Tap water filtration and purification usage and their impact on the concentrations of fluoride and other minerals - A community-based study.

OBJECTIVE: This study investigated the prevalence of water filtration and purification system (WFPS) use among residents of central Indiana (USA) and determined the effects of WFPS on the concentrations of fluoride, calcium, magnesium, potassium, and sodium in tap water. METHODS: A census-based questionnaire collected data on demographics, water use, and water sources. Participants were also asked to provide water samples from their tap water or the WFPS they used. Water samples were analyzed using ion-specific electrodes (fluoride) and atomic absorption spectrometry (metals). Mineral concentration comparisons between water sources used nonparametric tests; questionnaire associations were testing using correlations, chi-square tests, and nonparametric tests. RESULTS: One hundred and one participants completed the study, of which 71 % used some type of WFPS. Blacks were less likely to use WFPS than Asian or White participants (p = 0.045). Those with bachelor's degrees or higher were more likely to use WFPS (p = 0.003). The most used WFPS were pitcher filters (31 %), water softeners (21 %), reverse osmosis systems (11 %), faucet-mounted filters (4 %), and whole-house carbon filters (1 %). Reverse osmosis systems resulted in the lowest mineral concentrations (median, ppm; F-0.08, Ca-2.30, Mg-0.46, Na-4.60, P-0.35). Pitcher filters were largely comparable to unfiltered tap water. Water softeners resulted in the highest sodium concentrations (78.40 ppm). CONCLUSION: A large proportion of study participants use WFPS, with pitcher filters being the most common. Reverse osmosis systems had the most significant impact on reducing mineral levels in tap water, while pitcher filters do not adversely affect mineral concentrations. CLINICAL SIGNIFICANCE: Understanding how different WFPS affect the various minerals in tap water is essential for helping consumers in choosing the right system and for oral care providers to guide patients on water consumption and the need for fluoride supplementation, especially for those at high risk of dental caries.

Objective characterization of dental occlusal and fissure morphologies: Method development and exploratory analysis.

OBJECTIVE: To develop clinically applicable methods to characterize occlusal topography and assess possible associations between morphology and caries incidence and development. DESIGN: In this retrospective clinical study, we evaluated caries presence and severity pre- and post-orthodontic treatment for first molars of 147 patients (384 teeth). These teeth were previously scanned using a clinical intraoral scanner, and the obtained digital elevation models were used to 1) analyze the 3D occlusal surface parameters (n = 384) and 2) quantitatively characterize the mandibular molars' (n = 166) fissure patterns using three novel methods. Pearson correlation coefficients were calculated to evaluate the associations among the measurements, and presence/severity of caries pre- and post-treatment were assessed using generalized linear mixed-effects models. RESULTS: Robust quantitative fissure characterizations were developed, and reliable occlusal surface parameters were obtained. In the studied population, none of the parametric measurements (Slope: p = 0.62 for presence, p = 0.96 for severity; Relief Index (RFI): p = 0.36, p = 0.84; Orientation Patch Count rotated (OPCr): p = 0.48, p = 0.13; Dirichlet Normal Energy (DNE): p = 0.91, p = 0.15) or the fissure morphological measurements (Mesial Angle: p = 0.43; Distal Angle: p = 0.86; Average Angle: p = 0.52; Area Difference: p = 0.83; Percent Fissure: p = 0.68) were found to be significantly associated with caries status or severity. CONCLUSION: Despite the lack of correlation in the limited studied sample, the tools developed to characterize occlusal surface topography and fissure morphology have the potential to be used in more comprehensive clinical evaluations.

Impact of early childhood caries severity on oral health-related quality of life among preschool children in Mexico: A cross-sectional study.

