Biomedical subjects

Michael J Kanellis

Publications and source records attributed to Michael J Kanellis.

At least 19 recordsLinked to original sources

PubMed2006

Timing of fluoride intake in relation to development of fluorosis on maxillary central incisors.

OBJECTIVES: Several studies have focused on the timing of fluoride intake relative to the development of dental fluorosis. This study reports the relationships of fluoride intake during the first 48 months of life with fluorosis on early-erupting permanent teeth. METHODS: Subjects were followed from birth to 48 months with questionnaires every 3-4 months. Questionnaires gathered data on intakes from water, diet, supplements, and dentifrice to estimate total fluoride intake. Early-erupting permanent teeth of 579 subjects were assessed for fluorosis using the Fluorosis Risk Index (FRI) at approximately age 9. Fluorosis cases were defined as having FRI definitive or severe fluorosis on both maxillary central incisors. Individuals with FRI questionable fluorosis were excluded. The importance of fluoride intake during different time periods was assessed using t-tests and logistic regression. RESULTS: One hundred and thirty-nine (24%) subjects had fluorosis on both maxillary central incisors. Mean fluoride intake per unit body weight (bw) ranged from 0.040 to 0.057 mg/kg bw, with higher intake during earlier time periods and relative stability after 16 months. In bivariate analyses, fluoride intakes during each of the first 4 years were individually significantly related to fluorosis on maxillary central incisors, with the first year most important (P < 0.01), followed by the second (P < 0.01), third (P < 0.01), and fourth year (P = 0.03). Multivariable logistic regression analyses showed that, after controlling only for the first year, the later years individually were still statistically significant. When all four time periods were in the model, the first (P < 0.01) and second years (P = 0.04) were still significant, but the third (P = 0.32) and fourth (P = 0.82) were not. CONCLUSIONS: The first two years of life were most important to fluorosis development in permanent maxillary central incisors; however, this study also suggests the importance of other individual years.

Age Factors↗

PubMed2006

Longitudinal study of non-cavitated carious lesion progression in the primary dentition.

OBJECTIVES: This study reports changes in non-cavitated tooth surface diagnoses after a 4-year period. METHODS: Dental examinations were conducted for Iowa Fluoride Study cohort children who had non-cavitated lesions in the primary dentition and were also examined an average of 4 years later in the mixed dentition. Comparison of fluoride exposures, socioeconomic factors, and beverage consumption patterns were made between children who had lesions progress and those who did not. RESULTS: Of 129 non-cavitated pit and fissure lesions in the first exams, 40 (31%) progressed to either frank decay or filled status, while among 132 noncavitated smooth surface lesions, 7 (5%) were filled and none had frank decay in the second exam. No fluoride, socioeconomic status or beverage variables were significantly associated with lesion progression. CONCLUSIONS: Non-cavitated smooth surface lesions rarely progressed in this age group, but nearly one-third of pit and fissure lesions progressed.

Cariostatic Agents↗

PubMed2006

Associations between dental fluorosis of the permanent and primary dentitions.

OBJECTIVES: Relatively little is known about associations between primary and permanent tooth fluorosis. In this study, associations between dental fluorosis of the permanent and primary dentitions were assessed. METHODS: Subjects (n = 601) are in the Iowa Fluoride Study, which included fluorosis examinations of the primary and early-erupting permanent dentitions by trained dentist examiners. Relative risks, correlations, and logistic regression assessed associations between permanent tooth fluorosis and primary molar fluorosis. RESULTS: Ten percent had primary molar fluorosis at age 5; 36% had definitive (mostly mild), 28% questionable, and 36% no permanent incisor fluorosis at age 9. Those with primary molar fluorosis were significantly more likely to have definitive permanent incisor fluorosis (76% vs. 32%), and permanent molar fluorosis (59% vs. 16%). The strong association between primary and permanent tooth fluorosis is independent of level of fluoride intake. CONCLUSIONS: Detection of primary tooth fluorosis in pre-school children should alert clinicians and parents to the high likelihood of subsequent fluorosis in the permanent dentition.

Child↗

PubMed2005

Dentists' participation and children's use of services in the Indiana dental Medicaid program and SCHIP: assessing the impact of increased fees and administrative changes.

