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.

Preventive actions for enhancing oral health.

Preventive regimens that have proven efficacy for older adults include topical fluoride rinses, brush-on gels, and antiplaque agents. The efficacy of patient education for both dental office and institutional patients is documented in this article. The use of a preventive and oral health maintenance plan for each patient can improve his or her quality of life even in the face of multiple chronic conditions.

Epidemiologic studies of oral mucosal conditions--methodologic issues.

The methods used in the international English-language literature of epidemiologic investigations of oral mucosal conditions were reviewed. Methods used to study leukoplakia, lichen planus, recurrent herpes labialis, recurrent aphthous ulcers, geographic tongue and candidiasis are highlighted. In addition, studies of the full range of pathologies documented in a population were reviewed. The methodologic issues raised by the epidemiologic literature as well as those to be considered for future studies of oral mucosal conditions are presented. Emphasis is placed on study population selection, diagnostic criteria development, type and training of examiners, risk factor assessment and issues related to data collection, analysis and reporting.

Oral health status of a long-term-care, veteran population.

The Department of Veterans Affairs (VA) operates the largest, integrated health care system in the United States of America. The projected need for long-term-care in the VA health care system parallels an expected increase in need for care in the United States, but precedes the need for care in the general population by 25-30 yr. The VA's Office of Dentistry, in an effort to estimate the resource requirements of this swelling group of veterans, initiated in 1986-7 an oral health survey of long-term care patients. The overall goals were to describe the oral health status of VA nursing home care units (NHCU) residents and to develop a methodology for estimating future dental health services utilization. This study describes the oral health status of the study population. Demographic and oral health data were collected for 650 long-term care residents of six VA NHCUs between October 1986 and July 1987. Data were collected on sociodemographic status, medical history, dental caries, periodontal diseases, oral soft tissue pathology, and the presence of dental prostheses. Caries and periodontal disease were evaluated using the United States National Institute of Dental Research Survey of Employed Adults and Seniors protocols. The oral health status of the population is described using DMF and ESI indices, the prevalence of oral lesions, levels of tooth loss, oral hygiene scores, and the status of existing dentures. Findings show moderate levels of untreated dental caries and periodontal disease and significant tooth loss which increased with age. A need for preventive therapy, restorative dentistry, conservative periodontal therapy, and prosthodontic care was evident.(ABSTRACT TRUNCATED AT 250 WORDS)

New directions--constituencies and responsibilities.

Six critical questions are discussed as background information for the participants as the future direction for dental public health in North Carolina is considered. (1) Why should a dental program exist as part of the state public health program? (2) Who are the current and future constituents? (3) What programs will be necessary? (4) Where will dental public health programs function in the future? (5) How will dental public health programs function in the future? and (6) When will dental public health programs change? The Future of Public Health Report and the Year 2000 Objectives consider many of these questions for public health and dental public health. In addition to this information, the inequities of oral health status, access to care among various population groups, constituency building, and the roles of government agencies have to be considered. This presentation challenges public health to visualize possibilities for a future that cannot be seen, but that needs to be anticipated.

Causes of tooth loss in a veteran population.

Tooth loss in adults over age 35 usually is attributed to periodontal diseases. However, certain adult populations are known to have high caries rates. It is not clear to what extent caries contributes to tooth loss in adults. This pilot study examined the causes of tooth loss in a veteran population residing in an 800-bed, primarily long-term care facility. The study retrospectively reviewed 572 patients' dental records and documented causes for dental extractions. Of the sample population, 168 teeth were extracted in 51 patients who had 860 teeth present before treatment. Mean age of the patients undergoing extractions was 57.7 years, lower than the sample population of 60.1 years. Of the 168 teeth extracted, 105 (63%) were attributed to caries and 33 (20%) were documented as root tips, suggesting the presence of root caries. Fifty-five (33%) were extracted due to periodontal disease and six (4%) were extracted for prosthodontic reasons. Of the maxillary teeth, 67 percent were extracted for caries and 25 percent of periodontal reasons. Caries accounted for 57 percent and periodontal disease accounted for 42 percent of the mandibular teeth extracted. The order in which teeth were most frequently extracted was maxillary anteriors, mandibular anteriors, maxillary and mandibular premolars, and maxillary and mandibular molars. This study supports the recent work of authors who have found caries contributing significantly to tooth loss in adult populations.

Theoretical considerations in applying benefit-cost and cost-effectiveness analyses to preventive dental programs.

