Biomedical subjects

D Locker

Publications and source records attributed to D Locker.

At least 91 records · Page 5Linked to original sources

PubMed1997

Do item weights matter? An assessment using the oral health impact profile.

OBJECTIVE: To determine whether or not item weights contribute to the performance of the Oral Health Impact Profile (OHIP), a comprehensive measure of the functional, social and psychological outcomes of oral disorders. DESIGN: Data were obtained as part of an oral health survey of older adults living in Ontario, Canada. Subjects completed a personal interview, clinical examination and a self-complete version of the OHIP. OHIP scores were calculated in three ways: a simple count method, an additive method and a method incorporating item weights derived from the Thurstone paired comparison technique. These scores were calculated for the full 49-item version of the measure and for a short form consisting of 14 selected items. The discriminant, concurrent and predictive validity of these scores for the two versions of the measure were ascertained. PARTICIPANTS: Complete data were obtained for 522 subjects. Just over half were female (56 per cent) and their mean age was 66 years. RESULTS: The OHIP discriminated between groups based on dental status (dentate/edentulous), presence of dry mouth (yes/no) and, for the dentate, according to the number of remaining teeth (less than 20/20 or more) irrespective of scoring method or the version of the questionnaire used. All scores showed significant associations with self-rated oral health, self-perceived need for dental care and dissatisfaction with oral health status. There was evidence to suggest that weighted scores were better at discriminating between groups than the simple count method but no better than the additive method. Similar findings emerged with respect to the ability of the scores to predict prosthodontic, surgical and restorative treatment needs. CONCLUSIONS: Although the data suggested that item weights did improve the performance of the OHIP, the fact that simple scoring methods were as good as more sophisticated ones might mean that the OHIP could be used in contexts, such as patient assessment for clinical care, where the calculation of weighted scores was not feasible.

Aged↗

PubMed1997

Life circumstances, lifestyles and oral health among older Canadians.

OBJECTIVE: To examine the contribution of life circumstances and lifestyles, and the interaction between them, to the oral health status of older Canadians. DESIGN: Subjects were recruited using a telephone interview survey, based on random digit dialling and subsequently interviewed and clinically examined. PARTICIPANTS: Four hundred and ninety-eight dentate subjects aged 53 years and over living independently in Ontario, Canada. MEASURES: Subjects were classified as living in deprived, middle or privileged life circumstances based on their social and personal attributes. They were also classified as having relatively poor or relatively favourable lifestyles based on their health behaviours. The oral health status indicators used were: the number of missing teeth, the number of decayed and filled root surfaces, mean periodontal attachment loss, the number of oral symptoms in the previous four weeks, self-rated oral health, and a psycho social impact score. RESULTS: In bivariate analyses, life circumstances were significantly associated with three of these six indicators and lifestyles with five. Healthy lifestyles had an effect on the oral health status of those living in deprived and middle circumstances but not on the privileged, although no overall interaction effect was observed in multivariate analyses controlling for gender and age. CONCLUSIONS: These data suggest that, among this population, life circumstances and lifestyles are both related to oral health. They also indicate that the role of these factors varies according to the condition and health indicator in question.

Age Factors↗

PubMed1997

The efficacy of nonopioid analgesics for postoperative dental pain: a meta-analysis.

The evidence for the efficacy of nonopioid analgesics in the dental pain model was examined by conducting a meta-analysis. Studies were obtained by searching the literature from August 1996 back to 1975 using the terms pain, analgesics, and dentistry. This led to the review of 294 articles, of which 33 studies met the inclusion criteria. Pain scale results were transformed into a common percent scale and converted to N-weighted means with differences in efficacy considered significant using a 95% confidence interval. Collectively, therapeutic doses of the nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used in dentistry were significantly more efficacious than the combination of acetaminophen (600 or 650 mg) with codeine (60 mg). Similarly, specific doses of each of diflunisal, flurbiprofen, ibuprofen, and ketorolac were significantly more efficacious than the commonly used acetaminophen-codeine combination. These quantitative results show that particular NSAIDs may be more efficacious than the acetaminophen-codeine combination for relief of postoperative dental pain.

