Evaluation of dental plague removal procedure in adult population from the Lomza region.

INTRODUCTION: The National Health Fund guarantees to insured persons free dental treatment as part of a catalog of scopes and benefits, such as dental treatment. Among the services included in the appendix there is a dental plaque removal procedure, which can be performed in adults once every 12 months or once every 6 months in the case of pregnant and puerperal women. This procedure involves breaking down the bacterial biofilm above and below the gingiva, rinsing it in vases with water from the periodontal area, and additionally, through the cavitation effect, it causes the implosion of air bubbles, directly destroying bacterial cells. MATERIALS AND METHODS: The analysis covered 2,114 patients aged 18-89 who visited the dentist from 01/01/2019 to 31/12/2019. The dental clinic was located in a medium-sized town in the Podlaskie Voivodeship. The dental plaque removal procedures were performed on patients by dentists and then coded in accordance with the ICD9 Basic Edition Dictionary ICD9 CM (5.18) "23.1601 - Removal of plaque from 1/2 of the dental arch", respectively. The visits analyzed for this study were performed in the period from 01/01/2019 to 31/12/2019. In the following epidemiological descriptive study, secondary sources of information were used, in the form of collective reports generated from electronic records, which are stored in the dental clinic that provides dental care for patients under an agreement with the National Health Fund for general dental treatment. RESULTS: The total number of women undergoing the plaque removal procedure was significantly higher than the number of men. The distribution of patients in different age groups was uneven. The highest percentage of patients undergoing the dental plaque removal procedure occurred in the age groups of 18-29 and 30-39 years - 21% and 29% of all respondents, respectively. The lowest number of patients was found in the age group of 80-89 years (1%).There is a statistical difference in the total number of dental procedures and in each age group in favor of women in each group, except the 60-79 age group. The greatest number of dental plaque removal procedures, compared to other procedures, was performed in men aged 30-39 years. Among men, along with the increase in age up to the age of 60, the number of dental plaque removal procedures decreased by an average of 10%, a drastic decrease occurred at the age of 70-79 - only 10% of procedures were dental plaque removal procedures. Among women aged 30-59 who were patients of the clinic, the percentage of women with dental plaque removal was about 30%, only in the age group over 80 the percentage of women who underwent the procedure fell to less than 10%. CONCLUSIONS: The results of the study show that the sex and age of the inhabitants of the Lomza region are significant variables related to the procedures of removing plaque in a dental office. Observation showing a decrease in the number of these procedures with increasing age of patients and their more frequent occurrence in women generally requires detailed studies identifying the main determinants of existing relationships.

Practice characteristics and service provision rates of dental hygienists in Australia.

INTRODUCTION: Dental hygienists (DHs) have been practising in Australia since the early 1970s. OBJECTIVE: This study describes the clinical activity of Australian DHs. METHODS: A questionnaire was mailed to members of two professional associations representing DHs. Practitioner characteristics, employment characteristics and clinical activity on a self-reported typical practice day were collected. The proportion of each service item of all services provided was estimated. Associations between practice characteristics and service provision were assessed by log-binomial regression models. RESULTS: Adjusted response rate was 60.6%. Of the DHs included in analysis (n=341), 80% were employed in general practice, and nearly all (96%) worked in the private sector. About half (53.7%) of all service provided were preventive services, and one-fourth (23.9%) were diagnostic. Service provision varied by practice and practitioner characteristics, with the largest variations observed by practice type. Unadjusted analysis showed that general practice DHs provided a higher mean number of periodontal instrumentation and coronal polishing (0.92 vs 0.26), fluoride applications (0.64 vs 0.08), oral examinations (0.51 vs 0.22) and intraoral radiographs (0.33 vs 0.07) per patient visit and a lower mean number of impressions (0.05 vs 0.17) and orthodontic services (0.02 vs 0.59) than specialist practice DHs. In adjusted analysis, rates of periodontal services also significantly varied by practice type; other associations persisted. CONCLUSION: Service provision of DHs varied by practice type. Practice activity was dominated by provision of preventive services while provision of periodontal treatments, fissure sealants and oral examinations was relatively limited indicating areas in which DHs are possibly underutilized.