Benefit-cost analysis and cost-effectiveness analysis can be used to evaluate preventive regimens and aid policy-makers in making resource-allocation decisions. This paper demonstrates the application of benefit-cost and cost-effectiveness analyses to preventive dental programs. The two analyses are defined and described, and the purpose of each technic is compared. For a hypothetical community, four dental preventive programs are described: community water fluoridation, school water fluoridation, weekly school-based mouthrinses, and school-based sealants. Benefit-cost ratios and cost-effectiveness ratios are calculated for each program first assuming steady-state conditions, i.e., maximum caries reduction, and then for a 20-year period. Both explicit and implicit costs are included. Underlying assumptions and limitations, as well as the effects of changes in caries rates, differential attack rates, and discount rates on the outcome, are discussed. The analysis reveals that community water fluoridation yields the greatest net benefits and most favorable B/C and C/E ratios. School water fluoridation and mouthrinsing programs are the next most cost-effective, with similar B/C and C/E ratios when the implicit cost of teachers' time is omitted from the calculations. The school-based sealant program yields negative net benefits.

Dental public health postdoctoral education: a survey on the status of funding and career opportunities.

OBJECTIVES: This paper reports the results of a survey to determine the consequences of budget reductions on the status of dental public health postdoctoral training in the United States, and opinions of experts in education and practice regarding career opportunities in dental public health. METHODS: A survey was mailed to 154 dental and public health education and service institutions. RESULTS: Most respondents (74 of 103; 72%) agreed that training opportunities depend on funding, and 73 percent (n = 75) expressed the view that more dental public health specialists are needed. Respondents reported that funding for current dental public health master's degree and residency programs is less than satisfactory. Respondents involved in training of dental public health professionals held marginally statistically significant different opinions regarding career opportunities than those who were not involved. No significant differences in opinions of respondents existed by type of institution. CONCLUSION: With decreased numbers of dental graduates, improved funding for dental public health programs will be critical, particularly at the specialty entry level, to ensure that adequate numbers of specialists are trained and available to meet the oral health needs of all the US population.

Dental treatment and demand for services in a Veterans Administration Nursing Home Care Unit.

Planning the provision of dental care in nursing homes requires evaluation of both dental needs and demand for services. Dental treatment needs have been documented for residents of longterm care facilities. This paper examines the actual dental care provided to institutionalized persons demanding care. Dental records of 144 patients at a Veterans Administration Nursing Home Care Unit (NHCU) were reviewed to evaluate needs and treatment demands. About 20 percent of the NHCU patients were currently receiving dental treatment; the remainder were on recall (closed cases). Of the total services needed, slightly over half were denture related services, about a quarter were oral surgical services, and 16 percent were operative procedures. Almost a third refused some or all of the proposed dental treatment; seven percent were unable to be examined or treated. No statistically significant difference was found between the age and the level of nursing home care needed for those receiving treatment and those refusing treatment. Once the backlog of need was met, this NHCU dental program consisted primarily of recall exams, and prosthetic and oral surgical treatment. The case mix and refusal rate may change, however, as future cohorts of elders retain more teeth and have experienced preventive dental services during their lifetimes.

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.

Issues in financing dental care for the elderly.

The elderly make up an increasingly larger segment of the patient population in dental practices. This article reviews recent epidemiologic, demographic, and health services research, and concludes that significant segments of the elderly are at high risk for oral disease and/or limited access to dental treatment, and consequently warrant classification as high-risk groups for policy considerations. It then proposes policy options to the dental community and public decision makers. Oral care can be viewed as having three components. Two basic components are the primary care component--which includes diagnostic, preventive restorative, and periodontal care--and the acute care component--i.e., the treatment of oral pain, trauma, and infection. The third, rehabilitative component, has to do with the restoration of oral function, including prosthodontics and cosmetic dentistry. Viewing dental care in this perspective may help link funding for dental primary care services with that for other primary health services, and link restoration of function and improvement of quality of life with similar health services, like hearing, vision, and social services. In addition, approaching dental care policy makers on several levels--i.e., federal, state, and local--will contribute to our ability as a profession, in the decades ahead, to meet the oral health needs of more elders: including the frail, those at high risk for oral disease, and those with limited access to care.

Dental public health for the 21st century: implications for specialty education and practice.

