Comparisons between referred and non-referred patients to a university paediatric dental clinic.

BACKGROUND: Referrals of paediatric patients to a university clinic have been increasing over the last several years. AIM: To evaluate characteristics of referred and non-referred patients at the University of Iowa's Pediatric Dental Clinic (UIPDC). DESIGN: A retrospective chart review included dental records of 340 referred and 383 non-referred patients from July 1, 2015, to May 31, 2016 (n = 723). Age, distance to the clinic, size of the patient's community, insurance, number of teeth with decay, treatment needs, educational level of the provider, and presence of patient special health care needs were obtained. Descriptive statistics, bivariate analysis, and multivariable logistic regression were performed to analyze the outcomes (alpha = .05). RESULTS: Referred patients were more likely to live >60 miles away, live in a community of >75 000 people, have special health care needs, have caries/greater number of teeth with decay, need endodontic treatment, and were less likely to remain patients at the clinic (p < .0001). Referred patients were also more likely to need extractions (p = .0104), but less likely to need space maintenance/comprehensive orthodontic treatment (p = .0002). CONCLUSION: There was a difference in the complexity of patient treatment needs between referred and non-referred patients.

Longitudinal Study Assessing Factors Associated with Mutans Streptococci Acquisition in Infants and Toddlers.

PURPOSE: To assess the role of sociodemographic, dietary, and clinical factors in early mutans streptococci (MS) colonization in children aged 6 to 24 months who were followed for 18 months. MATERIALS AND METHODS: Ninety-four children (mean age: 11.5 ± 4.99 months at baseline) were enrolled in the study from the Women, Infants and Children Supplemental Nutrition Program during 2003-2004. Salivary MS levels of the children were determined at baseline and at 18 months using a semi-quantitative method. Detailed information about the children's beverage consumption pattern, dietary behavior, and clinical information about oral health status was collected at baseline, 9 months, and 18 months. None of the children included in this study had detectable levels of MS at baseline. RESULTS: Of the 94 children at baseline, 36 (38%) had acquired MS by the 18-month follow-up. The presence of >5 teeth [OR = 3.55 (1.46-9.04); p = 0.0062] was a significant risk factor for MS acquisition among the baseline variables. At 9 months, sports drinks consumption [OR = 5.56 (1.39-26.26); p = 0.0143] and presence of caries [OR = 9.36 (2.55-40.90); p < 0.0001] were significantly associated with MS colonization at 18 months. Higher maternal education [OR = 0.3 (0.07-1.36); p = 0.0351] was a protective factor at all the time points. CONCLUSION: Sugared beverage consumption, tooth-related factors, and lower maternal education can predict MS acquisition in young children.

Generalized permanent dentition fluorosis severity becomes less evident over time among a birth cohort.

Objectives: There are relatively few cohort studies which have examined changes in fluorosis appearance over time, and none of these have assessed changes in generalized fluorosis. In this analysis, we quantified and assessed changes in multiple measures of generalized fluorosis severity through childhood, adolescence, and young adulthood. Methods: Participants were from the Iowa Fluoride Study, a birth cohort recruited from 1992 to 1995. Permanent dentition fluorosis exams were carried out at ages 9, 13, 17, and 23 years using the Fluorosis Risk Index (FRI). Generalized fluorosis was assessed using mean FRI scores at the tooth- and person-level as well as a five-category measure of generalized fluorosis. Generalized fluorosis prevalence and severity was summarized at each time point and differences in adjacent time points were assessed using gamma statistics, signed-rank tests, and plotting changes in generalized fluorosis between adjacent time points. Results: We observed a statistically significant decline in the percentage of non-zero mean FRI scores at later exam ages at both the person- and tooth-levels. Based on our five-category generalized fluorosis measure, there were 34.0%-54.1% of participants with generalized fluorosis at baseline for each tooth group, and these percentages declined to 8.9%-27.2% at the age 23-year exam. Conclusions: We observed a statistically significant decline in generalized fluorosis severity scores and overall prevalence at later exam ages across all three measures of generalized fluorosis severity. This trend should be accounted for when estimating the prevalence of fluorosis in a population using fluorosis severity data collected in children and adolescents.

