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Biomedical subjects

J D Shulman

Publications and source records attributed to J D Shulman.

At least 19 recordsLinked to original sources
PubMed2006

Prevalence and risk factors associated with geographic tongue among US adults.

OBJECTIVE: To characterize the prevalence of geographic tongue (GT) among US adults. DESIGN: Population-based case-control study. MAIN OUTCOME MEASURES: The presence or absence of GT. SUBJECTS AND METHODS: Data from 16 833 adults examined during The Third National Health and Nutrition Examination Survey, 1988-1994 (NHANES III), a study based on multistage probability sampling were analyzed using SAS-callable SUDAAN 9.0.1. RESULTS: Geographic tongue point prevalence was 1.8% (95% CI: 1.4, 2.3). Multivariate logistic regression showed significant effects of race-ethnicity, with Whites (AOR = 1.8; 1.3, 2.5) and Blacks (AOR = 1.6; 1.2, 2.1) having greater odds of GT than Mexican-Americans; current corticosteroid therapy (AOR = 3.7; 1.54, 8.6). Cigarette smokers had lower GT prevalence (AOR = 0.4; 0.3, 0.6). Fissured tongue (FT) was strongly associated with GT among non-smokers: AOR = 17.5 (7.8, 39.5). We did not find significant associations with age, gender, oral contraceptive use, diabetes mellitus, allergy or atopy, psychological or dermatological conditions as previous research has suggested. CONCLUSIONS: Geographic tongue was more prevalent among Whites and Blacks compared with Mexican-Americans, positively associated with FT, and inversely associated with cigarette smoking.

Adolescent↗
PubMed2005

Prevalence of oral mucosal lesions in children and youths in the USA.

INTRODUCTION: There is a dearth of studies of oral lesions in children and youths using probability samples of a general population. The present paper describes the results of the Third National Health and Nutrition Examination Survey, 1988-1994 (NHANES III), and compares them to those of the National Survey of Oral Health in US Schoolchildren, 1986-1987. METHODS: The NHANES III was a large US study based on a multistage probability sample. Dentist examiners were trained to recognize, classify and record, in a standard manner, the clinical characteristics of each of the 48 conditions of interest using procedures based on the World Health Organization's Guide to Epidemiology and Diagnosis of Oral Mucosal Diseases. RESULTS: Examinations were performed on 10,030 individuals (10.26%) aged between 2 and 17 years, 914 of whom had a total of 976 lesions. The lip was the most frequent site of lesions (30.7%), followed by the dorsum of the tongue (14.7%) and the buccal mucosa (13.6%). Lesions were more prevalent in males (11.76%) than females (8.67%). The most prevalent lesions were lip/cheek bite (1.89%), followed by aphthous stomatitis (1.64%), recurrent herpes labialis (1.42%) and geographic tongue (1.05%). The prevalence of recurrent aphthous stomatitis in the NHANES III child and youth survey was substantially higher than that for adults, while the NHANES III adult estimates for geographic tongue (1.85%; 95% CI 1.42, 2.28) and cheek/lip bite (3.05%; 95% CI 2.36, 3.74) were substantially greater than those for children and youths (0.97% and 2.05%, respectively). CONCLUSION: Reported prevalences for rare conditions in other studies employing more selected samples (especially if standard errors or confidence intervals are not provided) should be interpreted with caution. Studies of adult populations, however valid, may have limited applicability to children.

Adolescent↗
PubMed2005

Risk factors associated with denture stomatitis in the United States.