Factors Associated with Undergoing Regular Dental Check-ups in Healthy Elderly Individuals.

The purpose of this study was to determine the distribution of healthy elderly individuals undergoing regular dental check-ups and identify any environmental or associated oral factors. A cross-sectional questionnaire survey was used to interview 216 individuals attending 2 welfare facilities for the elderly, of whom 160 were included in the final analysis. Items comprised age, sex, number of residual teeth, frequency of teeth/denture cleaning, subjective chewing ability, denture use, oral status, regular dental check-ups, visitation of the same dentist, number of dental visits in the past year, General Oral Health Assessment Index (GOHAI) (Japanese version) score, living situation, and use of routine medication. Individuals undergoing regular dental check-ups were defined as those with a primary dentist whom they saw for dental check-ups at least once a year. The rate of individuals undergoing regular dental check-ups was 75.0% in men aged 60-74 years, 58.8% in women aged 60-74 years, 70.0% in men aged 75 years or over, and 45.3% in women aged 75 years or over. Logistic regression analysis revealed a higher number of residual teeth (odds ratio [OR]=2.664 in comparison with those with fewer than 20 teeth, p=0.0427); cleaning teeth/dentures 3 or more times per day (OR=2.546 in comparison with cleaning them twice per day or less, p=0.0157); and a higher GOHAI score (OR=2.742 in comparison with those with a GOHAI score of less than 58, p=0.0263) as factors significantly correlated with undergoing regular dental check-ups. In conclusion, the results revealed that individuals undergoing regular dental check-ups had 20 or more residual teeth, cleaned their teeth/denture 3 or more times per day, and had a higher GOHAI score. This indicates that the best predictive factor for undergoing regular dental check-ups in healthy elderly individuals is their GOHAI score.

Dental service provision by oral health therapists, dental hygienists and dental therapists in Australia: implications for workforce modelling.

OBJECTIVE: Dental service provision rates are necessary for workforce planning. This study estimates patient and service rates for oral health therapists (OHTs), dental hygienists (DHs) and dental therapists (DTs). To identify important variables for workforce modelling, variations in rates by practice characteristics were assessed. DESIGN: A cross-sectional self-complete mailed questionnaire collected demographic and employment characteristics, and clinical activity on a self-selected typical day of practice. SETTING: Private and public dental practices in Australia. PARTICIPANTS: Members of the two professional associations representing DHs, DTs and OHTs. METHODS: For each practitioner type, means and adjusted rate ratios of patients per hour, services per visit and preventive services per visit were estimated. Comparisons by practice characteristics were assessed by negative binomial regression models. RESULTS: Response rate was 60.6% (n = 1,083), 90.9% were employed of which 86.3% were working in clinical practice and completed the service log. Mean services per patient visit provided by OHTs, DHs and DTs were 3.7, 3.5 and 3.3 and mean preventive services per patient were 2.1, 2.1 and 1.8 respectively. For all three groups, adjusting for explanatory variables, the rate of preventive services per patient varied significantly by practice type (general or specialist) and by the proportion of child patients treated. CONCLUSION: Services rates varied by age distribution of patients and type of practice. If these factors were anticipated to vary over-time, then workforce planning models should consider accounting for the potential impact on capacity to supply services by these dental workforce groups.

Racial disparities in orthodontic service use for Medicaid-enrolled children: An evaluation of the Washington Medicaid program.

INTRODUCTION: We assessed the relationship between race and orthodontic service use for Medicaid-enrolled children. METHODS: This cross-sectional study focused on 570,364 Medicaid-enrolled children in Washington state, ages 6 to 19 years. The main predictor variable was self-reported race (white vs nonwhite). The outcome variable was orthodontic service use, defined as children who were preauthorized for orthodontic treatment by Medicaid in 2012 and subsequently received orthodontic records and initiated treatment. Logistic regression models were used to test the hypothesis that nonwhites are less likely to use orthodontic care than are whites. RESULTS: A total of 8223 children were approved by Medicaid for orthodontic treatment, and 7313 received records and began treatment. Nonwhites were significantly more likely to use orthodontic care than were whites (odds ratio [OR] = 1.18; 95% confidence interval [CI] = 1.02, 1.36; P = 0.031). Hispanic nonwhite children were more likely to use orthodontic care than were non-Hispanic white children (OR = 1.42; 95% CI = 1.18, 1.70; P <0.001). CONCLUSIONS: In 2012, nonwhite children in the Washington Medicaid program were significantly more likely to use orthodontic care than were white children. The Washington Medicaid program demonstrates a potential model for addressing racial disparities in orthodontic service use. Future research should identify mechanisms underlying these findings and continue to monitor orthodontic service use for minority children in Medicaid.

