Cultural competency: dentistry and medicine learning from one another.
(57/808)
The Institute of Medicine (IOM) report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care is serving as a catalyst for the medical profession to re-examine the manner in which its institutions and training programs relate to cultural competence. This report found that racial and ethnic disparities exist in health care and that a lack of access to care does not fully explain why such disparities exist. The IOM study found bias, stereotyping, prejudice, and clinical uncertainty as possible contributing causes. The U.S. Surgeon General's Report on the Oral Health of the Nation also pointed to oral health disparities related to race, ethnicity, and culture. This paper discusses how medicine is responding to the Unequal Treatment report and the lessons to be considered for dentistry. Recommendations on how dentistry can apply the knowledge from this report to help reduce oral health disparities are suggested. (+info)
Addressing disparities in children's oral health: a dental-medical partnership to train family practice residents.
(58/808)
Providing oral health care to rural populations in the United States is a major challenge. Lack of community water fluoridation, dental workforce shortages, and geographical barriers all aggravate oral health and access problems in the largely rural Northwest. Children from low-income and minority families and children with special needs are at particular risk. Family-centered disease prevention strategies are needed to reduce oral health disparities in children. Oral health promotion can take place in a primary care practitioner's office, but medical providers often lack relevant training. In this project, dental, medical, and educational faculty at a large academic health center partnered to provide evidence-based, culturally competent pediatric oral health training to family medicine residents in five community-based training programs. The curriculum targets children birth to five years and covers dental development, the caries process, dental emergencies, and oral health in children with special needs. Outcome measures include changes in knowledge, attitudes, and self-efficacy; preliminary results are presented. The program also partnered with local dentists to ensure a referral network for children with identified disease at the family medicine training sites. Pediatric dentistry residents assisted in didactic and hands-on training of family medicine residents. Future topics for oral health training of family physicians are suggested. (+info)
Influence of angular position and degree of impaction of third molars on development of symptoms: long-term follow-up under good oral hygiene conditions.
(59/808)
To determine the risk of developing symptoms due to the presence of maxillary and mandibular third molars, we analyzed a reliable population sample by age, and according to third-molar position and impaction level using long-term follow-up data under conditions of good oral hygiene. Of 308 graduates from our dental school, a total of 776 third molars were followed up for periods of 11 to 27 years by means of intraoral radiographs. The development of symptoms, the participant's age, and third-molar angular position and degree of impaction were investigated. For both maxillary and mandibular third molars, the risk of developing a symptom correlated neither with angular position nor with impaction level. The first symptom associated with a third molar developed most frequently in their 20's for both maxilla (16.2%) and mandible (17.5%), with the next highest frequency being in their 30's (12.6%, maxilla; 13.0%, mandible). The status of third molars shows no relation to the subsequent development of symptoms if good oral hygiene is maintained. The low rates of symptom-development do not support removal of asymptomatic third molars. (+info)
Assessment of oral health related quality of life.
(60/808)
In Dentistry, as in other branches of Medicine, it has been recognised that objective measures of disease provide little insight into the impact of oral disorders on daily living and quality of life. A significant body of development work has been undertaken to provide health status measures for use as outcome measures in dentistry. In descriptive population studies, poor oral health related quality of life is associated with tooth loss. There is a less extensive literature of longitudinal clinical trials, and measurement of change and interpretation of change scores continues to pose a challenge. This paper reviews the literature regarding the development and use of these oral health related QoL measures and includes an appraisal of future research needs in this area. (+info)
Sugars and dental caries.
