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Biomedical subjects

D J Caplan

Publications and source records attributed to D J Caplan.

17 recordsLinked to original sources
PubMed2002

Relationship between number of proximal contacts and survival of root canal treated teeth.

AIM: The present study tested the hypothesis that having two proximal contacts (PCs) at access is associated with improved survival of root canal treated (RCT) teeth, controlling for important presenting conditions, endodontic variables and restorative factors. METHODOLOGY: A treatment database at the University of Iowa College of Dentistry was used to identify permanent teeth undergoing obturation between 1 July 1985 and 31 December 1987. The list was restricted to teeth of patients with at least one dental visit in each two-year interval from 1985 to 1996, and a simple random sample of 280 patients (n = 400 teeth) was selected. Dental charts, radiographs, and computerized databases were examined to ascertain variables of interest and to verify study inclusion criteria. Kaplan-Meier survival estimates were generated for the 221 teeth satisfying study inclusion criteria. Multivariate Cox models were developed, with standard errors adjusted to account for clustering of teeth within patients. RESULTS: The final Cox model showed that teeth with < or =1 PC at access were lost at a rate three times that of teeth with 2 PCs (hazard ratio = 3.1; 95% confidence interval = 1.9-5.1), controlling for tooth type, presence of radiographic caries at access, and presence of a crown before or after obturation. CONCLUSIONS: Because RCT teeth with two PCs at access experienced substantially better survival than teeth with fewer than two PCs, the influence of PCs on prognosis should be recognized during treatment planning. Future research should employ prospective study designs, capture additional variables, and provide data to support endodontic treatment decisions.

Humans↗
PubMed2001

Clinical factors related to noncompletion of root canal therapy.

OBJECTIVES: This study identified clinical factors related to noncompletion of root canal therapy (RCT) among patients in a dental health maintenance organization (HMO) based in Portland, OR. METHODS: A secondary analysis of a case-control study was conducted using data from 303 individuals enrolled continuously in the HMO from January 1, 1987, through December 31, 1994, who received endodontic access on a permanent nonwisdom tooth in 1987 or 1988. Person- and tooth-level characteristics were evaluated to compare patients whose accessed tooth was obturated by December 31, 1994, with patients whose accessed tooth was not obturated by that date. Written and electronic records were reviewed to ascertain study variables, and multivariate logistic regression models were developed to describe differences between the two groups. RESULTS: Incomplete RCT was more common among patients who were symptomatic prior to access and had more missing first molars at access. It also was more common among teeth that were decayed, had more pockets > or = 5 mm, and had fewer decayed or filled surfaces at access. CONCLUSIONS: Because patients with greater evidence of past and current oral disease were less likely to have completed RCT, they may require additional counseling about the importance of carrying through with prescribed treatment.

Adult↗
PubMed2001

A two-year longitudinal study of dental caries in permanent first molars of Korean elementary schoolchildren.

OBJECTIVE: This longitudinal study investigated dental caries increment in permanent first molars of Korean elementary schoolchildren. METHODS: A convenience sample of 722 children aged 7-9 years attending one urban elementary school was examined at baseline, with follow-up examinations at one and two years. Coronal surfaces of permanent first molars were scored with regard to caries experience and sealant status. RESULTS: Among sound occlusal surfaces at baseline, 21 percent of upper and 25 percent of lower surfaces developed caries during the two-year interval. In teeth that erupted between baseline and the first follow-up exam, over 10 percent of occlusal surfaces developed caries. Pit and fissure caries accounted for 93 percent of all new carious surfaces, while sealants had been placed on 16 percent of occlusal surfaces during the study. CONCLUSIONS: Recognizing the limitations of this convenience sample, dental sealants should be used more widely in this Korean population, and should be applied soon after tooth eruption.

Child↗
PubMed2000

Impact of analytic conventions on outcome measures in two longitudinal studies of dental caries.

