Biomedical subjects

B A Burt

Publications and source records attributed to B A Burt.

At least 19 recordsLinked to original sources

PubMed1997

How useful are cross-sectional data from surveys of dental caries?

Surveys are projects involving systematic data collection without a specific hypothesis to be tested and hence without a specific research design. This paper reviews their uses, and some of the issues involved with measuring dental caries in surveys. The principal benefits of surveys are in (a) monitoring trends in oral disease when the surveys are repeated periodically: and (b) giving dental health a visibility it might otherwise not get among policy-makers. On the other hand, they are of limited use in determining treatment needs for a population, evaluating treatment outcomes, and evaluating prevention programs. Some major issues in caries surveys today include difficulties with the DMF index; the use of exclusively visual versus visual-tactile criteria; "hidden" caries; and the appropriate role for early, non-cavitated carious lesions. The DMF index suffers from its mixing of disease and treatment, and more research is needed to determine the most appropriate role for exclusively visual criteria in surveys. Trade-offs, such as weighing the benefits of exclusively visual criteria against the probable greater difficulty in finding "hidden" caries, have not been determined. Inclusion of non-cavitated lesions in a survey will increase its cost. Organizers should therefore be clear before the survey on how this additional information will be used to justify the additional expense.

Costs and Cost Analysis↗

PubMed1996

Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus.

This study tested the hypothesis that severe periodontitis in persons with non-insulin-dependent diabetes mellitus (NIDDM) increases the risk of poor glycemic control. Data from the longitudinal study of residents of the Gila River Indian Community were analyzed for dentate subjects aged 18 to 67, comprising all those: 1) diagnosed at baseline with NIDDM (at least 200 mg/dL plasma glucose after a 2-hour oral glucose tolerance test); 2) with baseline glycosylated hemoglobin (HbA1) less than 9%; and 3) who remained dentate during the 2-year follow-up period. Medical and dental examinations were conducted at 2-year intervals. Severe periodontitis was specified two ways for separate analyses: 1) as baseline periodontal attachment loss of 6 mm or more on at least one index tooth; and 2) baseline radiographic bone loss of 50% or more on at least one tooth. Clinical data for loss of periodontal attachment were available for 80 subjects who had at least one follow-up examination, 9 of whom had two follow-up examinations at 2-year intervals after baseline. Radiographic bone loss data were available for 88 subjects who had at least one follow-up examination, 17 of whom had two follow-up examinations. Poor glycemic control was specified as the presence of HbA, of 9% or more at follow-up. To increase the sample size, observations from baseline to second examination and from second to third examinations were combined. To control for non-independence of observations, generalized estimating equations (GEE) were used for regression modeling. Severe periodontitis at baseline was associated with increased risk of poor glycemic control at follow-up. Other statistically significant covariates in the GEE models were: 1) baseline age; 2) level of glycemic control at baseline; 3) having more severe NIDDM at baseline; 4) duration of NIDDM; and 5) smoking at baseline. These results support considering severe periodontitis as a risk factor for poor glycemic control and suggest that physicians treating patients with NIDDM should be alert to the signs of severe periodontitis in managing NIDDM.

Adolescent↗

PubMed1995

Fifty years of water fluoridation.

On January 25, 1945, the city of Grand Rapids, Michigan, began adding sodium fluoride to its drinking water. This action culminated a 14-year period of research which continues to have far-reaching effects on both public health and the practice of dentistry. The fact that the oral health of children and young adults today has never been higher is a direct consequence of this research. These events, and the group of rather extraordinary people who were the principal actors in them, are so important a part of dentistry's development that they are worth a brief retelling.

Dental Caries↗

PubMed1995

Sugar consumption and caries risk in schoolchildren with low caries experience.

This paper assesses the risk from sugar consumption in a population of school children with low caries experience. It relates eight different measures of sugar consumption to the occurrence of any DMFS increment, and, separately, to approximal and pit-and-fissure DMFS. The data are from a 3-yr longitudinal study of 429 children, initially aged 11-15, residing in non-fluoridated rural communities in Michigan, USA. All children completed at least three dietary interviews, were present for baseline and final dental examinations, and had a parent or guardian provide questionnaire information on residence history, use of fluoride and dental services, and family history. Results indicated that a higher proportion of total energy intake from sugars increased the probability of caries on all surfaces, and a higher total intake of sugars was also associated with total caries increment. No relationship, however, was found between DMFS increment and the frequency of eating high sugar foods. Each additional 5 g of daily sugars intake was associated with a 1% increase in the probability of developing caries, and those whose energy intake from sugars was 1 SD above the mean had 2.0 times the risk of developing approximal caries than did children whose energy intake from sugars was 1 SD below the mean.

