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Biomedical subjects

Peter Milgrom

Publications and source records attributed to Peter Milgrom.

27 records · Page 2Linked to original sources
PubMed2003

Xylitol and dental caries: an overview for clinicians.

An overview of studies about xylitol and dental caries suggests potential clinical dental applications for xylitol. Xylitol is a naturally occurring, low-calorie sugar substitute with anticariogenic properties. Data from recent studies indicate that xylitol can reduce the occurrence of dental caries in young children, schoolchildren, and mothers, and in children via their mothers. Xylitol, a sugar alcohol, is derived mainly from birch and other hardwood trees. Short-term consumption of xylitol is associated with decreased Streptococcus mutans levels in saliva and plaque. Aside from decreasing dental caries, xylitol may also decrease the transmission of S. mutans from mothers to children. Commercial xylitol-containing products may be used to help control rampant decay in primary dentition. Studies of schoolchildren in Belize and Estonia, along with data from the University of Washington, indicate that xylitol gum, candy, ice pops, cookies, puddings, etc., in combination with other dental therapies, are associated with the arrest of carious lesions. A prospective trial in Finland has demonstrated that children of mothers treated with xylitol had lower levels of S. mutans than children of mothers treated with chlorhexidine or fluoride varnish. Food products containing xylitol are available commercially and through specialized manufacturers, and have the potential to be widely accessible to consumers.

Cariostatic Agents↗
PubMed2002

An ABCD program to increase access to dental care for children enrolled in Medicaid in a rural county.

OBJECTIVES: The Access to Baby and Child Dentistry (ABCD) Program addresses the needs of families in obtaining dental care. In this study, the program was evaluated in rural Stevens County, Washington. Aims were to assess utilization of dental services, average dental expenditures per child, and oral health status. METHODS: Medicaid-enrolled children aged 1-4 years were randomly assigned to the ABCD program (n=216) or to regular benefits (n=221). An outreach worker contacted each ABCD family and provided an orientation. Dental care utilization and expenditures were calculated from claims. A posttest-only design was used to evaluate oral health status. RESULTS: An enrollment effect was seen in ABCD, but the difference between groups was not sustained. There was a doubling of utilization between groups for the youngest cohort, while the others showed no differences. In the first year the rate was higher for the entire ABCD group than for the children not in ABCD (34.0% vs 24.7%). Thirty-three percent of ABCD children (70/212) who had visited the dentist had >1 appointment compared to 21.5 percent (47/219) for the children not in ABCD who had visited the dentist. There was no overall difference in expenditures, while expenditures for preventive services were greater for ABCD. ABCD children had fewer teeth with initial caries. The average incremental cost per child per initial lesion prevented was 31.44 dollars. CONCLUSION: ABCD most benefited the youngest cohort of children and improved health.

Child, Preschool↗
PubMed2002

How xylitol-containing products affect cariogenic bacteria.

BACKGROUND: The authors examined the effect of xylitol, a naturally occurring sweetener, on levels of Streptococcus mutans and S. sobrinus. They also investigated xylitol's mechanism of action. METHODS: The authors compared cariogenic bacteria levels before and after exposure to xylitol products in children and adults. In the first study, 187 children received xylitol-containing snacks in school for four weeks. In the second study, two adults received xylitol candy for four weeks. Unstimulated saliva samples were taken from all subjects. Gingival samples also were taken from the adults. The authors plated the samples on selective microbiological media. Individual isolates were plated on media with varying concentrations of xylitol, and were identified using specific DNA probes. Genetic relatedness was determined via pulse-field gel electrophoresis. RESULTS: The children's salivary S. mutans levels remained stable before and after xylitol exposure. Further analysis of the S. mutans isolates was conducted for seven children. Bacteria from five of these children grew with 10 percent or less xylitol at baseline, while the bacteria from all seven children grew with 15 percent xylitol after exposure to the xylitol-containing snacks, suggesting that the S. mutans increased in tolerance to xylitol during exposure. Six children had isolates with the same genotype at both time points. S. mutans and S. sobrinus levels were reduced in one of the adults as a result of xylitol exposure, and the bacterial isolates became more xylitol tolerant. In the second adult, S. mutans and S. sobrinus levels increased, while the subject maintained the same proportion of susceptible and tolerant strains as that at baseline. CONCLUSIONS: Overall, consumption of xylitol-containing snacks and candy did not reduce S. mutans levels. However, bacteria from five children and one adult became more xylitol tolerant. CLINICAL IMPLICATIONS: These results provide a basis on which xylitol-containing products can be recommended and xylitol's mechanism of action can be explained to patients.

Adult↗
PubMed2002

Evaluation of a dental society-based ABCD program in Washington state.

BACKGROUND: The authors present a two-year evaluation of a dental society-managed dental care program in Washington state. A variation of the Access to Baby and Child Dentistry, or ABDC, program, the Mom & Me program was initiated to increase access to dental care for Medicaid-enrolled children younger than age 6 years in Yakima County. METHODS: This evaluation includes enrollment and visit data, first- and second-year cost data and results of a survey conducted with dental society members. RESULTS: The number of dentists treating Medicaid-enrolled children on a regular basis more than doubled, from 15 to 38 general dentists. In the first two years of the program, 4,705 children were enrolled and approximately 51 percent visited a dentist. CONCLUSIONS: The responses of dentists surveyed were positive, and the authors suggest that a dental society-managed program under the ABCD program -umbrella is a unique strategy for improving access to dental care for Medicaid clients. CLINICAL IMPLICATIONS: ABCD programs provide an avenue for dentists to treat children who otherwise would not receive care.