UNLABELLED: Caries increment is the primary outcome measure used in most longitudinal studies of caries. Its computation requires the adoption of specific analytic conventions for handling examiner misclassification ("reversals"), teeth lost due to caries, and multiple events such as caries initiation and progression. However, little is known about the impact of these analytic conventions on cumulative incidence and incidence density--two additional outcome measures used in longitudinal studies. OBJECTIVE: We evaluated the impact of analytic conventions on caries outcome measures in two longitudinal caries studies. METHODS: A secondary analysis was undertaken using data from two studies: a 2-year observational cohort study of 683 older adults and a 3-year clinical trial of 1,754 children. Crude, net and adjusted increments were compared, effects of inclusion and exclusion of teeth lost due to caries were contrasted and measures of caries initiation and progression were assessed among subgroups in each study. RESULTS: Cumulative incidence indicated a high risk of caries (50% or more) in both studies but was not sensitive to subgroup differences. Increment and incidence density measures consistently revealed between-subgroup differences when subgroups had comparable numbers of teeth. For all three outcome measures, crude DFS values were larger than net DFS values. The adjusted DFS was similar to crude DFS in older adults, but similar to net DFS in children. Measurement of caries initiation and progression increased disease estimates for all three outcome measures. CONCLUSIONS: In the populations studied, analytic conventions for handling examiner misclassification, teeth lost due to caries and multiple events had a greater impact on inferences than the choice of outcome measure.

Adolescent↗
PubMed1999

Recommendations for endodontic referral among practitioners in a dental HMO.

This study assessed the effect of patients' presenting conditions on general practitioners' (GPs') self-reported endodontic referral patterns, and compared GPs' perceived indications for referral with those of endodontists. The study was based on a self-administered, confidential survey distributed to 79 GPs and 7 endodontists who provide care to members of one Dental HMO in the Pacific Northwest. GPs were most likely to recommend referral for teeth they felt needed surgical retreatment, but GPs and endodontists did not always agree on indications for referral. Compared with GPs, endodontists were more likely to recommend referral for patients with complex problems, but not necessarily technically difficult teeth. Compared with those with less experience, GPs with more than 10 yr both in dentistry and at this HMO were more likely to recommend (a) referring difficult cases rather than performing endodontic therapy themselves and (b) extracting perforated or root-fractured teeth prior to obturation rather than continuing treatment. Indications for referral that maximize favorable dental outcomes need to be identified.

Attitude of Health Personnel↗
PubMed1999

Factors contributing to the poorer survival of black Americans diagnosed with oral cancer (United States).

OBJECTIVE: The purpose of this study was to identify factors that contribute to the poorer survival of blacks in the United States diagnosed with oral cancer. METHODS: Data for 6,338 whites and 1,165 blacks diagnosed from 1988 to 1993 with squamous cell carcinoma of the oral cavity and pharynx were obtained from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program 1973-1993 Public-Use Database. The covariables were sex, age, geographic area, marital status, socioeconomic status (five census-tract measures), stage, anatomic site, grade, lymph node involvement, tumor size, and treatment. Hazard ratios were estimated with Cox regression. RESULTS: Adjusted for age and geographic area, the hazard of death from oral cancer was 1.7 (95% confidence interval: 1.5-1.9) times greater among blacks than whites. The addition of the socioeconomic status (SES) variables to the model reduced the hazard ratio for race to 1.3 (1.0-1.7). Further adjustment by stage and treatment reduced the hazard ratio for race to 1.1 (0.9-1.4). In a model containing all covariables (except lymph node involvement and tumor size), the hazard ratio for race remained 1.1 (0.9-1.4). Analyses with the outcome death from any cause gave similar results. CONCLUSIONS: Lower SES, more advanced stage, and differences in treatment accounted for 86% of the excess hazard of death from oral cancer among blacks.

Adolescent↗
PubMed1999

Methodological issues in longitudinal epidemiologic studies of dental caries.