Adolescent↗

PubMed1995

Fluoride--how much of a good thing? Introduction to the symposium.

January 25, 1995, is the 50th anniversary of the first controlled addition of fluoride to a public water supply. Those 50 years have seen extraordinary advances in oral health and consequent quality of life, for which fluoride use is generally considered the primary reason. More extensive exposure to fluoride in the modern era, however, has led to both a continuing decline in caries experience and an increased prevalence of dental fluorosis in children. At the other end of life, fluoride's role in bone strength among older people is not well defined. This symposium examines several aspects of fluoride use in the United States today, and has the purpose of helping to define the balance between maximizing the benefits of fluoride while minimizing its undesirable side effects.

Adult↗

PubMed1995

Longitudinal evaluation of sealing molars with and without incipient dental caries in a public health program.

OBJECTIVES: This study undertook a retrospective evaluation of the effect of sealants on the caries experience of initially sound and incipient permanent first molar pit and fissure surfaces. METHODS: Records of children with complete five-year records were obtained from a school-based dental sealant program in a fluoridated community. Sealants were placed on 677 tooth surfaces in 96 children; 120 tooth surfaces in 17 children who received baseline examinations were not sealed because of lack of caregiver consent. Tooth surfaces were initially diagnosed as being sound or having incipient lesions, and evaluated for caries status after five years. RESULTS: For initially incipient surfaces the five-year decay rate was 10.8 percent (41 of 380 surfaces) for sealed surfaces and 51.8 percent (29 of 56 surfaces) for nonsealed surfaces with an odds ratio of 8.88 (95% CI = 4.56, 17.35). Initially sound surfaces had a decay rate of 8.1 percent (24 of 297 surfaces) for sealed surfaces and 12.5 percent (8 of 64 surfaces) for nonsealed surfaces with an odds ratio of 1.63 (95% CI = 0.63, 4.08). The two odds ratios were significantly different. CONCLUSIONS: Initially sound tooth surfaces were unlikely to become decayed in five years, and did not benefit greatly from the application of sealants. Within the limitations of this study, there were clear efficiencies in sealing incipient, but not sound, surfaces. The targeting of teeth with incipient caries for sealants is therefore recommended.

Bisphenol A-Glycidyl Methacrylate↗

PubMed1995

Loss of periodontal attachment in HIV-seropositive military personnel.

The cross-sectional relationship between severe loss of periodontal attachment (LPA) and worsening immune status due to HIV infection was evaluated in 474 HIV-infected subjects (416 men, 58 women) aged 18 to 49 years who had been classified at stages 1 through 6 of the Walter Reed Army Institute of Research (WR) Staging Classification System. LPA was measured at four sites per tooth using a manual probe; severe LPA was defined as > or = 1 site/subject exhibiting > or = 5 mm LPA. Severe LPA was found in 94 (20%) of the subjects. Modeling with multiple logistic regression analysis revealed that WR stage and peripheral CD4+ lymphocyte cell counts were not significant independent predictors of severe LPA. Severe LPA was more common in subjects at WR stage 5 or 6 who exhibited oral candidiasis (OC), a marker of immune system damage, than in persons at those WR stages without OC (odds ratio = 7.85; 95% confidence interval (CI) = 1.94-31.81). After the analysis controlled for WR stage, younger subjects receiving AZT had greater odds of severe LPA than same-age subjects not taking the drug (e.g., odds ratio for subjects aged 30 years = 2.59; 95% CI = 1.22, 5.49). Other significant predictors in the model included male sex; retired military status; cigarette smoking; and presence of cratered, ulcerated, or necrotic interdental papillae. HIV-associated immune deficiency may be associated with localized severe LPA, but this may be an indirect association due to medication use, opportunistic infection, or other factors not captured by the WR staging system or peripheral CD4+ cell counts.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗

PubMed1994

Risk factors for total tooth loss in the United States; longitudinal analysis of national data.