Dentition status in 12-year-old children in Lódzkie province in 2014.

BACKGROUND: In the year 2014 an epidemiological study was carried out again in the region of Lódz amongst 12-year old children as a part of general study in Poland. OBJECTIVES: The purpose of the study was to evaluate the prevalence of carries, caries severity measured by the DMF index among 12-year old children in the region of Lódz. MATERIAL AND METHODS: 328 children aged 12 were randomly selected and examined, of which 176 girls and 152 boys respectively. The methodology was based on clinical examination according to WHO standards. The prevalence of carries, DMF index , treatment index was calculated in lodzkie voivodeship. RESULTS: The studies indicated that the prevalence of caries was 67.8 % for 12-year old children and decreased 1.4% in comparison with last studies in the region of Lódz. DMF index also decreased and the value was 1.63. The score obtained caused that the goal proposed by the WHO for 2015 for 12-year-old children was achieved in lodzkie voivodeship. SiC index in the study group was estimated at 4.03. Compare to the previous study in the SiC index value has been reduced in Lódzkie voivodeship. The result makes our study group very close to the next goal proposed by the WHO for 12-year-old children where SiC index should be less than 4. CONCLUSIONS: Intensity and prevalence of caries for 12 year old children in Lódz and surrounds suggests that it is on the decrease, and dental state in the study group is satisfactory.

Analysis of volume and costs of dental care provided in outpatient settings. / Analiz ob''emov i stoimosti stomatologicheskoi pomoshchi, okazyvaemoi v ambulatornykh usloviyakh.

A conducted analysis of volume and cost of dental care provided in outpatient settings proves the need for harmonization of Russian Ministry of Health's documentation regulating dental checks in adults and children, and the Programme of state guarantees.

Dental treatment need and dental general anesthetics among preschool-age children with cleft lip and palate in northern Finland.

Cleft lip and palate incidence is high in northern Finland. This study aimed to investigate the proportion of children in need of restorative dental treatment among cleft lip and palate patients in northern Finland, as well as their need for dental treatment under general anesthesia. The records of 183 cleft lip and palate patients, treated in Oulu University Hospital from 1997 to 2013, were reviewed. Data on dental caries were analyzed in association with cleft type, considering also the presence of syndromes. The frequency of dental general anesthetic (DGA) use, and of treatments, were also analyzed. Dental treatment need was most frequently observed, in this rather limited study population, in patients with the most severe deformities, namely bilateral cleft lip and palate, of whom 60% had caries. Among the study population, 11.5% (n = 21) had a syndrome. Of those, 57.1% had dental caries at the age of 3 or 6 yr, and only four could be treated without a DGA. Dental treatment under general anesthesia was performed in 14.8% of cleft patients without a syndrome, but in 38.1% of those with a syndrome. General anaesthesia is required for the provision of dental care more often in cleft (17.5%) than in non-cleft (0.2%) patients, and especially for those with a syndrome.

Disparity in perception of the working condition of dental hygienists between dentists and dental hygiene students in Japan.