BACKGROUND: The authors conducted a study to evaluate whether administrative changes, including higher fee schedules for dental services in the Indiana dental Medicaid program and the State Children's Health Insurance Program (SCHIP), were associated with improved dentist participation and utilization of dental services by children. METHODS: The authors evaluated dentists' participation and children's use of services for the two years before fees were increased to 100 percent of the 75th percentile of usual and customary fees, compared with two years after the increase. They obtained administrative data from the Indiana Department of Family and Social Services Administration and the Indiana Department of Public Health to determine participation rates and service use. RESULTS: The number of dentists seeing a Medicaid-enrolled child increased from 770 in fiscal year (FY) 1997 to 1,096 in FY 2000. The number of Medicaid-enrolled children with any dental visit increased from 68,717 (18 percent) to 147,878 (32 percent), with little difference between children enrolled through the Medicaid-SCHIP and traditional Medicaid programs by FY 2000. The mean number of visits per child per year and the mean number of procedures per child per year remained relatively constant. The cost per enrolled child increased from dollars 1.70 to dollars 6.70 per month, while the cost per child with a visit increased from dollars 9 to dollars 21 per month. CONCLUSION: The increase in fees and changes in administration of the Indiana dental Medicaid program were positively associated with improved dentist participation and children's use of dental services. PRACTICE IMPLICATIONS: Changes beyond increasing fees to 100 percent of the 75th percentile may be needed if Medicaid-enrolled children are to have access to dental care commensurate with their lower oral health status and greater need for services. Sustained fee increases also are important. As of 2003, no increase in dental fees had occurred in the Indiana Medicaid program since the increase in FY 1998.

Attitude of Health Personnel↗

PubMed2005

Natural history of treatment outcomes of permanent first molars: a study of sealant effectiveness.

BACKGROUND: Few studies have used insurance claims data to retrospectively assess the natural history--a natural process or flow of events without any special interventions--and treatment outcomes of teeth with dental sealants. METHODS: The authors constructed treatment outcome trees (TOTs) from the Iowa Medicaid claims and eligibility data (1996-2000) of continuously enrolled 6-year-old children who routinely used Medicaid dental services. The authors used the TOTs to compare the restorative treatments of sealed permanent first molars with those of nonsealed permanent first molars. RESULTS: Forty percent of routine utilizers received a sealant during the four-year period. Overall, 25 percent of molars received at least one restoration. Sealed molars were less likely to receive further restorative treatment than were nonsealed molars (13 versus 29 percent). Sealed molars had fewer extensive restorative treatments (crowns, endodontic therapy and extractions) than did nonsealed molars. The median time to restorative treatment of the sealed molars also was greater than that of the nonsealed molars. All four first molars had comparatively similar patterns of subsequent care. CONCLUSIONS: Permanent first molars with sealants received less subsequent restorative treatment than did those without sealants. TOTs are useful tools for identifying necessary outcome information needed for program evaluations. CLINICAL IMPLICATIONS: Greater use of sealants could reduce the need for subsequent treatment and prolong the time until treatment may be necessary for permanent first molars.

Child↗

PubMed2004

Twelve-month sealant retention in a school-based program using a self-etching primer/adhesive.

OBJECTIVES: Very little independent research has been done on the new self-etching primer/adhesives in dentistry. A recent clinical study compared two sealant application techniques involving self-etching primer adhesives and the traditional phosphoric acid etch. The purpose of this study was to compare these two techniques in an Iowa school-based sealant program. METHODS: Twelve-month sealant retention data on 208 students from the Des Moines, Iowa, school-based sealant program were analyzed retrospectively. RESULTS: Sealant retention reported at the person level showed that 60 percent of the students who received sealants at the five schools had to be recalled at one year to have one or more surfaces resealed. A logistic regression model at the person level demonstrated that the phosphoric acid technique was six times as likely to have retention of all the sealed tooth surfaces as those sealed with Prompt-L-Pop. CONCLUSIONS: In this study, many students had to be recalled to the chair 12 months after sealant application due to incomplete retention. Though sealants were retained in larger numbers with phosphoric acid, overall sealant retention at the tooth level was lower than previously published for clinical studies and school-based programs. Examining retention data at the person level, however, allows program administrators to plan resources more effectively and reevaluate sealant protocol to ensure as few children return for sealant reapplication.