BACKGROUND: This study reports denture stomatitis (DS) prevalence from a large USA probability sample from the National Health and Nutrition Examination Survey, 1988-1994 (NHANES III). METHODS: Oral examinations were performed on 3450 individuals 18-90+ years of age (mean: 59.2; SD: 0.50 years), 57.7% male and 42.3% female. Multivariable logistic regression models were fitted for DS using sociodemographic, denture quality, blood analytes, alcohol and tobacco use, history of diabetes, and current antibiotic use as covariates. Odds ratios (OR), adjusted for other covariates in each model (AOR) are presented. RESULTS: Of 3450 removable denture wearers, 963 (27.9%) had DS. DS prevalence was associated with wearing maxillary (AOR: 6.20) and mandibular (AOR: 5.21) complete dentures continuously; smoking >/=15 cigarettes day (maxillary complete: AOR = 1.31; mandibular complete: AOR = 1.50; maxillary partial: AOR = 2.04); vitamin A deficiency (mandibular complete: AOR = 5.97; maxillary partial: AOR = 5.67; mandibular partial: AOR = 24.42). Maxillary dentures with inadequate relines had approximately half the OR of DS than those with adequate relines (maxillary complete: AOR = 0.42; mandibular complete: AOR = 0.50). CONCLUSIONS: Denture stomatitis prevalence is associated with the amount of tissue covered by dentures, low vitamin A levels, cigarette smoking, and constant denture wear.

Adolescent↗
PubMed2004

The association of tobacco and other factors with recurrent aphthous stomatitis in an US adult population.

OBJECTIVE: To determine point and annual prevalence of recurrent aphthous stomatitis (RAS). SETTING: Reported prevalence of RAS in textbooks and much of the literature varies according to study location, patient selection and whether point prevalence (presence of lesions at examination) or period prevalence (history of lesions during a specified period) is reported. Many studies are based on non-probability samples and this may contribute to significant variation in reported prevalence and factors presumed to be associated with RAS. METHODS: We analyzed data from the Third National Health and Nutrition Examination Survey, 1988-1994, a large United States probability sample, for RAS and covariates suggested in the literature using bivariate and multivariate logistic regression. RESULTS: Oral mucosal examinations were performed on 17 235 adults 17 years and older. Of these, 146 (0.89%) had at least one clinically apparent aphthous lesion. For annual (reported) prevalence, Whites (20.87%) and Mexican-Americans (12.88%) had several fold higher prevalence of RAS than Blacks (4.96%). Adults younger than 40 years of age had almost twice the prevalence (22.54%) of those older than 40 years (13.42%). CONCLUSION: Annual prevalence was significantly higher in whites and Mexican-Americans (compared with blacks), individuals 17-39 years of age, cigarette non-smokers, and those with recurrent herpes labialis history; while it was lower in males. Point prevalence was significantly higher in whites, Mexican-American, individuals 17-39 years of age, cigarette non-smokers, and males.

Adolescent↗
PubMed2000

Carpal tunnel syndrome: effect on Army dental personnel.

The purpose of this study was 2-fold: (1) to determine the prevalence of hand problems, in particular carpal tunnel syndrome (CTS), among Army dental personnel; and (2) to identify dental professionals at risk. A 12-page survey was mailed to all U.S. Army military and civilian dental personnel. Of the 6,320 surveys mailed, 80.9% were returned completed. An analysis was performed identifying the prevalence of hand problems and CTS and noting differences between civilian and military dental personnel. Of the 5,115 surveys analyzed, 44.8% indicated hand problems and 25.4% were determined to indicate a high probability of CTS. Of the 18 dental job specialties, dental therapy assistants and dental hygienists had the highest prevalence of CTS, 73% and 57%, respectively. Army dental personnel are at greater risk of developing CTS than the general public, especially civilian dental personnel, who were female, older, and employed longer.

Adult↗
PubMed1999

Influence of the digital image display monitor on observer performance.

OBJECTIVE: To assess the influence of the display monitor on observer performance. MATERIAL AND METHODS: Artificial enamel lesions were created in 40 extracted teeth at random using 1/4 and 1/2 round burs. Teeth were mounted in dental stone blocks to simulate a hemidentition. Approximate exposures were recorded at 70 kVp using a Digota (Soredex, Orion Corp, Helsinki, Finland) digital imaging system, calibrated to achieve optimum density. Six dentists rated each image on a five-point scale for the presence or absence of a lesion. Radiographic images were viewed on the following monitors: (1) AlphaScan 711 (Sampo Corp.); (2) Multiscan 17 Se II (Sony Electronics Inc.); (3) DS 2000 (Clinton Electronics Corp.) and (4) Latitude CP Laptop (Dell Computer Corp.). Raters were allowed to magnify and to adjust density and contrast of each image at will. Receiver Operating Characteristic (ROC) analysis was performed and curves were plotted for each image. Data was subjected to repeated measures analysis of variance and ordinal logistic regression to test for significance between variables and to determine odds ratios. RESULTS: Mean ROC curve areas ranged from 0.8728 for the Sampo monitor to 0.8395 for the Sony. Repeated measures analysis of variance showed significant differences between observers (P < 0.0001), lesion size (P < 0.0001), examiner/monitor interaction (P < 0.033) and examiner/block interaction (P < 0.013). However, no significant difference was found between monitors. CONCLUSION: This study suggests that observer performance is independent of the visual characteristics of the display monitor.