Role of mutans streptococci, acid tolerant bacteria and oral Candida species in predicting the onset of early childhood caries.

Aim: Early childhood caries is the most common chronic infectious disease in children in the United States. This study, which is part of a larger, longitudinal study exploring oral microbiological components of caries development in children, reports on the impact of total mutans streptococci (MS), total acid tolerant bacteria and Candida species on the development of dental caries in a subset of these children. Of particular interest was the relationship between caries development and co-colonization of mutans streptococci and Candida species. Methods: Children between the ages of 12 and 47 months displaying no evidence of dental caries were recruited for a longitudinal study (n = 130). Twelve age- and gender-matched pairs were selected. In each pair, one child developed caries during the study, and one did not. Whole mouth plaque samples were collected by swab at baseline and every 6 months thereafter for a duration of 18 months and spiral plated for microbial counts (CFU/ml). Cut-offs based on percent of total cultivable flora were designated for all microbial measures. A scoring system designated the Plaque Microbial Index (PMI) was developed for use in statistical analyses to assess potential predictive factors for caries risk assessment. Results: Children who developed caries were significantly more likely to harbor higher percentages of acid tolerant bacteria (p = 0.003), MS (p < 0.001) and have Candida species present (p < 0.001) at ≥1 visit leading up to caries onset. Mean PMI scores derived from the aforementioned microbial measures, were higher for caries active children than caries free children (p = 0.000147). Co-colonization of MS and Candida species was significantly associated with caries development (p < 0.001) and detection of both at the same visit had a 100% positive predictive value and 60% negative predictive value for caries development. Conclusion: In children who developed caries, there was a statistically significant association with the percent of total flora that was acid tolerant, the percent of MS, the presence of Candida and co-colonization of MS and Candida species. Combining these microbial measures into PMI scores further delineated children who developed caries from those who remained caries-free. These microbiological measures show potential as predictive factors and risk assessment tools for caries development.

Racial and ethnic disparities in utilization of dental services among children in Iowa: the Latino experience.

OBJECTIVES: We sought to understand the role of Latino acculturation in dental care utilization in Iowa children. METHODS: We used logistic regression to evaluate factors associated with having a previous-year dental check-up with 2005 Iowa Child and Family Household Health Survey data. We constructed models to examine the association with race/ethnicity and used chosen interview language to measure Latino acculturation. RESULTS: After we controlled for several factors, having a regular dental care source, having a dental need, dental insurance status, family income, children's dental health rating, children's age, and brushing habits were associated with having a previous-year dental check-up. Race/ethnicity was indirectly associated with use of dental services through other related factors with significant differences for less-acculturated Latinos. CONCLUSIONS: Policymakers and health planners should implement strategies to address individual, community, and system factors affecting racial/ethnic minorities. A regular source of dental care for Latino children that will enhance their access to services should be ensured. Ignoring the needs of the fastest growing segment of children with the poorest oral health and the least access to care will lead to future increase of oral diseases in this population.

Examiner reliability of fluorosis scoring: a comparison of photographic and clinical examination findings.

OBJECTIVE: To assess and compare examiner reliability of clinical and photographic fluorosis examinations using the Fluorosis Risk Index (FRI) among children in the Iowa Fluoride Study (IFS). METHODS: The IFS examined 538 children for fluorosis and dental caries at age 13 and obtained intraoral photographs from nearly all of them. To assess examiner reliability, duplicate clinical examinations were conducted for 40 of the subjects. In addition, 200 of the photographs were scored independently for fluorosis by two examiners in a standardized manner. Fluorosis data were compared between examiners for the clinical exams and separately for the photographic exams, and a comparison was made between clinical and photographic exams. For all three comparisons, examiner reliability was assessed using kappa statistics at the tooth level. RESULTS: Interexaminer reliability for the duplicate clinical exams on the sample of 40 subjects as measured by kappa was 0.59, while the repeat exams of the 200 photographs yielded a kappa of 0.64. For the comparison of photographic and clinical exams, interexaminer reliability, as measured by weighted kappa, was 0.46. FRI scores obtained using the photographs were higher on average than those obtained from the clinical exams. Fluorosis prevalence was higher for photographs (33 percent) than found for clinical exam (18 percent). CONCLUSION: Results suggest that interexaminer reliability is greater and fluorosis scores are higher when using photographic compared with clinical examinations.

