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Biomedical subjects

J A Weintraub

Publications and source records attributed to J A Weintraub.

At least 19 recordsLinked to original sources
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↗
PubMed1998

Prevention of early childhood caries: a public health perspective.

This paper proposes strategies for preventing early childhood caries (ECC), preferably for the greatest number of children at the lowest cost. Population-based, public health approaches are more likely to reach the target population groups at risk of developing ECC than individual, private practice-based approaches. Different prevention and early intervention strategies are discussed and the following recommendations are made: 1) Continue to promote community water fluoridation. 2) Evaluate the effectiveness of other public health oriented measures to prevent ECC. 3) Develop a national ECC and rampant caries registry. 4) Link oral health screening and easily implemented, low-cost interventions with immunization schedules and public health nursing activities. 5) Increase opportunities for community-based interventions conducted by dental hygienists. 6) Change insurance reimbursement schedules to provide incentives for dentists to prevent disease. 7) Include dentistry in new child health insurance legislation for children as well as parents of infants and preschool children.

Child↗
PubMed1998

Academic dental public health diplomates: their distribution and recommendations concerning the predoctoral dental public health faculty.

OBJECTIVE: The purpose of this study was to assess the representation of academically based diplomates of the American Board of Dental Public Health (ABDPH) and to identify their perceptions on the training of dental public health predoctoral faculty. METHODS: Data were collected by a mailed, self-administered, 13-item questionnaire. The population was the 48 diplomates of the ABDPH as of March 1997 associated with academic institutions. RESULTS: Twenty of the 55 US dental schools had a diplomate of the ABDPH with a mean of 1.8 diplomates per school with a diplomate. An average of 4.5 full-time faculty members per school were associated with teaching dental public health. A master's degree in public health (MPH) was the most frequently suggested educational requirement for dental public health faculty. Continuing education courses were training needs perceived for dental public health faculty. The lack of time, money, and incentives, along with perceived rigidity of requirements for board certification, were reported as major barriers for faculty becoming dental public health board certified. CONCLUSIONS: Numerous challenges confront the development of a strong dental public health presence in US dental schools. These challenges include, among others, insufficient numbers of academic dental public health specialists and insufficient motivations to encourage promising candidates to pursue specialty status.

Attitude of Health Personnel↗
PubMed1998

The development of competencies for specialists in dental public health.

This paper describes the process of developing new competency statements and performance indicators for the specialty of dental public health. These competencies help define the specialty and provide a base for educational curricula and the specialty board examination. The process included a survey of four target groups: all board members, all directors or co-directors of advanced education programs in dental public health, people who had become diplomates in the last three years, and all students currently enrolled in dental public health programs. Many constituencies were represented at the workshop, conducted in May 1997, to develop the competency document. After the workshop, the document underwent a series of review activities.

Clinical Competence↗
PubMed1998

A longitudinal study of schoolchildren's experience in the North Carolina Dental Medicaid Program, 1984 through 1992.

OBJECTIVES: This evaluation of a state Medicaid dental program describes dental treatment received, relates treatment needed to treatment received, and describes enrollment and use over an 8-year period. METHODS: Three databases were linked: (1) clinical records from a 1986/87 statewide epidemiological survey, providing data on treatment need; (2) Medicaid dental claims from 1984 through 1992, providing data on treatment received; and (3) Medicaid enrollment files from 1984 through 1992. RESULTS: Half of Medicaid-enrolled children never used dental services. Among users of dental services, 45% and 25% of children needed restorations in primary and permanent teeth, respectively. In this group, 29% had all needs met, 28% had needs partially met, and 43% had no needs met. Forty-six percent of children sought care for only 1 year. CONCLUSIONS: Federal guidelines for dental care are not met in this typical Medicaid population of short-term enrollees who use services sporadically. Programs should aim to increase use and ensure that all needed services, especially preventive procedures such as sealants, can be completed within the short period of time a child attends for care.

Adolescent↗
PubMed1998

Uses of oral health related quality of life measures in Public Health.

OBJECTIVE: The purpose of this paper was to review the current status of oral health related quality of life (OHRQoL) measures from a dental public health perspective. METHOD: Three questions are posed. (1) What additional work is needed in the development or application of quality of life measures? (2) How can existing quality of life measures be used most effectively now? (3) Can existing data be used for secondary analyses of 'generic questions' concerning the relationships between oral health care and quality of life outcomes? In answering these questions, methodological issues are discussed, existing sources of data are described, and recommendations are suggested for future directions. CONCLUSIONS: Current measures can be used for assessment of oral health impacts in adults, and to a lesser extent, for policy development. Other measures need to be developed that are relevant for children and their families, and for disease prevention and health promotion programmes. Continued psychometric analyses are needed to provide short, valid and reliable instruments that can be easily administered in public health settings. Longitudinal studies are needed to determine if the OHRQoL measures are responsive to access to dental care, different types of care including early diagnosis and treatment, and completion of care. The extensive array of existing measures need to be compared, equivalency of scores determined, and recommendations made for the appropriateness of their use in different circumstances and for different purposes.