Analysis of Variance↗
PubMed1998

Effect of different background lighting conditions on diagnostic performance of digital and film images.

OBJECTIVE: To compare the performance of a photostimulable phosphor (PSP) imaging system with radiographic film for the detection of approximal lesions under two background lighting conditions. METHODS: Bitewing exposures were made of the extracted human teeth with artificial approximal lesions using D-speed and E-speed radiographic film and a PSP imaging plate. Eight dentists rated 12 approximal surfaces in each image on a 5-point scale. Images were viewed with overhead fluorescent room lighting on and off. ROC curves were generated for each image receptor and lighting condition. Repeated measures analysis of variance ANOVA tested differences between observers, lesion size, image receptor, lighting condition. RESULTS: Mean ROC curve areas for D-speed film viewed in full ambient light scored highest (0.8030) followed by E-speed film using dark conditions (0.7386). The lowest mean curve area was found when PSP (enhanced mode) images were viewed in a dark room (0.6726). Significant differences were found between observers, lesion size, image receptor and image receptor-lesion size interaction. No significant difference was found with background lighting. CONCLUSIONS: Background lighting does not appear to effect the ability to detect artificial approximal lesions.

Analysis of Variance↗
PubMed1998

Dental public health for the 21st century: implications for specialty education and practice.

A panel of public health practitioners sponsored by the Health Resources and Services Administration met December 6-8, 1994, to examine current roles and responsibilities for dental public health workers and to recommend changes in education and training to meet challenges posed by an evolving health care system. Overall, at least the same number, if not more, dental public health personnel will be needed in the future. While some new roles were identified, the panel felt that only small numbers of personnel will be needed to fill these new roles. Not all of these roles necessarily require a dental degree. The panel felt that a need exists for more academicians for dental schools, schools of public health, dental public health residencies, and dental hygiene programs; oral epidemiologists and health services researchers; health educators; and specialists in utilization review/outcomes assessment, dental informatics, nutrition, program evaluation, and prevention. To meet these personnel needs: (1) dental public health residency programs should be structured to meet the educational needs of working public health dentists with MPH degrees through on-the-job residency programs; (2) the standards for advanced specialty education programs in dental public health should be made sufficiently flexible to include dentists who have advanced education and the requisite core public health courses; (3) flexible MPH degree programs must be available because of the rising debt of dental students and the decreased numbers of graduating dentists; (4) loan repayment should be available for dentists who have pursued public health training and are working in state or local health departments; and (5) standards for advanced education in dental public health should be developed for dental hygienists.

Certification↗
PubMed1997

Acute fluoride toxicity from ingesting home-use dental products in children, birth to 6 years of age.

OBJECTIVE: This paper analyzes reports to the American Association of Poison Control Centers (AAPCC) of suspected overingestion of fluoride by children younger than 6 years of age between 1989 and 1994, and estimates the probably toxic amounts of various home-use fluoride products in children younger than 6 years of age. METHODS: Annual incidence rates of reported fluoride exposures attributed to dietary supplements, toothpaste, and rinses were calculated. Probably toxic amounts of each product were calculated using the frequently cited dose of 5 mg/kg. RESULTS: Children younger than 6 years of age accounted for more than 80 percent of reports of suspected overingestion. While the outcomes were generally not serious, several hundred children were treated at health care facilities each year. A 10 kg child who ingests 50 mg fluoride (10.1 g 1.1% NaF gel; 32.7 g 0.63% SnF2 gel; 33.3 g 1,500 ppm F toothpaste; 50 g 1,000 ppm F toothpaste; and 221 mL 0.05% NaF rinse) will have ingested a probably toxic dose. CONCLUSIONS: Overingestion of fluoride products in the home is preventable. Dentists and other health care providers should educate parents and child care providers about the importance of keeping fluoride products out of reach of children. Manufacturers should be encouraged by the ADA and the FDA to use child-resistant packaging for all fluoride products intended for use in the home.

