Patients' esthetic expectations and satisfaction with complete dentures.

STATEMENT OF PROBLEM: Understanding the factors affecting patients' satisfaction with their dentures is essential to achieving higher satisfaction rates. PURPOSE: The purpose of this clinical study was to test for possible relationships between the esthetic satisfaction of complete denture therapy and factors including age, sex, and esthetic expectations. MATERIAL AND METHODS: Data were integrated from 4 previous studies of complete denture satisfaction, and a secondary data analysis was performed. All studies, which had similar methodologies, recorded patients' esthetic expectation and satisfaction scores using a 0 to 10 visual analog scale. The Sign test was used to test the difference between satisfaction and expectations. The Fisher exact, Spearman rank correlation, Wilcoxon rank sum, and Kruskal-Wallis tests, as well as the Cochran-Mantel-Haenszel test using ridit scores, were used to assess the relationships regarding the heterogeneity among studies, satisfaction, and factors of interest. RESULTS: Of the 283 participants studied, 52% were female, and the median age was 58 years. The satisfaction scores exceeded expectation scores significantly (P<.001), although they were both high. Age, sex, and expectations were different among studies (P<.008); age also differed between sexes (P=.004). After adjusting for the study, men had higher expectations than women (P=.005); there was no sex difference in level of satisfaction. Only in men was satisfaction positively correlated with expectations (r=0.300; P<.001). CONCLUSIONS: Overall, patients were more esthetically satisfied than they expected after completing denture therapy; esthetic satisfaction did not differ between sexes or with age. The expectation of men was higher than that of women and was positively correlated with their level of satisfaction.

Secular trends in hospital emergency department visits for dental care in Kansas City, Missouri, 2001-2006.

OBJECTIVES: We determined the trends, risk factors, and costs of emergency department (ED) visits for dental complaints during a six-year period in Kansas City, Missouri (KCMO). METHODS: We used de-identified hospital discharge data from all facilities serving KCMO during 2001-2006. Using the International Classification of Diseases, Ninth Revision codes, we determined both counts and rates of ED visits related to toothache or tooth injury and analyzed the discharge diagnosis and costs of these visits. We used multivariable regression analysis to assess risk factors for the ED visits for dental complaints. RESULTS: We found a significant increasing trend in dental complaint visits during the six-year period (from 13.1% to 19.0%, p < 0.01). Dental caries accounted for 20.4%, pulpitis or periapical abscess accounted for 14.8%, dental injury accounted for 8.7%, temporomandibular joint (TMJ) disorders accounted for 1.5%, and all other unspecified dental diseases accounted for 54.6% of the ED visits for dental complaints. The mean charge was approximately $360 per visit and was highest for TMJ disorders ($747) and lowest for unspecified other dental diseases ($277). Self-pay (38.3%) and Medicaid (32.3%) constituted the majority of the payment sources. Multivariable regression analysis indicated that self-payers, nonwhite people, adults, people with lower family income, and weekends were associated with increased use of ED visits for dental complaints. CONCLUSIONS: There was a significant increasing trend in dental complaint-related ED visits. EDs have become an important site for people with dental problems to seek urgent care, particularly for individuals who self-pay or are on Medicaid.

Obesity and dental caries in children aged 2-6 years in the United States: National Health and Nutrition Examination Survey 1999-2002.

OBJECTIVE: This study assessed the associations between obesity and dental caries in young children participating in a national survey. METHODS: Participants included 1507 children aged 2-6 years who received dental examinations and had at least 10 primary teeth in the National Health and Nutrition Examination Survey 1999-2002. Decayed/filled teeth (dft) counts of primary dentition were obtained, and weight and height were measured. Body mass index (BMI; kg/m2) was calculated, and participants were categorized using age- and gender-specific criteria as underweight (<5th percent), normal (5th-85th percent), at risk for overweight (>85th and <95th percent), and overweight (> or =95th percent). With appropriate sample weighting, relationships between dft and BMI were assessed using the Kruskal-Wallis test and multivariable logistic regression. RESULTS: Seventy-four percent of children were classified as normal weight, 11 percent as at risk for overweight, and 11 percent as overweight; 58 percent did not have caries; 30 percent had 1-5 dft and 12 percent had >5 dft. When caries experience was compared across BMI categories stratified by age and race characteristics, statistically significant association between caries and obesity was found only for 60- <72-month age group. In the comparison between children with normal and at-risk BMI only, significant associations were also found in the Hispanic and non-Hispanic Black strata. In multivariable logistic regression models to predict caries experience, family income and age were statistically significant predictors for severe early childhood caries only. CONCLUSIONS: There appears to be no significant association between childhood obesity and caries experience after controlling forage, race, and poverty/income ratio. However, further studies are needed to better understand this relationship.

Using a multifaceted approach including community-based service-learning to enrich formal ethics instruction in a dental school setting.