Adult↗
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↗
PubMed1997

Dental caries and treatment need in schoolchildren related to Medicaid enrollment.

OBJECTIVES: This study compared dental caries status and treatment need in four groups of children: those not enrolled in Medicaid, those enrolled in Medicaid who used dental services prior to a dental survey, those enrolled in Medicaid who used services after the survey, and those enrolled in Medicaid who did not use dental services. METHODS: This study used data on 6,620 children 5 to 18 years of age, who were representative of North Carolina schoolchildren and who participated in a statewide oral health survey in 1986-87. Clinical results from the survey were linked with a separate data base of Medicaid claims and enrollment files from 1984 to 1992. With this link, the surveyed children were classified into the four study groups and dental status compared. RESULTS: Medicaid-enrolled children who used services prior to the survey had the highest caries prevalence of all groups (DMFS = 1.74 at ages 6 to 11 years), and had fewer treatment needs (D/DMFS = 19%) than children outside of Medicaid (DMFS = 0.95, D/DMFS = 33%). Enrolled children who never used dental services had a caries prevalence (DMFS = 0.83) similar to children outside of Medicaid, yet had greater unmet treatment need (D/DMFS = 62%). CONCLUSIONS: Caries prevalence did not differ substantially among groups; however, the level of unmet treatment did very. Some Medicaid-enrolled children had a significant portion of their restorative treatment needs met.

Adolescent↗
PubMed1997

The relationship between clinical tooth status and receipt of sealants among child Medicaid recipients.

This study investigated the association between caries status and sealant need at a prior survey and subsequent sealant use in a Medicaid program. Clinical data from a 1986-87 statewide epidemiological survey (N = 8026) representative of North Carolina (NC) schoolchildren (grades K-12) were linked with all NC Medicaid dental claims submitted during 1987-92, yielding 570 children in the survey who had at least one dental visit during 1987-1992. From the 570, 390 children were included: 71 who received sealants (S) and 319 who received non-sealant care (NS). Children were excluded based on age, having preexisting sealants, or having no sealant-eligible molars or premolars. S and NS were compared on baseline dfs, DMFS, and sealant need, controlling for the patient's age, number of visits, and the provider's propensity to seal. At all ages, NS was twice as likely to have had prior dfs or DMFS (OR = 2.04, 95% CI = 1.15, 3.70). The association between sealant receipt and prior sealant need varied by age. At 6 to 11 years, S and NS had equal likelihood of sealant need (OR = 1.41, 95% CI = 0.62, 3.18). At 12 to 15 years, NS had a greater likelihood of sealant need (OR = 6.82, 95% CI = 1.60, 29.08). Caries-free status was associated with subsequent sealant receipt. Prior sealant need caused variability in dentists' decisions, depending on the child's age and past caries experience. Sealants were used infrequently by most providers and for a minority of patients. These findings are important for the Medicaid program and for future non-randomized studies of sealant effectiveness.

Adolescent↗
PubMed1996

Exploratory case-control analysis of psychosocial factors and adult periodontitis.

We explored the association between social factors and adult periodontitis by comparing self-reported information for daily strains and symptoms of depression in 71 cases and 77 controls. Cases and controls were selected from among 1,426 participants in the Erie County Risk Factor Study. We found differences among those who scored higher than their peers on measures of social strain. The odds ratio (OR) and 95% confidence interval (95% CI) for the association between case status and Role Strain score of 2.27 or more was 2.84, 95% CI = 1.08 to 7.46. We also examined serum antibody, dichotomized at the median, for three periodontal pathogens (Bacteroides forsythus [IgG Bf], Porphyromonas gingivalis [IgG Pg], Actinobacillus actinomycetemcomitans [IgG Aa]), and assessed interaction between antibody levels and a Depression score derived from the Brief Symptom Inventory. IgG Pg and IgG Aa were both strongly associated with case status (OR = 4.52, 95% CI = 1.99 to 10.3 and OR = 5.29, 95% CI = 2.34 to 12.0, respectively). IgG Bf was associated with periodontal disease but only among individuals who had higher scores for Depression (OR = 6.75, 95% CI = 1.25 to 36.5). Smoking status was associated with case status (OR = 4.95, 95% CI = 1.86 to 13.2). We assessed these findings prospectively by examining factors associated with more extensive disease among the 71 case subjects after 1 year of follow-up. We found baseline smoking status and IgG Bf among individuals scoring high on Depression at baseline to be associated with more extensive disease (8.1% or more of the sites showing further breakdown). In this population an elevated Depression score may be a marker for social isolation, which could play a role in immune function during periods of social strain. This exploratory analysis has served to identify specific lines of inquiry concerning psychosocial measures as important environmental factors in adult periodontitis.

Adult↗
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

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

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

Child↗
PubMed1993

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↗
PubMed1993

The association of oral status with systemic health, quality of life, and economic productivity.