Acute Disease↗
PubMed1997

Consumer satisfaction with dental care: where have we been, where are we going?

This paper reviews research developments in the area of dental patient satisfaction over the past three decades, contrasts these with comparable developments in medicine, and suggests directions for future work in the dental arena. The conclusion of the review is that developments in managed care in medicine have stimulated a level of effort in patient satisfaction measures that have gone well beyond that in managed dental care. Analogous work in dentistry is needed as managed dental care plans grow in number.

Attitude to Health↗
PubMed1997

The prevalence of chapped lips during an army hot weather exercise.

OBJECTIVES: To identify risk factors associated with chapped lips in soldiers during prolonged exposure to a hot, dry environment. METHODS: We examined 1,053 of 2,500 soldiers (42%) participating in a desert training exercise at Fort Irwin, California, in September 1983. We measured the prevalence of chapped lips during the third week of a 4-week training period. Our independent variables (complexion, sex, lip protectant use, age, and the prevalence of recurrent herpes labialis) were obtained by observation and interview. RESULTS: We found severe chapping in 150 (10%) and moderate chapping in 247 (23.5%) of the soldiers. Stepwise ordinal logistic regression was used to identify risk factors associated with chapped lips and to determine the prevalence odds ratios (OR). Risk factors with statistically significant associations with chapped lips were the presence of recurrent herpes labialis (OR = 2.88), very fair complexion (OR = 3.23), and fair complexion (OR = 1.58). CONCLUSIONS: Moderate to severe chapping occurred in approximately one-third of the soldiers. Lip protectants appeared to be relatively ineffective in the prevention and treatment of chapped lips but were associated with a lower prevalence of recurrent herpes labialis.

Adolescent↗
PubMed1996

Potential effects of opportunity cost on dental school patients.

Predoctoral clinic fees are set below those of private practices to attract patients. Treatment in a predoctoral clinic requires more and longer appointments and patients spend more time waiting to be seen than in a private practice. This time has a value that economists call opportunity cost, the value of the next best alternative (the hourly wage for an employed patient). A model comparing total cost (fee plus opportunity cost) of treatment in dental schools and private practices for insured and uninsured patients is presented. As patient income increases, the total cost of some treatment plans becomes higher in dental schools than in private practices. To insured patients, however, the out-of-pocket cost of a treatment plan depends on copayments rather than fees. This makes predoctoral clinics less competitive. Considering opportunity cost further increases dental schools' lack of competitiveness. For insured patients, more treatment plans will have a lower total cost in private practice. Clinic directors must realize that if opportunity costs are not reduced, the market may dictate that fees be lowered to remain competitive with private practitioners. They are in competition for patients based on total cost, and efficiencies that reduce opportunity cost may increase revenue and attract patients.

Academic Medical Centers↗
PubMed1996

Provision of free and discounted dental services to selected populations: a survey of attitudes and practices of dentists attending the 1996 Dallas Midwinter Meeting.

