Biomedical subjects

Gregg H Gilbert

Publications and source records attributed to Gregg H Gilbert.

At least 37 records · Page 2Linked to original sources

PubMed2003

Comparing longitudinal binary outcomes in an observational oral health study.

Observational studies continue to be recognized as viable alternatives to randomized trials when making treatment group comparisons, in spite of drawbacks due mainly to selection bias. Sample selection models have been proposed in the economics literature, and more recently in the medical literature, as a method to adjust for selection bias due to observed and unobserved confounders in observational studies. Application of these models has been limited to cross-sectional observational data and to outcomes that are continuous in nature. In this paper we extend application of these models to include longitudinal studies and binary outcomes. We apply a two-stage probit model using GEE to account for correlated longitudinal binary chewing difficulty outcomes. Chewing difficulty was measured every six months during a 24-month period between two groups of subjects: those either receiving or not receiving dental care. Dental care use was measured at six-month intervals as well. Results from our proposed model are compared to results using a standard GEE model that ignores the potential selection bias introduced by unobserved confounders. In this application, accounting for selection bias made a major difference in the substantive conclusions about the outcomes of interest. This is due in part to an adverse selection phenomenon in which those most in need of treatment (and consequently most likely to benefit from it) are actually the ones least likely to seek treatment. Our application of sample selection models to binary longitudinal observational outcome data should serve as impetus for increased utilization of this promising set of models to other health outcomes studies.

Dental Health Services↗

PubMed2003

Incidence of dental radiographic procedures during a 48-month population-based study of dentate adults.

OBJECTIVES: The purpose of this population-based study was to quantify the incidence of radiographic procedures and the intervals between radiographic exposures. STUDY DESIGN: The Florida Dental Care Study was a prospective cohort study of a representative sample of dentate adults. In-person interviews and dental examinations were conducted at baseline, with subsequent interviews every 6 months during 48 months of follow-up. Dental record information was abstracted afterward. RESULTS: Thirteen percent of all dental procedures, and 42% of all diagnostic procedures, were radiographic. Annual person-level incidence of receipt of any radiograph was 48%. Incidence of specific types of radiographic procedures ranged from 5% to 30%. Among the 45% of the sample population who had had more than 1 bitewing procedure, 70% of the intervals between bitewing exposures were 1 year or longer. Receiving more than 1 full-mouth series or panoramic radiographic in any 24-month period was very rare. CONCLUSIONS: Annual incidence of radiographic procedures was substantially higher than the incidence reported in previous studies based on responses by dentists to hypothetical situations, but was stable during the 4 years of follow-up. On the basis only of intervals between exposures, and not of clinical status on the day of service, there was no substantial evidence of inappropriately frequent radiographic examinations.

Adult↗

PubMed2003

Relationship of dental status, sociodemographic status, and oral symptoms to perceived need for dental care.

OBJECTIVE: Previous studies have noted a discrepancy between clinically determined oral health status (normative need), patients' perceptions, and perceived significance of dental signs and symptoms. Our objective was to quantify the relationships between normative need and self-reports to improve our understanding of the factors that contribute to perceived need for care. METHODS: Clinical examination and questionnaire data were derived from the Florida Dental Care Study, a study of oral health and dental care, in a representative sample of community-dwelling adults aged > or = 45 years. The questionnaire provided information about presence of signs and symptoms, self-ratings of oral health, perceived need for dental care, and sociodemographic status (SDS). Perceived need was measured on a 4-point nominal scale. RESULTS: Self-reported broken filling, broken denture, cavities, loose tooth, teeth that look bad, and toothache were strongly associated with self-reported perceived need for dental care. Satisfaction with dental health was also associated with perceived need, but self-rated oral health was not. Most measures of SDS were associated with perceived need. However, in a single multiple regression, with self-reported signs and symptoms accounted for, race, age group, sex, and educational attainment were not significantly associated with a currently perceived dental problem. CONCLUSIONS: Certain dental signs and symptoms were significantly associated with perceived need for dental care, as were certain aspects of SDS; even once differences in dental signs and symptoms had been taken into account. Disaggregating measurement of perceived need from a single dichotomous ('yes/no') scale to a 4-point nominal scale was elucidative.