Acid Etching, Dental↗

PubMed2004

The relationship between healthful eating practices and dental caries in children aged 2-5 years in the United States, 1988-1994.

BACKGROUND: As a result of the introduction of multiple fluoride vehicles and other preventive agents, caries prevalence rates in young children have been declining over the past two decades in the United States. However, changing dietary patterns in young children may offset some of the oral health benefits of fluoridation. The objective of this study was to examine the relationship between caries in primary teeth and healthful eating practices in young children. METHODS: The authors used data from the third National Health and Nutrition Examination Survey to investigate the relationship between healthful eating practices (such as breast-feeding, eating breakfast and consuming five servings of fruits and vegetables a day) and dental caries (untreated tooth decay and overall caries experience) in the primary dentition among children aged 2 through 5 years. RESULTS: The odds of experiencing caries in primary teeth were significantly greater in nonpoor children who did not eat breakfast daily or ate fewer than five servings of fruit and vegetables per day (odds ratio, or OR = 3.77; 95 percent confidence interval, or CI, 1.80 to 7.89 and OR = 3.21; 95 percent CI, 1.74 to 5.95, respectively). No association was found between breast-feeding and caries in primary teeth. CONCLUSION: Young children with poor eating habits are more likely to experience caries. Overall, the findings support the notion that dental health education should encourage parents, primary caregivers and policy-makers to promote healthful eating practices, such as eating breakfast daily, for young children. PRACTICE IMPLICATIONS: Dental professionals are well-positioned to inform parents and caregivers regarding age-appropriate healthful eating practices for young children entrusted in their care.

Age Factors↗

PubMed2002

Primary tooth fluorosis and fluoride intake during the first year of life.

OBJECTIVES: Few studies in North America have assessed dental fluorosis of the primary dentition and few, if any, anywhere have assessed the relative importance in fluorosis etiology of fluoride intake during different time periods or from multiple sources. The purpose of this paper is to report on analyses relating estimated prenatal fluoride intake and fluoride intake during different parts of the first year of life to primary tooth fluorosis. METHODS: As part of The Iowa Fluoride Study, subjects were recruited at birth and studied longitudinally. Trained examiners assessed dental fluorosis for children aged 4-7 years using the Tooth Surface Index of Fluorosis (TSIF) adapted for the primary dentition. Detailed parent questionnaires at childbirth were used to estimate prenatal fluoride intake and questionnaires sent at 6 weeks and 3, 6, 9, and 12 months were used to estimate fluoride intake during the first year of life (combined fluoride intake from water, food and beverage, supplements, and dentifrice). There were 504 children with prenatal and at least four of the five postnatal responses with complete data. RESULTS: Fluorosis prevalence was 12.1%, occurring primarily on the second primary molars. Receiver operating characteristic (ROC) curves and logistic regression were used to assess the importance of different time periods' fluoride intake. In bivariate analyses, fluoride intake during each time interval was individually significantly related to fluorosis occurrence. For multivariate analyses, the period from 6 to 9 months was most important individually (P = 0.0001), and no other period was jointly statistically significant. CONCLUSIONS: Results suggest that the middle of the first year of life is most important in fluorosis etiology for the primary dentition in this setting.

Area Under Curve↗

PubMed2002

Dental caries in the primary dentition: assessing prevalence of cavitated and noncavitated lesions.

BACKGROUND: Dental caries in the primary dentition has received renewed attention in recent years because caries in the primary dentition is predictive of later caries experience, and because of efforts to address early childhood caries. More detailed caries diagnostic criteria have been developed and used for the permanent teeth; however, such criteria have not been widely adopted for caries diagnosis in the primary dentition. METHODS: As part of the Iowa Fluoride Study, caries diagnostic criteria were developed specifically for the primary teeth. The criteria included noncavitated (d1) lesions and cavitated (d2-3) lesions. Examinations were conducted on 698 children in the primary dentition by two trained examiners who did duplicate examinations on 11 percent (n = 67) of these children. RESULTS: Interexaminer agreement for any d1 and any d2-3 lesions at the person level was 100 percent. At the tooth level for d1d2-3f, there was 98.5 percent agreement and kappa was .91. For d1 at the tooth level, agreement was 97.0 percent agreement and kappa = .24. For d2-3 it was 99.4 percent agreement and kappa = .81. Prevalence of untreated d2-3 was 16.5 percent, while that of d1 was 24.1 percent. Nearly 73 percent had no d2-3 or filled surfaces, while over 63 percent had no d1, d2-3, or filled surfaces. Decay experience was most common on the primary second molars. About 56 percent of untreated d2-3 decay was located in the pits and fissures, while 58 percent of d1 decay was located on smooth surfaces. CONCLUSION: Despite some concern with reliability of diagnosing d1 lesions, it appears that the d1d2-3 criteria are informative and useful in assessing the primary dentition.