BACKGROUND: Information is scarce on Early Childhood Caries (ECC) in Mexican preschool children and its impact on quality of life. AIM: To evaluate the ECC prevalence and its impact on OHRQoL in 3-5 years-old Mexican children according to disease severity. DESIGN: Caries was determined at two thresholds: (1) children with at least one caries lesion (ICDAS-1-6) and (2) children with at least one lesion in dentin (ICDAS-3-6). OHRQoL was assessed through the Mexican Early Childhood Oral Health Impact Scale (M-ECOHIS). Associations among caries severity, M-ECOHIS, and other variables were assessed by ordinal logistic regression. RESULTS: A total of 409 children participated (53.8% girls, 46.2% boys). Caries prevalence was 82.2% considering all lesions, and 45.0% for dentinal lesions. Significant linear trends (p < .05) among caries levels and categories of exposure were found for socioeconomic variables, dietary habits, and toothbrushing habits. Attending rural private schools (OR = 1.39, 95%CI = 1.11-1.72; p < .01), two main meals/day (OR = 2.75, 95%CI = 1.26-6.03; p = .01) and unsupervised toothbrushing (OR = 3.20, 95%CI = 1.96-5.24; p < .01) increased the risk to have high caries severity levels. M-ECOHIS scores were statistically significant associated with caries levels (χ2 (4)  = 175.85, p < .01; trend across groups z = 12.63 Prob > |z| < 0.01). CONCLUSIONS: M-ECOHIS was significantly associated with caries severity. Type of school, age groups, parents' educational level, family income, and living conditions were correlated with caries, showing how distinctive risk indicators were associated with different caries stages.

An investigation into the potential anticaries benefits and contributions to mineral intake of bottled water.

BACKGROUND: Bottled water has become the most consumed beverage in the United States. The authors aimed to inform the dental profession about the potential anticaries benefits of some bottled waters and to provide information about their possible contributions to fluoride, calcium, magnesium, sodium, and potassium intakes. METHODS: The authors chose a convenience sample by purchasing all different bottled waters from the main supermarkets operating in Indianapolis, Indiana. The authors analyzed the fluoride content using a fluoride ion-specific electrode and metal concentrations using atomic absorption spectroscopy. They used dietary reference intakes to calculate hypothetical intakes of all minerals. RESULTS: The authors identified 92 different bottled waters. Fluoride concentrations were generally low (mean, 0.11 parts per million [ppm]; median, 0.04 ppm). Only 2 waters contained more than 0.7 ppm fluoride (0.95 ppm and 1.22 ppm). Metal concentrations varied considerably among waters. Calcium concentrations ranged from less than 0.1 through 360 ppm (mean, 26.9 ppm; median, 5.2 ppm), which were greater than those of magnesium (range, < 0.01-106 ppm; mean, 7.5 ppm; median, 1.9 ppm), sodium (range, < 0.01-109 ppm; mean, 11.1 ppm; median, 2.9 ppm), and potassium (range, < 0.01-43 ppm; mean, 3.6 ppm; median, 1.2 ppm). Overall, most bottled waters do not contribute to adequate intakes of fluoride, potassium, or sodium or to recommended dietary allowances for calcium and magnesium. Nonetheless, some waters can provide meaningful contributions to fluoride, calcium, and magnesium intake. CONCLUSIONS: The fluoride concentration in 90 of the 92 studied bottled waters is insufficient to contribute to caries prevention. Only a few bottled waters can be considered health-promoting. PRACTICAL IMPLICATIONS: Dental professionals should consider the mineral content of water consumed by their patients during caries risk assessment.

Prevalence of molar-incisor hypomineralization and other enamel defects and associated sociodemographic determinants in Indiana.