The NHANES I Epidemiologic Follow-up Study (NHEFS) of 1982-84 collected longitudinal data from 10,523 individuals initially seen during the first National Health and Nutrition Examination Survey (NHANES I) of 1971-75. Among this additional data was information on the incidence of total tooth loss during the 10 years between the surveys, which could then be added to NHANES I data to identify risk factors. In this analysis, a series of bivariate analyses were carried out, followed by logistic regression analysis to assess the simultaneous effect of major variables. Results showed that 7.4 percent of dentate Americans aged 25-74 at NHANES I became edentulous over the next 10 years. In bivariate analyses, the incidence of edentulism was correlated with baseline measures of lower income and education status, poorer oral health, self-perceptions of poor general health and oral health, absence of a regular dentist, and a lower number of remaining teeth at baseline. No correlation was found with gender and geographic region, nor with self-reported diabetes and arthritis, and age was not a factor when the number of remaining teeth at baseline were taken into account. In a logistic regression model assessing the effect of these variables simultaneously, none of the demographic variables retained significance; the only variable statistically significant in both age groups was the number of teeth remaining at baseline. Other significant variables in younger persons were higher periodontal disease scores, perceived poor dental health, perceived need for extractions, history of smoking, and low ascorbic acid intake. Some of these variables were reflections of negative health behavior and attitudes rather than direct correlates. Principal findings from this study were the importance of early tooth loss in eventual edentulism and the virtual disappearance of gender and age as determinants of total tooth loss.

Adult↗

PubMed1994

Periodontitis and aging: reviewing recent evidence.

This review critically examines recent research on the relation between age and periodontitis. It concludes that some loss of periodontal attachment and alveolar bone is to be expected in older persons, but age alone in a healthy adult does not lead to a critical loss of periodontal support. Although moderate loss of alveolar bone and periodontal attachment is common in the elderly, severe periodontitis is not a natural consequence of aging.

Adult↗

PubMed1994

Trends in caries prevalence in North American children.

Data for caries in the permanent and primary dentitions of children in Mexico, the United States, and Canada are reviewed from the years around 1982 to the present time. Sources are national, state, and provincial surveys, together with a number of smaller, local surveys. Data from minority populations are also reviewed. Conclusions are that caries prevalence and severity in the permanent dentition are continuing to decline in the general populations of Canada and the United States, but that caries experience in the primary dentition may have stabilised since around 1986-87. There is nothing in the limited data available from Mexico to suggest a decline in that country, caries levels remaining high. There are considerable geographic variations in caries experience in the general populations of the United States and Canada; the highest prevalence and severity is found in Quebec. Caries is more prevalent and severe in the indigenous populations of Canada and the United States than in the general population, but there are indications of a decline in the permanent dentitions of those indigenous groups. Caries will probably decline further in the general populations of Canada and the United States before it reaches an irreducible minimum, but that point may not be far away because caries experience is already very low in many localities. It is anticipated that the recent introduction of salt fluoridation in Mexico will help to bring down the high caries levels in that country.

Adolescent↗

PubMed1994

The Michigan study: the relationship between sugars intake and dental caries over three years.

National policies to reduce consumption of sugars to about half of their current levels have been suggested to reduce caries, an approach which assumes that caries experience is directly related to amounts of sugars consumed. This paper uses data from the Michigan diet study to question whether such policies would be effective. The Michigan study (1982-1985) collected detailed dietary information and caries incidence over a three-year period on 499 children aged 10-15 years at baseline. Results showed that caries incidence was poorly related to sugars intake, whether measured as total daily amount, between-meal intake, sugars as a proportion of total energy, or frequency of consumption. Boys had an average daily consumption of 156 g of sugars from all sources, girls 127 g. Mean caries incidence was 2.9 DMFS over the three years. When children were divided into quartiles by amounts of sugars consumed, those in the highest quartile, compared to the lowest, had a relative risk of 1.22 of developing caries. This relative risk rose to 1.80 for proximal lesions. The risks were similar when consumption was restricted to between-meal sugars. If consumption of sugars were to be cut to half that of present levels in this population, fat consumption would be likely to rise from its present level fo 38 per cent of total energy to around 47 per cent. National policies to restrict consumption of sugars might therefore be not only expensive and ineffective, but could damage the public health by inadvertently leading to higher consumption of fats.