It is well established that many systemic adverse health conditions have manifestations in the oral cavity. The purpose of this paper is to summarize the available scientific evidence that describes the opposite effect, how adverse oral health conditions affect three aspects of daily living: 1) systemic health, 2) quality of life, and 3) economic productivity. Examples of oral health affecting systemic health include rheumatic fever patients who develop infective endocarditis from oral bacteria and organ transplant patients who develop severe complications from oral infections. Both systemic health and quality of life are compromised when edentulousness, xerostomia, soft tissue lesions, or poorly fitting dentures affect eating and food choices. Conditions such as oral clefts, missing teeth, severe malocclusion, or severe caries are associated with feelings of embarrassment, withdrawal, and anxiety. Oral and facial pain from dentures, temporomandibular joint disorders, and oral infections affect social interaction and daily behaviors. The results of oral disorders can be felt not only physically and socially but also economically in our society. Dental disease accounts for many lost work and school days. Lower wage earners and minorities are disproportionately affected. Although there are many studies that evaluate these relationships, most are case reports, cross-sectional studies, or studies restricted to small or unique population groups. Lack of standardized measurements make comparisons across studies difficult. More population-based and longitudinal studies are needed to better understand the nature of these relationships.

Absenteeism↗
PubMed1992

University of North Carolina Caries Risk Assessment Study: comparisons of high risk prediction, any risk prediction, and any risk etiologic models.

The purpose of this analysis is to compare three different statistical models for predicting children likely to be at risk of developing dental caries over a 3-yr period. Data are based on 4117 children who participated in the University of North Carolina Caries Risk Assessment Study, a longitudinal study conducted in the Aiken, South Carolina, and Portland, Maine areas. The three models differed with respect to either the types of variables included or the definition of disease outcome. The two "Prediction" models included both risk factor variables thought to cause dental caries and indicator variables that are associated with dental caries, but are not thought to be causal for the disease. The "Etiologic" model included only etiologic factors as variables. A dichotomous outcome measure--none or any 3-yr increment, was used in the "Any Risk Etiologic model" and the "Any Risk Prediction Model". Another outcome, based on a gradient measure of disease, was used in the "High Risk Prediction Model". The variables that are significant in these models vary across grades and sites, but are more consistent among the Etiologic model than the Predictor models. However, among the three sets of models, the Any Risk Prediction Models have the highest sensitivity and positive predictive values, whereas the High Risk Prediction Models have the highest specificity and negative predictive values. Considerations in determining model preference are discussed.

Child↗
PubMed1992

Factors influencing the selection of dental hygiene as a profession.

Since the mid-1970s, the dental hygiene profession has experienced a decline in the number of applicants. Reasons cited for this decline are fewer traditional college-age students, an increase in the career opportunities available to women, and a decrease in student financial aid. Four-year dental hygiene programs have experienced applicant decline faster than two-year programs. The purpose of this study was to determine factors that influenced university freshmen to designate dental hygiene as a career choice. Factors examined included reasons for choosing or not choosing a career in dental hygiene, and retention in the college major chosen. A questionnaire was mailed to three groups of students who entered the University of North Carolina-Chapel Hill as freshmen from 1985 through 1987: (1) all students who designated dental hygiene as a major on their entrance application; (2) a random sample who did not; and (3) all the freshman during that time period who subsequently matriculated into the dental hygiene program. The overall response rate was 78% (n = 80). Subjects began to explore career opportunities at a mean age of 16. Having a family member/friend in the selected field was found to be the most influential factor in career selection. Among dental hygiene students, contact with a dental hygienist was perceived to be influential in their career choice. Entering college freshmen exhibited a lack of knowledge about the dental hygiene profession, and most had not received any information about dental hygiene in high school. These findings can be used to develop recruitment strategies.

Adult↗
PubMed1991

Consistency of orthodontic treatment decisions relative to diagnostic records.

The purpose of this study was to evaluate how incremental information obtained from different types of diagnostic records contributes to the determination of orthodontic treatment decisions. Pretreatment records of 57 orthodontic patients were assessed by five orthodontists who were part-time faculty members and also in private practice. This sample consisted of dental school orthodontic patients who had Class II malocclusions and included patients at three different dental developmental stages. The following diagnostic records were used: study models (S), facial photographs (F), a panoramic radiograph (P), a lateral cephalogram (C), and its tracing (T). Five combinations of diagnostic records were presented to the orthodontists in the following sequence: (1) S; (2) S + F; (3) S + F + P; (4) S + F + P + C; and (5) S + F + P + C + T. The simultaneous interpretation of all diagnostic records (S + F + P + C + T) was used as the "diagnostic standard." There was a diagnostic standard for each of the patients and for each of the orthodontists. The diagnostic standard was achieved: (1) S = 54.9%, (2) S + F = 54.2%, (3) S + F + P = 60.9%, and (4) S + F + P + C = 59.9%. Thus, in a majority of cases (55%), study models alone provided adequate information for treatment planning, and incremental addition of information from other types of diagnostic records made small differences.

Adult↗