Adult↗
PubMed2002

How do U.S. and Canadian dental schools teach interpersonal communication skills?

The status of instruction in interpersonal communication was surveyed in forty U.S and Canadian dental schools. Key faculty members were identified, and syllabi and course descriptions were collected and content-analyzed. The following findings were obtained for responding schools: 1) only one-third of schools had courses specifically focusing on interpersonal communication; 2) more than half of the schools offered these types of courses only during the first two years; 3) the most common topics were communication skills, patient interviewing, and patient education/consultation; 4) the most frequently used method of teaching was lectures; active practice was used less often; 5) written examination was the primary instructional evaluation tool, whereas more sophisticated performance-oriented assessments were used less often; and 6) about half of the teachers did not have a D.D.S. degree; those not dentists were primarily psychologists. At least eight of the forty dental schools surveyed do not appear to meet the accreditation guidelines for predoctoral programs in this area of instruction. Some could not identify a faculty member responsible for such instruction. Schools offering more extensive instruction were more likely to offer active rather than passive teaching and use more sophisticated student evaluation strategies. This research suggests a need for reevaluation of teaching in this subject area.

Canada↗
PubMedDate not supplied

Improving utilization of preventive dental services by Medicaids-enrolled children: focus on the parents.

The Access to Baby and Child Dentistry (ABCD) program was implemented in Washington State in 1995 to increase utilization of dental services for children enrolled in Medicaid. The program has increased utilization of services; nevertheless, only 54 percent of Medicaid-enrolled children in ABCD who received care were given a topical fluoride treatment. To gain a better understanding of why children may not be receiving topical fluoride treatment, we interviewed parents. Focus group research found strong parental support for preventive services. Parents were willing to take their children to regular dental visits, but lack of knowledge of benefits was common. This lack of knowledge translated into a failure to fully utilize the topical fluoride benefits. We recommend that the program continue to encourage participation of dentists, regularly update information about program benefits for both dentists and parents, and enhance the visibility of the program in the community.

Adult↗
PubMedDate not supplied

Children's fear and behavior in private pediatric dentistry practices.

PURPOSE: This study assessed the proportion of children with dental fear, the proportion of children with negative behavior and the relationship of children's dental fear and children's negative behavior in private pediatric dentistry practices in western Washington state. METHODS: A total of 421 children seen in 21 private pediatric dentistry practices in western Washington State participated. The average age of the children was 6.8+/-2.8 years (range=0.8-12.8 years). An average of 21 children were studied per practice (range=7-25 children). Dental fear was measured using the parents' version of the Dental Subscale of the Child Fear Survey Schedule (CFS). Behavior of the child during treatment was rated using the Frankl scale. Additional data were collected regarding the child's previous experiences and parental fear. RESULTS: The children's average item score on the 15-item CFS was 2+/-0.7, corresponding to a total score of 29.6 out of 75, where 75 indicates maximum fear. The proportion of children with dental fear, defined as an average item score of > or = 2.5 (corresponding to a total score of > or = 38), was 20% (85/421, 95% CI=16.3, 24%). The proportion of children who displayed negative behavior during treatment was 21% (95% CI=17.5, 24%). A prevalence ratio of 2.4 was calculated to describe the relationship between children's behavior during treatment and children's dental fear prior to dental treatment. Multivariate logistical regression analysis showed children with dental fear, younger children, and children exposed to treatment involving local anesthesia have higher odds of displaying negative behavior. CONCLUSIONS: The proportion of children with dental fear in private pediatric dentistry practices was 20%, and the proportion of children with negative behavior during treatment was 21%. Children with negative behavior had greater odds of having dental fear and children with dental fear had greater odds of having negative behavior. Screening for dental fear may allow pediatric dentists to prepare children more adequately for positive treatment experiences.

Age Factors↗
PubMedDate not supplied

Xylitol, sweeteners, and dental caries.

The purpose of this report was to provide an overview of xylitol and other polyol sweeteners and dental caries for clinicians and to discuss current applications for dental practice and potential community-based public health interventions. Xylitol, like other polyol sweeteners, is a naturally occurring sugar alcohol. Studies suggest polyols are noncariogenic. Furthermore, studies indicate that xylitol can decrease mutans streptococci levels in plaque and saliva and can reduce dental caries in young children, mothers, and in children via their mothers. Food products containing xylitol are now available and have the potential to be widely accessible to consumers to help control rampant decay. Determining whether products contain adequate xylitol amounts for practical use towards prevention is challenging, however, because xylitol content is not clearly labeled. Sufficient evidence exists to support the use of xylitol to reduce caries. Clinicians and dental associations should push for clear recommendations of efficacious dose and frequency of xylitol use and for clear labeling of xylitol content in products to help consumers choose appropriately.

Cariostatic Agents↗