PubMed Health⌕ Search

Biomedical subjects

G H Gilbert

Publications and source records attributed to G H Gilbert.

At least 19 recordsLinked to original sources
PubMed1996

Root caries and root defects in urban and rural adults: the Florida Dental Care Study.

As part of the Florida Dental Care Study--a longitudinal study of risk factors for changes in dental health--the authors examined and interviewed 873 adults aged 45 years and older. During the examination, clinicians noted the number of teeth present and the participant's dental condition, including presence of root caries and fillings or noncarious defects on the roots. The interview was conducted to collect demographic and other information such as the adults' perceptions about dental care and their perceptions about their own dental health. The authors found that men, African-Americans, adults living in rural areas and those living in poverty were significantly more likely to have root caries than other participants. The data reported in this article will serve as baseline information for subsequent research.

Aged↗
PubMed1995

Access to and patterns of use of oral health care among elderly veterans.

Utilization of The Department of Veterans Affairs (VA) dental care system is best understood in the context of the health care system at large. Veterans' use of dental care is apparently influenced by a wide variety of factors that include: barriers to access to non-VA systems (such as a lack of health insurance and the inability to afford non-VA care); ineligibility for VA services (such as absence of a service-connected disability); characteristics of the VA delivery system itself (such as eligibility priorities, geographic distribution of VA facilities, and quality of VA care); and characteristics of the veteran population (such as veterans' illness level, their perceived need for care, and their satisfaction with and perceived quality of VA care). The Department of Veterans Affairs offers a unique opportunity to study the effect of certain delivery system characteristics on utilization behavior and veterans' use of specific dental services. Health services research on the VA oral health care system will 1) provide information useful to improve veterans' oral health and the effectiveness and efficiency of VA dental care delivery and 2) improve our understanding of utilization behavior in large public sector health care systems that are surrounded by private sector health care settings. The following topics should be included in a VA oral care health services research agenda: development of a uniform, system-wide dental care data base; an understanding of the long-term benefits that result from the use of specific dental services and determination of the services that are the most cost-effective; an understanding of the characteristics of delivery systems and of the dental care providers who promote the most appropriate, effective, and efficient care; a better understanding of how VA makes veterans aware of their eligibility; an understanding of the relationship between medical and dental care use in the VA system; and an understanding of the degree to which discontinuity exists in dental care services of veterans.

Aged↗
PubMed1995

Pilot study comparing parents' and third-grade schoolchildren's attitudes toward braces and perceived need for braces.

An instrument developed for third-grade schoolchildren and their parents was pilot-tested for its ability to measure orthodontic attitudes and perception of the child's need for braces. Seventy-eight children and 54 parents were surveyed. Forty-six percent of the children wanted braces while 61% believed that they needed braces. Correlation between desire for braces and perceived need was 0.47, suggesting that desire and perceived need were only moderately correlated in children. Sixty-three percent of the parents believed that their child needed braces. Despite such proportions of children and parents perceiving a need for treatment, three-fourths of the children and two-thirds of the parents were satisfied with the appearance of the child's teeth. Attitude subscales, derived from the attitude survey, and clinical orthodontic parameters were used to model children's and parents' perceived need for braces in the child. No clinical parameter was a significant correlate in either children's or parents' model of perceived need. Neither race nor gender contributed significantly to either model. The subscales Concern for Appearance and Social Aspects of Braces were the strongest covariates of children's perceived need for braces. Concern for Appearance was the most important correlate in the parents' model. These data suggest that parents' perceived need for orthodontic treatment for their third-grade children is determined primarily by a concern for appearance rather than clinical status. In third-graders, perceived aesthetics and social aspects apparently have more influence than clinical status in creating a perception of need for braces.

Attitude to Health↗
PubMed1994

Perceived need for dental care in dentate older adults.

