds ratio, 2.31; 95% CI, 2.02-2.60), and TNFRSF11A (rs4263037; P=1.60×10(-9); odds ratio, 1.41; 95% CI, 1.29-1.53). These findings replicated for CTLA4 and HLA-DQA1 in an independent cohort of Italian cases and control individuals. Further analysis revealed distinct, but overlapping, disease-associated loci for early- and late-onset forms of myasthenia gravis. In the late-onset cases, we identified 2 association peaks: one was located in TNFRSF11A (rs4263037; P=1.32×10(-12); odds ratio, 1.56; 95% CI, 1.44-1.68) and the other was detected in the major histocompatibility complex on chromosome 6p21 (HLA-DQA1; rs9271871; P=7.02×10(-18); odds ratio, 4.27; 95% CI, 3.92-4.62). Association within the major histocompatibility complex region was also observed in early-onset cases (HLA-DQA1; rs601006; P=2.52×10(-11); odds ratio, 4.0; 95% CI, 3.57-4.43), although the set of single-nucleotide polymorphisms was different from that implicated among late-onset cases. CONCLUSIONS AND RELEVANCE: Our genetic data provide insights into aberrant cellular mechanisms responsible for this prototypical autoimmune disorder. They also suggest that clinical trials of immunomodulatory drugs related to CTLA4 and that are already Food and Drug Administration approved as therapies for other autoimmune diseases could be considered for patients with refractory disease.

Oral health knowledge among elderly patients.

BACKGROUND: The purpose of this study was to determine the level of oral health knowledge among patients 65 years or older to identify areas in which knowledge gaps exist. METHODS: The authors administered the Comprehensive Measure of Oral Health Knowledge questionnaire to patients 65 years or older at a university-based dental clinic and examined associations between oral health knowledge scores and participants' demographic and dental characteristics. RESULTS: Most participants were familiar with basic dental disease prevention and treatment; however, many participants were unfamiliar with concepts pertaining to periodontal disease, oral cancer, and children's oral health. CONCLUSIONS: Advocates for geriatric oral health should educate elderly populations about the risk factors associated with periodontal disease and oral cancer, especially as they become more at risk of experiencing these diseases. PRACTICAL IMPLICATIONS: Educational messages aimed at both routine and nonroutine users of dental care should be developed on the basis of universal health literacy principles to facilitate understanding among elderly adults, who have varying literacy levels.

Community Awareness of HPV Screening and Vaccination in Odisha.

Introduction. A number of new technologies including cervical cancer screening and vaccination have introduced new tools in the fight against cervical cancer. Methods. This study was set in Odisha, India, at the Acharya Harihar Regional Cancer Center and study research infrastructure at the Asian Institute of Public Health. IRB approvals were obtained and a research assistant recruited 286 women aged 18-49 years, who provided informed consent and completed a survey tool. Data were entered into EpiData software and statistical analysis was conducted. Results. 76.3% women participants were married, 45.5% had sexual debut at age 21 or greater, 60.5% used contraception, 12.2% reported having a Pap smear in the past, and 4.9% reported having prior genital warts. Most, 68.8% had never heard of HPV and 11.9% were aware that HPV is the main cause of cervical cancer. 82.9% women thought that vaccinations prevent disease, and 74.8% said they make the decision to vaccinate their children. Conclusion. The Odisha community demonstrated a low level of knowledge about cervical cancer prevention, accepted vaccinations in the prevention of disease and screening, and identified mothers/guardians as the key family contacts.

Oral cancer examinations among smokers and moderate-heavy drinkers, United States, 2008.

OBJECTIVES: Smoking and moderate-heavy alcohol consumption are primary risk factors for oral cancer. This report uses national data to test whether adults with these risk factors received oral cancer examinations (OCEs) at a rate consistent with their risk. METHODS: Data from the 2008 National Health Interview Survey (NHIS) were used for this analysis. The main outcome variables described lifetime receipt of extraoral or intraoral OCEs. Other variables described health-care visits, as well as the timing of, reasons for, and type of practitioner providing the most recent OCE. Descriptor variables were smoking and drinking status. Covariates included several sociodemographic factors. Weighted bivariate and multivariable analyses were conducted using SUDAAN software. RESULTS: According to the 2008 NHIS, about 34 percent of adults aged 40 years or older reported receiving either an extraoral or intraoral examination during their lifetime. Current smokers were no more likely to have received an OCE than were never smokers, controlling for relevant covariates. Moderate-heavy drinkers and light drinkers were significantly more likely to have received an OCE than were lifetime abstainers. CONCLUSIONS: Current smokers did not receive OCEs at a rate consistent with their increased risk, whereas moderate-heavy drinkers did. One explanation for this finding is that medical and dental visit behaviors indirectly influenced OCE rates. Dentition status played an important role, as having teeth is strongly associated with dental visit behaviors. Health-care practitioners are encouraged to consider the smoking and drinking statuses of their patients when they conduct routine physical examinations of the head and neck.