Comorbidities in Children with Autism Spectrum Disorder Undergoing Oral Rehabilitation Under General Anesthesia.

Purpose:To investigate the oral health needs and comorbidities among patients with autism spectrum disorder (ASD) undergoing oral rehabilitation under general anesthesia (GA) at a university hospital.
Methods: Records of patients with ASD who underwent oral rehabilitation under GA between January 2016 and May 2019 were reviewed to identify comorbid conditions and oral health needs. Statistical analysis consisted of descriptive and bivariate analyses (alpha = 0.05).
Results:A total of 160 patients from three to 18 years of age fulfilled the inclusion criteria. Seventy-eight percent were male and 69 percent had public insurance. Be- havioral issues, such as anxiety, aggression and nonverbal status, were observed more frequently than reported in the ASD literature. Dental caries, poor oral hygiene and gingivitis were the most common dental conditions observed. Radiographs, sealants, stainless steel crowns and extractions were the most common treatments rendered. Bivariate analysis revealed that subjects who had eight to 15 comorbidities were likely to be older.
Conclusions: Patients with ASD have many dental needs and may have comorbid medical conditions that directly affect the safe delivery of GA and dental treatments. As patients with ASD age, the number of comorbidities increases.

Impact of chronic condition status and severity on dental utilization for Iowa Medicaid-enrolled children.

BACKGROUND: Although Medicaid-enrolled children with a chronic condition (CC) may be less likely to use dental care because of factors related to their CC, dental utilization for this population is poorly understood. OBJECTIVE: To assess the relationship between CC status and CC severity, respectively, on dental utilization for Iowa Medicaid-enrolled children. RESEARCH DESIGN: Retrospective cohort study of Iowa Medicaid data (January 1, 2003 to December 31, 2006). SUBJECTS: Medicaid-enrolled children aged 3 to 14 (N = 71,115) years. MEASURES: The 3M Corporation Clinical Risk Grouping methods were used to assess CC status (no/yes) and CC severity (episodic/life-long/malignancy/complex). The outcome variable was any dental utilization in 2006. Secondary outcomes included use of diagnostic, preventive, routine restorative, or complex restorative dental care. RESULTS: After adjusting for model covariates, Iowa Medicaid-enrolled children with a CC were significantly more likely to use each type of dental care except routine restorative care (P = 0.86) than those without a CC, although the differences in the odds were small (4%-6%). Compared with Medicaid-enrolled children with an episodic CC, children with a life-long CC were less likely to use routine restorative care (P < 0.0001), children with a malignancy were more likely to use complex restorative care (P < 0.03), and children with a complex CC were less likely to use each type of dental care except complex restorative care (P = 0.97). CONCLUSIONS: There were differences in dental utilization for Iowa Medicaid-enrolled children by CC status and CC severity. Children with complex CCs were the least likely to use dental care. Future research efforts should seek to understand why subgroups of Medicaid-enrolled children with a CC exhibit lower dental utilization.

Sodium hypochlorite pulpotomies in primary teeth: a retrospective assessment.