Aged↗

PubMed2003

Two-year incidence of oral disadvantage, a measure of oral health-related quality of life.

UNLABELLED: Dental research has progressed from describing the burden of oral disease using traditional epidemiologic measures of incidence and prevalence, to measuring how oral disease, oral signs, and oral symptoms affect the daily activities and the overall quality of life of the individual. However, longitudinal evaluation of these associations remains rare. OBJECTIVES: To (i). describe the 2-year incidence and patterns of oral disadvantage; (ii). identify dimensions of oral health measures that are significant antecedents of oral disadvantage; and (iii). determine which oral health dimensions are the most strongly predictive of oral disadvantage. METHODS: The Florida Dental Care Study was a longitudinal study of oral health in diverse groups of persons who at baseline had at least one tooth and were 45 years or older. Incidence rates, odds ratios, and 95% confidence intervals were used to describe oral disadvantage and its relation to other measures of oral health. RESULTS: Nearly one-half of the participants experienced oral disadvantage at least once during 24 months of follow-up. The strongest antecedents associated with oral disadvantage were toothache pain and chewing difficulty. CONCLUSIONS: The incidence of oral disadvantage is substantial and consistent with the notion that oral health has a substantial impact on quality of life. Measures of oral pain and oral functional limitation were more strongly predictive of oral disadvantage than disease and tissue damage antecedents.

Aged↗

PubMed2003

Incidence of endodontic treatment: a 48-month prospective study.

The purpose of this study was to determine the incidence of endodontic services provided to participants in a longitudinal cohort study. The "Florida Dental Care Study" was a prospective cohort study using a representative baseline sample of 873 dentate adults. An in-person interview and clinical dental exam were conducted at baseline, 24, and 48 months after baseline, with telephone interviews every 6 months between those times. Dental record information was abstracted afterward. Thirteen percent of participants received at least one endodontic procedure after baseline. Endodontic services constituted approximately 2% of all dental procedures performed. Conventional root canal therapy comprised 94% of the endodontic services and was approximately evenly distributed among anterior teeth, premolars, and molars. Retreatment and apicoectomy each accounted for 3% of the endodontic procedures. The most common self-reported reasons for the dental visit in which a root canal occurred were "toothache," "abscess," and "dental sensitivity." A significant percentage of persons received some type of endodontic treatment in this diverse adult sample. Dental abscesses or toothaches were the main reason(s) for endodontic treatment, but not all persons with these conditions during follow-up sought dental treatment of any variety.

Aged↗

PubMed2003

The paradox of dental need in a population-based study of dentate adults.

BACKGROUND: Studies typically find that predisposing and enabling factors strongly predict dental utilization, but that need factors do not. However, few longitudinal studies have been conducted, and few have comprehensively measured dental need. OBJECTIVES: To describe the paradox of dental need, and to test three hypotheses regarding need and dental care use. MATERIALS AND METHODS: An observational study that included 873 persons who participated for interview and clinical examination at baseline and 24 months, with 6-month telephone interviews in between. RESULTS: Persons who entered the dental care system during follow-up were actually in better dental health than those who did not. The ability of need factors to predict dental care use, and in which direction, varied with how dental need and the dental care use outcome were measured (eg, care of any type, problem-related care, to receive a dental cleaning, to get a dental checkup). CONCLUSIONS: A substantial number of dental problems remained or developed among the population that did not enter the dental care system. The paradox of dental need has three components: (1) need predicts dental care use but is dependent upon how need is measured; (2) however, persons with a higher probability of new dental problems are actually less likely to seek dental care; and (3) self-reported disease and oral pain are associated with a higher likelihood of seeking care, whereas clinically-determined need, such as chewing difficulty, lower self-rating, and satisfaction with oral health, are actually associated with a lower likelihood, the former direction being the predominant and expected direction.

Adult↗

PubMed2003

Social determinants of tooth loss.