Previous studies have observed a substantial difference between need for dental care as determined by professional dental examiners (determined by disease presence) and that reported by potential dental patients (which may or may not be based on perceived disease presence). In this study of community-dwelling dentate older adults a substantial difference was also observed. To explore the role that factors other than disease presence may have in determining perceived current need for dental care, subjects were queried about their current oral signs, oral symptoms, psychosocial impacts from oral disease, and other factors hypothesised as affecting current need for dental care. When reporting perceived current need, subjects apparently were not responding to overall assessments of their dental health or periodontal health; rather, they were responding to specific oral signs and symptoms, and their effects. In a multivariate model, dental pain was most strongly associated with perceived need, followed by the psychosocial effects of oral diseases, reported presence of cavities, and reported presence of loose teeth. However, substantial percentages of persons reported oral signs, symptoms, and effects that would be judged professionally as sufficient for reporting a current need for dental treatment, yet did not report a need. With oral signs and symptoms accounted for, persons with less discretionary income and those who were less satisfied with their last dental visit were actually more likely to perceive a current need for dental care.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Dental care use by U.S. veterans eligible for VA care.

Military veterans eligible for dental care in U.S. Department of Veterans Affairs (VA) facilities cooperated for a mailed survey about their dental care utilization. Subjects were selected because of their eligibility for continuing dental care in VA facilities at no monetary cost. However, only 48% reported the VA as their only or primary source of dental care; this allowed us the opportunity to compare dental care frequency by those who received dental care at no monetary cost with those who did not, as well as measure delivery system effects on dental care use. Consequently, we tested respondent-level and delivery system-level hypotheses regarding determinants of veterans' dental care use. Predisposing characteristics (dentate status, usual reason for dental visits, and the importance placed on dental care and oral health) were the strongest determinants of interval since last dental visit. Enabling determinants (current source of dental care, and having a regular source of care) were also significant, but measures of need for dental care (perceived oral health and perceived need for treatment) were not. More recent dental care use by veterans who used the VA delivery system as their source of dental care, even with dental care payment source and other determinants accounted for, suggests that the VA delivery system may have promoted more regular use compared to other systems.

Adult↗
PubMed1993

Attitudinal and behavioral characteristics of older Floridians with tooth loss.

In this cross-sectional study of Floridians aged 65 yr or older, 600 persons were interviewed to identify the characteristics of individuals who survived into old age with an intact or nearly intact dentition. Persons with total or partial tooth loss reported less frequent dental care, less ability to pay dental care fees, less frequent dental hygiene, and were more likely to have been smokers or diabetic. Persons with tooth loss also had less positive attitudes toward dentists and dental care. These cross-sectional findings are consistent with tooth loss being the result of disease-, behavior-, and attitude-related causes, and/or their interactions. Tobacco use, diabetes, and infrequent oral hygiene and dental care may increase risk for dental disease; decreased ability to pay for dental treatment may impair utilization of non-extraction treatment options, and negative attitudes toward dental treatment may influence the desire for non-extraction treatment options. Research targeted toward modifying attitudes toward dental treatment may be useful in preventing or delaying tooth loss, and measurement of attitudes may be a useful way to identify individuals at the greatest risk for tooth loss for intervention studies.

Aged↗
PubMed1993

Mouth dryness as reported by older Floridians.

Thirty-nine percent of 600 community-dwelling older Floridians (mean age of 78 yr) reported having mouth dryness. Seventy-nine percent of respondents reported at least one medical condition, 57% were taking at least one prescribed or over-the-counter medication, and 33% were taking at least one potentially xerostomic medication. Reported mouth dryness was highly associated with the number of potentially xerostomic medications. After stratification by medication usage, age, diabetes, arthritis, perceived medical health, and dependence in physical functioning were significantly associated with mouth dryness. Persons with dry mouth were also more likely to have reported dental symptoms, signs of dental disease, sensory changes, and other oral symptoms. Ten percent of those who reported mouth dryness also said that their mouths felt dry when eating a meal, 10% said that they had difficulties swallowing foods, and 15% of persons with dry mouth also said that the amount of saliva in their mouths was too little. Sixty-five percent of persons with dry mouth reported doing one or more dryness-related behaviors. These results suggest that the prevalence of xerostomia was high, and the impact of dry mouth on individuals' daily behaviors was significant.