PURPOSE: In 2007, the University of Iowa's advanced training program in pediatric dentistry replaced the traditional formocresol vital pulpotomy technique with a 5% sodium hypochlorite (NaOCl) technique. The purpose of this study was to evaluate the clinical/radiographic success over 21 months of 5% NaOCl as the medicament in primary molar pulpotomies compared to published data for formocresol and ferric sulfate pulpotomies. METHODS: A retrospective chart audit was performed to evaluate results for all primary molar pulpotomies completed during a 12-month period using NaOCl. Dental records were reviewed for clinical and radiographic findings subsequent to pulp therapy. Clinical and radiographic criteria used to determine pulpotomy success were based on scientific literature. RESULTS: One hundred ninety-two NaOCl primary molar pulpotomies were completed in 118 patients; 131 (68%) primary molars from 77 children were available for follow-up examination (mean time since pulpotomy=10.5 months). NaOCl pulpotomies had a 95% clinical and 82% overall radiographic success rate. External root resorption was the most common pathologic finding. Pulpotomy success diminished over time. CONCLUSIONS: Clinical and radiographic success rates in this study on NaOCl pulpotomies are comparable to formocresol and ferric sulfate pulpotomies reported in the literature. Further study with longer observation periods is warranted.

Transitioning Adolescent Patients with Special Health Care Needs from Pediatric to Adult Dental Care.

Health care transition from adolescence into adulthood is a complex process that often lacks care coordination, planning, and collaboration among the parties involved. Dental transition is significantly more challenging for adolescents with special health care needs. Shortage of qualified general dentists willing to treat these individuals and low dental reimbursement by public insurance programs are significant barriers to successful transition. Adequate training to increase dental workforce, insurance benefits, protocol development, and research are needed to ensure successful transition for this population. Meanwhile, it is important to target individuals less likely to access adequate oral health care and achieve satisfactory transition.

Management of Head Lice in Dental Offices: A Call for Updated Policies.

Purpose: To compare knowledge, policy, and management regarding patients with suspected head lice between general dentists (GPs) working at Federally Qualified Health Centers (FQHCs) and pediatric dentists (PDs).
Methods: A 14-item survey was emailed to 340 active dentists in Iowa, Missouri, and Kansas. Statistical analysis consisted of bivariate and multiple logistical regression analysis (alpha = 0.05).
Results: The response rate was 20.0 percent, comprising 27 GPs, 39 PDs, and one other specialist. Among the respondents, 23.9 percent were familiar with the American Academy of Pediatrics guidelines on head lice and 27.0 percent had a policy about patients with head lice in their practice. PDs were more likely to be familiar with the AAP guidelines on head lice (P =0.001), have received training on head lice (P =0.032), and feel comfortable identifying head lice in patients (P =0.015). PDs were also more likely to proceed with dental treatment if suspecting a patient had active head lice (odds ratio 4.27; 95 percent confidence interval = 1.19 to 84.59; P =0.002).
Conclusion: PDs are more willing to treat patients with suspected head lice and to personally discuss the topic with parents. Neither group universally followed current guidelines in working with children with head lice.

Impact of chronic condition status and severity on dental treatment under general anesthesia for Medicaid-enrolled children in Iowa state.

OBJECTIVE: To assess the impact of chronic condition (CC) status and CC severity, respectively, on the odds of receiving dental treatment under general anesthesia (GA) for Medicaid-enrolled children by age group. METHODS: This was a retrospective analysis of Iowa Medicaid-enrolled children <15 years (n = 62 721) from 2005 to 2008. 3M Clinical Risk Grouping Software identified each child's CC status (yes/no) and assigned children with a CC into a hierarchal CC severity group (episodic/life-long/complex). Multiple variable logistic regression models were used to identify the determinants of dental treatment under GA. RESULTS: Less than 1% of children received dental treatment under GA. While there was no significant difference in dental treatment under GA by CC status for children <6, those with a life-long CC were twice as likely to receive dental treatment under GA as demographically similar children with an episodic CC (P < 0.05). Children ages 6-14 with a CC were three times as likely as those without a CC to receive treatment under GA (P = 0.001). There was also a direct relationship between CC severity and dental treatment under GA use for older children. Those living in nonmetropolitan areas were more likely to receive treatment under GA as were children who previously received dental treatment under GA. CONCLUSIONS: Chronic condition status and severity were more important determinants of dental treatment under GA for Medicaid-enrolled children ages 6-14 than for those <6. Understanding these relationships is a critical step in developing clinical strategies and interventions aimed at preventing dental disease for Medicaid-enrolled children whose reasons for needing dental treatment under GA are modifiable.