BACKGROUND: The aim of this study was to determine the prevalence and severity of molar-incisor hypomineralization (MIH) in a cohort of school-aged children in Indiana. METHODS: A calibrated examiner screened eligible school-aged children for MIH and other enamel defects. The authors used the integrated Modified Developmental Defects of Enamel Index and the European Academy of Pediatric Dentistry criteria to examine the permanent first molars, permanent incisors, and primary second molars. The authors used descriptive statistics, exact 95% confidence intervals, and χ2 tests for analysis (α = 5%). RESULTS: A total of 337 participants (mean [standard deviation] age, 9.1 (1.7) years; 52% 6 through 8 years; 66% non-Hispanic white) were examined. The prevalence estimate for MIH was 13% as opposed to a 52% prevalence estimate for any enamel defect (AED) of any of the index teeth. Living in an area with water fluoridation levels greater than 0.7 parts per million or being non-Hispanic black was significantly associated with higher prevalence of AED (P < .05) but not with the prevalence of MIH. Demarcated opacities were the most prevalent defects (43%), followed by atypical restorations (32%). Higher age and higher number of MIH-affected surfaces were associated with larger MIH defect extension (P < .05). CONCLUSIONS: Nearly 1 in 6 children in Indiana had at least 1 permanent first molar with MIH. Water fluoridation levels and race or ethnicity were associated with the prevalence of AED but not with MIH prevalence. PRACTICAL IMPLICATIONS: US dental practitioners should be cognizant that MIH is a common finding. Children with a high number of MIH-affected surfaces would benefit the most from early identification and management as the extension of the defects tends to worsen with age.

Acceptance of Behavior Guidance Techniques Used in Pediatric Dentistry by Parents From Diverse Backgrounds.

Objective. To investigate if parental background affects acceptance of behavior guidance techniques. Background. Behavior guidance techniques are used for the safe and effective treatment of pediatric patients. Acceptance of these techniques may vary by racial and ethnic background. Methods. A total of 142 parents were recruited and asked to rate videos showing: active restraint/protective stabilization (AR), general anesthesia (GA), nitrous oxide sedation (N2O), oral premedication/sedation (OP), passive restraint/protective stabilization (PR), tell-show-do (TSD), and voice control (VC) techniques. Results. Hispanic parents rated VC most acceptable, followed by TSD, PR, and pharmacologic techniques. Black and white parents rated TSD, followed by N2O, as most acceptable, and AR and PR as least favorable. Hispanics found GA significantly less acceptable than whites or blacks. Hispanics were less accepting of AR than blacks; but more accepting of PR than whites. TSD was highly rated among all 3 cohorts. Parental background affected acceptance of the techniques in this study.

Midwestern Latino caregivers' knowledge, attitudes and sense making of the oral health etiology, prevention and barriers that inhibit their children's oral health: a CBPR approach.

BACKGROUND: Using community-based participatory research, the Health Protection Model was used to understand the cultural experiences, attitudes, knowledge and behaviors surrounding caries etiology, its prevention and barriers to accessing oral health care for children of Latino parents residing in Central Indiana. METHODS: A community reference group (CBPR) was established and bi-lingual community research associates were used to conduct focus groups comprised of Latino caregivers. Transcripts were analyzed for thematic content using inductive thematic analysis. RESULTS: Results indicated significant gaps in parental knowledge regarding caries etiology and prevention, with cultural underlays. Most parents believed the etiology of caries was related to the child's ingestion of certain foods containing high amounts of carbohydrates. Fewer parents believed either genetics/biological inheritance or bacteria was the primary causative factor. Fatalism negatively impacted preventive practices, and a clear separation existed concerning the perceived responsibilities of mothers and fathers to provide for the oral needs of their children. Females were more likely to report they were primarily responsible for brushing their children's teeth, overseeing the child's diet and seeking dental care for the child. Fathers believed they were primarily responsible for providing the means to pay for professional care. Perceived barriers to care were related to finances and communication difficulties, especially communicating with providers and completing insurance forms. CONCLUSION: The main study implication is the demonstration of how the CBPR model provided enhanced understanding of Latino caregivers' experiences to inform improvements in oral prevention and treatment of their children. Current efforts continue to employ CBPR to implement programs to address the needs of this vulnerable population.

Fluoride in the diet of 2-years-old children.