As longitudinal epidemiologic studies of dental caries address increasingly complex research questions, approaches to analysis of data from those studies have become more sophisticated. This review examines methods available for analyzing and reporting data from such studies. Traditional analytic methods utilize the DMFS increment as the outcome measure in longitudinal studies of caries. However, two other outcome measures may be needed to address some research issues: cumulative incidence, which quantifies caries risk; and incidence density, which quantifies caries rate. Four major analytic decisions have to be addressed when computing DMFS increment: examiner misclassification ("reversals"), teeth lost due to caries, findings from more than two examinations, and multiple events such as caries initiation and progression. We present a uniform approach for enumerating caries events that permits the same analytic decisions made in calculating DMFS increment to be applied to cumulative incidence and incidence density calculations. In view of the variety of analytic decisions that must be made when enumerating events in longitudinal studies of caries, authors should specify how all potential changes in caries status were handled. Furthermore, if a study uses more than one outcome measure, the same decisions for enumerating events should be used when computing those measures.

DMF Index↗
PubMed1999

Nightguard vital bleaching of tetracycline-stained teeth: 54 months post treatment.

PURPOSE: The purpose of this longitudinal whitening study was to determine the stability, post-treatment side effects, and patient satisfaction after 6 months of active treatment of tetracycline-stained teeth with 10% carbamide peroxide at 0 and 54 months post treatment. MATERIALS AND METHODS: Twelve patients who completed the study (80%) were contacted and asked to participate in a survey concerning their whitening experience. Subjects were asked whether there had been any change in the shade of their teeth after treatment, and if they had experienced any side effects that they believed were treatment-related. Eight of the twelve patients underwent clinical examination. RESULTS: Ten patients (83%) reported no obvious shade change or only a slight darkening not noticed by others. Two (17%) reported a slight darkening that is probably noticeable by other people, but no one reported moderate darkening or significant darkening back to original shade. All respondents (n = 12) denied having to have a crown or root canal that they believed was treatment-related. Examiners who compared preoperative and post-treatment photographs and Vita shade values were in agreement with the patient's perceptions of shade change. The degree of improvement was significant for both the immediate (0 mo) and the 54-month post-treatment comparison with the pretreatment shade (p < .005 and p < .01 respectively). CLINICAL SIGNIFICANCE: Results of this nightguard vital bleaching study indicate that tetracycline-stained teeth can be whitened successfully using extended treatment time, and that shade stability may last at least 54 months after treatment. Patients who participated in this study were overwhelmingly positive about the procedure in terms of shade retention and lack of post-treatment side effects.

Carbamide Peroxide↗
PubMed1999

Complex sampling: implications for data analysis.

Investigators in dental public health often use strategies other than simple random sampling to identify potential subjects; however, their statistical analyses do not always take into account the complex sampling mechanism. Often it is not clear whether a given strategy requires adjustment for stratification and/or cluster sampling of observations. We propose that the need for such adjustment depends on the primary study objective. As a general rule, we recommend that if the study goal is to estimate the magnitude of either a population value of interest (e.g., prevalence), or an established exposure-outcome association, adjustment of variances to reflect complex sampling is essential because obtaining appropriate variance estimates is a priority. However, if the study goal is to establish the presence of an association, especially in a preliminary investigation of novel conditions or understudied populations, obtaining appropriate variance estimates may not be of primary importance; hence, adjustment of variances for complex sampling is not always required, but often is recommended. This paper describes several types of complex sampling designs, methods of adjusting for complex sampling strategies, examples illustrating the effect of adjustment, and alternative approaches for analysis of complex samples.

Analysis of Variance↗
PubMed1999

A comparison of increment and incidence density analyses in evaluating the anticaries effects of two dentifrices.