A panel of public health practitioners sponsored by the Health Resources and Services Administration met December 6-8, 1994, to examine current roles and responsibilities for dental public health workers and to recommend changes in education and training to meet challenges posed by an evolving health care system. Overall, at least the same number, if not more, dental public health personnel will be needed in the future. While some new roles were identified, the panel felt that only small numbers of personnel will be needed to fill these new roles. Not all of these roles necessarily require a dental degree. The panel felt that a need exists for more academicians for dental schools, schools of public health, dental public health residencies, and dental hygiene programs; oral epidemiologists and health services researchers; health educators; and specialists in utilization review/outcomes assessment, dental informatics, nutrition, program evaluation, and prevention. To meet these personnel needs: (1) dental public health residency programs should be structured to meet the educational needs of working public health dentists with MPH degrees through on-the-job residency programs; (2) the standards for advanced specialty education programs in dental public health should be made sufficiently flexible to include dentists who have advanced education and the requisite core public health courses; (3) flexible MPH degree programs must be available because of the rising debt of dental students and the decreased numbers of graduating dentists; (4) loan repayment should be available for dentists who have pursued public health training and are working in state or local health departments; and (5) standards for advanced education in dental public health should be developed for dental hygienists.

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.

Training status and interest in certification of nondiplomate faculty teaching predoctoral dental public health.

OBJECTIVES: A survey was conducted to better understand the training needs of faculty members without dental public health (DPH) specialty board certification who teach DPH to dental students. METHODS: An 11-item questionnaire was sent to 193 non-DPH diplomate faculty members at US dental schools who were dentists and at least one of the following: a member of the American Association of Dental Schools Community and Preventive Dentistry Section, a referral from an academic American Board of Dental Public Health diplomate, a DPH faculty listed on the school's Web pages, a DPH contact from the AADS Institutional Directory, or the school's dean if no other contact. RESULTS: A 70 percent response rate was obtained. Seventy-nine percent of the respondents taught at least one national board-related DPH topic. Among these faculty members, 67 percent have or are in training for the master of public health, 26 percent have completed or are in a DPH residency, and 63 percent desire training in one or more of the DPH topics. The majority (64%) does not plan to take the specialty exam, while 28 percent plan to take the exam within five years. About half reported no personal incentives to take the exam and 39 percent perceived no institutional incentives. CONCLUSIONS: These nondiplomate teachers of predoctoral DPH desire training, but appear to have barriers and perceive few benefits to achieving DPH board certification.

Academic dental public health diplomates: their distribution and recommendations concerning the predoctoral dental public health faculty.

OBJECTIVE: The purpose of this study was to assess the representation of academically based diplomates of the American Board of Dental Public Health (ABDPH) and to identify their perceptions on the training of dental public health predoctoral faculty. METHODS: Data were collected by a mailed, self-administered, 13-item questionnaire. The population was the 48 diplomates of the ABDPH as of March 1997 associated with academic institutions. RESULTS: Twenty of the 55 US dental schools had a diplomate of the ABDPH with a mean of 1.8 diplomates per school with a diplomate. An average of 4.5 full-time faculty members per school were associated with teaching dental public health. A master's degree in public health (MPH) was the most frequently suggested educational requirement for dental public health faculty. Continuing education courses were training needs perceived for dental public health faculty. The lack of time, money, and incentives, along with perceived rigidity of requirements for board certification, were reported as major barriers for faculty becoming dental public health board certified. CONCLUSIONS: Numerous challenges confront the development of a strong dental public health presence in US dental schools. These challenges include, among others, insufficient numbers of academic dental public health specialists and insufficient motivations to encourage promising candidates to pursue specialty status.

The demands of the summer season.

Dentistry in the summer season of a practice can be a balancing act in integrating career and family needs. In addition, the complex concerns of continuing education, participating in professional organizations, and changing financial planning needs must be addressed in this stage. Although dental schools are responsible for formal education, continued learning for personal and professional growth rests with the individual.

Practice management considerations for an aging population.

Older adults are visiting their dentists more frequently than in the past and expecting higher levels of oral health throughout their lives. Special considerations for this age group and marketing tips are discussed.

Managing patients with Alzheimer's: the primary care role of dentists.

The primary care role of a dentist in the comprehensive care and management of a patient with Alzheimer's disease and the caregiver is described. As part of a geriatric assessment team, the dentist can contribute to a strategy addressing these patients' complex needs.

Practice patterns of male and female dentists.

The 1985 ADA Survey of Dental Practice was used to compare practice characteristics of 1,414 males and 110 females who graduated from dental school in or after 1975. Similarities and differences in practice, patient, and productivity characteristics were identified among male and female dentists. Additionally, multivariate analyses showed gender, practice type, and age as significant predictors of productivity.

Practice characteristics of women dentists.

The literature on practice characteristics of women dentists is discussed to identify the information available on how women practice dentistry. Few reports have been published that describe or analyze such data. Of the available studies, few are national in scope and even fewer compare male and female age-matched graduation cohorts. With the increase in the number of women dentists, human resource planning and analyses and design of educational curricula will require improved knowledge of the practice characteristics of men and women dentists.