OBJECTIVES: In Japan, there continues to be a shortage of active dental hygienists. The scope of dental hygienists' practice is also considered to be unclear. One of the reasons for this is that dental hygienists find the working conditions during dental hygiene education different from those in reality. The purpose of this study was to clarify the actual working condition of dental hygienists in dental clinics, as well as evaluate the awareness of dental hygiene students and dentists regarding the working condition of dental hygienists. METHODS: Questionnaires were sent by post to 481 dentists and were distributed to 89 dental hygiene students. The awareness about the working condition of dental hygienists was compared between dentists and dental hygiene students. RESULTS: Two hundred twenty-two dentists and 89 dental hygiene students responded to questionnaires. Dental hygiene students considered the team of 'dental hygienist, dental technician and clerk' to be more effective in providing dental care than dentists (P < 0.001). Among the dentists, 37.1% did not find any clear distinction between hygienists and assistants in their clinics. However, 97.4% of dental hygiene students answered that dental team members should clearly inform patients of the distinction between hygienists and assistants. CONCLUSIONS: This study indicated that there was disparity between dentists' and dental hygiene students' perception of dental hygienists' working conditions, and dental team work was not always effective. For training high quality dental hygienists, all educational institutions related to dentistry must educate students regarding the more realistic dental hygienists' working condition, as well as benefits.

Lack of Correlation between Benign Brain Tumors and Markers of Oral Health.

UNLABELLED: Case control studies implicating dental X-rays in the genesis of intracranial meningiomas have yielded conflicting results. To further evaluate what risk, if any, that intracranial meningioma might be associated with dental X-rays, we examined the association of benign brain tumor incidence with the number of dentists and other correlates of oral health in U.S. states and the District of Columbia. We compared these correlations to the association of the same markers of oral health with Alzheimer's death rates. Poor oral health, especially periodontal disease, is a well-established risk factor for dementia. RESULTS: Pearson correlations, number of cases (49, no data from Kansas or Maryland) and significance (2 tailed p values) of benign brain tumor incidence and parameters of oral health are presented. None of the correlations approached statistical significance. In contrast, Alzheimer's deaths by state were negatively correlated with number of dentists and other markers of oral health. CONCLUSION: Our finding of a total lack of correlation between benign brain tumors and markers of oral health and, by implication, dental X-rays, suggests there may be no relationship between dental X-rays and meningioma or other benign brain tumors. This conclusion is strengthened by our demonstration of the known negative correlation between Alzheimer's and dental care.

Association between periodontal disease and pregnancy outcomes.

OBJECTIVE: To evaluate the association between periodontal disease and pregnancy outcomes like preterm birth and low birth weight. PATIENTS AND METHOD: Interviewer-administered questionnaires were completed by the subjects who attended the antenatal clinic of the Lagos University Teaching Hospital, Lagos. Information obtained included; maternal age, gestational age, marital status, educational status, occupation and expected date of delivery. After delivery, the questionnaire was completed with baby's weight at birth and the actual date of delivery. Clinical assessment of the periodontium was done using Oral Hygiene Index (OHI) and Community Periodontal Index of Treatment Needs (CPITN). Participants were divided into three groups: Test, Control I and Control II groups. Scaling and polishing were done for all patients with periodontal disease before (Test group) and after delivery (Control I). All Control II participants (those without periodontal disease) were given Oral hygiene instructions. Descriptive and comparative analyses were done using Epi info version 2008. RESULTS: Four hundred and fifty women received the questionnaire but the response rate was 94%, giving an actual sample size of 423 participants. Maternal age range was between 18 and 34 years with mean age of 29.67 (± 3.37). Gestational age at the point of recruitment was between 10 weeks and 26 weeks with mean of 23.34 (± 4.05). The prevalence of periodontal disease among the study group was 33.38%. About 71% of the participants attained tertiary level of education; only 0.7% had no formal education. There was 9.9% use of alcohol among the participants. The mean oral hygiene score for the participants was 1.94 (± 1.31). The prevalences for preterm deliveries, low birth weight and spontaneous abortion were 12.5%, 12.1% and 1.42% respectively. CONCLUSION: This study confirms periodontal disease as a probable risk for adverse pregnancy outcomes such as preterm delivery and low birth weight. Therefore, health workers should be encouraged to promote good oral health among women.

The demand for preventive and restorative dental services.

