Oral health knowledge, practices, and status among outpatient veterans at the VA Maryland Health Care System.

Poor oral health can have a significant impact on overall health and quality of life. Yet few studies have established the oral health needs of outpatient veterans. The purpose of this study was to assess the oral health knowledge and practices, the dental status, and the periodontal treatment needs of outpatient veterans seeking primary care services at a statewide healthcare system. Veterans were interviewed and received an oral examination by a trained examiner using NIDCR criteria for dental caries detection and the Community Periodontal Index of Treatment Needs (CPITN). The mean age of the study participants' (n = 135) was 57.7 (SD = 14.1) years. Ninety-five percent of the sample was male and 44% African-American. Untreated coronal and root caries was present in 57% and 36% of veterans, respectively. Sixty-nine participants received the periodontal examination, with 29% of them in Category III. An interpretation of these findings shows a high need for preventive and restorative oral health care among outpatient veterans receiving primary services in an integrated and comprehensive VA health care system.

Relationship of self-reported oral health and nutritional risk among hospitalized older adults.

Oral health and nutritional risk were assessed in 300 hospitalized older adults using self-reported instruments. Patients who self-reported poor oral health status were at greatest nutritional risk. Study results suggest that self reported oral health and nutritional risk are multidimensional and that screening instruments may help identify patients who could benefit from a dental referral. The combination of nutritional and oral health screening methods may be an efficient and cost-effective method for nondental health care providers to identify and refer older adults for oral health care.

Issues in the treatment of root caries in older adults.

Increased life expectancy, improvements in tooth retention, and higher expectations about oral health will continue to result in an increased demand for esthetic restorative dental care. Using demographics as a predictor of future dental treatment needs, root caries may be one of the most significant patient management issues of the next decade. Root caries also can present the clinician with challenging restorative problems. The best treatment option is determined by the lesion, the caries rate, the condition of the patient, and the esthetic requirement or desire. Material selection is critical for successful restoration of root caries. The treatment of root caries also should include methods for the prevention of future lesions. Although caries risk assessment is not a perfected science, models can assist in estimating caries risk and then guide the clinician toward the most suitable preventive approach.

Oral/pharyngeal, laryngeal, and lung cancer discharge trends in Department of Veterans Affairs hospitals.

OBJECTIVE: This paper describes trends in oral and pharyngeal (O/P) cancer diagnoses in Department of Veterans Affairs (VA) hospitals from 1983 to 1993 and compares these trends to those of laryngeal and lung cancers. METHODS: The VA patient treatment file was used to identify unique hospital discharges from 1983 to 1993 having ICD-9-CM codes for O/P, laryngeal, and lung cancers. Descriptive statistics were tabulated to determine prevalence and distribution. Trends of change over time were analyzed using regression analyses of the percent rate on year. RESULTS: Between 1983 and 1993 the annual number of O/P cases among users of VA hospitals decreased from 4,983 to 3,298. Despite overall declines in O/P cancer discharges in VA, cancer of the pharynx, tongue, and salivary gland continues to increase. O/P cancer in younger persons also continues to increase in VA. Overall, laryngeal cancers significantly increased, while no significant change was associated with lung cancer. CONCLUSIONS: VA needs to evaluate the changes in the patterns of O/P cancer to ascertain whether this represents a shift in care from inpatient to outpatient care. VA should seek further information regarding these trends to better plan, implement, and evaluate programs to provide early diagnosis and treatment targeted to veterans.

Maryland veterans' knowledge of risk factors for and signs of oral cancers and their use of dental services.

OBJECTIVES: The purpose of this study was to evaluate outpatient veteran'í knowledge about risk factors for and signs of oral cancers, and their utilization of dental services. DESIGN: Patients receiving primary health care services were surveyed during August 1997. SETTING: Primary health care services at three medical centres within the VA Maryland Health Care System (VAMHCS). SUBJECTS: A total of 135 outpatient veterans were interviewed. INTERVENTION: Questionnaire administered by trained interviewers. MAIN OUTCOME MEASURES: Fifteen percent of the sample were eligible for dental care at the VA, while over 40% of those veterans participating in the study were unaware of their VA eligibility for dental services. Fifty six percent of the total sample received dental services from a private dentist, while 13% reported they had no provider of dental care. Of those not eligible for dental care at the VA (n = 115), the majority (67%) received dental care from a private dentist. Current use of tobacco and alcohol was reported by 27% of the sample. Nonsmokers were more likely to visit the dentist in the previous year than smokers (OR = 2.39, 95% C.I. 1.11,5.12). Although 84% correctly identified tobacco use as a risk factor, only 39% correctly identified regular alcohol use as a risk factor. CONCLUSIONS: Veterans at higher risk for oral cancers were less likely to have visited the dentist in the previous year, and, overall, were ill informed and misinformed about these cancers.

