Perception of racism explains the difference between Blacks' and Whites' level of healthcare trust.

OBJECTIVE: To test the hypothesis that the level of healthcare trust does not differ between Blacks and Whites. DESIGN: Cross-sectional telephone-based survey. METHODS: This study recruited low-income residents of Miami-Dade and Duval counties in Florida by using random-digit dialing (RDD). One thousand and five residents participated; however, analyses were limited to Black (n=550) or White (n=374) respondents. Trained interviewers used a structured questionnaire to obtain information about respondent demographics, trust in health care, perception of racism, and access to care. RESULTS: Black respondents included fewer males (P=.0146) and younger subjects (P < or = .05); otherwise, they were similar to White respondents. Compared to Duval County respondents, Miami-Dade respondents were younger (< or = .05), richer (< or = .05), and mostly males (P=.0355). Blacks perceived more racism than did Whites (P<.0001). Healthcare trust differed by race and respondents' county (P<.0001). The proportion of variance in healthcare trust explained (R2) by race was 2%. Introducing perception of racism into the model eliminated differences in trust between White and Black respondents. Overall, the model explaining healthcare trust accounted for 21.2% of the variance in trust; the model adjusted for respondents' county, demographics, access to care, and liking treatment during routine appointment. CONCLUSION: This study observed that perception of racism accounted for the residual differences in healthcare trust between Whites and Blacks; therefore, healthcare distrust may not be an attribute of Blacks. Respondents' experience with the healthcare system accounted for most of the difference in trust.

Osteotome sinus elevation and simultaneous placement of porous-surfaced dental implants: a morphometric study in rabbits.

The objective was to establish a model in rabbits in which to study the healing events associated with localized indirect osteotome-mediated maxillary sinus floor elevation in conjunction with simultaneous placement of sintered porous-surfaced dental implants. On one side of the maxilla of each of 28 rabbits, a sintered porous-surfaced titanium alloy press-fit implant was placed without the use of a bone graft material, while on the collateral side an implant was placed after first adding Bio-Oss graft particles to the osteotomy. Specimens were retrieved for morphometric assessment of bone contact and bone ingrowth of the porous implant surface after 2, 4, 6 and 8 weeks of healing. All implants became osseointegrated by bone ingrowth into the porous implant surface. While the addition of graft particles did not result in a statistically significant increase in the parameters measured, a trend for greater bone contact and particularly bone ingrowth at the apices of the implants was seen as healing time increased. The rabbit maxillary sinus can be used to study healing following placement of sintered porous-surfaced dental implants using the indirect sinus elevation procedure.

Removal, replacement and placement of amalgam restorations by Ontario dentists in 2002.

AIM: To determine the patterns of removal, replacement and placement of amalgam restorations by Ontario dentists. METHODS: A structured self-administered postal survey was sent to dentists randomly selected from the list of all dentists licensed to practise dentistry in Ontario. The questionnaire sought information on the numbers of 1-, 2-, 3- and > or = 4-surfaced amalgam restorations and core amalgam build-ups that each dentist removed, replaced and placed during a 7-day period. RESULTS: A total of 878 (44%) of 1,994 dentists responded to the survey. Most dentists (82%) who returned completed questionnaires (n = 837) had removed, replaced or placed at least one amalgam restoration during the 7-day period. Most respondents (90%) were general practitioners; respondents practised for a mean of 45.7 weeks each year and had practised for a mean of 20.1 years. On average, each dentist removed 8.91 (standard deviation [SD] 17.32) amalgam restorations during the 7-day period. However, the mean number of new amalgam restorations placed was just 6.64 (SD 18.88): 2.99 (SD 8.74) new restorations in previously unrestored teeth and 3.65 (SD 11.40) replacements of amalgam restorations removed from previously restored teeth. For the year 2002, it was estimated that the 6,915 dentists registered to practise in Ontario had removed 2,855,178 (95% confidence interval [CI] 2,484,566-3,225,790) amalgam restorations. Overall, the dentists placed 2,112,800 (95% CI 1,682,307-2,543,292) amalgam restorations; 1,163,665 (95% CI 919,204-1,408,126) to replace amalgams in previously restored teeth and 949,135 (95% CI 763,103-1,135,166) as new amalgam restorations. CONCLUSIONS: Removal of old amalgam restorations by Ontario dentists exceeds current levels of placement and replacement of amalgam restorations.