Acetaminophen↗

PubMed1996

Large deletions induced in the white gene of Drosophila melanogaster by the antitumoral drug cis-dichlorodiammineplatinum(II): influence of non-homologous recombination.

We have studied two mutants carrying large deletions induced in the white gene of Drosophila by the antitumoral drug cisplatin. The breakpoints of the deletions were located by southern analysis and the sequences of the deletion junctions were determined. Two base-pair repeats are associated with the ends of these deletions; one of the repeats is preserved in the new junction after the deletion. DNA sequences such as A-T rich, alternating purine/pyrimidine tracts, polypurine-polypyrimidine tracts and topoisomerase I and II cleavage sites are found near the junctions. These results suggest that illegitimate recombinational processes are involved in the generation of cisplatin-induced large deletions.

ATP-Binding Cassette Transporters↗

PubMed1996

Sexual risk and HIV-testing behaviour by gay and bisexual men in Canada.

Behavioural epidemiology is an important aspect of HIV research, particularly among marginalized populations where measurement of rates of infection have not been conducted. This Canadian study provides a country-wide analysis of the characteristics and behaviours of gay and bisexual men, and examines the influence of geographic, socio-demographic and lifestyle influences on sexual behaviour and test-seeking. A purposive sample of 4,803 men was recruited through gay-identified venues. In order to provide national representation seven sampling strata were defined. Data were collected by self-completed questionnaire. A three-level hierarchical logistic regression analysis is used to model two behaviours, unprotected anal intercourse and test-seeking. The results showed that, nationally, 22.9% of respondents reported at least one episode of unprotected anal intercourse in the previous 3 months, and 63% had been tested. Characteristics and behaviours of men varied across the country. Geographic differences appear to be less important in explaining unprotected anal intercourse than test-seeking. In conclusion, policy, programmes and social environment appear to exert an important influence on test-seeking, whereas cultural and psychosocial dimensions appear to have a greater influence on sexual behaviour.

AIDS Serodiagnosis↗

PubMed1996

A method of estimating tooth life expectancy.

One of the most important outcome measures for dental services is the increase in tooth life expectancy which is brought about by the interventions provided. Thus, a convenient and accurate index of tooth survival is critical both to clinical decision making and to more general assessments of public dental health policies. This paper describes a simple method of approximating tooth life expectancy (TLE). The method is based on the assumption that tooth survival follows a simple declining exponential function. Assuming a constant mortality rate, TLE is the integral of the survival function, expressed as S(t) = e-mu t, where t is time and mu the constant mortality rate. Using 3-year tooth-specific mortality rates for 491 subjects aged 50 years or more, tooth-specific life expectancies for the population as a whole where found to range from 27 years for upper canines to 71 years for lower incisors. Individuals with a mean periodontal attachment loss greater than 4 mm and people on low incomes had significantly lower tooth life expectancies than their periodontally fit and more wealthy counterparts. This technique can be used to obtain disease-specific or intervention-specific tooth life expectancies. Thus, gains in TLE for individuals with different oral, social and behavioural characteristics can be calculated. The declining exponential approximation of tooth life expectancy has the potential to become a powerful tool in the evaluation of dental services and treatments.

Cuspid↗

PubMed1996

Work stress, job satisfaction and emotional well-being among Canadian dental assistants.

Although dentistry is considered to be a stressful occupation, few data exist on work stress among dental assistants. In a previous paper, the extent and nature of work stress among this group was described and linked to a behavioural outcome; namely, intentions to change jobs or seek work outside of dentistry. In this paper the psychological outcomes of work stress, in the form of job satisfaction and emotional well-being, are examined. Using data collected by a mail survey, it was revealed that the main sources of dissatisfaction for dental assistants were low incomes, lack of opportunity to develop professionally and lack of recognition. Almost one-in-five had scores on a standard measure of emotional distress, which indicated a cause for concern. Work stress proved to be a significant predictor of job satisfaction, and work stress and job satisfaction emerged as significant predictors of emotional well-being. Social support while at work showed direct and interactive effects on job satisfaction but not emotional well-being. Role ambiguity, under-utilization of skills and low self-esteem emerged as important issues. These results are of interest theoretically and have important implications for the way dental practice and dentistry are organized.

