Methods employed for other systematic reviews.

Two separate groups of reviewers were involved in the Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life. The training of the independent reviewers and the methodology they used differed from that of the team at the Research Triangle Institute and the University of North Carolina at Chapel Hill (RTI/UNC).

Oral cancer knowledge and opinions among Maryland nurse practitioners.

OBJECTIVES: As part of a Maryland statewide oral cancer needs assessment, a census of adult and family practice nurse practitioners was conducted to determine their knowledge of oral cancer risk factors, diagnostic procedures and related opinions. METHODS: Information was obtained through a pretested, 40-item, self-administered mail questionnaire of 389 nurse practitioners. A second complete mailing was sent three weeks after the initial mailing; two postal card reminders were mailed at 10 and 17 days after the second mailing, which yielded a response rate of 56 percent. RESULTS: Most nurse practitioners identified the use of tobacco, alcohol, and prior oral cancer lesions as real risk factors. But only 35 percent identified exposure to the sun as a risk for lip cancer. Respondents were not overly knowledgeable about the early signs of oral cancer, most common forms, or sites for oral cancer. Only 19 percent believed their knowledge of oral cancer was current. Nurse practitioners who reported having a continuing education course on oral cancer within the past two to five years were 3.1 times more likely to have a high score on knowledge of risk factors and 2.9 times more likely to have a high score on knowledge of both risk factors and of diagnostic procedures than were those who had never had a continuing education course. CONCLUSIONS: The reported knowledge of oral cancer, in conjunction with opinions about level of knowledge and training, point to a need for systematic educational updates in oral cancer prevention and early detection.

Perspectives of Maryland adult and family practice nurse practitioners on oral cancer.

OBJECTIVES: Because oral and pharyngeal cancer mortality in Maryland ranks seventh among states and sixth for black males, a statewide oral cancer needs assessment was conducted. The purposes of this qualitative descriptive study were to obtain indepth information on nurse practitioners' awareness and opinions of oral cancer, oral cancer examinations, and related factors. These findings were intended to supplement a previous survey conducted among Maryland nurse practitioners. METHODS: A professional focus group moderator conducted one face-to-face focus group with 11 nurse practitioners and one telephone focus group with eight nurse practitioners. Criterion-purposeful sampling and qualitative content analysis were employed. RESULTS: Findings showed that oral cancer is a neglected public health problem and, based on their formal training, not one considered by nurse practitioners to be their responsibility. Although aware of other cancers, none of the nurse practitioners recognized that oral cancer was a public health problem in the state. Numerous barriers were cited for this neglect, including their lack of training and, in one case, unpleasant feelings about examining the mouth. Participants concluded that oral cancer is part of their responsibilities and that they are interested in related continuing education courses. CONCLUSIONS: The focus groups of nurse practitioners provided rich and insightful suggestions for future strategies to help solve the oral cancer problem in Maryland, which supplemented the quantitative mail survey conducted earlier.

U.S. dental hygienists' knowledge and opinions related to providing oral cancer examinations.

BACKGROUND: Because U.S. dental hygienists play a significant role in providing prevention and early-detection services, it is important to describe and evaluate their oral cancer knowledge and opinions. METHODS: A pretested survey, cover letter, and prepaid return envelope were mailed to 960 dental hygienists, followed by three complete follow-up mailings. RESULTS: The respondents were not as knowledgeable about oral cancer risk factors and diagnostic procedures as hypothesized. Although the respondents were well informed about certain key aspects of oral cancer risk factors and diagnostic procedures, there were many aspects of these topics in which they were deficient and in some cases misinformed. CONCLUSIONS: Dental hygiene curricula should be updated and continuing education coursesabout oral cancer should be developed and implemented.

Parental perceptions of unmet dental need and cost barriers to care for developmentally disabled children.

PURPOSE: The purpose of this investigation was to describe and assess the disparities, if any, in parental perceived cost barriers to oral health care among developmentally disabled children using a national data set. METHODS: Data from the 1997 National Health Interview Survey (NHIS) were analyzed using a SUDAAN statistical package. RESULTS: After adjusting for age and sex, parental perception of unmet need was significantly associated with developmentally disabled children 2-17 years in lower socioeconomic groups. CONCLUSIONS: Though most children from lower socioeconomic groups are eligible for Medicaid coverage, parents of these children perceive cost barriers to dental care. Children with developmental disabilities face even more perceived barriers to care based on family income.

Maryland dental hygienists' knowledge and opinions of oral cancer risk factors and diagnostic procedures.