Evaluation of a two-hour oral health education program for medical students.

This study used a pretest-posttest design to assess the effectiveness of a two-hour oral health training program for medical students that was developed and taught by a geriatric dentist as a model undergraduate medical education curriculum. A 3D-item multiple choice and true-false written evaluation assessed medical students' knowledge and attitudes of geriatric oral health. Medical students' scores on the evaluation improved significantly after attending the two-hour program. The addition of a geriatric dentist as a member of the interdisciplinary teaching team can impact medical students' knowledge and attitudes about oral health in the elderly. [Article copies available from The Haworth Document Delivery Service:

Oral cavity and pharyngeal cancer among Department of Veterans Affairs hospital discharges.

OBJECTIVES: The purpose of this study is to determine the number of oral cavity and pharyngeal cancers among hospital discharges at Department of Veterans Affairs (VA) medical centers in one 12-month period. METHODS: A SAS file was created from the patient treatment file (PTF) with all discharges during fiscal 1990 having ICD-9-CM codes for oral cavity and pharyngeal cancer. Up to 10 discharge diagnoses from the most recent discharge summary were included in the data set. ICD-9-CM codes for alcohol dependence syndrome, drug dependence, and nondependent abuse of drugs also were included. ICD-9-CM codes for salivary and nasopharyngeal cancers were excluded. RESULTS: There were 3,733 unique individuals discharged with a diagnosis of oral cavity and pharyngeal cancer. The majority of cases (62%) were found in the oral cavity. The age distribution of oral cavity and pharyngeal cancer did not parallel the age distribution of veterans discharged during this year. Race and ethnicity of those discharged with the disease does not differ from that of all VA hospital discharges for 1990. CONCLUSIONS: VA data provide descriptive statistics of oral cavity and pharyngeal cancer among VA hospital discharges. VA data sets such as the PTF may offer the opportunity to examine hospital management issues, length of stay, and co-morbid diagnoses associated with oral cavity and pharyngeal cancer.

Gains in dental care use not shared by minority elders.

Americans have steadily increased their reported use of dental services over the past 30 years. Persons aged 65 years and older have made the greatest gains, from 16 percent in 1957-58 to 43 percent in 1989. This article reviews national data on reported use of dental care over the past three decades, focusing on differences in rates of utilization on the basis of age, race, and national origin. In addition, differences in sample selection, definitions of race and national origin, and data collection methodology were reviewed to identify systematic sources of bias in comparing the data. Findings indicate that reported dental care use among minority elders has not increased parallel with elders of all races and national origins. In 1957-59, 17 percent of white elders versus 9 percent of nonwhite elders had seen a dentist within the past year. By 1989 percentages had improved to 45 percent of whites, but only 22 percent of blacks and 40 percent of Hispanics. In addition, reporting and recording race and national origin varied considerably during the three decades, hampering comparisons over time. Finally, published national data on usual correlates of dental care use (dentition status, insurance, age, income, and education) are inadequate to explain the causes of these discrepancies. More research is needed to identify barriers to use of dental care by all Americans, particularly those of African and Hispanic descent.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of medication on parotid salivary flow rates in an individual with dementia of the Alzheimer type.

Data available on the relationship between salivary function and specific drug therapy are sparse. We measured unstimulated and stimulated parotid salivary flow rates associated with the drug therapies. Our ancillary study design is an N = 1 double-blind randomized controlled trial in which the patient undergoes a series of treatment blocks of either placebo or active treatment. The purpose of the parent N of 1 study was to find the "best single drug" treatment for a resistive patient diagnosed with dementia of the Alzheimer type. This study demonstrates that thiothixene was associated with inconsistent effects on parotid flow. Oxazepam had no effect on his parotid function, and diphenhydramine hydrochloride had inconsistent but generally negative effects. The data also show that this individual with dementia of the Alzheimer type had lower baseline unstimulated and stimulated parotid salivary flow rates when compared with mean "normal" values; however, flow rates were above the lowest 10th percentile of "normal" volunteers.

Oral cancer screening in the elderly.

Oral cancers represent approximately 3% of all cancers diagnosed in the United States. Oral cancer is one-fifth as common as cancer of the breast, colon, and lung but more than twice as common as cervical cancer. Incidence rates for oral cancer are highest among older men. Epidemiologic data identify alcohol and tobacco as major risk factors associated with the disease. Screening for oral cancer is a simple, non-invasive procedure which can be easily incorporated into the comprehensive assessment of older patients. Oral cancer screening can detect early, localized lesions which are associated with an improved prognosis. Five-year survival rates are more than four times greater in individuals with localized lesions than those with distant metastases. Since older Americans visit their physician more often than their dentist, the physician's medical examination provides an excellent opportunity to screen for oral cancers.