Test of a method to determine socially acceptable occlusal conditions.

A method for determining the social acceptability for dental appearance across the full range of occlusal conditions found in a natural population was developed and tested. The strategy used in developing the Social Acceptability Scale of Occlusal Conditions (SASOC) was to present photographs of 100 dental study models to a large sample of high school students (n = 880) and their parents (n = 403) whose responses were measured by a semantic differential instrument. After refinement of the semantic differential instrument scale scores were derived for each study model by computing the mean individual scores. Ranks were assigned to the mean scores. The Pearsonian correlation obtained between parent and student subsamples was 0.95. The reliability and validity of SASOC were assessed. COCSTOC measures of specific occlusal traits for these 100 study models are available. The future task involves the development of a highly reliable regression equation for predicting social acceptability scores from a small number of objective physical measurements.

A factor analysis of traits as measured by COCSTOC-MOT to identify occlusal trait combinations.

Occlusal conditions which vary significantly from accepted social norms for dental appearance may socially handicap an individual. An instrument is required by which socially unacceptable occlusal conditions can be identified by members of the public who have internalized society's norms for acceptable dental appearance. The factors identified in this paper make it possible to select a reasonable number (100) of models for constructing a measurement instrument which depicts the full range of occlusal patterns found in a natural population for use in assessing the social acceptability of occlusal conditions. This paper presents the methodology and process used to identify individual occlusal traits which tend to occur together in trait combinations or independently and their range from "normal" to extreme. Data on the frequency distribution of the individual COCSTOC measurements found in a natural population was subjected to a factor analysis which identified 18 occlusal patterns (combinations of traits) and five unique or independent traits or anomalies.

Priorities to preserve fluoride uses: rationales and strategies.

Well-planned, new initiatives are required to preserve fluoride uses, especially water fluoridation. Discussed are barriers to fluoride promotion, evidence about public and health-care providers' knowledge and opinions about fluoride use and decision making, implications of sources of public information on fluorides, consequences to professionals and the public of being misinformed about fluorides, and four general strategies for promoting fluorides under varying conditions. Educational and political initiatives must be appropriate to state needs and conditions. Four broad categories of actions include: diagnosis and planning for education/promotion; public and professional education under both noncontroversial and controversial conditions, political persuasion where required, and changing the context of fluoridation decision making to prevent public referenda on public health measures.

Issues in the widespread adoption of pit-and-fissure sealants.

Seven issues affecting the use of sealants have been discussed, and five strategies have been suggested to promote their wider use in private and public settings. A strong initiative by industry, in conjunction with organized dentistry and government, is needed to generate public demand and to promote appropriate use by practitioners and auxiliaries. The most fruitful market for sealants at present and in the future may be through public health programs using dental auxiliaries, because the primary prevention of dental caries is stressed more in this area, whereas private practitioners tend to focus more on treating caries. During these times of financial restriction, there is all the more reason to focus effective caries prevention on those tooth surfaces that develop more than half of all carious lesions. The most efficient use of the limited private and public funds that are available to promote oral health must be made. Given the new sealant materials available and the opportunity to delegate their application to auxiliary personnel in both private and public practice, the challenge now is to promote the widespread use of this technology in conjunction with appropriate fluorides so that no child is denied the opportunity to enjoy a caries-free dentition.

Future elementary schoolteachers' knowledge and opinions about oral health and community programs.

Dental public health practitioners can play a critical role in assuring that elementary schoolteachers have current, scientifically accurate oral health information upon which to base decisions on behalf of the children they teach. Teachers traditionally have educated children about oral health and often participate in school-based prevention programs. This project examined the knowledge and opinions about oral health and community programs, and the perceived future roles and responsibilities in school-based preventive oral health programs, of 313 elementary education majors enrolled at the University of Minnesota. Descriptive results indicate that these future teachers were ill informed and held inconsistent opinions about basic concepts and information related to oral health and oral health promotion. Findings suggest the need for greater public health efforts directed toward improving oral health knowledge and opinions of this influential population about effective community oral health programs.

Oral health education and promotion in maternal and child health: a position paper.

Oral health education and promotion are the connecting mechanisms among prevention, policy development and program implementation, maintenance and evaluation. Given the preventive procedures available today, all focus populations of women and children should have access to accurate information about such procedures as well as access to the procedures themselves. Furthermore, appropriate methodologies need to be utilized for community oral health education and these methods differ from those commonly used for individual education. In the context of maternal and child health there are unprecedented opportunities for new accomplishments in oral health. The health education model most appropriate for these groups is the public health model, an approach designed to empower as well as inform, and one that fosters shared decision making among community members and health professionals. Dental professionals have the responsibility to address this challenge, and to help correct the health information inequities that prevail, especially among the traditionally informationally disenfranchised subfocus populations discussed in this paper.

School-based preventive regimens and oral health knowledge and practices of sixth graders.