An assessment of crown-to-root ratios with short sintered porous-surfaced implants supporting prostheses in partially edentulous patients.

PURPOSE: Implant length, implant surface area, and crown-to-root (c/r) ratio and their relationship to crestal bone levels were analyzed in 2 groups of partially edentulous patients treated with sintered porous-surfaced dental implants. MATERIALS AND METHODS: One hundred ninety-nine implants were used to restore 74 partially edentulous patients with fixed prostheses. Implants were categorized according to their length ("short" versus "long") and estimated surface area ("small" versus "large"). "Short" implants had lengths of 5 or 7 mm, while "long" implants were either 9 or 12 mm in length. "Small" implants had estimated surface areas of < or = 600 mm2, while "large" implants had estimated surface areas > 600 mm2. Other data collected included c/r ratio (measured on articulated diagnostic casts), whether or not the implants were splinted, and standardized sequential radiographs. RESULTS: The mean c/r ratio was 1.5 (SD = 0.4; range 0.8 to 3.0), with 78.9% of the implants having a c/r ratio between 1.1 and 2.0. Neither c/r ratio nor estimated implant surface area (small or large) affected steady-state crestal bone levels. However, implant length and whether the implants were splinted did appear to affect bone levels. Long implants had greater crestal bone loss (0.2 mm more) than short implants; splinted implants showed greater crestal bone loss (0.2 mm more) than nonsplinted ones. These differences were statistically significant. DISCUSSION AND CONCLUSIONS: Sintered porous-surfaced implants performed well in short lengths (7 mm or less) in this series of partially edentulous patients. The data suggested that long implants and/or splinting can result in greater crestal bone loss; longer implants and splinted implants appeared to favor greater crestal bone loss in this investigation. These conclusions are, of course, specific to the implants used and would not be relevant to other implant types.

The influence of dental insurance on institutionalized older adults in ranking their oral health status.

To assess whether dental insurance influences how institutionalized older adults ages 65 and older rank their oral health status, a census survey was designed for residents of Durham's (Canada) Municipal Homes for the Aged. The odds ratio (OR) and the Cochran & Mantel-Haenszel's OR were used to estimate the crude and adjusted effect of dental insurance on oral health status, respectively. Overall, 64 percent participated in the interview. Oral health status was ranked as "good," "very good" or "excellent" by 57 percent of the participants. This ranking was clearly unrelated to the residents having dental insurance, as only 28 percent had dental coverage. Significant effect modifiers included age, dental status and whether the participant had visited the dentist within the last year. Dental insurance positively influenced how dentate participants ranked their oral health status (OR = 2.26; 95 percent CI = 1.19; 4.28). In edentulous participants, age and visiting the dentist within the last year modified the effect of dental insurance on oral health status. Having dental insurance reduced the odds of reporting "good," "very good" or "excellent" oral health (OR = 0.20; 95 percent CI = 0.08; 0.49) among the participants ages 85 and older who did not visit the dentist within the last year; however, the opposite was true for their younger counterparts who visited the dentist within the last year (OR = 7.20; 95 percent CI = 1.08; 47.96). In this population, therefore, dental insurance was associated with higher oral health status rank among the dentate, but its effect on the edentulous population depended on age and the pattern of visiting the dentist.

Estimated quantity of mercury in amalgam waste water residue released by dentists into the sewerage system in Ontario, Canada.

AIM: To estimate the quantity of dental amalgam that Ontario dentists release into waste water. METHODS: Information from a self-administered postal survey of Ontario dentists was combined with the results of other experiments on the weight of amalgam restorations and the quantity of amalgam waste that bypasses solids separators in dental offices. Algorithms were developed to compute the quantity of amalgam waste leaving dental offices when dentists used or did not use ISO 11143 amalgam particle separators. RESULTS: A total of 878 (44.0%) of 1,994 sampled dentists responded to the survey. It was estimated that Ontario dentists removed 1,880.32 kg of amalgam (940.16 kg of mercury) during 2002, of which 1,128.19 kg of amalgam (564.10 kg of mercury) would have been released into waste water in Ontario if no dentists had been using a separator. Approximately 22% of the dentists reported using amalgam particle separators. On the basis of current use of amalgam separators, it was estimated that 861.78 kg of amalgam (430.89 kg of mercury or 170.72 mg per dentist daily) was released in 2002. The use of amalgam separators by all dentists could reduce the quantity of amalgam (and mercury) entering waste water to an estimated 12.41 kg (6.21 kg of mercury, or 2.46 mg per dentist per day). CONCLUSION: Amalgam particles separators can dramatically reduce amalgam and mercury loading in waste water released from dental offices.