An attitudes and practices survey of dentists attending the Dallas Midwinter Meeting in January 1996 in Dallas was conducted as a collaborative effort between the Dallas County Dental Society and the Baylor College of Dentistry. The survey was developed to help determine participating dentists' attitudes and practices in the area of provision of dental services on a discounted or free basis to disadvantaged patient groups. A total of 225 dentists responded to the survey. Of these surveyed dentists, 213 (94.6%) were in private practice and 199 (88.4%) described themselves as general dentists. A considerable amount of charitable dental services, discounted and free, was reported to be provided by the group of respondent dentists. A total of 152 (67.6%) of the dentists surveyed reported providing discounted or free care to elderly patients with low income, 125 (55.6%) provided such care to low-income patients without age restriction, and 137 (60.9%) cared for patients of record with temporary financial hardship. In other patient categories, 79 (35.1%) of the dentists provided free/discounted services to handicapped persons and 47 (20.9%) provided care to homebound patients. These findings concerning charitable practices by dentists were similar to those found in a comparable survey conducted by the American Dental Association in 1994. Dentists were fairly evenly split as to their preference where to volunteer services. Of the total respondents, 84 (40.6%) preferred providing services in their own office and 91 (44.0%) preferred to do so at a community health clinic that hosted volunteers.

Attitude of Health Personnel↗
PubMed1994

Perceived needs for dental continuing education within the Army dental care system.

Results of a worldwide survey examining the perceived needs for continuing education (CE) among Army general dentists and their supervisors are presented. Responses from 255 supervisors and 528 dentists were available for analysis. There was overall lack of agreement between supervisors and dentists concerning CE preferences; supervisors selected risk or clinic management topics and dentists chose patient care topics. Years of practice, practice location, and advanced general dentistry program participation strongly influenced dentists' perceived needs. Results suggest that in evaluating or planning for CE programs, differences in perceived needs between various groups within the dental care system must be considered.

Adult↗
PubMed1994

A comparison of dental fitness classification using different class 3 criteria.

Examinations were performed on 585 Army Reserve Component soldiers during their 2-week Annual Training at Fort Pickett, Virginia, from June through September 1991. Of the 585 soldiers examined, 338 (57.8%) were in class 3 using the current DoD criteria, while 272 (46.5%) were in class 3 using the previous criteria. Of 585 paired examinations, there was agreement between the two systems in 531 (90.8%) examinations. Over 96% of the disagreement represented patients put in class 2 under the old system who were put in class 3 under the new system. In the aggregate, there were 19.3% more soldiers put into class 3 under the new system. The major source of this difference was partially erupted or pericoronally involved third molars. The increase in the class 3 proportion is due to the lack of operational criteria in the old system. Data collected under the current system provide more detailed information for administrative epidemiologic purposes. Because of the additional clinical guidelines under the current DoD criteria, the inevitable differences should be considered when pre- and post-DoD instruction dental fitness classification data are compared for a population.

Dental Health Surveys↗
PubMed1994

Treatment needs and treatment time for soldiers in dental fitness class 2.

A systematic random sample of 962 dental records of soldiers in class 2 was reviewed by six general dentists and their estimates of periodontal and non-periodontal treatment time were recorded. The majority (88.9%) required some treatment. Periodontal treatment time ranged from 0 to 18 hours with a median and mode of 0 hours, a mean of 1.18 hours, and a standard deviation of 2.96 hours. Non-periodontal treatment time ranged from 0 to 58 hours with a median of 3 hours, a mode of 0 hours, a mean of 4.51 hours, and a standard deviation of 5.11 hours. When consultation time is included, the total time was 5.89 hours per soldier.

Adult↗
PubMed1992

The prevalence of recurrent herpes labialis during an army hot weather exercise.

A survey was performed on 1,062 of 2,500 (42%) Army personnel participating in a desert training exercise at Fort Irwin, California, in September 1983. The prevalence of recurrent herpes labialis (RHL) and chapped lips was observed during the third week of a four-week training period. Complexion, sex, lip protectant use, age, and time spent outdoors were obtained by observation and interview. Recurrent herpes labialis was found in 46 subjects (4%). Stratified analysis and stepwise logistic regression were used to identify risk factors associated with RHL and to determine the prevalence odds ratios (POR). Risk factors with statistically significant associations with RHL were lip protectant use (POR = 0.19), chapped lips (POR = 2.87), being female (POR = 5.00), and light complexion (POR = 2.48). These findings strongly support the use of lip protectants during prolonged exposure to hot, dry climates as a prophylaxis against recurrent herpes labialis. Additional studies should focus on excitatory factors of RHL; and clinical trials of the efficacy of the lip protectants to protect against RHL and chapped lips should be undertaken.

Adolescent↗