This study aimed to determine whether incidence density (ID) calculations of caries incidence rates would provide a more sensitive means of detecting caries-preventive effects than would traditional techniques. A secondary analysis was conducted using data from a 1981 study in which three dentifrices were compared in a double-blind randomized clinical trial. Subjects were examined at baseline and 1, 2 and 3 years after baseline. Three-year DMFS increments were calculated for 1,754 subjects attending the baseline and 3-year examinations. Caries ID rates then were calculated for 2, 661 subjects who had at least two examinations, using each surface's net increment (-1, 0 or +1) as the numerator and the surface's time at risk as the denominator. Despite theoretical advantages, the ID method did not alter the conclusions drawn using DMFS increments, apparently because (a) subjects lost to follow-up were similar to those completing the study, and (b) loss to follow-up was similar among treatment groups.

Adolescent↗
PubMed1998

Racial differences in survival of oral and pharyngeal cancer patients in North Carolina.

OBJECTIVE: This study seeks to determine whether lower survival of black versus white oral and pharyngeal cancer patients is due to, or differs by, stage at diagnosis. METHODS: Subjects identified through the North Carolina Central Cancer Registry included all black and white North Carolina residents diagnosed from 1987 to 1990 with malignant squamous cell carcinoma of the oral cavity or pharynx. Proportional hazards regression models were used to calculate hazard ratios for all-cause mortality during the first 18 months after diagnosis, adjusting for age, reported histologic grade, site, and several time-dependent interactions. RESULTS: Within the first two months after diagnosis, the black/white hazard ratio for mortality among those with localized disease was 11.8 (95% CI = 3.7, 37.5), compared to 6.4 (95% CI = 2.6, 15.8) for those with advanced disease. During months 3 to 18 after diagnosis, black/white hazard ratios were 2.07 (95% CI = 1.03, 4.18) among those with localized disease and 1.12 (95% CI = 0.85, 1.47) for those with advanced disease. CONCLUSIONS: In the first 18 months after diagnosis, blacks with oral and pharyngeal cancer have higher all-cause mortality than whites diagnosed at the same stage of disease. Racial differences are greater among those with localized disease than for those with more advanced conditions.

Adolescent↗
PubMed1997

Factors related to loss of root canal filled teeth.

OBJECTIVES: This case-control study characterized factors related to loss of root canal filled (RCF) teeth among members of the Kaiser Permanente Dental Care Program, a dental health maintenance organization based in Portland, Oregon. METHODS: Individuals were identified who were enrolled continuously from January 1, 1987, through December 31, 1994, underwent initial root canal therapy on a permanent tooth (excluding third molars) in 1987 or 1988, had a clinical examination within two years after endodontic access, and were at least 21 years old at access. Patients who lost the RCF tooth by December 31, 1994, were defined as cases (n = 96); those who did not were defined as controls (n = 120). Computerized data, dental radiographs, and chart entries were reviewed to ascertain variables of interest, and multivariable logistic regression was used to describe differences between the groups. RESULTS: RCF teeth of cases had fewer proximal contacts at access than RCF teeth of controls (odds ratio = 2.7; 95% Cl = 1.4, 5.1). Cases were older (odds ratio = 1.4; 95% Cl = 1.1, 1.9 per 10-year increase) and more likely to have had a facial injury than controls (odds ratio = 3.6; 95% Cl = 1.2, 10.5). Cases also had more missing teeth (odds ratio = 1.5; 95% Cl = 1.0, 2.1) and more plaque (odds ratio = 1.7; 95% Cl = 1.0, 2.6). CONCLUSIONS: Conditions evident during treatment planning may help dentists assess patients' chances of losing an RCF tooth.

Adult↗
PubMed1996

Salivary flow and risk of tooth loss in an elderly population.

