Oral health disparities and psychosocial correlates of self-rated oral health in the National Survey of American Life.

OBJECTIVES: We sought to better understand the determinants of oral health disparities by examining individual-level psychosocial stressors and resources and self-rated oral health in nationally representative samples of Black American, Caribbean Black, and non-Hispanic White adults. METHODS: We conducted logistic regression analyses on fair or poor versus better oral health using data from the National Survey of American Life (n = 6082). RESULTS: There were no significant racial differences. Overall, 28% of adults reported having fair or poor oral health. Adults with lower income and less than a high school education were each about 1.5 times as likely as other adults to report fair or poor oral health. Higher levels of chronic stress, depressive symptoms, and material hardship were associated with fair or poor oral health. Adults living near more neighborhood resources were less likely to report fair or poor oral health. Higher levels of self-esteem and mastery were protective, and more-religious adults were also less likely to report fair or poor oral health. CONCLUSIONS: Social gradients in self-rated oral health were found, and they have implications for developing interventions to address oral health disparities.

Evaluating oral health promotion: need for quality outcome measures.

Oral health promotion effectiveness reviews have identified the need to improve the quality of the evaluation of interventions. A project was undertaken to identify and assess the quality of available outcome measures. This paper describes the methodology adopted and highlights the need for further development of oral health promotion outcome measures. Initially a thorough and comprehensive search of both the published and unpublished literature was undertaken to identify potential outcome measures. A set of quality criteria was then developed and used to assess the identified measures. The search identified a total of 1202 outcome measures of which 39% (n = 466) were developed for use with schoolchildren. A high proportion of the identified measures were classified as health literacy and healthy lifestyle outcomes, appropriate for the evaluation of oral health education activities. Only 1% (n = 12) of measures identified were classified in the healthy public policy category. When reviewed against the quality criteria, 49% (n = 594) of the measures were considered satisfactory. The poorest performing measures were those classified as healthy lifestyle and health literacy measures in which only 33% (n = 72) and 41% (n = 240), respectively, were deemed to be of satisfactory quality. In conclusion, a significant number of oral health promotion evaluation outcome measures have been identified although their quality is highly variable. Very few high-quality outcome measures exist for use in the evaluation of oral health policy and environmental interventions. The lack of appropriate and high-quality outcome measures is hampering the development of oral health promotion.

Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis--United States, 1988-1994 and 1999-2002.

PROBLEM/CONDITION: Dental caries is a common chronic disease that causes pain and disability across all age groups. If left untreated, dental caries can lead to pain and infection, tooth loss, and edentulism (total tooth loss). Dental sealants are effective in preventing dental caries in the occlusal (chewing) and other pitted and fissured surfaces of the teeth. Enamel fluorosis is a hypomineralization of enamel related to fluoride exposure during tooth formation (first 6 years for most permanent teeth). Exposure to fluoride throughout life is effective in preventing dental caries. This is the first CDC Surveillance Summary that addresses these conditions and practices. REPORTING PERIOD: 1988-1994 and 1999-2002. SYSTEM DESCRIPTION: The National Health and Nutrition Examination Survey (NHANES) is an ongoing survey of representative samples of the civilian, noninstitutionalized U.S. population aged >/=2 months in NHANES 1988-1994 and all ages during 1999-2002. The dental component gathered information on persons aged >/=2 years. RESULTS: During 1999-2002, among children aged 2-11 years, 41% had dental caries in their primary teeth. Forty-two percent of children and adolescents aged 6-19 years and approximately 90% of adults had dental caries in their permanent teeth. Among children aged 6-19 years, 32% had received dental sealants. Adults aged >/=20 years retained a mean of 24 of 28 natural teeth and 8% were edentulous. Among persons aged 6-39 years, 23% had very mild or greater enamel fluorosis. Disparities were noticed across all age groups, among racial/ethnic groups, persons with lower education and income, and by smoking status. From 1988-1994 to 1999-2002, four trends were observed: 1) no change in the prevalence of dental caries in primary teeth among children aged 2-11 years, 2) a reduction in prevalence of caries in permanent teeth of up to 10 percentage points among persons aged 6-19 years and up to six percentage points among dentate adults aged >/=20 years, 3) an increase of 13 percentage points in dental sealants among persons aged 6-19 years, and 4) a six percentage point reduction in total tooth loss (edentulism) among persons aged >/=60 years. INTERPRETATION: The findings of this report indicate that the dental caries status of permanent teeth has improved since the 1988-1994 survey. Despite the decrease in caries prevalence and severity in the permanent dentition and the increase in the proportion of children and adolescents who benefit from dental sealants, disparities remain. PUBLIC HEALTH ACTION: These data provide information for public health professionals in designing interventions to improve oral health and to reduce disparities in oral health, for researchers in assessing factors associated with disparities and dental caries in primary teeth, and in designing timely surveillance tools to monitor total fluoride exposure.