Child, Preschool↗

PubMedDate not supplied

Frequency of reported dental visits and professional fluoride applications in a cohort of children followed from birth to age 3 years.

PURPOSE: The purpose of this study is to report the prevalence of having a dental visit and/or a topical fluoride treatment at the dental visit from birth to age 36 months from an observational, longitudinal study of a cohort of children followed since birth. METHODS: Multiple questionnaires were sent to the families of children enrolled in a study of fluoride ingestion to ask parents if their child had had a dental (or dental hygiene) appointment and/or a fluoride treatment during the time interval since the previous mailed survey. Data were analyzed to determine the percentages of children who had at least one dental visit or at least one fluoride treatment by one, two or three years of age. RESULTS: Three hundred and forty parents completed all eleven questionnaires during the 36-month study period. Of these, 2% reported having taken their child for a dental visit by one year of age, 11% by two years of age and 31% by three years of age. Of those with a visit by three years of age, 19% received at least one fluoride treatment. CONCLUSIONS: Despite recommendations for early dental visits, only 31% of the children in this cohort had been seen by a dentist by the time they reached their third birthday and 19% of these had received a professional fluoride treatment.

Child, Preschool↗

PubMedDate not supplied

Tooth eruption symptoms: a survey of parents and health professionals.

UNLABELLED: It is commonly believed that teething in infants can cause a variety of signs and symptoms. Previous studies have suggested an association between teething and fever, irritability, drooling, rashes, vomiting, diarrhea, night crying, and convulsions. PURPOSE: The objective of this study was to evaluate differences in the beliefs of pediatricians, pediatric dentists and parents regarding symptoms caused by teething in infants. METHODS: A survey consisting of demographic information and questions concerning commonly reported symptoms associated with teething was administered to 100 randomly selected Iowa pediatricians, all practicing pediatric dentists in Iowa (n = 33) and a convenience sample of 120 parents from the greater Iowa City area. Responses were analyzed using the Chi-square test. RESULTS: Response rates for each group were: pediatricians 45%; pediatric dentists 76%; and parents 50%. The majority of individuals in each group believed that teething in infants can cause swollen gums, drooling, irritability, inflamed gums, restlessness, sleeplessness, and fever. There were significant differences in the percent of agreement relating to drooling (p = 0.001), inflamed gums (p = 0.001), and sleeplessness (p = 0.027). A greater percentage of pediatric dentists and parents agreed that these symptoms were caused by teething than did pediatricians. The largest difference between groups was related to the association between teething and diarrhea. The majority of parents (56.7%) and pediatric dentists (52.0%) believed that diarrhea is associated with teething compared to just 9.1% of pediatricians. CONCLUSIONS: These results support the hypothesis that differences regarding beliefs about teething symptoms exist between parents, pediatricians, and pediatric dentists. There is more agreement between parents and pediatric dentists than between either of these groups and pediatricians.

Attitude of Health Personnel↗

PubMedDate not supplied

Current understanding of the epidemiology mechanisms, and prevention of dental caries in preschool children.

The seriousness and societal costs of dental caries in preschool children are enormous. National data shows that caries is highly prevalent in poor and near poor US preschool children, yet this disease is infrequently treated. The etiology includes elevated colonization levels of mutans streptococci, high frequency sugar consumption, and developmental defects on primary teeth. A necessary first step in preventing dental caries in preschool children is evaluating the child's caries risk factors that include socioeconomic status, previous carious experience, presence of white spot lesions, presence of visible plaque, perceived risk by dental professionals, and microbiologic testing for the presence or quantity of mutans streptococci. Based on this knowledge, different preventive strategies, as well as different intensities of preventive therapies, can be employed. Caries preventive strategies in preschool children include diet modifications to reduce high frequency sugar consumption, supervised tooth brushing with fluoridated dentifrice, systemic fluoride supplements to children living in a nonfluoridated area that are at risk for caries, professional topical fluoride with fluoride varnish, and sealants for primary molars.