Aged↗
PubMed1993

Oral signs, symptoms, and behaviors in older Floridians.

Six hundred community-dwelling older Floridians were interviewed regarding the presence of reported signs of dental conditions, dental and oral symptoms, behavioral impact from dental conditions, and orofacial sensory changes. The prevalence of any single oral sign, symptom, or behavioral impact was generally low. A notable exception was the 39 percent prevalence of dry mouth. However, from 10 percent to 29 percent of persons had at least one of these dental signs, dental symptoms, dental behavioral impacts, or sensory changes. These findings are consistent with a noteworthy burden from nonoptimal oral health status, and these burdens were significantly more prevalent in irregular dental attenders, persons with lower household incomes, and persons who reported poorer general health. Inclusion of these non-disease items in an assessment of oral health status seems warranted, and would allow a broader evaluation of oral health outcomes.

Aged↗
PubMed1992

Periodontal status of older Floridians attending senior activity centers.

Older adults attending senior activity centers in Florida cooperated for a questionnaire and an oral examination. The 671 ambulatory dentate seniors in this report had a mean of 17.0 teeth. The mean attachment loss was 3.5 mm from the cementoenamel junction (CEJ), and the mean pocket depth was 2.1 mm. 24% of the sample had at least 1 site with attachment loss of 7 or more mm; the majority of these persons had only 1 or 2 severely-involved sites. The extent and severity index of attachment loss (2 mm or more threshold) was (88%, 3.7 mm). Use of pocket depths alone would have substantially underestimated prevalence of periodontitis in this older sample. Sites with severe attachment loss were typically not accompanied by severe pockets. Evidence of a history of moderate disease in this cross-sectional study was prevalent (62% of persons had a maximum attachment loss of 4-6 mm), as was evidence of a history of severe disease (24% had at least 1 site with attachment loss of 7 mm or more).

Aged↗
PubMed1992

Eligible veterans' choice between VA-covered and non-VA-covered dental care.

Veterans who were eligible for dental care in Department of Veterans Affairs (VA) facilities at no monetary cost responded to a mailed questionnaire. Seventy-one percent were aware that they were actually eligible for VA dental care. However, only 48 percent reported the VA as their only or primary source of dental care. Eligibility status, perceived quality of VA dental care, use of VA medical care, perception that one's income meets expenses, and perceived need for dental care were significant correlates of using the VA as one's current source of dental care. Level of formal education, perception that one's income meets expenses, transportation pattern, geographic distance from a VA facility, and eligibility status were significant correlates of using the VA as one's current medical care source. Research on VA utilization offers the opportunity to study issues of access to, and use of, a large public health care system whose patients largely receive care at no monetary cost. Veterans' use of VA dental and medical care is apparently influenced by a wide variety of factors, ranging from barriers to access to non-VA systems, to characteristics of the VA delivery system itself, to need for treatment.

Adult↗
PubMed1992

Oral and maxillofacial surgical therapy for the older adult.

Older adults can present with a wide range of oral and maxillofacial diseases and conditions, and many of these are best treated surgically. One of the distinguishing features of geriatric surgery is the large percentage of older adults who have medical conditions that must be planned for perioperatively. Good communication between the surgeon and the primary care physician is important for this perioperative management. Orofacial infections, the most common of which are odontogenic in origin, require some form of surgical treatment and may or may not require treatment with antibiotics. Preprosthetic and reconstructive surgery may be necessary to treat the sequelae of oral and maxillofacial fractures, the sequelae of tooth loss, or surgical defects incurred during the treatment of cancer, osteomyelitis, osteoradionecrosis, or disorders of the TMJ.

Aged↗
PubMed1992

An operational definition of the homebound.