Adolescent↗

PubMed1993

A retrospective analysis of the cost-effectiveness of dental sealants in a children's health center.

A retrospective patient record analysis was conducted to study the cost-effectiveness of dental sealants placed under routine, unrestricted practice condition in a fluoridated community. The 26 dentists who provided care at the clinic over the period of the study used their own clinical judgement to determine sealant placement or alternative treatment. Dental services for 275 patients at a children's dental clinic for low-income families were evaluated. All children had at least 3 years between their first and last dental visit (mean = 5.8 years). A lifetable analysis was conducted to compare the probability of survival (restoration-free tooth years) and costs incurred to first molars of children who did not receive sealants, received any sealants, or received sealants on all first molars. Among the children with sealants, comparisons were also made between sealed and unsealed teeth in children who did and did not have a first molar restoration prior to sealant placement. Costs included the costs of sealants and restorative treatments for these teeth over time. Depending on the conditions under which sealants were placed, cost-savings or improving cost-effectiveness with time were found. A strategy of identifying children with prior restorations and sealing the remaining molars showed cost-savings within 4-6 years. For other comparisons, incremental cost-effectiveness ratios became more favorable over time.

Child↗

PubMed1993

Collecting state-level oral health data when resources are limited: an approach to oral health surveillance.

Many states and localities do not have the resources to conduct oral health surveys of their whole populations, but the demands for data collection continue to increase for both program administration and for Maternal and Child Health Block Grant funding. As one response to this problem, the Oral Health Program of the Michigan Department of Public Health developed an oral health surveillance system as a low-cost method of collecting usable data from the service populations of local health agencies providing direct patient care in Michigan. A record form, to be completed by dentists or hygienists in those agencies at initial or recall examinations, was developed and pilot-tested for all patients of target age groups who presented over a specified four-week period. This paper gives the results from 19 agencies that participated in the pilot test in Michigan. Results showed that 40.5 percent of 2-5-year-olds (n = 341) had some caries experience, their d/dft was 78.2 percent, and mean dft was 4.8 (SD +/- 3.5). Among the 6-19-year-olds (n = 710), 61.4 percent had experienced caries, the D/DFT was 41.8 percent, and the mean DFT was 4.2 (SD +/- 3.2). Among the adults examined, 45.1 percent of 20-64-year-olds (n = 820) and 38.1 percent of those 65 years or older (n = 105) had two or more teeth with untreated decay. These data suggest a high level of untreated disease among the service populations of the local dental health agencies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

Relative consumption of sucrose and other sugars: has it been a factor in reduced caries experience?

This paper examines the impact on the development of caries, especially on the proximal and the free smooth surfaces, that follows the reduction in sucrose consumption and the increase in consumption of the monosaccharides in the United States and Great Britain. Laboratory evidence shows that sucrose has a special role in proximal- and smooth-surface caries because of its ability to produce extracellular polysaccharides with the mutans streptococci, thus increasing plaque's ability to adhere to the enamel surface. Evidence from human studies, however, is less clear about the relative cariogenicity of the various sugars, possibly because experimental conditions are difficult to maintain in such studies. In the USA sucrose consumption has been diminishing for some year and is now only 47% of the total sugar consumption of 61 kg per person annually. The change in Britain has been less pronounced, sucrose there in 1984 constituted 83% of total consumption of 47.9 kg per person. Sucrose consumption in Britain is, therefore, higher than in the United States, even though the average total consumption of all sugars is higher in the USA. Limited data suggest that proximal- and smooth-surface lesions also constitute a higher proportion of caries incidence in Britain than in USA, and a cause-and-effect hypothesis between these factors is explored. Dietary education for oral health should harmonize with that for general health by emphasizing sensible food choices, which generally means selection of low-fat, low-sugar foods.

Adolescent↗

PubMed1993

An assessment of survival rates and within-patient clustering of failures for endosseous oral implants.