Clinical Versus Radiographic Caries Diagnosis in Primary Tooth Approximal Surfaces.

Purpose: The purpose of this study was to compare approximal carious lesions in dentin diagnosed by clinical examination with those diagnosed radiographically in high caries-risk children. Methods: Eighty-four Amish two- to 11-year-olds were evaluated clinically by calibrated examiners using standard epidemiological criteria and radiographically using standard criteria as part of baseline examinations for a two-year pilot clinical trial. Approximal carious surfaces diagnosed by clinical examination were compared to those diagnosed radiographically to determine the number of lesions misdiagnosed by clinical examination alone. Comparisons between the number of lesions detected by clinical exam and radiographic exam were made using McNemar's test. Results: Among 124 anterior approximal tooth surfaces, clinical examination alone identified 61 lesions (49.2 percent), while radiograph examination identified 72 lesions (58.1 percent); thus, nine percent of lesions were misdiagnosed by clinical examination alone. For the 412 posterior approximal tooth surfaces included in the study, 101 lesions (24.5 percent) were identified by clinical examination, whereas 229 lesions (55.6 percent) were identified via radiographic examination. Thus, 128 (31.1 percent) were misdiagnosed by clinical examination alone. Conclusions: Clinical examinations without radiographs significantly underestimate caries prevalence. Therefore, the use of radiographs should be encouraged in epidemiological studies and clinical trials.

Multidisciplinary care for a patient with syndromic craniosynostosis: A case report with 20 years of special care.

AIM: The functional and structural complexities accompanying syndromic craniosynostosis make dental care for these patients particularly challenging. We report a case of long-term care for a syndromic craniosynostosis patient. The objective of this report is to introduce special care guidance and clinical recommendation, so that oral health care providers, as key members of a multidisciplinary care team, can provide optimal diagnosis, treatment, and management for the patient with syndromic craniosynostosis. CASE REPORT: The patient of this case report had a medical history of syndromic craniosynostosis involving multiple comorbidities. Over the past 20 years, a multidisciplinary care team has successfully treated the patient. Dental and medical procedures that the patient has received include cranial surgeries, prophylactic dental care, caries control, growth hormone therapy, comprehensive orthodontic treatment in conjunction with orthognathic surgeries, and plastic surgery. CONCLUSION: Oral health care providers can play essential roles in multidisciplinary care for patients with craniosynostosis by understanding the patients' unique oral health conditions and dentofacial deformities. To provide optimal oral health care in a multidisciplinary team, clear communication between the members of the care team is crucial.

Relationships between caregivers' responses to oral health screening questions and early childhood caries.

OBJECTIVE: This study evaluated relationships between caregiver responses to oral health screening questions and caries in young children. METHODS: Two samples of caregivers answered identical eight-item screening questionnaires about their oral health. One sample included children enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) who were 24 to 42 months of age; the other sample included 3- to 5-year-old children attending a pediatric dental clinic. Using chi-square and relative risk, questionnaire findings were related to children's caries history based on clinical caries exams. RESULTS: Questions significantly (P < 0.05) related to children's caries in the older sample included caregivers' poorer rating of their oral health, less frequent dental visits, current or recent caries, and history of tooth loss due to caries. However, only questions pertaining to tooth loss were related to caries in the younger sample. CONCLUSION: Caregivers' reported loss of teeth due to caries was significantly associated with caries development in their children in both samples, and may be a useful means for early identification of children at high risk.

Considerations on optimal fluoride intake using dental fluorosis and dental caries outcomes--a longitudinal study.