OBJECTIVES: To quantify racial and socioeconomic status (SES) disparities in oral health, as measured by tooth loss, and to determine the role of dental care use and other factors in explaining disparities. DATA SOURCES/STUDY SETTING: The Florida Dental Care Study, comprising African Americans (AAs) and non-Hispanic whites 45 years old or older who had at least one tooth. STUDY DESIGN: We used a prospective cohort design. Relevant population characteristics were grouped by predisposing, enabling, and need variables. The key outcome was tooth loss, a leading measure of a population's oral health, looked at before and after entering the dental care system. Tooth-specific data were used to increase inferential power by relating the loss of individual teeth to the disease level on those teeth. DATA COLLECTION METHODS: In-person interviews and clinical examinations were done at baseline, 24, and 48 months, with telephone interviews every 6 months. PRINCIPAL FINDINGS: African Americans and persons of lower SES reported more new dental symptoms, but were less likely to obtain dental care. When they did receive care, they were more likely to experience tooth loss and less likely to report that dentists had discussed alternative treatments with them. At the first stage of analysis, differences in disease severity and new symptoms explained tooth loss disparities. Racial and SES differences in attitudes toward tooth loss and dental care were not contributory. Because almost all tooth loss occurs by means of dental extraction, the total effects of race and SES on tooth loss were artificially minimized unless disparities in dental care use were taken into account. CONCLUSIONS: Race and SES are strong determinants of tooth loss. African Americans and lower SES persons had fewer teeth at baseline and still lost more teeth after baseline. Tooth-specific case-mix adjustment appears, statistically, to explain social disparity variation in tooth loss. However, when social disparities in dental care use are taken into account, social disparities in tooth loss that are not directly due to clinical circumstance become evident. This is because AAs and lower SES persons are more likely to receive a dental extraction once they enter the dental care system, given the same disease extent and severity. This phenomenon underscores the importance of understanding how disparities in health care use, dental insurance coverage, and service receipt contribute to disparities in health. Absent such understanding, the total effects of race and SES on health can be underestimated.

Black or African American↗

PubMed2003

Socioeconomic and demographic disparities in symptoms of orofacial pain.

OBJECTIVES: The purpose of this study was to document the association between socioeconomic status (SES) and the prevalence and impact of orofacial pain by anatomical location. In addition, differential effects of SES on orofacial pain across levels of sex, race, and age were documented. METHODS: The subjects were 724 participants in the Florida Dental Care Study, a study of oral health among dentate adults, aged 45 years and older at baseline. Pain prevalence and subjective ratings were assessed for a range of orofacial pain sites using a standardized telephone interview. RESULTS: Lower SES was associated with reporting pain and pain impact at many, but not all, of the orofacial sites. Some sex, race, and age cohort differences in orofacial pain were found when adjusting for differences in socioeconomic position. The most consistent result, as evidenced by similar findings across orofacial pain sites, was that the effects of SES on orofacial pain appear to have a sex-differentiated effect. CONCLUSION: Consistent with findings for other subjective measures of oral health, persons of lower SES are at increased risk for orofacial pain and pain-related behavioral impact.

Age Factors↗

PubMed2003

The dynamics of toothache pain and dental services utilization: 24-month incidence.

OBJECTIVES: The aims of this study were twofold: (1) to describe patterns of change in reported toothache pain, and (2) to examine the impact of toothache pain on dental care utilization and vice versa. METHODS: Data from the Florida Dental Care Study (FDCS), a longitudinal study of oral health and dental service utilization conducted in north Florida, were used to measure self-reported toothache pain among dentate adults at baseline and four subsequent times during a 24-month period. Only persons 45 years of age or older with at least one remaining natural tooth at baseline were eligible. A total of 873 subjects participated, 764 of whom participated through 24 months. The analysis is focused on modeling transitions in the reported experience of toothache pain during intervals of six months. RESULTS: At the time of the baseline interview, 11.5 percent of subjects reported current toothache pain. During subsequent six-monthly interviews, from 13.4 percent to 21.6 percent of subjects reported having experienced toothache pain during the prior six-month interval. Among those with no toothache pain at baseline (n = 772), 31.2 percent experienced toothache pain at some time during the 24-month study period. The six-month incidence probability reflects the likelihood of developing toothache pain by estimating the conditional probability of reporting a toothache in a later interval given that this problem was not reported in the earlier one (for consecutive pairs of intervals). Overall, the six-month incidence probability for toothache pain in this study was. 11. Significantly higher 24-month incidence was observed for African-American subjects, those with less formal education, those in poorer financial circumstances, and problem-oriented dental attenders. CONCLUSIONS: In this diverse sample of adults, toothache pain occurs frequently and is quite variable overtime. Toothache occurs in conjunction with various forms of self-reported oral disease (e.g., abscess, cavities) or tissue damage (e.g., loose tooth, broken tooth, bleeding gums). Subjects who experience toothache are slightly more likely than others to utilize dental services in the time period proximate to the toothache pain.