To investigate the relationship between salivary flow and tooth loss, 818 randomly selected dentate people aged 65 and older and living in North Carolina were administered a dental health interview and examination. A single paraffin-stimulated whole saliva sample of 3 ml was collected and flow rate was calculated. Three years later, 490 people were re-examined and tooth loss was determined. Thirty-five percent of the participants had salivary flow rates of 1.0 ml/min or less at baseline and 41% lost at least one tooth over the 3-yr follow-up. A logistic regression model controlling for marital status, race, and socioeconomic status showed that those with low salivary flow were more likely to lose at least one tooth during the 3-yr study period than were those with normal flow (odds ratio = 1.52, 95% CI = 1.02-2.24). Results from this representative study of community-dwelling older adults support the concept that compromised salivary flow is related to tooth loss. This finding should be considered in the management and prevention of oral diseases.

Age Factors↗
PubMed1995

A quarter century of changes in oral health in the United States.

This paper provides an overview of the oral health status of Americans since the 1960s. Data from seven national surveys, conducted between 1960 and 1987, have been presented. Estimates of coronal and root caries, periodontal diseases, and tooth loss were reviewed. In addition, data on edentulism and oral cavity and pharyngeal cancer were included. Although the purpose of this paper is descriptive rather than analytical, some important trends have been noted: The number of children who were free from dental caries increased dramatically between 1963 and 1987. By 1987, almost one-half of school children between the ages of 5 and 17 were caries-free. Among those children with dental decay, the number of teeth affected has also declined. The oral health of adults also improved during the 27-year period included in this review. In particular, the mean number of missing teeth and the percentage of edentulous adults have declined substantially. Trends in periodontal diseases were difficult to determine due to changes in the measures of periodontal diseases utilized in the surveys. In the most recent survey of employed U.S. adults, approximately 44 percent were found to have gingivitis and slightly more than 13 percent had periodontal pockets 4-5 mm in depth. Approximately 30,000 new cases of oral cavity and pharyngeal cancer were diagnosed in 1993, resulting in approximately 8,000 deaths. African Americans have higher incidence and mortality rates than white Americans and also have a much lower five-year survival rate.

Adolescent↗
PubMed1993

The oral health burden in the United States: a summary of recent epidemiologic studies.

The nation's health care system is currently under scrutiny. A topic of great interest to the dental community is whether dentistry should be included in a plan for national health reform, and if so, what procedures should be covered. To answer this question, 1) the current oral disease burden in the United States should be assessed, and 2) factors associated with this burden should be described. This paper reviews several recent large-scale epidemiologic surveys of oral health in the United States, summarizes their major findings, outlines important risk factors for oral disease, and makes recommendations regarding future oral epidemiologic surveys. The discussion is limited to the following conditions: dental caries, periodontal diseases, tooth loss, edentulism, oral cancer, and orofacial clefts. Five out of six 17-year-olds have at least one decayed, missing, or filled tooth surface (DMFS), with a mean of eight DMFS per 17-year-old. However, 25 percent of the country's children have 75 percent of the dental caries; minority children, rural dwellers, those with minimal exposure to fluoride, and those from less educated or poorer families tend to have a greater caries experience. Root caries, gingivitis, periodontal pockets, and loss of periodontal attachment are more common among older individuals. Whites have more teeth than do Blacks of similar ages, and edentulism is more common among those with less education and income. Of those age 65+, over 40 percent are edentulous and only 2 percent have all 28 teeth. An estimated 30,000 new cases and 8,000 deaths were attributed to oral cancer in 1991, with Black males having higher incidence and mortality rates than other subgroups. Oral clefts occur in about one in 700 total births, with Native Americans having the highest incidence.

Adolescent↗
PubMedDate not supplied

Effect of retention grooves on fracture strength of Class 2 composite resin and amalgam restorations.

The effect of approximal retention grooves on fracture strengths of class 2 composite resin and amalgam restorations was tested in vitro. Results indicated that retention grooves significantly improved (P less than 0.05) the compressive strength of amalgam restorations (38.6% stronger). For posterior composite resin restorations, there was no significant difference in mean compressive strength of restorations in preparations with and without retention grooves.

Composite Resins↗