The purpose of this investigation was to examine the degree to which a multifaceted approach to formal ethics instruction including community-based service-learning can enrich the learning environment and how it influences students' attitudes and perceptions about their role as oral health care providers, access to care, disparity, and working in a diverse community. Students' attitudes were evaluated prior to and following the seven-week course to determine if community-based service-learning had any impact on their perceptions. Factor analysis was conducted; and based on the identified factor structure, subscales were computed and used for subsequent analyses of change in attitude over time (pre- and post-test results) and to compare assessment of experience between discipline groups (dental and dental hygiene) as well as gender. There was a statistically significant difference in student attitudes from the beginning of the course to the end about volunteering in the community (p=.036). Additionally, there was a statistically significant difference (p<.01) between male and female students related to course impact on career choice and personal ability. Female students reported the course had a greater impact on their career choice and personal ability than did males. Students were required to complete a reflection paper on their service-learning experience. Reflective papers were analyzed using the qualitative constant comparative method. Reflective papers served as a rich source of information for understanding student perceptions related to their role as oral health care providers, access to oral health care, disparity, and cultural competence. Both dental and dental hygiene students indicated a desire for additional opportunities to participate in community-based service-learning activities and a desire for addressing the current access to care issues in their curricula. We found that a multifaceted approach to ethics instruction incorporating a community-based service-learning component provided an enriched environment for the discussion of several ethical issues facing oral health care providers today.

Perspectives on affirmative action in academic dental institutions: the U.S. Supreme Court rulings in the University of Michigan cases.

In June 2003 the U.S. Supreme Court upheld the constitutionality of using race as a factor in higher education admissions decisions. This article considers the impact of the Supreme Court decisions on admissions procedures at selected academic dental institutions (ADI) and their parent institutions. We interviewed fifty-eight leaders considered to be individual stakeholders at seven ADI and their related parent institutions, state dental associations, and state legislatures using a common set of questions about the Supreme Court decisions. Educators from the ADI and their parent institutions were consistent in their responses that the rulings upheld affirmative action as necessary to achieve diversity. State organized dentistry officials did not appear to be as aware as others of the rulings, whereas legislators were mixed in their responses. Except for the University of Michigan undergraduate admissions procedures, it remains to be seen what the impact will be for other higher education institutions and for academic dental institutions. Although the rulings have provided guidelines for achieving diversity using race/ ethnicity as one of several factors, the rulings will possibly be challenged, thus requiring vigilance on the part of parent institutions and their ADI to ensure compliance with the spirit of the rulings and to avoid attack from opponents of affirmative action.

A comparison of private and public dental students' perceptions of extramural programming.

This project was undertaken to compare the opinions of private and public dental school students' perceptions concerning extramural programming, which is defined as any aspect of the curriculum in which undergraduate dental students provide dental care outside the main dental facility. A survey instrument was used to collect data from undergraduate students at a private (N = 267; 88.4 percent response rate) and at a public (N = 213; 67.2 percent response rate) dental school. When asked to rate the value of various extramural sites in making them a better dentist, both groups rated private dental offices the most valuable and prisons the least valuable. When questioned about the amount of time students should spend each year in extramural programming, private students, overall, desired 34 percent more time than did public students. When asked what percentage of the total time spent in extramural programming students should spend providing various categories of dental care, public school students thought 26 percent more time should be spent rendering preventive services/health education than did the private students. The private students indicated a stronger desire (13 percent more) for rendering clinical services than did public students. Both private and public students were most likely to enter group private practice after graduation. The increasing interest in community-based programs makes the information gained from this study useful for future curriculum planning.

Intentional use of the Hawthorne effect to improve oral hygiene compliance in orthodontic patients.

The purpose of this study was to evaluate whether the home care of noncompliant adolescent orthodontic patients with "poor" oral hygiene could be improved through the use of a deception strategy designed to intentionally induce the Hawthorne effect. This effect is often cited as being responsible for oral health improvements of control groups that receive placebo treatments. It is thought that participating in and fulfilling the requirements of a study alters subjects' behavior, thereby contributing to the improvement. Forty patients with histories of poor oral hygiene were assigned, in a quasi-random fashion, to two groups. Experimental subjects (n = 20) were presented with a situation that simulated participation in an experiment. These included the use of a consent form; distribution of tubes of toothpaste labeled "experimental"; instructions to brush twice a day for two minutes using a timer; and a request to return unused toothpaste. Control subjects (n = 20) had no knowledge of study participation. Tooth surface area covered with plaque was used as a proxy measure of home care behavior. It was measured at baseline, three months, and six months. Mean percentages of tooth surface covered with plaque for the experimental and control groups were 71 (+/- 11.52) and 74 (+/- 11.46) at baseline; 54 (+/- 13.79) and 78 (+/- 12.18) at three months; and 52 (+/- 13.04) and 79 (+/- 10.76) at six months. No statistically significant difference (p > .05) was obtained between groups at baseline. Statistically significant differences (p < .05) were found between groups at three and six months. Significant differences (p < .05) were also found only for the experimental subjects between baseline and each of the two subsequent observation periods. The efficiency and potential effectiveness of this strategy suggest that additional research be conducted to assess oral health improvements and possible applications to the private practice setting.