OBJECTIVES: To examine Maryland dental hygienists' (DHs) knowledge of oral cancer risk factors and diagnostic procedures, as well as opinions about the currency and adequacy of their oral cancer knowledge, educational preparation, interest in, and preferred types of, continuing education courses. METHODS: Seven hundred DHs were randomly selected from a registry of 2677 Maryland licensed dental hygienists. A mailed survey instrument provided baseline data on 331 (RR = 60%) DHs. Stratified tabular and logistic analytical techniques were employed (alpha level < or =0.05). RESULTS: Most correctly identified tobacco use (99.7%) and alcohol use (89%) as risk factors; however, 31% incorrectly identified poor oral hygiene as a risk factor. 64% of DHs correctly identified older age as a risk factor, yet only 16% identified that the majority of oral cancers are diagnosed in the 60+ year old age group. Nearly 91% correctly identified the examination procedures of the tongue for oral cancer detection; while only 16% of DHs correctly identified erythroplakia and leukoplakia as the conditions most likely associated with oral cancer. CONCLUSIONS: Gaps in knowledge exist and strongly suggest the need for continuing education courses to clarify risk factors and diagnostic procedures associated with earlier oral cancer detection and prevention.

A community participatory oral health promotion program in an inner-city Latino community.

OBJECTIVES: This paper reports the planning, implementation, process evaluation, and refinement of an oral health community participatory project in Mount Pleasant, an inner-city Latino neighborhood of Washington, DC. The main goal was to explore the feasibility of implementing such a project. METHODS: The PRECEDE-PROCEED model was used to guide the planning and process evaluation of this project, in conjunction with community organizational methods. A steering committee, which met periodically, was formed to assist in program planning, implementation, and evaluation. The needs assessment of the community identified extensive dental health problems among children and deficiencies in their parents' oral health knowledge, opinions, and practices. In response, culturally appropriate health education and promotion activities were planned and implemented in collaboration with local community organizations, volunteers, and local practitioners. Process evaluation was used to provide feedback into the refinement of the community approach, which included record keeping and an inventory approach to activities completed and resources used. The overall impact and usefulness of this program were assessed informally using an anonymous open-ended questionnaire directed to members of the steering committee, and an outreach survey using a convenience sample at a local Latino health fair. RESULTS: The implementation of such a community participatory approach was feasible and useful for building upon existing local resources and addressing oral health concerns in a community not reached by traditional dental care and health promotion initiatives. Individuals in this community showed a substantial interest in oral health matters and participated in a variety of oral health prevention activities. The community approach adhered to community-based research principles.

Maryland dental hygienists' assessment of patients' risk behaviors for oral cancer.

PURPOSE: This study examined Maryland dental hygienists' knowledge of tobacco and alcohol use as oral cancer risk behaviors; the practice of obtaining comprehensive medical histories regarding patients' current, past, and type/amount of alcohol and tobacco used; and their opinions about the adequacy of their tobacco and alcohol cessation educational preparation in a state that ranks unusually high for oral cancer mortality rates. METHODS: The data source was the Maryland Oral Cancer Survey of Dental Hygienists conducted in November 1997 (MDOCSDH, 1997) with a simple random sample of 700 dental hygienists selected from a registry of 2,677 licensed dental hygienists in Maryland. Data were collected with a 40-item self-administered mailed questionnaire. Unweighted data from 331 returned surveys (response rate = 60%) were analyzed using SAS and SUDAAN Software. Stratified and logistic data analysis techniques were utilized, and the results were evaluated statistically using a .05 level of significance. RESULTS: Nearly all of the responding dental hygienists knew that tobacco is an oral cancer risk factor. Most probed their patients' present use of tobacco in medical histories; however, fewer assessed patients' past use and type/amount of tobacco used. Very few believed that they were adequately prepared to provide tobacco cessation education, although the majority agreed that dental hygienists should be prepared to provide this type of information. The majority of respondents also knew that alcohol use is an oral cancer risk factor; however, less probed their patients' present use of alcohol in medical histories compared to assessing present tobacco use. Even fewer assessed patients' past use and type/amount of alcohol used. A very small minority believed that they were adequately prepared to provide alcohol cessation education. Yet, in contrast to tobacco cessation counseling preparation, few respondents believed that dental hygienists should be prepared to provide alcohol cessation education. There was a significant relationship (p < .05) between screening for all three aspects of tobacco use and agreement of dental hygienists that they were adequately prepared to provide tobacco cessation education. Of seven background characteristics, practice setting was the only one found to be positively associated (p < .05) with even one of three complete medical history screening indices--the practice of assessing all three tobacco screening items. CONCLUSION: There is a need to provide more complete and accurate information in tobacco and alcohol educational programs for Maryland dental hygienists. Additional research is needed to explore sources of noninterest or discomfort in assessing patients' use of these substances, since a substantial number of Maryland dental hygienists do not assess all aspects of patients' tobacco and alcohol usage and do not agree that dental hygienists should be prepared to provide tobacco and alcohol cessation education for their patients. Maryland dental hygienists' opinions regarding the adequacy of their tobacco and alcohol cessation education appear to accurately reflect their practice of obtaining comprehensive medical histories regarding these substances.