OBJECTIVES: This study aimed to calculate the fluoride concentrations of commonly consumed foods and beverages for 2-years-old children utilizing market basket information for the US Midwest region. METHODS: Total Diet Study food lists were cross-referenced with National Health and Nutrition Examination Survey-What We Eat in America data to determine the foods and beverages to be included. Fluoride concentrations were determined using a modification of the hexamethyldisiloxane microdiffusion technique. Fluoride concentrations were summarized for each of the food categories. Daily dietary fluoride intake was estimated using a simulation analysis. RESULTS: Food and beverage fluoride concentrations varied widely, ranging from nondetectable for some oils and dairy products to more than 3.0 µgF/g food for some processed meats, fish and fruits. The estimated mean (±SD) daily dietary fluoride intake, excluding dentifrice and supplements, was 412±114 µgF/d. The estimated average ingestion for a 2-years-old weighing 12.24 kg was 0.034±0.009 mg/kg/d. A diet based on foods and beverages in the fifth percentile of fluoride intake distribution for an average child would result in 247 µgF/d or 0.020 mg/kg/d, while a diet with foods and beverages in the 95th percentile would result in a total intake of 622 µgF/d or 0.051 mg/kg/d. CONCLUSIONS: The fluoride concentrations of foods and beverages vary widely, and, if items in the 95th percentile of fluoride intake distribution are ingested, children could consume more fluoride than the recommended 0.05 mg/kg/d. Fluoride intake calculated in this study was higher than historically reported dietary levels.

Relationship between enamel fluorosis severity and fluoride content.

OBJECTIVES: Enamel fluorosis is a hypomineralization caused by chronic exposure to high levels of fluoride during tooth development. Previous research on the relationship between enamel fluoride content and fluorosis severity has been equivocal. The current study aimed at comparing visually and histologically assessed fluorosis severity with enamel fluoride content. METHODS: Extracted teeth (n=112) were visually examined using the Thylstrup and Fejerskov Index for fluorosis. Eruption status of each tooth was noted. Teeth were cut into 100 µm slices to assess histological changes with polarized light microscopy. Teeth were categorized as sound, mild, moderate, or severe fluorosis, visually and histologically. They were cut into squares (2 × 2 mm) for the determination of fluoride content (microbiopsy) at depths of 30, 60 and 90 µm from the external surface. RESULTS: Erupted teeth with severe fluorosis had significantly greater mean fluoride content at 30, 60 and 90 µm than sound teeth. Unerupted teeth with mild, moderate and severe fluorosis had significantly greater mean fluoride content than sound teeth at 30 µm; unerupted teeth with mild and severe fluorosis had significantly greater mean fluoride content than sound teeth at 60 µm, while only unerupted teeth severe fluorosis had significantly greater mean fluoride content than sound teeth at 90 µm. CONCLUSIONS: Both erupted and unerupted severely fluorosed teeth presented higher mean enamel fluoride content than sound teeth. CLINICAL SIGNIFICANCE: Data on fluoride content in enamel will further our understanding of its biological characteristics which play a role in the management of hard tissue diseases and conditions.

Fluoride content of infant foods.

Excessive fluoride consumption during the first 2 years of life is associated with an increased risk of dental fluorosis. Estimates of fluoride intake from various sources may aid in determining a child's risk for developing fluorosis. This study sought to assess the fluoride content of commercially available foods for infants, and to guide dentists who are advising parents of young children about fluoride intake. Three samples each of 20 different foods (including fruits and vegetables, as well as chicken, turkey, beef/ham, and vegetarian dinners) from 3 manufacturers were analyzed (in duplicate) for their fluoride content. Among the 360 samples tested, fluoride concentration ranged from 0.007-4.13 µg fluoride/g food. All foods tested had detectable amounts of fluoride. Chicken products had the highest mean levels of fluoride, followed by turkey products. Consuming >1 serving per day of the high fluoride concentration products in this study would place children over the recommended daily fluoride intake. Fluoride from infant foods should be taken into account when determining total daily fluoride intake.

Fluoride content in plaque solids and fluid after ingestion of fluoridated milk.