Chronic tooth decay is the most common chronic condition in the United States among children ages 5-17 and also affects a large percentage of adults. Oral health conditions are preventable, but less than half of the US population uses dental services annually. We seek to examine the extent to which limited dental coverage and high out-of-pocket costs reduce dental service use by the nonelderly privately insured and uninsured. Using data from the 2001-2006 Medical Expenditure Panel Survey and an American Dental Association survey of dental procedure prices, we jointly estimate the probability of using preventive and both basic and major restorative services through a correlated random effects specification that controls for endogeneity. We found that dental coverage increased the probability of preventive care use by 19% and the use of restorative services 11% to 16%. Both conditional and unconditional on dental coverage, the use of dental services was not sensitive to out-of-pocket costs. We conclude that dental coverage is an important determinant of preventive dental service use, but other nonprice factors related to consumer preferences, especially education, are equal if not stronger determinants.

Oral health of older people admitted to hospital for needs assessment.

OBJECTIVES: To describe the clinical oral health status, treatment needs and oral-health-related quality of life (OHRQoL) of older people admitted to older persons' wards at Dunedin Public Hospital due to a sudden worsening of their general health. Participants and methods: A systematic oral assessment was undertaken for a consecutive case series of 200 patients (59.5% female; mean age 82.6 years, sd 6.6) admitted to older person's wards at Dunedin Public Hospital. The Oral Health Impact Profile-20 (OHIP-20) was used to assess OHRQoL. RESULTS: One in three (36.0%) had been living independently at home prior to admission, and over half (55.0%) had been admitted for a medical reason which required assessment. Half (50.0%) of the participants were dentate (with an average of 16.8 teeth). There was an average of 1.9 decayed teeth present in the dentate group; 70.7% of individuals required restorations or extractions, and about 90% required only simple scaling of the teeth and prophylaxis. A reline or a replacement denture were required by three-quarters of those with dentures. Almost two-thirds of participants did not have a regular dentist, and fewer than one in three had made a dental visit in the previous year. One in six described their oral health as 'fair' or 'poor', and just under one-third reported dry mouth. Dentate participants, those without xerostomia, and those reporting better oral health had better OHRQoL, reflected in lower OHIP-20 scores. Affecting 37.1% of participants, functional limitation was the most commonly experienced of the OHIP-20 domains, followed by physical disability and physical pain (18.0% and 15.6% respectively). CONCLUSIONS: The oral health of medically compromised and functionally dependent but cognitively competent older people in this study is generally poor. If transfer to long-term care is indicated, early and proper preventive measures and appropriate dental contact should be advocated in order to reduce morbidity and improve quality of life for older people.

Polish public programme of dental caries prevention in children aged 6, 12 and 18 years in 2012.

INTRODUCTION: Studies conducted within the framework of "Monitoring of oral health in Polish population", adapted by Ministry of Health, determined the percentage of children aged up to 18 years who were involved in prophylactic programme in schools. OBJECTIVE: The study aimed at analyzing the prophylactic programme conducted in 2012 in Poland, combined with the procedure of sealing of primary and permanent lateral teeth in 3 age groups. MATERIAL AND METHODS: A total of 5,723 children aged 6, 12 and 18 years living in 7 voivodeships were involved in epidemiological study. The study was conducted pursuant to WHO recommendations (Oral Health Surveys). RESULTS: The percentage of children in particular age groups involved in prophylactic programme was: 34.8% and 97.3%, while the 18-year-olds were not subject to prophylaxis. Taking into account the completion status of prophylactic programmes, considerable differences between voivodeships were observed. A minor percentage of children aged 6 years had primary and permanent teeth sealed with their respective share being 0.6% and 7.1%. The percentage of children aged 12 years with sealed teeth amounted to 33%. The noticed disprities in the percentage of sealed teeth in particular voivodeships ranged from 1.4 to 56.0%. Less than 1% (0.8%) of examined 18-year-olds required sealing of teeth as generally lateral teeth in this age were filled or affected by dental caries. CONCLUSIONS: 1. Having analyzed the place of residence (urban, rural area) in relation to the number of children involved in prophylactic programme, no differences were observed in children aged 6 years. However, considerable disparities were present between particular voivodeships. A minor percentage of 6-year-olds had sealed permanent teeth, its value was less regarding primary teeth. 2. Nearly all children aged 12 years were subject to fluoride prophylactic programme, while in four voivodeships it amounted to 100%. The percentage of sealed teeth was 33%. From the analysis of number of sealed teeth in examined children transpires that more than 67% of children had no sealing of teeth, while 13% of them had from 4 to 6 teeth with sealants.