(61/808)
A dynamic relation exists between sugars and oral health. Diet affects the integrity of the teeth; quantity, pH, and composition of the saliva; and plaque pH. Sugars and other fermentable carbohydrates, after being hydrolyzed by salivary amylase, provide substrate for the actions of oral bacteria, which in turn lower plaque and salivary pH. The resultant action is the beginning of tooth demineralization. Consumed sugars are naturally occurring or are added. Many factors in addition to sugars affect the caries process, including the form of food or fluid, the duration of exposure, nutrient composition, sequence of eating, salivary flow, presence of buffers, and oral hygiene. Studies have confirmed the direct relation between intake of dietary sugars and dental caries across the life span. Since the introduction of fluoride, the incidence of caries worldwide has decreased, despite increases in sugars consumption. Other dietary factors (eg, the presence of buffers in dairy products; the use of sugarless chewing gum, particularly gum containing xylitol; and the consumption of sugars as part of meals rather than between meals) may reduce the risk of caries. The primary public health measures for reducing caries risk, from a nutrition perspective, are the consumption of a balanced diet and adherence to dietary guidelines and the dietary reference intakes; from a dental perspective, the primary public health measures are the use of topical fluorides and consumption of fluoridated water. (+info)
Oral health of patients with Parkinson's disease: factors related to their better dental status.
(62/808)
Contrary to intuitive preconceptions, patients with Parkinson's disease (PD) have been reported to have less carious teeth. The present study was undertaken to seek responsible factors for this unexpected finding. The PD patients consisted of 31 consecutive university hospital outpatients who were 60 years old or over, and the controls of 104 comparable outpatients at a dental clinic. They were inspected for their dental status, and interviewed on their toothbrushing habits and dietary preferences. Their unstimulated saliva samples were collected and their flow volume and pH were measured. The total numbers of carious teeth (DMFT: Decayed, Missing, and Filled Teeth) and other related variables were compared between the two groups by stratification. In total, the DMFT for the PD patients was significantly fewer than for the control. The salivary flow and pH were correlated to the DMFT, but the difference between the two groups was not significant. Frequency of toothbrushing was higher among the PD patients. The lower DMFT among the patients became insignificant when salivary pH was 6 or less, toothbrushing was 2 times a day or less, or the response was positive to the question on the habit of eating snacks between regular meals. In summary, the oral health of PD outpatients with mild symptoms was better than the controls. However, in cases with poor oral hygiene status, the PD patient's oral health was not different from the control. This suggests that they are not invariably protected from caries-associated factors. The generic property of PD may not fully explain the apparent difference in DMFT. (+info)
Animal source foods and human health during evolution.
(63/808)
Animal source foods (ASF) have always been a constituent of human diets. Their pattern of use, however, changed in dramatic ways over the course of human evolution. Before 2 million years ago (mya), meat in particular was acquired opportunistically via hunting of small or young animals and scavenging of animals killed by other species. At some point after that time, humans began to hunt cooperatively, making possible the acquisition of meat from large game. The marked increase in human heights between 2.0 and 1.7 mya may be linked to more efficient means of acquiring meat, namely through hunting. The final pattern of meat (and other ASF) use before the modern era is associated with the shift from hunting and gathering beginning approximately 10,000 y ago. This fundamental dietary change resulted in a narrowing of diet, reduced consumption of meat and increased focus on domesticated grains. The study of archaeological human remains from around the world reveals that this period in human dietary history saw a decline in health, including increased evidence of morbidity (poorer dental health, increased occlusal abnormalities, increased iron deficiency anemia, increased infection and bone loss). Human populations living in developing and developed settings today rely on meats with lipid compositions that when eaten in excess promote cardiovascular disease. As humans become more sedentary and eat more high fat foods, we can expect to see increases in heart disease, osteoporosis and other diseases of "civilization." (+info)
Public health and aging: retention of natural teeth among older adults--United States, 2002.
(64/808)
During the past several decades, the percentage of older adults who have retained their natural teeth has increased steadily. This trend is expected to continue, resulting in improved oral function and quality of life. To estimate the prevalences of tooth retention and total tooth loss in 2002 among adults aged >/=65 years, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated that in 26 (52%) states, more than half of older adults reported having most (i.e., losing five or fewer) of their natural teeth. However, rates varied substantially among states and by selected characteristics. With tooth retention, older adults remain at risk for dental caries (i.e., tooth decay) and periodontal disease. To help adults maintain healthy teeth for life, community-based strategies should promote healthy behaviors, optimal use of fluoride, timely examinations and clinical services, and increased research into preventing oral diseases and promoting oral health among adults. (+info)