Cariostatic Agents↗

PubMedDate not supplied

Interdental spacing and caries in the primary dentition.

PURPOSE: This study assessed the relationship between interdental spacing patterns and caries experience in the primary dentition. METHODS: Caries examinations were conducted amoung 356 children 4 to 6 years of age. At the time of the examinations, alginate impressions were obtained and poured in yellow stone. From the stone casts, each interdental area was categorized as: (1) space > 1 mm, (2) space < 1 mm, (3) no space, teeth in contact, or (4) no space, teeth overlapped. These categories were collapsed into presence or absence of space for each interdental site, and counted for each individual. Analyses assessed the relationships between interdental spacing and caries experience with separate analyses for anterior spacing, posterior spacing and total spacing. RESULTS: Children with more total interdental spaces had less decay experience and less untreated decay than children with fewer interdental spaces, and children with more molar spacing had less molar decay experience; however, these relationships were weak. Correlation analyses demonstrated significant relationships between number of decayed surfaces and total number of interdental spaces (r=-0.11, P=.04) and number of molar sites with interdental spaces (r=-0.13, P=.02). Multivariate analyses revealed the total number of interproximal spaces to be weakly associated with interproximal caries experience, but that fluoride exposure was a much stronger predictor. CONCLUSIONS: Absence of interdental spaces is weakly associated with greater decay experience in the primary dentition.

Chi-Square Distribution↗

PubMedDate not supplied

Dental visits and professional fluoride applications for children ages 3 to 6 in Iowa.

PURPOSE: The purpose of this study was to report the occurrence of having a dental visit and/or a topical fluoride treatment from age 36 months to 72 months among a cohort of children followed longitudinally since birth. METHODS: Families of children enrolled in a study of fluoride ingestion were asked about their children's dental appointments and office fluoride treatments occurring during the time interval since the previous mailed questionnaire. Percentages of children who had at least 1 dental visit and at least 1 fluoride treatment during each 6-month period, each year of life, and cumulatively from birth were calculated separately. Factors related to dental visits were assessed using generalized linear models. RESULTS: Among those with complete data, 71% reported a visit cumulatively from birth to 48 months, 89% from birth to 60 months, and 96% by age 72 months. Similarly, 27% reported a professional fluoride treatment by 48 months, 44% by 60 months, and 66% by 72 months. CONCLUSIONS: Among children who had not been seen by a dentist by age 3, almost all were seen by age 6. Similarly, among those who had no professional fluoride treatment by age 3, almost two-thirds received one by age 6.

Adult↗

PubMedDate not supplied

Overview of the evidence for clinical interventions in pediatric dentistry.

PURPOSE: The purpose of this report was to describe the quantity of published literature and types of studies supporting the use of 4 pediatric dentistry procedures: (1) ferric sulfate pulpotomy; (2) stainless steel crowns; (3) space maintainers; and (4) atraumatic restorative technique (ART). METHODS: When available, titles and abstracts of reports written in English and published over a 36-year period (1966-2002) concerning these procedures were retrieved from MEDLINE. They were classified using a modified classification scheme that, in addition to the study designs, also considered the 4 dimensions of measuring dental outcomes. RESULTS: The quantity of available literature concerning each dental procedure varied considerably. Even though many reports were published on treatments, only a small proportion of the published literature for each procedure was found to evaluate outcomes, regardless of outcome dimension. Besides outcomes evaluations, studies on techniques, material properties, and review articles comprised a large proportion of the literature. Clinical dimension of outcomes was most commonly studied. Case series and case reports were the most frequently used study designs to report outcomes. CONCLUSIONS: The outcomes-related literature to support some of the commonly performed treatments is limited both in quantity and study types. More reports are needed to develop the evidence base to support the commonly performed procedures in pediatric dental practice. Additional analyses reporting of the literature are also needed to assess internal and external validity of the studies.