Aged↗

PubMed2002

Orofacial pain-related communication patterns: sex and residential setting differences among community-dwelling adults.

This study documented orofacial pain-related communication patterns among community-dwelling dentate adults, health care providers, and persons in the respondent's social network. We report communication patterns for orofacial pain by symptom (toothache pain, pain when chewing, temperature sensitivity of the teeth, painful oral sores, and jaw joint pain). The subjects for the study were 724 participants in the 42-month interview of the Florida Dental Care Study, a longitudinal study of oral health among dentate adults, age 45 and older at baseline. The data were collected using a standardized telephone interview. Pain was more likely to be discussed with a lay consultant (41-66% depending on the symptom) than a health care professional (21-62%). Consistent with studies that report females tend to rely on social networks to cope with pain, more female respondents than males reported having talked to a lay consultant about orofacial pain for most of the symptoms. We also found that rural Black adults were less likely to speak to a health care professional about their orofacial pain. The findings highlight the importance of family, friends, and neighbors within the lay consultation and support network for persons with pain. Recent interest in self-care and the use of complementary and alternative approaches to treatment suggest the importance of considering influences acting within the environment of persons with pain.

Aged↗

PubMed2002

Race/ethnic differences in health care use for orofacial pain among older adults.

The purpose of this study was to describe race/ethnic differences in the use of formal health care services for painful oral symptoms by older adults. We also considered the sex of the respondent rather than assuming that males and females within a specific racial group would use health care services similarly. To our knowledge, these specific utilization patterns have never been reported before in the pain literature.Telephone interviews were conducted on a stratified random sample of 1,636 community dwelling older (65+) north Floridians. A total of 5,860 households were contacted and screened, with 75.3% participating to the point where their eligibility for the study could be determined. Overall race/ethnic differences in patterns of health care use for orofacial pain were not found. However, when we stratified race/ethnicity by sex, Black females (37.6%) were the least likely to have visited a health care provider, followed by non-Hispanic White females (47.2%), non-Hispanic White males (49.3%), and Black males (62.7%). Point estimates of odds ratio, adjusting for financial differences, indicate that more non-Hispanic White males (OR=1.79) and Black males (OR=2.74) visited a health care provider than Black females. Our results also suggest that for older Black adults, financial constraints have a more significant impact on decisions about health care for orofacial pain than they do for non-Hispanic Whites. For non-Hispanic White respondents, characteristics of the pain symptoms were significant determinates of health care use for their painful oral symptoms. Pain at its worst was a positive predictor for four of the five analyses (jaw joint pain, painful oral sores, temperature sensitivity, and toothache pain). The duration variable (years with pain) was a negative predictor of health care use. This is consistent with the conclusion that individuals seek care early in the course of the symptom, i.e. an active care seeking phase, make emotional or physical adjustments, and then resign themselves to the symptoms.

Black or African American↗

PubMed2002

Use of specific dental treatment procedures by dentate adults during a 24-month period.