Oral health and prophylactic-therapeutic needs of children aged 6 years in Poland in 2012.

BACKGROUND: Irrespective of the fact that in developed countries, a reduction of dental caries incidence is observed, it still remains the most common chronic disease affecting children in Poland. OBJECTIVES: In the paper, the results of nationwide epidemiological studies conducted in Poland in 2012 within the framework of the Nationwide Dental Health Monitoring Programme were presented. MATERIAL AND METHODS: The children aged 6 years were enrolled into the study. Clinical assessment of oral health status of children was made in accordance with WHO recommendations. RESULTS: The percentage of healthy children aged 6 years, who did not have any signs of dental caries manifested with cavity, tooth filling or tooth loss was only 14.4%. On average, only one tooth per child was filled due to dental caries and four out of five teeth affected by dental caries required invasive treatment. Index of conservative treatment was very low and amounted to 0.23 +/- 0.24. CONCLUSIONS: The results demonstrate high caries prevalence and significant prophylactic-therapeutic needs.

Dental status of junior high school students in Lódzkie voivodeship.

OBJECTIVE: Dental caries still constitutes a serious health problem in Lódzkie voivodeship. The aim of the article was to evaluate the dental status of 15-year-old adolescents living in Lódzkie voivodeship based on epidemiological studies conducted in 2011. MATERIAL AND METHODS: The study group was comprised of 177 students at the age of 15 years living in Lódzkie voivodeship, selected on the basis of stratified cluster sampling method. The study was conducted pursuant to WHO recommendations. The dental caries prevalence and intensity among students were calculated as well as the components values (DMFT), dental caries severity, treatment index and SiC index. The study results were analyzed using the statistical methods. RESULTS: From the study results transpires that dental caries was observed in 93.8% of students. The dental caries severity amounted to 6.18. Having compared urban and rural areas, the statistically higher number of teeth subject to treatment was observed in the latter. The SiC and treatment index were 8.20 and 0.54, respectively. CONCLUSIONS: On the basis of gathered data, the deterioration of dental status in adolescents aged 15 years from Lódzkie voivodeship was observed. Furthermore, it is strictly related to the place of residence.

Establishment of prevention: what do dentists in northern Germany suggest?

OBJECTIVE: Dentists' suggestions for the establishment of preventive care were investigated on 3 levels; dentist, dental associations and unions (DAU), and health care system (HCS). Associations between categories of suggestions and dentists' characteristics were explored. METHODS: A postal survey was sent to 2,075 dentists practicing in Bremen and Lower Saxony. The answers on 3 open-ended questions were analysed in a qualitative manner based on the quality control protocol (QCP) of the Federal Joint Committee. Quantitative methods were used for exploring associations between categories of suggestions and gender as well as age. RESULTS: Response rate was 33% (n=685). Dentists made 2,120 suggestions (dentist=752, DAU= 574, HCS= 794). The majority of dentists (90%) suggested educating and motivating patients. Dentists stated that support from DAU is needed in educating the public (50%), offering preventive-oriented training (35%), and in advertising for prophylaxis (18%). On the HCS level, about 60% of the suggestions concerned remunerating prophylaxis and expanding the existing bonus system. Significantly more female (p=0.010) and younger dentists (p=0.031) contributed to educating patients than male and older dentists. CONCLUSION: Education is the key message of this work. Essential topics such as prevention for elderly and risk groups were not a focal point. Education on the DAU and HCS levels can be realised through organising nation-wide health campaigns. Funding options for prevention and regulating multidisciplinary work between dentists and other health-care providers should be examined. These changes can contribute enormously to further establish prevention.

Analysis of dental treatment performed by dental residents at General Dentistry Department of Tokyo Dental College Chiba Hospital over 6 years following introduction of mandatory dental clinical training system.