Homebound status is a critical eligibility criterion for Medicare reimbursement of some home care services, yet little discussion has been undertaken to establish a valid definition of it. We propose an operational definition of homebound status, and we measure its validity for community-dwelling elderly in the Massachusetts Health Care Panel Study (MHCPS). The MHCPS is a longitudinal study of a cohort of elderly persons (N = 1,625), which began in 1974, with follow-up surveys in 1976, 1980, and 1985. Validity was measured by comparing responses from the operational measure to persons' responses to questions that we judged should be associated with a valid measure of homebound status. This construct validity method resulted in correlations that were significant and in the expected direction, and that suggested that this operational measure is a highly specific, moderately sensitive, valid measure. These results underscore the need for researchers investigating the homebound to discuss the validity and limitations of their homebound measures, and in what context these measures are useful.

Activities of Daily Living↗
PubMed1991

Tooth loss and caries prevalence in older Floridians attending senior activity centers.

Older adults attending 14 senior activity centers in six countries of Florida cooperated for a questionnaire and an oral examination. The mean age was 76.5 yr, and about one-third were 80 yr or older. One-third of the dentate persons had dental caries. Most of the carious lesions were on the crown, not the root, and most of the decay was primary, not recurrent. Most of the persons with a need for caries treatment were likely to seek dental care; however, the majority of carious surfaces were in persons who reported being infrequent users of care. These results from ambulatory older adults suggest that older adults have significant caries treatment needs, and provide support for the view that the treatment of older U.S. adults may grow in the coming decades.

Aged↗
PubMed1990

Principles of surgical risk assessment of the elderly patient.

Treatment of the elderly will comprise increasingly higher proportions of practice time in the future, and issues regarding this treatment are more salient now than ever before. Because more elders are seeking treatment, surgeons need to be comfortable with assessing the potential risks associated with surgical procedures in their elderly patients, many of whom have multiple chronic diseases. Risks that need to be considered are those physiologic changes normal for aging, pathologic changes due to disease, and psychosocial changes that may occur with aging. This article assesses the contribution each of these changes makes to surgical risk, and discusses the principles of gerontology and geriatric medicine that are relevant to risk assessment.

Aged↗
PubMed1990

Predictors of older adults' longitudinal dental care use. Ten-year results.

Our purpose was to identify factors predictive of reported dental care use by elders (65+) over a ten-year period in Massachusetts. The Massachusetts Health Care Panel Study began in 1974-75 (wave 1) as a statewide survey of 1625 noninstitutionalized elders. Wave 2 occurred in 1976, wave 3 in 1980, and wave 4 in 1985. The 540 persons who participated in all four waves are the subject of this report. The remainder either died, entered nursing home, or were lost to follow-up. This longitudinal design permits analysis of cohort, aging, and period effects. The outcome variables were self-reported dental care use within two years, or more than two years, as reported at waves 1, 3, and 4. Wave 2 was excluded because less than two years had elapsed since the previous wave. To identify factors predictive of reported use, we used a generalization of the logistic regression model that included a random effect term, which accounts for repeated measures being made on the same subjects. Covariates in the model were dentate status, education, income, cohort, sex, martial status, and time. The variable "time" served as a measure of aging/period effects. Persons were grouped into four birth cohorts. Before adjusting for other covariates, cohort was significantly associated with dental care use, but was not so in the full multivariate model. Dentate status, education, and income were significant predictors of use. The cohort effect was explained by dentate status, education, and income. Time was not significant, indicating no aging/period effects in this ten-year period, or that their net effect was zero.

Aged↗
PubMed1990

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.

Adult↗
PubMed1989

'Ageism' in dental care delivery.

Older adults will comprise increasingly higher proportions of dentists' practice time in the future, and issues regarding their treatment are more salient now than ever before. Psychosocial issues and attitudes toward treating older patients are among the most important of these. Ageism, defined as negative attitudes or prejudice toward older adults, has implications in dental care delivery. It can be manifested by the attitudes that older people have toward their own aging process, by those who provide their health care, and by society. This article proposes a more appropriate definition of ageism, and discusses the forms ageism can take in the dental care setting.

Aged↗