This study examined endosseous cylinder implant survival, defined as the unqualified presence of the implant in the mouth at the end of the observation period, in 598 consecutive VA patients, with a total of 2098 implants. Data were taken from the Department of Veterans Affairs (VA) Dental Implant Registry, which has maintained longitudinal data on the survival of individual dental implants in VA patients since 1987. The maximum time of observation in any one patient was 2040 days (5.6 yr). Survival analysis by use of life-table methods was carried out on both an implant- and a patient-specific basis. Implant cases were accrued randomly, and therefore a random censoring model was used. A correlated binomial model was used for assessment of the degree of within-patient clustering of implant removals. Results showed that the implant-specific survival rate during the longest time interval (5.6 yr) was 89.9%; the patient-specific implant survival rate during the same time was 78.2%. Among implants which were removed, the mean time to removal was 292 days. The hazard function, which describes the probability of implant loss as a function of time, decreased steadily throughout the observation period. The correlated binomial model suggested a clustering of removals within patients with multiple implants (rho = 0.11, p = 0.0001). The odds of having a second implant removed were 1.3 times greater if the patient had already had one implant removed. This study suggests that when implants fail, they do so soon after placement, and the likelihood of failure decreases steadily from implantation through the first five years post-surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Evaluation of appropriate use of dietary fluoride supplements in the US.

Recent epidemiologic and related evidence suggests the following trends: 1. the prevalence of caries continues to decline in children of the US and several other developed countries; 2. the prevalence of mild dental fluorosis is increasing; 3. the majority of the cariostatic effects of fluoride are topical; and 4. dietary fluoride supplements are a risk factor for dental fluorosis. These trends, and the scientific evidence on fluoride and fluorosis, suggest that it is time to re-evaluate the use of dietary fluoride supplements. This paper examines the evidence for each of the four trends and the use of fluoride supplements in caries prevention today.

Dental Caries↗

PubMed1992

The changing patterns of systemic fluoride intake.

Fluorosis prevalence has increased in North America since the 1930's-1940's. It may also have increased since 1970, though the evidence for that is less clear. Continued monitoring will help determine whether increased fluorosis prevalence in children in the United States is a cohort effect from the 1970's. This review considers the evidence for an increase in fluoride ingestion from all sources since the 1970's. If an increase has occurred, the most likely sources are fluoride dietary supplements, inadvertent swallowing of fluoride toothpastes, and increased fluoride in food and beverages. For adults, there is no evidence from dietary surveys to show that fluoride intake has increased over the last generation. Dietary surveys for children aged six months to two years are similarly inconclusive, though the great variation in fluoride content of various infant foods might be obscuring real effects. The data on fluoride intake by children from food and beverages, infant foods included, are not strong enough to conclude that an increase in fluoride ingestion has occurred since the 1970's. However, the suggested upper limit of fluoride intake is substantially being reached in many children by ingestion of fluoride from food and drink (0.2-0.3 mg per day) and from fluoride toothpaste (0.2-0.3 mg per day). Two public health issues that arise from this review are: (a) the need for a downward revision in the schedule for fluoride supplementation, and (b) education on the potential for high fluoride concentration of soft drinks and processed fruit juices.

Adult↗

PubMed1992

Epidemiology of dental diseases in the elderly.

The aging of the American population will have enormous social ramifications, among which will be a greater focus on the elderly patient. Traditionally, the dental status of this group has been extracted teeth and full dentures, but that is now steadily changing. There were 41.1% of Americans aged 65 or older who were edentulous in 1985 to 1986, but a good proportion of them have been edentulous for many years. The prevalence of total tooth loss will continue to decline with time. The growth of a dentate elderly population, however, leaves more of that group at risk of caries. Caries, once seen as a disease of childhood, is now clearly a lifelong disease. Elderly persons are particularly at risk of root caries, which follows as a consequence of periodontitis. Total tooth loss and severe caries are both associated with lower socioeconomic status. Although cross-sectional survey data invariably show, on average, a greater extent of periodontitis among older than among younger persons, periodontitis is not considered a disease of aging. The age difference in surveys is not because of greater susceptibility among the elderly but represents disease accumulated over time. Limited longitudinal data suggest that rapid loss of periodontal attachment, serious enough to threaten the dentition, is found in 7% to 15% of any population. But this group exhibits the disease when young. Those who have retained a more-or-less intact dentition into old age rarely exhibit a sudden onset of periodontitis. If such a change is seen it could be indicative of broader changes in the immune system.

Aged↗