The purpose of this study was to examine the oral health knowledge and reported practices of sixth grade students in Wichita, Kansas. A quasi-experimental design was used to test differences between two groups: (1) children who had completed a four-year regimen referred to as the National Preventive Dentistry Demonstration Program (NPDDP), and (2) a control group of children who had not been exposed to any aspect of the NPDDP. Based on incidental learning theory, the research question was whether or not students' knowledge and practices were consistent with the preventive regimes provided at school. The study reported here was not directly connected with the NPDDP. A school nurse-administered questionnaire was obtained from 284 students 16 months after the NPDDP had terminated. Students in all groups reported similar dental health practices; no practical differences were found among groups with regard to knowledge about appropriate fluoride uses and benefits. Students who received sealants were somewhat more knowledgeable about the use and purpose of sealants. Although students in five of the six NPDDP groups had received preventive regimens, these data suggest that they lacked awareness and understanding of the procedures and their value in preventing oral diseases. Generally, students were unable to discriminate among methods appropriate for preventing dental caries and periodontal diseases. Education regarding the purpose and value of preventive regimens should be consistent with, and an integral part of, the delivery of such services.

Dental hygienists' knowledge and opinions about fluorides and fluoridation.

This article reports results of a study of 563 practicing Minnesota and Wisconsin dental hygienists' knowledge and opinions about fluorides and water fluoridation. Two independent samples were selected randomly from the populations of licensed dental hygienists residing in the two states. Data were collected using a pretested, 42-item, mailed questionnaire. An 84 percent response was achieved with two followup reminders. These data provide baseline information about the caries prevention knowledge and attitudes of practicing dental hygienists in two states. Respondents from both states held similar levels of knowledge about fluorides and opinions about decision making on fluoridation. Fluoride topics, especially water fluoridation, were not receiving high priority in patient education, although nearly all believed that dental hygienists should promote water fluoridation actively. Two-thirds of respondents from both states believed fluoridation decisions should be made by health authorities, rather than by elected officials or through public vote. Greater attention to patient education about fluoride and community water fluoridation is needed by dental hygienists.

Dental hygienists' knowledge, opinions, and use of pit and fissure sealants: a comparison of two states.

This article reports results of a study of 563 practicing Minnesota and Wisconsin dental hygienists' knowledge, opinions, and use of pit and fissure sealants. The study was carried out six months prior to the 1983 NIH Consensus Development Conference on Dental Sealants in the Prevention of Tooth Decay. It therefore provides baseline information for two states prior to the initiation of widespread public information about the positive value of sealants that occurred as a result of that conference. Such baseline information is relevant for future studies of the diffusion of adoption of this caries-preventive technology by dental hygienists. Two independent samples were selected randomly from the populations of licensed dental hygienists residing in the two states. Data were collected using a 42-item mailed questionnaire, with an 84 percent response. Data were analyzed for both interstate and intrastate comparisons. Respondents were generally knowledgeable and had favorable opinions about sealants, although they had low levels of training in their use. Sealants were being used in 54 percent of the offices in which respondents practiced, with the dentist placing them most often. Among hygienists who applied sealants at all, more than two-thirds did so three or fewer times per week. Eighty-four percent indicated they would like to apply sealants more often. The most frequent reasons given for nonuse were lack of acceptance by the dentist-employer and nondelegation.

Knowledge and attitudes of schoolteachers toward oral health programs and preventive dentistry.

Because teachers often take on major roles in school dental health programs, three surveys were completed between 1973 and 1981 to measure teachers' attitudes and knowledge about oral health and their own participation in school programs. The questionnaires were sent to teachers whose schools were included in major dental caries preventive programs and teachers whose schools were not included in such programs. Results showed that: Teachers were quite willing to teach oral health topics and were willing to take on a wide range of teaching, but not administrative, responsibilities. Teachers' acceptance of these responsibilities appeared to decrease during the surveys, possibly as a function of school budget difficulties, indicating a need for incentives and positive rein-forcement. However, their acceptance of responsibilities was not affected by their participation in preventive programs. Schoolteachers had basic misinformation about the purposes of personal oral hygiene, and about the relative effectiveness of measures such as oral hygiene and consumption of fluoridated water in preventing dental caries. The preventive knowledge of teachers was unaffected by either the passage of time or participation in school preventive programs. A series of recommendations is given for the inservice education of school-teachers.

Health educational aspects of preventive dental programs for school-age children in 34 countries--final results of an FDI international survey.