Adult↗

PubMed1996

Patterns of and reasons for tooth extractions in general dental practice in Ontario, Canada.

While substantial proportions of the population of Ontario, Canada continue to have teeth extracted, little is known about the reasons for this loss. In this survey of Ontario general dental practitioners, 128 dentists provided information on 6143 patients they saw during a reference week. Approximately one-in-seven of these patients had or were going to have one or more extractions as part of their current course of treatment. The mean number of extractions for patients having at least one tooth taken out was 2.3 (SD = 2.5). Emergency patients were more likely than regular patients to have at least one extraction but, on average, had fewer teeth taken out. Orthodontic considerations were the main reason for tooth loss in childhood, caries continued to be an important cause of tooth loss at all ages and periodontal disease accounted for more teeth lost after 40 years of age than caries. This study differs from almost all others in finding that, overall, more permanent teeth were extracted because of periodontal disease than because of caries. The former accounted for 35.9% of teeth lost and the latter for 28.9%. While this may be due to methodological differences between this and other studies, it is consistent with epidemiological data on periodontal disease in the Ontario population and data showing that Ontarians receive little in the way of periodontal care.

Adolescent↗

PubMed1996

Is dental health education effective? A systematic review of current evidence.

In order that health service resources are allocated in the way which most benefits the population, systematic review of the available evidence regarding the effectiveness of programmes and interventions are required. This study examined papers relating to dental health education interventions, which were published between 1982 and 1994 (n = 143). Each was scored by two independent researchers according to twenty predetermined validity criteria. For each paper which achieved a validity score of more than 12 (n = 37), data concerning the objectives of the intervention, the types and numbers of participants, and the outcomes, were extracted from the article. Where sufficient data were provided in a paper which met more than 15 of the validity criteria quantitative meta-analysis was carried out i.e. the results of the studies were pooled in order to calculate an overall intervention effect with confidence intervals. This combination of qualitative and quantitative review techniques showed that dental health interventions have: a small positive, but temporary effect on plaque accumulation (reduction in plaque index = 0.37 95% CI -0.29-0.59); no discernible effect on caries increment and a consistent positive effect on knowledge levels. The results of this analysis suggest that further efforts to synthesise current information about dental health education, in a systematic way, are required, along with maintenance of rigorous scientific standards in evaluation research.

Confidence Intervals↗

PubMed1996

Who is dentally anxious? Concordance between measures of dental anxiety.

Studies of the prevalence of dental anxiety in general population samples have produced estimates which range from a low of 2.6% to a high of 20.4%. It is not clear whether these reflect real differences among populations or whether they are the result of the use of different measures and different cut-off points. We undertook a large scale mail survey of dental anxiety in a random sample of the adult population living in Metropolitan Toronto designed to assess the performance of and agreement between three measures. These were Corah's DAS, the single item used by Milgrom and colleagues in Seattle and the ten-point fear scale used by Gatchel. These measures and their published cut-off points produced prevalence estimates of 10.9%, 23.4% and 8.2% respectively. While there was a significant association between scores on pairs of measures the agreement between them was far from perfect. Kappa values ranged from 0.37 to 0.56, indicating only fair to moderate agreement beyond chance. There was evidence to indicate that the dentally anxious subjects identified by each measure differed according to certain behavioural and other characteristics. The results of the study suggest the need to revisit the issue of measurement in studies of dental anxiety.

Adolescent↗

PubMed1996

Variations in restorative treatment decisions: an international comparison.

Variations between dentists in treatment thresholds and diagnostic decisions based on radiographs have not been fully explained. Since variations have been shown to exist between as well as within countries, it is possible that the structure of incentives inherent in different health care systems, and cultural influences on health and health care may play a part. This paper compares the results of a study undertaken in Scotland with a replication study undertaken in Canada concerning dentists' restorative thresholds and treatment decisions based on radiographic evidence. The Canadian dentists operated with greater sensitivity but lower specificity than their Scottish counterparts, although ROC analysis indicated similar overall abilities to detect carious lesions. The dentists' action thresholds also differed. However, methodological issues mean that the data from the study need to be interpreted with caution.