Six years have passed since the introduction of legislation mandating at least 1 year of clinical training for those who have passed the national dentist examination. To determine whether clinical training has been appropriately implemented at the General Dentistry Department of Tokyo Dental College Chiba Hospital, a managed-type clinical training facility, the number of patients treated and types of dental and dental technical work performed by dental residents trained by the department were summarized and analyzed. The number of patients treated per dental resident increased from 11 in 2006 to 15 in 2011. By treatment type, periodontic treatment was the most frequently performed throughout the study period, followed by endodontic treatment. Conservation treatment, prosthodontic treatment with crowns/bridges, and prosthodontic treatment with dentures were performed at a similar moderate frequency, while oral surgical treatment was performed least frequently throughout the study period. The frequency of periodontic treatment increased slightly, whereas that of endodontic treatment decreased slightly or remained almost unchanged after introduction of the mandatory clinical training system. When the distribution of dental treatment performed at our department was compared with that of dental treatment performed by general dentists across Japan in 2011, our department showed a slightly lower frequency of periodontic treatment and higher frequency of endodontic treatment than the national total, whereas the frequency of other types of treatment was similar between the two populations. These results demonstrated that appropriate clinical training has been provided by our department to meet the purpose of offering dentists the opportunity to acquire the basic diagnostic and treatment abilities that would enable them to provide appropriate treatment for injuries and diseases frequently encountered in daily practice. The study also revealed some problems, such as a decreasing number of residents engaging in dental technical work each year. For additional improvement in the quality of dental clinical training, more analyses are needed to further identify and address potential problems in the system.

Adjusting for confounding by neighborhood using a proportional odds model and complex survey data.

In social epidemiology, an individual's neighborhood is considered to be an important determinant of health behaviors, mediators, and outcomes. Consequently, when investigating health disparities, researchers may wish to adjust for confounding by unmeasured neighborhood factors, such as local availability of health facilities or cultural predispositions. With a simple random sample and a binary outcome, a conditional logistic regression analysis that treats individuals within a neighborhood as a matched set is a natural method to use. The authors present a generalization of this method for ordinal outcomes and complex sampling designs. The method is based on a proportional odds model and is very simple to program using standard software such as SAS PROC SURVEYLOGISTIC (SAS Institute Inc., Cary, North Carolina). The authors applied the method to analyze racial/ethnic differences in dental preventative care, using 2008 Florida Behavioral Risk Factor Surveillance System survey data. The ordinal outcome represented time since last dental cleaning, and the authors adjusted for individual-level confounding by gender, age, education, and health insurance coverage. The authors compared results with and without additional adjustment for confounding by neighborhood, operationalized as zip code. The authors found that adjustment for confounding by neighborhood greatly affected the results in this example.

Oral hygiene, periodontal health and chronic obstructive pulmonary disease exacerbations.

AIM: To assess the associations of oral hygiene and periodontal health with chronic obstructive pulmonary disease (COPD) exacerbations. MATERIAL AND METHODS: In total, 392 COPD patients were divided into frequent and infrequent exacerbation (≥2 times and <2 times in last 12 months) groups. Their lung function and periodontal status were examined. Information on oral hygiene behaviours was obtained by interview. RESULTS: In the univariate analysis, fewer remaining teeth, high plaque index (PLI) scores, low tooth brushing times, and low regular supra-gingival scaling were significantly associated with COPD exacerbations (all p-values <0.05). After adjustment for age, gender, body mass index, COPD severity and dyspnoea severity, the associations with fewer remaining teeth (p = 0.02), high PLI scores (p = 0.02) and low tooth brushing times (p = 0.008) remained statistically significant. When stratified by smoking, fewer remaining teeth (OR = 2.05, 95% CI: 1.04-4.02) and low tooth brushing times (OR = 4.90, 95% CI: 1.26-19.1) among past smokers and high PLI scores (OR = 3.43, 95% CI: 1.19-9.94) among never smokers were significantly associated with COPD exacerbations. CONCLUSIONS: Fewer remaining teeth, high PLI scores, and low tooth brushing times are significant correlates of COPD exacerbations, indicating that improving periodontal health and oral hygiene may be a potentially preventive strategy against COPD exacerbations.