The survey was conducted as part of a project of the Working Group on Oral Health Promotion of CORE, in order to provide a basis for the FDI to plan ways to assist its member associations in developing successful preventive dental programs for school-age children. Mail questionnaires were distributed through national dental associations and completed by dental program directors. A total of 119 responses from 34 countries has been analysed. The programs reported tended to be young, supported by public funds, carried out in schools and part of ongoing agency or organizational programs. Instructional activities were the most frequently mentioned service provided routinely for all children, followed by early detection and treatment services. Primary preventive services appeared to be provided least frequently. About 60 per cent of programs served children drinking water from central sources, but only 16 per cent of programs served children drinking optimally fluoridated water. Water fluoridation was the most frequently mentioned procedure that respondents would have liked to see added or extended if additional resources were to be made available. Program organization was the most frequently mentioned reason for program success. The five most frequently mentioned barriers were insufficient financial resources (most often cited), manpower limitations, low public acceptance, non-supportive attitudes among policy makers and inadequate facilities. As a result of the survey three major needs were identified: (1) the need for more efficient application of known effective primary protective methods, especially against dental caries; (2) the need to improve the correspondence between program objectives, the types of services provided and the evaluation methods used to assess and evaluate program achievements; and (3) the need for greater understanding of the scope of community health educational aspects of oral health, prevention and dental treatment. Specification of these and similar problems should lead the FDI working group to recommend priorities on the type of assistance to provide to member nations and the manner of its provision, perhaps in concert with the World Health Organization and the International Association for Dental Research.

Preventive dental programs for school-age children in 8 countries: pilot survey, 1979.

This paper reports the results of a pilot project, sponsored by the FDI Working Group on Oral Health Promotion, which was designed to describe preventive dental programs for school-age children in 10 countries. A mail questionnaire was developed to obtain information about program philosophy, target population, preventive program components, promotion and educational methods, barriers to program development, program priorities and evaluation methods. In this pilot phase, a total of 27 questionnaires were returned from 8 countries (Argentina, Federal Republic of Germany, France, Japan, Singapore, Sweden, Thailand, United Kingdom). Respondents generally recognized the need to include three major program elements in order to build comprehensive programs, primary preventive measures, early detection and treatment services, and instructional activities for children and adults. Financial problems were cited most frequently as barriers to program development, followed by manpower, public acceptance, policy decisions, policy-maker attitudes, legal constraints and transportation. The domain of educational problems associated with initiating and maintaining children's preventive dental programs is broad and diverse. Educational problems, roles and methods seemed to be pervasive, cutting across all program components. Although the greatest educational emphasis appeared to be on oral hygiene, the need was also recognized to include educational components for each dental program element or service, such as fluoride rinsing. Educational needs related not only to children, but to policy-makers, dental and other health professionals and program and school personnel. The FDI Working Group has expanded the survey and collected data from a much larger number of countries during 1979-1981. Results of the larger survey will be presented at the Annual World Dental Congress of the FDI in Vienna, 1982.

Use of sealants: societal and professional factors.

At present, sealant use continues at a low level in private practice by dentists and hygienists, and is moderate in community programs although there is high interest in their use in public health settings. Widespread delegation of sealant application to hygienists has not occurred even though the majority of state dental practice acts allow it, and even though practicing hygienists are highly interested in applying sealants. Use in federally sponsored programs is minimal or nonexistent. Information about sealants and adequate clinical experience in their application appear minimal in dental training institutions, and few opportunities have existed for continuing education. Generally, knowledge about sealants among dentists is low; many hold doubtful opinions. Insurance carriers, including commercial, provider, and governmental programs, appear reluctant to reimburse for sealants without purchaser demand and organized dentistry's blessings. Although society emphasizes patient rights to informed consent, few opportunities exist for the public, including group insurance purchasers and union negotiators, to learn about sealant use in conjunction with appropriate fluoride use. Public educational materials are sparse. Manufacturer marketing efforts at present, aimed at providers alone, are at best minimal, with a few exceptions; those targeting the public are nonexistent. Organized dentistry's Council statements may have contributed to a constriction, to date, in the flow of public information about sealants from industry. Lack of communication, or miscommunication, between practitioners and dental scientists has resulted in much misinformation and confusion about the value of sealants and their use. And, the contemporary status of dental manpower and the economy of dental practice in the private sector appear to have provided an infertile environment for acceptance of sealants as a primary preventive technology. In the public sector, interest in sealants is high but two primary constraints are inadequate manpower and lack of financial resources. Clearly there has been a time-lag in the adoption of new sealant products, and it is apparent that no one factor can explain this lag; rather, many complex factors must be taken into account simultaneously. Extent of need does not appear to have influenced use, to date. Often, social change is slow, and all things considered, the lag observed for sealants may not be totally unreasonable.(ABSTRACT TRUNCATED AT 250 WORDS)

Impact of an NIDR educational program on the teaching of caries prevention in dental hygiene.

An evaluation is reported of selected educational and promotional activities of the National Institute of Dental Research related to caries prevention. Data were collected from U.S. dental hygiene program directors (n = 183) and faculty (n = 718) by mail questionnaire between November 1984 and May 1985. The impact of NIDR activities on the caries prevention curricula in dental hygiene education programs was investigated. Results show that the educational activities of the NIDR, as well as selected state and program characteristics, are associated with differences in the caries prevention curricula of dental hygiene programs and the caries prevention teaching of the faculty. The more frequent and the more personal the contact with NIDR activities, the greater the emphasis given to caries prevention in the curriculum structure and in the teaching practices of the faculty.