Perspectives of Maryland dentists on oral cancer.

BACKGROUND: Maryland's mortality rate for oral and pharyngeal cancer is seventh highest overall in the United States, sixth highest for men and third highest for African-American men. As part of a statewide needs assessment and in follow-up to a mail survey of Maryland general dentists, focus groups were conducted to obtain more in-depth information about why dentists do not provide a comprehensive oral cancer examination for most of their patients and how to solve this problem from a dentist's perspective. METHODS: A trained focus group moderator conducted two focus groups of general practice dentists in two locations in Maryland. Five major themes emerged from the two focus groups: inaccurate knowledge about oral cancer; inconsistency in oral cancer examinations; lack of confidence in when and how to palpate for abnormalities; lack of time to routinely provide oral cancer examinations; and recommendations to help resolve these issues. CONCLUSIONS: The focus groups provided a rich source of ideas on how to best provide dentists with continuing education about oral cancer prevention and early detection. Participants also provided opinions about the need to improve the public's awareness of oral cancer and its prevention. CLINICAL IMPLICATIONS: Dentists need to include comprehensive oral cancer examinations as part of their routine oral examinations for all appropriate patients.

Professional and community efforts to prevent morbidity and mortality from oral cancer.

BACKGROUND: Oral and pharyngeal cancers cause significant morbidity and mortality, yet there has been little improvement in survival rates in the past 30 years. Because early diagnoses significantly increase survival rates, the authors summarize several approaches to educating and mobilizing the dental profession and the public about this problem. Clinicians are invited to initiate similar programs to catalyze change in their own communities. METHODS: The authors found that many approaches have been used to define the problem and initiate change. These include surveys, focus groups, development of consortia, media programs, flyers, leaflets, prescription pads, legislation and professional endorsements. RESULTS: In Maryland in 1996, only 20 percent of adults reported receiving an oral cancer examination, and most oral cancers were diagnosed at late stages by physicians, not dentists. Results of the public educational campaigns in the regions of New York/New Jersey and Maryland have not been formally evaluated, but there is a developing consensus that oral cancer diagnostic practices in the regions with active educational programs are increasing. CONCLUSIONS: Coalitions or partnerships among individuals and organizations from government, academia, private practice, industry, the general community and the media can affect awareness about oral cancer prevention and early detection on a regional basis. CLINICAL IMPLICATIONS: By increasing awareness of oral cancer among the dental profession and the public, earlier diagnosis of these cancers with consequent improved cure rates is likely. Providing oral cancer diagnostic services as a routine part of an oral examination also may motivate patients to visit the dentist at least once a year.

Dental hygienists' knowledge, opinions, and practices related to oral and pharyngeal cancer risk assessment.

METHODS: A pre-tested, validated 62-item survey was mailed to a 1% national random sample of licensed dental hygienists, (n = 960). Four complete mailings of the instrument resulted in a 74.4% percent return rate of which 65% percent were usable (n = 464). Respondents provided information on their knowledge of oral cancer risk assessment factors, their use of health history questions to assess patients' oral cancer risks, how they conduct oral cancer examinations, and their beliefs about their oral cancer training. Data were analyzed using descriptive and inferential statistics and evaluated at a significance level of p < or = 0.05. RESULTS: Based on responses to 14 questions, the average score on knowledge of oral cancer risk factors was 7.92, with a significant difference found among age groups and year of graduation, (p = 0.006). On average, dental hygienists assessed five of eight risk assessment items with "use of alcohol" receiving the least attention. Although nearly 100% percent agreed that oral cancer examinations for adults 40 years of age or older should be provided annually, only 66% percent reported doing so for patients on their initial appointment. Seventy-four percent believed they were adequately trained to provide oral cancer examinations, while only 27 percent agreed that they were prepared to provide tobacco cessation counseling. There was no significant correlation between knowledge of oral cancer risk factors and probing these risk factors when conducting a health history. CONCLUSIONS: Results from this study indicate that interventions are needed to increase dental hygienists' knowledge of oral cancer risk factors, correct misinformation, and close the gap between their knowledge and its application in providing prevention and early detection services. The majority believed that they are not as knowledgeable as they could be and are interested in attending an oral cancer continuing education (CE) course.

The prevalence of dental caries and fluorosis in Japanese communities with up to 1.4 ppm of naturally occurring fluoride.