OBJECTIVES: The "optimal" intake of fluoride has been widely accepted for decades as between 0.05 and 0.07 mg fluoride per kilogram of body weight (mg F/kg bw) but is based on limited scientific evidence. The purpose of this paper is to present longitudinal fluoride intake data for children free of dental fluorosis in the early-erupting permanent dentition and free of dental caries in both the primary and early-erupting permanent teeth as an estimate of optimal fluoride intake. METHODS: Data on fluoride ingestion were obtained from parents of 602 Iowa Fluoride Study children through periodic questionnaires at the ages of 6 weeks; 3, 6, 9, 12, 16, 20, 24, 28, 32, and 36 months; and then at 6-month intervals thereafter. Estimates of total fluoride intake at each time point were made by summing amounts from water, dentifrice, and supplements, as well as other foods and beverages made with, or containing, water. Caries data were obtained from examinations of children at ages 5 and 9 years, whereas fluorosis data were obtained from examinations of children only at age 9 years. RESULTS: The estimated mean daily fluoride intake for those children with no caries history and no fluorosis at age 9 years was at, or below, 0.05 mg F/kg bw for nearly all time points through the first 48 months of life, and this level declined thereafter. Children with caries had generally slightly less intakes, whereas those with fluorosis generally had slightly higher intakes. CONCLUSIONS: Given the overlap among caries/fluorosis groups in mean fluoride intake and extreme variability in individual fluoride intakes, firmly recommending an "optimal" fluoride intake is problematic.

A Preexperimental Study to Assess the Impact of an Interdisciplinary Educational Intervention on Nurses' Knowledge of Perinatal and Infant Oral Health Care.

OBJECTIVE: The objective of this study was to assess the impact of an interdisciplinary educational intervention on the knowledge of nursing practitioners regarding perinatal and infant oral health (PIOH) care. MATERIALS AND METHODS: This was a preexperimental study conducted among nursing practitioners in Lagos, Nigeria. Participants received hands-on training and didactic lectures, which included dental caries etiology and risk factors; oral hygiene and dietary education; teething and its management; dental trauma and its prevention; nonnutritive habits; screening, referrals, and counseling; and fluoride varnish application. Knowledge of the trainees was assessed using pre- and posttest questionnaires. Level of statistical significance was set at P < 0.05. RESULTS: Overall, 110 nurses participated in the study with a mean age of 40.9 ± 10.8 years; 106 (96.4%) were females. Approximately 88% of the participants had not received formal training on PIOH. The baseline mean scores of the participants' knowledge on oral hygiene, teething, trauma, caries, and oral habits were 4.31 ± 1.9, 9.84 ± 2.6, 2.59 ± 1.7, 4.24 ± 1.8, and 1.45 ± 0.6, respectively; this increased significantly (P < 0.001) following the educational intervention with posttest mean scores as 7.58 ± 0.8, 11.79 ± 1.3, 4.34 ± 1.9, 6.19 ± 1.8, and 1.82 ± 0.4 and six-month evaluation scores as 6.21 ± 1.8,7 10.27 ± 3.1, 4.39 ± 1.5, 5.91 ± 1.8, and 1.79 ± 0.5, respectively. Overall posttest (31.4 ± 4.2) and six-month (28.6 ± 6.2) knowledge scores were significantly higher than the pretest values (22.4 ± 4.8, P < 0.001). At the six-month post-intervention survey, 84% of the nurses reported inclusion of PIOH education in their routine general health education sessions. CONCLUSION: There was a positive impact of the educational intervention as evidenced by an increase in the knowledge of the nurses on PIOH care and the inclusion of PIOH education in their general health education. A slight decline between posttest and six-month evaluation scores indicates a need for continuous education and evaluation.

Factors associated with dental caries experience in 1-year-old children.