This study explored differences in dental biofilm solids and fluid fluoride after ingestion of NaF or Na2FPO3 in milk or non-fluoridated milk. Eighteen volunteers ingested 1 mg fluoride in 200 mL of milk or 200 mL of non-fluoridated milk. Biofilm samples were collected at baseline, 30, 60, and 240 min and biofilm solids and fluid were micro-analyzed for fluoride. Analysis of variance was performed and the total delivery, retention, and clearance of fluoride to biofilm solids and fluid were estimated as the area under the curve between 0 and 240 min. No statistically significant differences were found for baseline values. Biofilm fluid fluoride values ranged from 0.11 ± 0.05 to 0.21 ± 0.08 µg F/mL while biofilm solid values ranged from 0.62 ± 0.39 to 1.75 ± 1.16 µg F/g. Biofilm fluid values were significantly lower at 60 min for Na2FPO3 in milk. Clearance profiles for biofilm fluid diverged after the initial 60 min. Na2FPO3 had a smaller area under the curve from 60 to 240 min than NaF. Results of this study indicate that the release and clearance of fluoride in biofilm vary among fluoridation compounds and that the concentrations in biofilm solids and fluid also vary and are not correlated to each other in many cases.

Retention of dental sealants placed on sound teeth and incipient caries lesions as part of a service-learning programme in rural areas in Mexico.

BACKGROUND: Dental sealants are an effective treatment for the prevention and management of caries. OBJECTIVE: To determine the retention of sealants placed in a rural setting in Mexico as part of an international service-learning (ISL) programme and to determine associations between dental sealant's retention and caries diagnosis at the time of sealant placement. METHODS: Children aged 6-15 were examined for dental caries, received sealants by dental students as part of an ISL programme, and were re-examined 4, 2, or 1 years after placement to assess sealant survival. Sealants were placed on permanent sound surfaces and enamel caries lesions [International Caries Assessment and Detection System (ICDAS) criteria]. Sealant survival was explored using Cochran-Mantel-Haenszel tests and multivariate prediction models. RESULTS: 219 (46%) of 478 (mean age = 10.53 SD = 5.11) children who had received sealants returned for a recall examination (mean age = 10.89 SD = 3.11). After 1-4 years, 96.4% to 60.6% of the sealants placed on sound teeth had survived, and for sealants placed on surfaces with enamel caries lesions (ICDAS 1-3), 94.2% to 55.6% had survived. Differences were not statistically significant. CONCLUSIONS: Sealants had survival rates comparable to those previously reported in the literature. Sealants placed on sound and enamel caries lesions had similar survival rates.

An international, multidisciplinary, service-learning program: an option in the dental school curriculum.

INTRODUCTION: Many health professions students who treat Spanish-speaking patients in the United States have little concept of their culture and health related traditions. The lack of understanding of these concepts may constitute major barriers to healthcare for these patients. International service-learning experiences allow students to work directly in communities from which patients immigrate and, as a result, students gain a better understanding of these barriers. OBJECTIVE: This article describes the implementation of an international, multidisciplinary, service-learning program in a dental school in the United States. PROGRAM DESCRIPTION: The Indiana University International Service-Learning program in Hidalgo, Mexico began in 1999 as an alternative spring break travel and clinical experience for medical students, focusing on the treatment of acute health problems. Travel-related preparatory sessions were offered, and no learning or service objectives had been developed. The program has evolved to include a multidisciplinary team of dental, medical, nursing, public health and social work students and faculty. The experience is now integrated into a curriculum based on the service-learning model that allows students to use their clinical skills in real-life situations and provides structured time for reflection. The program aims to enhance teaching and foster civic responsibility in explicit partnership with the community. Preparatory sessions have evolved into a multidisciplinary graduate level course with defined learning and service objectives. PROGRAM EVALUATION METHODS: In order to assess the program's operation as perceived by students and faculty and to evaluate student's perceptions of learning outcomes, evaluation tools were developed. These tools included student and faculty evaluation questionnaires, experiential learning journals, and a strengths, weaknesses, opportunities and threats analysis. FINDINGS: Evaluation data show that after program participation, students perceived an increase in their cultural awareness, cross-cultural communication skills and understanding of barriers and disparities faced by Latinos in the United States. Faculty evaluations offer insights into the lessons learned through the implementation process. CONCLUSION: The development of a service-learning based curriculum has posed challenges but has enriched international service experiences.