OBJECTIVES: To (a) describe the incidence of use of specific dental services; (b) test the hypothesis that certain predisposing, enabling, and need (PEN) factors are differentially predictive of service use; and (c) test the hypothesis that even with other PEN factors taken into account, race and household income are differentially predictive of certain dental services. Previously, this study identified PEN factors that predicted use of any care; herein we identify whether these same factors were differentially predictive of specific service use among users of at least one service. METHODS: The Florida Dental Care Study was a longitudinal study of persons aged 45 years or older who had at least one tooth. Subjects participated for interviews and clinical examinations at baseline and 24 months later, with 6-monthly telephone interviews between those times. RESULTS: Seventy-seven percent of subjects reported one or more visits. Results from a single multivariate multiple logistic regression suggested that even once analysis was limited to persons who used at least one dental service, at least one measure from each of the PEN domains was predictive of specific dental service use. CONCLUSIONS: Each PEN domain was predictive of service use, even once limited to persons with at least one visit. Even with differences in other PEN variables taken into account, African-Americans were much less likely to receive dental cleanings, restorative dentistry and fixed prosthodontic services, and were much more likely to have a tooth extracted. Household income was predictive of receipt of fixed prosthodontic services, but not other service categories.

Black or African American↗

PubMed2002

A prospective study of the validity of data on self-reported dental visits.

OBJECTIVE: To measure the validity of self-reported dental visits from a diverse sample of adults. METHODS: The Florida Dental Care Study was a longitudinal cohort study of a diverse sample of residents of north Florida, USA. In-person interviews and dental examinations were conducted at baseline, 24 and 48 months after baseline, with half-yearly telephone interviews in between. Dental record information was abstracted afterward. RESULTS: Agreement between self-report and dental record at each half-yearly interview ranged from 84 to 91%. Validity did not differ between persons of key sociodemographic groups (sex, race, age group, rural/urban residence, poverty status, level of formal education, or problem-oriented/regular approach to dental care). In a single bivariate multiple logistic regression (two outcomes: (i) self-reported use; and (ii) use measured from the dental chart), odds ratio estimates over-lapped for each of the 20 predictors. CONCLUSIONS: Validity of self-reported dental care use was good. There would have been few differences in conclusions made about predictors of dental care use had chart data been available earlier.

Adult↗

PubMed2002

Racial differences in orofacial pain.

This study investigated racial differences in the subjective report of orofacial pain in a stratified sample of adults dwelling in the community. The subjects were 724 participants in the Florida Dental Care Study, a longitudinal study of oral health among dentate adults aged 45 years and older at baseline. Pain prevalence and subjective ratings were assessed for a range of orofacial pain sites by means of a standardized telephone interview. The results suggest that white respondents were more likely to report painful oral sores than were black respondents (19.0% vs 6.3%). As was consistent with findings from patients seeking health care and laboratory-based experimental pain studies, a higher percentage of black subjects rated pain as severe enough to have an impact on behavior for temperature sensitivity (59.6% vs 30.3%), pain when chewing (70.0% vs 40.0%), and painful oral sores (53.8% vs 27.9%). These racial differences were most apparent within male sex for temperature sensitivity, pain when chewing, and toothache pain, with black men rating pain as more severe than white men. For jaw joint pain and painful oral sores, both black and white women rated pain as more severe than did white men. This study has documented race by sex interactions in the impact from orofacial pain across multiple symptoms in a community-based sample.

Journal Article↗

PubMed2002

Racial differences in predictors of dental care use.

OBJECTIVE: To test five hypotheses that non-Hispanic African Americans (AAs) and non-Hispanic whites (NHWs) differ in responsiveness to new dental symptoms by seeking dental care, and differ in certain predictors of dental care utilization. DATA SOURCES/STUDY SETTING: Florida Dental Care Study, comprising AAs and NHWs 45 years old or older, who had at least one tooth, and who lived in north Florida. STUDY DESIGN: We used a prospective cohort design. The key outcome of interest was whether dental care was received in a given six-month period, after adjusting for the presence of certain time-varying and fixed characteristics. DATA COLLECTION/EXTRACTION METHODS: In-person interviews were conducted at baseline and 24 months after baseline, with six-monthly telephone interviews in between. PRINCIPAL FINDINGS: African Americans were less likely to seek dental care during follow-up, with or without adjusting for key predisposing, enabling, and oral health need characteristics. African Americans were more likely to be problem-oriented dental attenders, to be unable to pay an unexpected $500 dental bill, and to report postbaseline dental problems. However, the effect of certain postbaseline dental signs and symptoms on postbaseline dental care use differed between AAs and NHWs. Although financial circumstance was predictive for both groups, it was more salient for NHWs in separate NHW and AA regressions. Frustration with past dental care, propensity to use a homemade remedy, and dental insurance were significant predictors among AAs, but not among NHWs. The NHWs were much more likely to have sought care for preventive reasons. CONCLUSIONS: Racial differences in responsiveness to new dental symptoms by seeking dental care were evident, as were differences in other predictors of dental care utilization. These differences may contribute to racial disparities in oral health.