Using toluidine blue as an adjunct to oral visual cancer screening among high-risk individuals may lead to increased detection of oral submucous fibrosis.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: A community-based RCT for oral cancer screening with toluidine blue. Su WW, Yen AM, Chiu SY, Chen TH. J Dent Res 2010;89(9):933-7. REVIEWER: Mark D. Macek, DDS, DrPH PURPOSE/QUESTION: Does using toluidine blue as an adjunctive tool for oral visual cancer screening lead to higher detection rates of oral premalignant lesions among high-risk populations? SOURCE OF FUNDING: Information not available TYPE OF STUDY/DESIGN: Randomized controlled trial LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Not applicable.

Measuring conceptual health knowledge in the context of oral health literacy: preliminary results.

OBJECTIVES: Health literacy encompasses several abilities including word recognition, reading comprehension, communication skills, and conceptual knowledge. To date, conceptual knowledge has not been included in oral health literacy research. This study assesses the validity and reliability of a new instrument and describes conceptual oral health knowledge among a sample of low-income adults. METHODS: One hundred Baltimore adults were administered the Rapid Estimate of Adult Literacy in Medicine (REALM), Short Test of Functional Health Literacy in Adults (Short-TOFHLA), and a new survey of conceptual oral health knowledge. Respondents were also asked about sociodemographics, dental health, and utilization. RESULTS: Psychometric analysis was used to identify a subset of oral health knowledge questions from the new survey instrument. The resulting Comprehensive Measure of Oral Health Knowledge (CMOHK) was categorized into three levels of knowledge (poor, fair, good). Nearly one-third of Baltimore adults exhibited the lowest level. CMOHK scores were significantly associated with age, education level, and word recognition (REALM). CMOHK scores were not associated with reading comprehension (Short-TOFHLA) or dental care visits. Instrument reliability was good (Cronbach alpha = 0.74). CONCLUSIONS: This preliminary study yielded a new measure of oral health conceptual knowledge, available for use in future oral health literacy studies. The author presents a conceptual framework of oral health literacy that separates health literacy into four unique components and places decision-making at the center. Future studies are needed to determine whether this framework is supported by empirical data and leads to improvements in oral health and reductions in health disparities.

Race/ethnicity and untreated dental caries: the impact of material and behavioral factors.

OBJECTIVE: To use nationally representative data, group variables into categories of material and behavioral factors, and assess their relative contribution to racial/ethnic variation in untreated caries. METHODS: Participants were from the Third National Health and Nutrition Examination Survey (NHANES III), aged 20-50 years. Material factors were income, education, employment status, dental insurance status, and urban residence. Behavioral factors were marital status, tobacco use, alcohol use, obesity, and social support. All models were additionally adjusted for age, gender, and quartile of missing teeth. The outcome was three or more carious teeth. RESULTS: Non-Hispanic blacks and Mexican-Americans displayed excess risk of untreated caries compared with non-Hispanic whites when adjusted for age, sex, and missing teeth (adjusted odds ratios 1.73 and 1.69, respectively). The addition of behavioral factors to this model resulted in virtually no changes in the adjusted odds ratios for race/ethnicity and untreated caries. When material factors were added to the basic model the excess risk for untreated caries among non-Hispanic blacks was reduced by approximately 21% and that of Mexican-Americans was no longer statistically significant compared with non-Hispanic whites (adjusted odds ratios 1.36 and 0.83, respectively). CONCLUSIONS: Much of the excess risk for untreated dental caries among non-Hispanic blacks and Mexican-Americans compared with non-Hispanic whites was eliminated when material factors were controlled, while no risk reductions were observed when behavioral factors were controlled. Addressing material factors may provide greater reductions in untreated caries disparities than behavioral interventions, and these risk reductions may vary with racial/ethnic group.

Oral cancer examinations among adults at high risk: findings from the 1998 National Health Interview Survey.

OBJECTIVES: Cigarette smoking and alcohol use are risk factors for oral and pharyngeal cancer. Recommendations for periodic oral cancer examinations highlight the importance of examining high-risk smokers and alcohol users. This investigation assessed whether cigarette smoking and alcohol use were associated with receipt of an oral cancer examination. METHODS: The cross-sectional 1998 National Health Interview Survey was used. Covariates included age, sex, race/ethnicity, poverty status, and geographic region. Weighted bivariate and multivariate analyses were stratified by dentition status and limited to adults aged > or = 40 years. RESULTS: Regardless of dentition status, current smokers were no more likely to have received an examination than were never smokers. The associations between alcohol use and receipt of an examination were mixed, and were generally more favorable among those who had a dental visit in the last year. Dentate current and former alcohol users were more likely than abstainers to have received an examination. There was no statistically significant association between alcohol use and receipt of an oral cancer examination among edentulous adults. CONCLUSIONS: Practitioners should improve the provision rates of oral cancer examinations in accordance with published guidelines, especially among current smokers and edentulous alcohol users who have not been to the dentist in the last year. Recommendations for improvement are presented.