Adolescent↗

PubMed1996

Using subjective oral health status indicators to screen for dental care needs in older adults.

A study was undertaken to assess the ability of a number of subjective oral health status indicators to identify community-dwelling older adults who need dental treatment. The indicators consisted of a single-item self-rating of treatment need, a 15-item psychosocial impact index and the 49-item Oral Health Impact Profile (OHIP). Data for the study were collected as part of an oral health survey of Canadians aged 50 years and over. The associations between these subjective indicators and clinically defined dental treatment needs were assessed using statistics for determining the predictive power of a diagnostic test. Although there were statistically significant associations between the subjective and clinical measures, values for statistics such as sensitivity, positive predictive values and positive likelihood ratios were low. Although the measures did not perform well as screening tests, they did identify a sub-group of individuals whose clinical conditions impacted significantly on daily life and who would probably benefit the most from dental treatment. In this respect, the subjective measures assessed here can themselves be interpreted as indicators of need which complement conventional clinical measures of needs for dental care.

Activities of Daily Living↗

PubMed1996

Incidence of root caries in an older Canadian population.

This paper reports the results of a longitudinal study of Canadians aged 50 years and over which was designed to estimate the three-year incidence of root caries. At baseline, 699 randomly selected dentate subjects were clinically examined and 493 were examined again after three years. Over this period 27.4% had one or more root DFS increments and the mean DFS increment was 0.6 per person. Because DFS increments overstate root caries incidence DS increments were also calculated. Relatively few baseline variables were associated with either DFS or DS increments. In logistic regression analyses, age was the only variable associated with one or more root DFS increments, while age, dental visiting pattern and wearing a partial denture were associated with one or more root DS increments. In both cases, the predictive power of the models was poor but improved marginally when baseline root caries experience was also entered as an independent variable.

Age Factors↗

PubMed1996

Using area-based measures of socioeconomic status in dental health services research.

OBJECTIVES: This paper reports the results of a study to assess the value of an area-based measure of socioeconomic status in dental health services research. METHODS: Data on oral health were collected using a telephone interview survey of a random sample of persons aged 50 years and older living independently in Ontario, Canada. Postal codes and a computerized census database were used to identify the mean household income of the enumeration area in which each subject lived. Analyses were undertaken to determine the extent to which the area-based measure of household income substitutes for and supplements self-reported household income in predicting oral health outcomes. RESULTS: The results indicate that the enumeration area mean was not a good predictor of self-reported household income in this population. However, the area-based measure identified as much variation in nine oral health outcome variables as did the self-reported measure. Also, the socioeconomic status of the area in which the subjects lived had an effect on health and health-related behaviors that was independent of their household socioeconomic status. CONCLUSIONS: The use of area-based measures in dental health services research is promising and warrants further exploration.

Activities of Daily Living↗

PubMed1996

Factors influencing the amount and type of dental services received by older adults in four municipalities in Ontario, Canada.

OBJECTIVES: The purpose of this study was to investigate the factors influencing the pattern (amount and types) of dental care provided to dental visitors participating in the baseline stage of the Ontario Study of the Oral Health of Older Adults. METHODS: We interviewed and examined older adults from four municipalities in Ontario and obtained dental service records for the previous two years for those reporting a dental visit. Individual services and their corresponding time and values were aggregated into categories. We compared the pattern of care for dentate and edentulous subjects, and by age, municipality of residence, and social, demographic and economic characteristics. RESULTS: The 473 subjects received 5,031 services, more than four hours of dental care per subject over the two years. The 29 edentulous subjects received about one-third the number of services compared with the dentate; however, there were no differences in relative time units (RTUs) or relative value units (RVUs). Among the dentate the amount of care (RVUs) varied by municipality of residence and by visiting behavior, but not by age, income, or other socioeconomic variables. CONCLUSIONS: Both dentate and edentulous visitors received over two hours of care per person per year. Dental care patterns were influenced by dental status, area of residence, and visiting behaviors.