Black or African American↗

PubMed2002

On adding a dental practice component to an ongoing longitudinal population-based study of oral health.

OBJECTIVE: To determine the feasibility and effectiveness of adding a dental practice component to the Florida Dental Care Study (FDCS). METHODS: The FDCS was a study of dental health in which no treatment was provided. In-person interviews and clinical examinations were conducted at baseline, 24 months, and 48 months, with six-month telephone interviews between those times. Participants reported any dentists visited and treatment received. All but four of the 764 participants at the 24-month session gave written permission to review their dental records. Dental hygienist research assistants abstracted information on treatment that was received during the 48-month interval. RESULTS: Of the 286 practices named by FDCS subjects, all but 10 (of whom five refused) practices participated. Eight practices allowed access to records, but did not allow us to record fees. Fees were unavailable at another 13 practices. Of the 764 persons who participated for the 24-month interview, 677 ultimately reported at least one dental visit during the first 48 months of the study. Of those 677, we located dental records on 619. We also found records on four of the 111 persons who reported no dental visits, by querying practices while recording information on other participants. Charts varied in comprehensiveness; nevertheless, in conjunction with office staff consultation, all practices had adequate record of what procedures were performed. CONCLUSIONS: Although time intensive, this method of collecting data substantially increased information about dental treatment received, compared to relying on participant self-report and clinical examination.

Data Collection↗

PubMed2002

Orofacial pain: racial and sex differences among older adults.

OBJECTIVES: This study investigated racial differences in orofacial pain symptoms in a sample of older adults. Orofacial pain prevalence, persistence, severity, and behavioral impact were assessed. We also tested whether sex and race interact, such that racial differences are only observed for a single sex, or whether sex differences only occur within a single racial group. METHODS: Telephone interviews were conducted with a stratified random sample of 1,636 community-dwelling older (age 65+ years) north Floridians. RESULTS: Racial differences were not found for 12-month prevalence or pain ratings for any painful oral symptom, or in the total number of symptoms. The most consistent racial differences were in behavioral impact associated with pain. Blacks reported greater behavioral impact as defined by pain having reduced their daily activities or motivating them to take some action in response to pain. For toothache pain, that action was more likely to have been some form of self-medication. These relationships persisted after controlling for socioeconomic status, approach to health care, and pain intensity in multivariable models. CONCLUSION: Although pain prevalence is an important public health variable, this study suggests that other pain-related variables, such as behavioral impacts, are useful when describing disparities associated with orofacial pain.

Black or African American↗

PubMed2002

Racial and socioeconomic disparities in oral disadvantage, a measure of oral health-related quality of life: 24-month incidence.

OBJECTIVES: This paper estimates the incidence of oral disadvantage based on the subject's approach to dental care, sex, race, and financial status; identifies demographic and socioeconomic characteristics that were associated with oral disadvantage; and determines if these characteristics were differentially associated with the three domains of oral disadvantage. METHODS: The Florida Dental Care Study was a longitudinal study of oral health in diverse groups of persons who at baseline had at least one tooth, were 45 years or older, and were either African American or non-Hispanic white. Incidence rates, odds ratios, and 95 percent confidence intervals were used to describe oral disadvantage and its relation to race, income, and other key sociodemographic characteristics. RESULTS: The strongest independent predictors of oral disadvantage were approach to dental care (problem-oriented attenders or regular), and situation if faced with an unexpected $500 dental bill. Demographic and socioeconomic characteristics were differentially associated with each disadvantage domain. CONCLUSIONS: African Americans, females, rural residents, individuals who did not graduate from high school, individuals with limited financial resources, and problem-oriented dental attenders had significantly higher occurrences of oral disadvantage. Racial and sex disparities in oral disadvantage were largely explained by differences in approach to dental care and financial resources between these groups.

Black or African American↗