Fluoride content of water used to reconstitute infant formula.

OBJECTIVE: To assess the fluoride content of water used to reconstitute infant formula by a Latino population living in the Indianapolis, Indiana, area. BACKGROUND: Negligible as well as excessive fluoride can be detrimental to oral health. Estimates of fluoride intake and exposure for individuals may aid in the determination of their risk for developing dental fluorosis or caries. METHODS: Interviews were conducted to determine brands of bottled water used to reconstitute infant formula. Identified brands were analyzed for fluoride concentration. RESULTS: Of the 458 samples tested (from 20 brands), fluoride concentration ranged from 0.006 to 0.740 µg/mL. All brands but one had fluoride concentration less than 0.7 µg/mL, with 16 brands having less than 0.22 µg/mL. Most bottled waters analyzed in the study comply with the American Dental Association recommendation to prevent fluorosis. Comparisons made demonstrated that only waters targeted for infants and that are fluoridated do not comply with recent American Dental Association recommendations.

Differences in exposure and biological markers of fluoride among White and African American children.

OBJECTIVE: To determine differences in self-reported fluoride exposure and fluoride exposure biomarkers between two racial groups. METHODS: Questionnaires regarding fluoride exposure, urine and water collection kits were distributed to African American and White 7-14-year-old children. Children received a dental exam for fluorosis. Water, urine, and saliva were analyzed for fluoride content. Questionnaire responses and results of sample analyses were compared and observed differences were analyzed. RESULTS: 83 African American and 109 White children completed the study. Dental fluorosis was observed in 62.5 percent White and 80.1 percent African American children. Significant differences were found for fluorosis prevalence and severity between the groups (P < 0.05). Less African American children reported having used fluoride supplements in the past. White children began brushing their teeth at an earlier age. More White children visited a dentist for the first time before age 3. African American children reported currently using larger amounts of toothpaste. More Whites than African Americans had received topical fluoride treatments over the previous year. All of these differences were significant. Multivariate models showed that supplement use and amount of toothpaste used for brushing had significant associations to a child's fluorosis scores. Fluoride concentration of water and saliva was not different for the two groups; however, the fluoride content in urine was significantly higher in African Americans than in Whites [P < 0.05; 1.40 +/- standard deviation (SD) 0.65 ppm versus 1.08 +/- SD 0.28 ppm]. CONCLUSIONS: Differences in fluoride exposure between two racial groups were observed. These differences are complex and need to be better defined.

Development of a standardisation device for photographic assessment of dental fluorosis in field studies.

PURPOSE: This study evaluated the agreement between clinical and photographic assessment of dental fluorosis (DF) in 73 children during a field study, using portable equipment and a standardising device. MATERIALS AND METHODS: A dental exam was performed using the Tooth Surface Index of Fluorosis (TSIF). Photographs of the facial aspects of front teeth and from the occlusal aspect of the mandibular posterior teeth were taken. All photographs were taken following a standard operating procedure. Photographs of anterior and posterior teeth were coded and assigned a random study number. Examiners scored photographs as fluorosis cases or non-cases. RESULTS: Agreement among the clinical examiners ranged from good to excellent. Agreement was also good for the repeated photographic evaluations. In total, 22% of the children were diagnosed with DF during a clinical exam, and 19% were diagnosed with DF using the photographs. CONCLUSIONS: Development of this method aided in the photographic assessment of DF. The photographs obtained were a useful tool for documenting DF, to re-train examiners, and to determine intra- and inter-examiner agreement.