Age Factors↗

PubMed1996

Relationship between dental and general health behaviors in a Canadian population.

OBJECTIVES: Because the promotion of healthier life styles has become a public health issue of increasing interest, a survey was conducted to compare levels of preventive oral and general health behaviors. METHODS: A randomly selected population of voters aged 19 years and older living in a multicultural suburb of metropolitan Toronto, Canada, participated in a mail survey. RESULTS: Dentate respondents (n = 976) reported high optimal levels for at least daily toothbrushing (96%); moderate levels of preventive yearly dental examination (69%); and low levels for flossing (22%), using an interdental device (25%), not snacking between meals (12%), and consuming fewer than two cariogenic foods on the previous day (26%). For the general health behaviors, the majority did not smoke (75%), had low alcohol intake (89%), used seat belts (69%), and exercised three times weekly (50%). Additive indices for the oral and general health behaviors were significantly, although weakly, correlated (r = 13; P < .001) and few respondents (31.3%) scored high on both indices. OLS regression on a combined index of oral and general health behaviors found that females, older respondents, and those with higher incomes were more likely to engage in a higher level of health behaviors. CONCLUSIONS: These results indicate the need to develop health promotion life style programs that incorporate both dental and general health components and to target these programs to younger age groups, males, and those with low incomes.

Adolescent↗

PubMed1996

Incidence of and risk factors for tooth loss in a population of older Canadians.

Data on the incidence of tooth loss in community-dwelling older Canadians have not previously been reported. Since recent US studies of older adults were conducted in predominantly rural communities, their results may not be generalizable to Canada, where the majority of older adults live in major metropolitan or urban settings. This paper describes a study designed to estimate the incidence of tooth loss in older Canadians and to identify factors predictive of that loss. Using personal interviews and clinical examinations, we obtained baseline and three-year follow-up data from 491 dentate subjects. Overall, 23.2% lost one or more teeth between baseline and follow-up. Only six, or 1.2%, became edentulous. Twelve baseline factors were significantly associated with the probability of loss. However, in a logistic regression analysis, only five had significant independent effects. These were gender, marital status, self-rating of oral health status, the number of decayed root surfaces, and a mean periodontal attachment loss of 4 mm or more. The predictive ability of the model was poor, largely because tooth loss is a complex outcome which depends on decisions taken by dentists and patients. Since this decision-making process cannot be captured in epidemiological studies, observational studies are needed to cast further light on tooth loss in this population.

Aged↗

PubMed1996

Variations in the social impact of oral conditions among older adults in South Australia, Ontario, and North Carolina.

Previous studies among older adults have demonstrated that oral disease frequently leads to dysfunction, discomfort, and disability. This study aimed to assess variations in the social impact of oral conditions among six strata of people aged 65 years and older: residents of metropolitan Adelaide and rural Mt Gambier, South Australia; residents of metropolitan Toronto-North York and non-metropolitan Simcoe-Sudbury counties, Ontario, Canada; and blacks and whites in the Piedmont region of North Carolina (NC), United States. Subjects were participants in three oral epidemiological studies of random samples of the elderly populations in the six strata. Some 1,642 participants completed a 49-item Oral Health Impact Profile (OHIP) questionnaire which asked about impacts caused by problems with the teeth, mouth, or dentures during the previous 12 months. The percentage of dentate people reporting impacts fairly often or very often was greatest among NC blacks for 41 of the OHIP items. Two summary variables of social impact were used as dependent variables in bivariate and multivariate least-squares regression analyses. Among dentate people, mean levels of social impact were greatest for NC blacks and lowest for NC whites, while people from South Australia and Ontario had intermediate levels of social impact (P < 0.01). Missing teeth, retained root fragments, root-surface decay, periodontal pockets, and problem-motivated dental visits were associated with higher levels of social impact (P < 0.05), although there persisted a two-fold difference in social impact across the six strata after adjustment for those factors Among edentulous people, there was no statistically significant variation in social impact among strata. The findings suggest that there are social and cultural factors influencing oral health and its social impact, and that those factors differ most between dentate blacks and whites in NC.

Black or African American↗