Manual para estudios epidemiológicos sobre las manifestaciones orales de la infección por el VIH / Manual para estudios epidemiológicos sobre las manifestaciones orales de la infección por el VIH / A guide for epidemiological studies of oral manifestations of HIV infection

Se calcula que el número de personas infectadas en todo el mundo por el virus de la inmunodeficiencia adquirida (VIH) supera ya los once millones; a la vez, se intensifican los esfuerzos para comprender mejor todos los aspectos de la infección. Las lesiones orales anomalías figuran entre las primeras manifestaciones de la infección, por lo que los profesionales de la salud bucodental se encuentran en condiciones inmejorables para contribuir de modo considerable a las investigaciones epidemiológicas

Donde los recursos lo permitan podrán emprenderse estudios independientes centrados exclusivamente en las lesiones orales, pero es más probable que las afecciones bucodentales se estudien junto con otros aspectos clínicos de la infección por el VIH. Sea cual fuere el enfoque adoptado, para que los resultados tengan validez y sean comparables a escala mundiales es esencial normalizar la terminología y los métodos de examen, diagnóstico, registro y análisis de los datos. El presente manual pretende servir de base para esa normalización. El diseño de los estudios epidemiológicos se aborda en función de los objetivos, la selección de poblaciones apropiadas para cada estudio, el tamaño de las muestras, la determinación de la situación respecto de la infección por el VIH y los criterios de diagnóstico

Manual para estudios epidemiol'ogicos sobre las manifestaciones orales de la infecci'on por el VIH / Sandra L. Melnick ... [et al.] / A Guide for epidemiological studies of oral manifestations of HIV infection

En este manual se establece el marco para abordar de forma normalizada el estudio epidemiológico de las afecciones bucodentales asociadas a la infección por el VIH. Habida cuenta de que las lesiones orales son uno de los primeros síntomas de la infección por el VIH y de su evolución hacia el SIDA, la publicación responde a la necesidad de facilitar el acopio y las comparaciones de datos mediante la normalización de la terminología, de los criterios de diagnóstico y los procedimientos de examen clínico y de los métodos de análisis y notificación de datos. Con ese marco los autores se proponen estimular la comparación de los resultados obtenidos en distintos estudios y poblaciones y a la vez considerar el estado de salud bucodental como parte integrante del tratamiento óptimo de los casos y de las actividades de vigilancia. El manual está destinado tanto a los epidemiólogos experimentados que estén interesados en las afecciones bucodentales asociadas con el VIH como a los profesionales de la salud bucodental sin conocimientos especializados de epidemiología. Contiene una guía para la planificación de los estudios epidemiológicos, con consejos para el establecimiento de objetivos, la selección de poblaciones de estudio apropiadas y la determinación del tamaño de la muestra. Para facilitar la coherencia de los diagnósticos y los informes, se exponen criterios concisos de diagnóstico clínico para cada una de las enfermedades micóticas, bacterianas y víricas, de los trastornos idiopáticos y de las neoplasias con manifestaciones orales que son más comunes y se asocian con el VIH. Se indican claramente los casos que requieren pruebas específicas para confirmar el diagnóstico. En el libro se definen asimismo los procedimientos clínicos normalizados para el examen de la cavidad bucal y los labios. En las secciones restantes se dan ejemplos de análisis y organización de los datos y se examina el formato de los informes de los estudios. El manual concluye con breves definiciones de los términos epidemiológicos más corrientes

Manifestations buccales de l' infection à VIH : guide des études épidémiologiques / Sandra L. Melnick ... [et al.] / A Guide for epidemiological studies of oral manifestations of HIV infection

Ce guide présente une approche systématique de l'organisation des études épidémiologiques sur les affections buccales associées à l'infection par le virus de l'immunodéficience humaine (VIH). Soulignant que les lésions buccales comptent parmi les premiers symptômes de l'infection à VIH et de l'évolution de l'infection vers le SIDA, le présent guide met l'accent sur la nécessité de faciliter la collecte et la comparaison des données en utilisant une terminologie, des critères de diagnostic, des procédures d'examen clinique et des méthodes normalisées applicables à l'analyse et au compte rendu des résultats. Cette présentation permet à l'auteur d'inciter à comparer les résultats obtenus dans différentes études et auprès de différentes populations, tout en considérant l'examen de santé bucco-dentaire comme faisant partie intégrante de la prise en charge optimale des cas et de la surveillance des maladies associées à l'infection par le VIH. Le présent guide est destiné aux épidémiologistes qui s'intéressent aux lésions buccales associées au VIH, ainsi qu'aux praticiens de la santé bucco-dentaire, sans spécialisation en épidémiologie

A Guide for epidemiological studies of oral manifestations of HIV infection / Sandra L. Melnick ... [et al.] / Manifestations buccales de l' infection à VIH : guide des études épidémiologiques / Manual para estudios epidemiológicos sobre las manifestaciones orales de la infección por el VIH

Establishes the framework for a standardized approach to the epidemiological study of oral conditions associated with HIV infection. Noting that oral lesions are among the first symptoms of both infection with HIV and progression to AIDS, the guide responds to the need to facilitate data collection and comparisons through use of standardized terminology, standardized diagnostic criteria and procedures for clinical examination, and standardized methods for the analysis and reporting of data. In presenting such a framework, the authors aim to encourage the comparison of findings from different studies and different populations, while also making oral health status an integral part of optimum case management and of surveillance activities. The guide is addressed to established epidemiologists with an interest in HIV-associated oral conditions as well as to oral health practitioners who lack specialized knowledge of epidemiology. The guide has five main sections. The first provides background information about HIV infection and AIDS, emphasizing the role that epidemiological studies of oral manifestations can play in improving the understanding and control of this disease. A brief introduction to the principles of epidemiology is also provided, together with an explanation of key terms. The second and most extensive section provides a guide to the design of epidemiological studies, including advice on the establishment of objectives, the selection of appropriate study populations, and the determination of sample size. To facilitate consistent diagnosis and reporting, the guide sets out concise clinical diagnostic criteria for each of the most common HIV-associated fungal, bacterial, and viral diseases, idiopathic conditions, and neoplasms having oral manifestations. Cases where specific tests are needed to confirm diagnosis are clearly indicated. The book also defines standard clinical procedures for the examination of the oral cavity and lips. The remaining sections provide examples of data analysis and layout, and discuss the format of study reports. The guide concludes with brief definitions of common epidemiological terms