Prevención en salud periodontal: recomendaciones actualizadas y estatus del conocimiento directamente aplicable al entorno mexicano / Periodontal health prevention: updated recommendations and status of the knowledge directly applied to the Mexican scope

Objetivo: Establecer, a través de la revisión de la literatura, el impacto potencial de los procedimientos clínicos y de salud pública en el bienestar de los tejidos periodontales, en términos de lineamientos explícitos de evaluación y en el contexto de la investigación científica/profesional relevante a México. Métodos: Revisión estructurada de la literatura sobre prevención y salud periodontal en México (1990-2004); se cotejaron los hallazgos con esquemas de evaluación de la calidad de la evidencia científica y recomendaciones asociadas (Canadian Task Force on Preventive Health Care). Resultados: Los esquemas de evaluación arrojaron una clasificación cualitativa de la evidencia científica/profesional y de recomendaciones directamente relevantes a intervenciones preventivas en salud periodontal. Treinta y un artículos publicados entre 1990 y 2004 (inclusive) cumplieron con criterios de solidez metodológica y fueron agrupados en seis niveles de calidad de evidencia. Grosso modo, esta literatura no cubre con diversidad, ni a profundidad la multiplicidad de temas y retos pertinentes a la salud periodontal en México. Conclusiones: Este enfoque permitió identificar la necesidad de continuar documentando ciertos problemas de salud epidemiológicamente importantes. Es fundamental establecer acciones y emplear métodos definidos para extender el conocimiento actualmente disponible, así como operacionalizar esta información en las actividades clínicas y de salud pública

Association between dental caries and pneumonia in patients with systemic lupus erythematosus.

OBJECTIVE: To establish the association between oral pathology and pneumonia in patients with systemic lupus erythematosus (SLE). METHODS: Thirty women with SLE, consecutively admitted for hospitalization because of pneumonia, and 60 noninfected controls with SLE (30 hospitalized and 30 ambulatory), matched by age, sex, and date of hospitalization to the cases, were enrolled. At entry, information about sociodemographic variables, traditional infection risk factors, SLE characteristics, treatment, and comorbidity was gathered by medical chart review. In every patient, one rheumatologist performed a complete physical examination, and assessed disease activity and chronic damage using validated indices; and one periodontist performed a standardized oral health evaluation including the use of 6 international oral health indices. RESULTS: Twenty-eight patients with community-acquired and 2 patients with nosocomial pneumonias were included. Age of the total study population was 38.8 +/- 14.6 years, mean number of SLE criteria 6.3 +/-1.95, and disease duration 6.6 +/- 7.2 years, with no differences among the 3 groups. Cases had greater disease activity and damage, and were taking higher doses of prednisone than ambulatory controls (p

Validity of screening tests for Sjögren's syndrome in ambulatory patients with chronic diseases.

OBJECTIVE: To determine the validity of screening tests for Sjogren's syndrome (SS) in ambulatory patients with chronic diseases. METHODS: Three hundred randomly selected patients from the rheumatology and internal medicine clinics of a tertiary care center were assessed for SS according to the American-European Consensus Group criteria. During the screening phase, an interview, the European questionnaire for sicca symptoms, Schirmer-I test, and the wafer test were carried out in all patients. Patients with positive screening had confirmatory tests including fluorescein staining test, nonstimulated whole salivary flow, and autoantibody testing. Confirmatory tests were also done in 13 patients with negative screening. During the last phase, lip biopsy was proposed to patients who met preestablished criteria. RESULTS: Women made up 79% of the study population. Mean age of subjects was 42.8+/-15.7 years. Two hundred twenty patients (73%) had positive screening. The distribution of positive test results was: xerophthalmia 118 (39%), xerostomia 103 (34%), Schirmer-I test 101 (34%), and wafer test 187 (62%) patients. Forty (13%) patients met criteria for SS. All screening tests were useful for identifying patients with SS; however, the model composed of at least one positive response to the European questionnaire (EQ1), Schirmer-I test, and wafer test showed the best performance. CONCLUSION: Use of the European questionnaire, Schirmer-I test, and wafer test in parallel was useful for identifying patients with SS among ambulatory patients with chronic diseases.