Estimating the weight of dental amalgam restorations.

AIM: Data on the weights of amalgam restorations are lacking. The aim of this study was to determine these weights and to develop criteria to facilitate their estimation. METHODS: Four separate regression models with 4 covariates in various combinations were used to estimate the weight of amalgam restorations. Model I, based on 514 restorations from both natural and anatomical replica teeth, contained 3 covariates: the number of restored surfaces (covariate A), the type of tooth (covariate B) and whether the restoration had been removed from a natural tooth or an anatomical replica tooth (covariate C). Model II, based on 359 restorations from anatomical replicas, contained 2 covariates: A and B. Model III, based on 155 restorations from natural teeth, contained 3 covariates: covariates A and B and whether the natural teeth had been extracted in 2002 or at least 15 years previously (covariate D). In model IV, covariate D was removed from model III. RESULTS: Model I explained 72% of the variation in the weight of restorations; the partial R2 for covariates A, B and C in model I was 0.5818, 0.797 and 0.0579, respectively (p < 0.001). In model III, the weights of the restorations did not depend on covariate D (p = 0.93). The least square mean weight of amalgam restorations with 1, 2, 3, and 4 or more surfaces restored (and 95% confidence interval) was 0.31 g (0.28-0.34 g), 0.49 g (0.45-0.53 g), 0.81 g (0.76-0.86 g) and 1.38 g (1.31-1.45 g), respectively. CONCLUSION: The number of surfaces restored (covariate A) accounted for at least 80% of the variation in the weight of restorations in all models and therefore provides the best estimate for the weight of amalgam restorations.

The weight of wastes generated by removal of dental amalgam restorations and the concentration of mercury in dental wastewater.

OBJECTIVE: To determine the amount of amalgam entering the waste stream during removal of dental amalgam restorations. METHODS: Dental amalgam restorations were removed from anatomic replica teeth and natural teeth by means of a tungsten carbide bur, a high-speed handpiece and a conventional suction system. The weight of amalgam particles trapped in the primary and secondary solids separators was determined. Amalgam particles were filtered from wastewater with 15-microm filter paper and weighed. The concentration of total mercury in the effluent collected (by instantaneous flow-through) during the removal of amalgams, with and without an ISO-certified separator, was measured by means of cold-vapour atomic absorption spectrophotometry. RESULTS: About 60% by weight of the amalgam removed was found in the effluent, about a third was retained in the primary solids separator and less than 10% was retained in the secondary solids separator. The ISO-compliant separator reduced the concentration of mercury in the instantaneous flow-through discharge by 99.4%, from 31.2973 mg/L to 0.1800 mg/L. CONCLUSIONS: About 60% of the waste generated during the removal of amalgams escaped the primary and secondary solids collectors and was released into the wastewater. An ISO-certified amalgam particle separator was effective in removing the amalgam from the wastewater.

The effect of dental insurance on the ranking of dental treatment needs in older residents of Durham Region's homes for the aged.

The effect of dental insurance on the ranking of dental needs in older adults has not been reported previously. We examined this effect using data obtained from a cross-sectional survey of older adults living in homes for the aged in Durham Region, Ontario. History of dental insurance was obtained during interviews. Dental needs, assessed during clinical examinations, were ranked from no need to urgent need according to the guideline of the American Dental Association. The associations between the rank of dental needs, dental insurance and other factors were analyzed with the Kruskal Wallis test, chi-square test, analysis of variance and multiple logistic regression. Of the 252 participants, 80 (31.7%) had been insured continuously since 1974, 69 (27.4%) had no need for dental treatment and 59 (23.4%) needed urgent dental care. More of the continuously insured than the uninsured residents were dentate (46/80 [57.5%] vs. 75/172 [43.6%], p = 0.04). Ranking of the need for care was not significantly influenced by dental insurance; need of any kind was explained by being dentate (odds ratio 12.3, 95% confidence interval 5.6 27.3).