OBJECTIVES: Dental caries in early childhood is an important public health problem. Previous studies have examined risk factors, but they have focused on children during the later stages of the disease process. The purpose of this study was to assess the factors associated with caries in children aged 6 to 24 months as part of a cross-sectional analysis. METHODS: Two hundred twelve mothers with children 6 to 24 months of age were recruited from Special Supplemental Nutrition Program for Women, Infants, and Children clinic sites in southeastern Iowa for participation in a longitudinal study of dental caries. Baseline assessments included detailed questions regarding the children's beverage consumption, oral hygiene, and family socioeconomic status. Dental caries examinations using the d(1)d(2-3)f criteria and semiquantitative assessments of salivary mutans streptococci (MS) levels of mother and child were also conducted. Counts of the number of teeth with visible plaque were recorded for maxillary and mandibular molars and incisors. RESULTS: Of the 212 child/mother pairs, 187 children had teeth. Among these children, the mean age was 14 months, and 23 of the children exhibited either d(1), d(2-3), or filled lesions. Presence of caries was significantly associated with older age, presence of MS in children, family income <$25,000 per year, and proportion of teeth with visible plaque. CONCLUSIONS: Results suggest that not only microbial measures, including MS and plaque levels, are closely associated with caries in very young children, but that other age-related factors may also be associated with caries. Continued study is necessary to more fully assess the risk factors for caries prevalence and incidence in preschool children.

Oral health knowledge levels of Hispanics in Iowa.

BACKGROUND: Hispanics disproportionately experience preventable oral health conditions in the United States. This study aimed to determine the oral health knowledge (OHK) of Hispanic adults in Iowa to identify potential gaps in knowledge. METHODS: This cross-sectional study included a convenience sample of self-identifying Hispanic adults. Data pertaining to oral health literacy and demographic, cultural, and dental characteristics were collected. OHK was assessed with the Conceptual Measure of Oral Health Knowledge, and it was categorized as low or high. Bivariate analyses and multiple logistic regression models were conducted to identify the variables related to OHK (P < .05). Institutional review board approval was obtained. RESULTS: Three hundred thirty-eight participants completed the questionnaire, 68% of participants completed the questionnaire in Spanish, and 51% of all participants had low OHK. Participants were less likely to correctly answer questions pertaining to children's oral health, periodontal disease, and oral cancer. Low OHK was associated with having less than 12th grade education, lack of dental insurance, and preference for a Spanish-speaking oral health care provider. CONCLUSIONS AND PRACTICAL IMPLICATIONS: OHK appears to be low in this population. Increasing OHK may help decrease oral health disparities and improve oral health outcomes. Furthermore, it is important that oral health care providers have an understanding of barriers that can impede patients' understanding of the health care system. Specifically, minority populations, such as Hispanics, may have a harder time because of certain cultural differences that exist among this ethnic group.

The relationships between fluoride intake levels and fluorosis of late-erupting permanent teeth.

OBJECTIVES: To examine the relationships between fluoride intake levels and fluorosis of late-erupting permanent teeth. METHODS: The current study used information collected from 437 children in the longitudinal Iowa Fluoride Study. Participants' fluoride intake information was collected using questionnaires from birth to age 10 years. Estimated mean daily fluoride intake was categorized into low, moderate, and high intake tertiles for each age interval (2-5, 5-8, and 2-8 years). Bivariate analyses were performed to study the relationships between self-reported fluoride intake levels during three age intervals and dental fluorosis. RESULTS: For canines and second molars, the prevalence of mostly mild fluorosis was less than 10% in the lowest fluoride intake tertile and more than 25% in the highest intake tertile. For both first and second premolars, the prevalence in the low and high intake tertiles was approximately 10-15% and 25-40%, respectively. When estimated total daily fluoride intake was 0.04 mg/kg BW during ages 2-8 years, the predicted probability of fluorosis was 16.0%, 20.5%, 21.8%, and 15.4% for canines, 1st and 2nd and premolars and 2nd molars, respectively. We found that an incremental increase in fluoride intake during the age 5- to 8-year interval led to greater odds for development of mostly mild dental fluorosis in late-erupting teeth compared to increases in fluoride intake during other age intervals. CONCLUSIONS: Our results clearly show that dental fluorosis prevalence is closely related to fluoride intake levels and that teeth have greater susceptibility to fluoride intake during certain age intervals.