Child↗

PubMedDate not supplied

Effects of nonnutritive sucking habits on occlusal characteristics in the mixed dentition.

PURPOSE: Little is known about the extent to which nonnutritive sucking habits contribute to malocclusion in the mixed dentition. The purpose of this study was to report on the relationship between certain occlusal traits in the mixed dentition and longitudinal sucking behaviors. METHODS: Dental examinations were conducted on 630 children in the mixed dentition who participated in a large, ongoing longitudinal study. Five hundred eighty consented to impressions, and 524 adequate study models were obtained. Of these, 444 also had adequate longitudinal nonnutritive sucking data obtained via mailed questionnaires to parents at 3- to 6-month intervals from birth to 8 years. Sucking behaviors were grouped by predominant type and duration. Study models were hand articulated using wax bites to evaluate the occlusion for the presence of open bite, crossbite, molar relationship, and excessive overjet. Bivariate statistical analyses related presence of these malocclusions to sucking duration and type. RESULTS: Fifty-five percent of the children had malocclusions (anterior open bite, posterior crossbite, bilateral Class II molar relationship, or overjet >4 mm). Class II molar relationship was most common (30%). Overall, anterior open bite and posterior crossbite was associated with habits of 36 months or more. Sustained pacifier habits, including those of 24 to 47 months, were associated with anterior open bite and Class II molar relationships, while digit habits were associated with anterior open bite when sustained for 60 months or longer. CONCLUSIONS: Malocclusions are quite prevalent in the mixed dentition, and anterior open bite and posterior crossbite may be preventable by modifying nonnutritive sucking behaviors.

Chi-Square Distribution↗

PubMedDate not supplied

Oral health behaviors of children in low and high socioeconomic status families.

PURPOSE: This prospective longitudinal study compared the patterns of oral health behaviors between low and high socioeconomic status (SES) families participating in the Iowa Fluoride Study for a period of 9 years. METHODS: Information on oral health behaviors, including consumption of juices/juice drinks, soda pop, and powder-based drinks, dental visits, and tooth-brushing frequency, was collected longitudinally at periodic intervals from 6 to 108 months of age. Dental exams were conducted at 5 and 9 years of age. Classification of low socioeconomic status (SES; n=70) and high-SES (n= 128) children was based on baseline family income and mothers' education levels, with middle SES excluded. RESULTS: Low SES children consistently had significantly greater consumption of soda pop and powder-based beverages. There were, however, virtually no differences at any time point between groups in: (1) tooth-brushing frequency; (2) use of dentifrice; or (3) fluoride concentration in drinking water. Furthermore, the mean number of decayed and filled surfaces was significantly higher in the low-SES group. CONCLUSIONS: Results suggest that beverage consumption patterns are a key difference between high- and low-socioeconomic status families and could in part explain differences in caries experience between subjects of different SES. Modification of the pattern of soda pop and powder-based beverage consumption in the low-SES groups might reduce their caries experience.

Carbonated Beverages↗

PubMedDate not supplied

Survey of Iowa general dentists regarding the age 1 dental visit.

PURPOSE: The purpose of this study was to assess Iowa general dentists regarding the age 1 dental visit. METHODS: A 15-item survey was mailed to 1,521 licensed dentists to address their knowledge, attitudes, and behavior regarding the age 1 dental visit. Chi-square statistics and logistic regression models were used to analyze data. RESULTS: Seven hundred fifteen (47%) useable surveys were returned from 2 mailings. Five hundred forty (76%) general dentists were familiar with the American Academy of Pediatric Dentistry (AAPD) age 1 dental visit recommendation. Most reported obtaining this information through continuing education (37%). Eleven percent believed the first dental visit should occur between 0 and 11 months of age, and 66% reported seeing children younger than 2. "Prefer to refer infants to a pediatric dentist" (20%) was the most common reason for not seeing children 0 to 23 months old. Bivariate and multivariate logistic regression analyses indicated that dentists who believed children should have their first dental visit at 0 to 23 months and those willing to see children at age 0 to 23 months were younger, more recent graduates, more likely to be female, aware of the AAPD recommendations, and were already seeing children 0 to 23 months. CONCLUSIONS: The majority of Iowa general dentists are aware of the AAPD age 1 dental visit recommendation.

Adult↗