OBJECTIVES: The purpose of this study was to determine the relationship between the concentration of fluoride in drinking water and the prevalence of dental caries and fluorosis in seven Japanese communities with different concentrations of fluoride occurring naturally in the drinking water. METHODS: A total of 1,060 10- to 12-year-old lifetime residents were examined to determine the prevalence of dental caries and fluorosis in communities with trace amounts to 1.4 ppm fluoride in the drinking water in 1987. Systemic fluorides (drops or tablets) have never been available in Japan and the market share of fluoride-containing toothpaste was 12 percent at the time of the study. RESULTS: The prevalence of dental caries was inversely related and the prevalence of fluorosis was directly related to the concentration of fluoride in the drinking water. The mean DMFS in the communities with 0.8 to 1.4 ppm fluoride was 53.9 percent to 62.4 percent lower than that in communities with negligible amounts of fluoride. Multivariate analysis showed that water fluoride level was the strongest factor influencing DMFS scores. The prevalence of fluorosis ranged from 1.7 percent to 15.4 percent, and the increase in fluorosis with increasing fluoride exposure was limited entirely to the milder forms. CONCLUSIONS: The findings of this study conducted in 1987 in Japan parallel those reported by Dean et al. in the early 1940s.

Practices of Maryland dentists: oral cancer prevention and early detection--baseline data from 1995.

OBJECTIVES: To investigate practices and opinions of general dentists in Maryland, USA, related to oral and pharyngeal cancer prevention and early detection. DESIGN AND METHODS: A pre-tested, 34-item questionnaire, cover letter and addressed, stamped envelope were mailed in the summer, 1995, to a simple random sample of 800 members and non-members of the American Dental Association practicing in Maryland. A reminder postcard was sent 3 weeks after initial mailing; a second complete mailing to all non-respondents 6 weeks after first mailing. RESULTS: Over 90% of dentists asked about patient's current use of tobacco but only 77% assessed patient's history of tobacco use and types and amounts used. Fewer (66%) asked about present use of alcohol. Ninety percent reported providing an oral cancer examination at the initial appointment for patients 40 years of age or older; only 6% provided the examination for edentulous patients and only 40% reported palpating lymph nodes of patients 80% or more of the time. CONCLUSIONS: Dentists' reporting on providing oral cancer examinations and taking appropriate health histories are disappointing. These results call for comprehensive educational interventions in terms of changes in dental curricula and as continuing education courses especially since most dentists were interested in continuing education courses on oral cancer prevention and early detection.

Survey of U.S. dentists' knowledge and opinions about oral pharyngeal cancer.

BACKGROUND: Oral pharyngeal cancer constitutes the most life-threatening of all dental and craniofacial conditions. The U.S. five-year survival rate of 52 percent for these cancers is one of the lowest and has not changed in decades. METHODS: The authors mailed a pretested survey to 7,000 randomly selected general dentists. They obtained information on 3,200 dentists' levels of knowledge about oral pharyngeal cancer risks and diagnostic procedures for providing an oral cancer examination, as well as about related opinions and interest in continuing education, or CE, courses on the topic. The authors carried out analyses using unweighted data; they used both bivariate and logistic analytical techniques and evaluated at a significance level of P < or = .01. RESULTS: Based on responses to 14 questions, the average knowledge of oral cancer risks score was 8.4. About one-half of dentists surveyed knew the two most common sites of intraoral cancer and that most oral cancers are diagnosed at a late stage. CONCLUSIONS: The reported knowledge of these dentists regarding oral cancer suggests that they are not as knowledgeable as they could be about cancer prevention and early detection and that they recognize these deficiencies. Most of the dentists were interested in oral cancer CE. CLINICAL IMPLICATIONS: Dentists need to know where in the mouth to look and what types of lesions to look for to provide a comprehensive oral cancer examination.

Oral pharyngeal cancer prevention and early detection. Dentists' opinions and practices.

BACKGROUND: The five-year survival rate for patients in the United States diagnosed with oral pharyngeal cancer is 52 percent, which suggests that these cancers are diagnosed at late stages. The authors conducted this study to determine U.S. dentists' opinions and practices regarding oral cancer prevention and early detection. METHODS: The authors mailed a pretested survey to 7,000 randomly selected general practitioners. A total of 3,200 dentists provided information on how they conduct oral cancer examinations, their use of health history questions to assess patients' oral cancer risks and their oral cancer training and practices. The authors carried out analyses using unweighted data; both bivariate and logistic analytical techniques at a P < or = .01 level of significance were used. RESULTS: On average, dentists assessed about five of the eight health history items on the survey. Eighty-six percent indicated that they did not conduct oral cancer examinations on edentulous patients 18 years of age or older; 81 percent, however, reported that they conducted oral cancer examinations for 100 percent of their patients 40 years of age or older on their initial appointment. CONCLUSIONS: The reported practices of these dentists regarding oral cancer, in conjunction with their opinions about key aspects of these practices and their training, point to a need for systematic educational updates in oral cancer prevention and early detection. CLINICAL IMPLICATIONS: Dentists need to determine their patients' risks for oral cancers and provide routine and comprehensive oral cancer examinations.