Biomedical subjects

Steven M Levy

Publications and source records attributed to Steven M Levy.

51 records · Page 3Linked to original sources

PubMed2002

Follow-up study of dental students' esthetic perceptions of mild dental fluorosis.

OBJECTIVES: Several studies have assessed people's esthetic perceptions of dental fluorosis, suggesting that concerns may be greater than believed previously. Few studies have assessed dental students' perceptions and none has done so over time. The purpose of this paper is to report on changes in dental students' esthetic perceptions of dental fluorosis and other conditions. METHODS: Fourth-year dental students (n=45) completed questionnaires about computer-generated photographs of fluorosis and other conditions, using the same protocol as when they were entering dental students. Results were compared for each of the eight images at the individual level using paired statistical tests. RESULTS: Although many patterns were generally consistent, there were a substantial number of differences in results over time, concerning both the mild fluorosis and non-fluorosis images. In general, students tended to score both fluorosis and non-fluorosis images more favorably as fourth-year students. When rating images from very pleased (1) to very embarrassed (10), fourth-year students rated the images significantly more favorably than they had done as first-year students for normal/control, incisal third only dental fluorosis, and a more generalized, mild fluorosis. Similarly, with a visual analog scale from satisfactory (0) to unsatisfactory (69), fourth-year students reported significantly lower (more favorable) scores than they had done as first-year students for the normal/control, diastema/no fluorosis, more involved mild fluorosis, and incisal third only mild fluorosis. There were no obvious changes in the relative levels of favorable evaluation of fluorosis vs. the other conditions. CONCLUSIONS: Fourth-year dental students generally had more favorable esthetic perceptions of mild dental fluorosis and other conditions than they had reported as entering students.

Adult↗

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↗

PubMed2002

Associations of pacifier use, digit sucking, and child care attendance with cessation of breastfeeding.

OBJECTIVE: Breast milk is the recommended method of nutrition for newborns and infants. Several studies have investigated factors associated with the cessation of breast-feeding. This study assessed the associations between pacifier use, digit sucking, childcare attendance, and breastfeeding cessation among 1387 infants in the Iowa Fluoride Study. STUDY DESIGN: This was a longitudinal questionnaire survey. Mothers completed mailed questionnaires sent at infant ages 6 weeks, 3 months, and 6 months. POPULATION: Parents were recruited postpartum at 8 Iowa hospitals. OUTCOMES MEASURED: Survival analysis (using Cox proportional hazards model) assessed the time covariate effects of pacifier use, digit sucking, and child care attendance on cessation of breastfeeding, while adjusting for other possible confounding variables (not planning to breastfeed, maternal smoking, infants' sex and antibiotic use, maternal and paternal age and education, and income group). RESULTS: Percentages of women who did any breastfeeding were 46%, 36%, and 27%, at 6 weeks, 3 months, and 6 months, respectively. Percentages using pacifiers were 81%, 71%, and 59%. Combinations of pacifier use and digit sucking for various levels of child care had statistically significant associations with cessation of breastfeeding, with the effect being strongest for pacifier users and digit suckers with no child care days (hazard ratio = 1.88; 95% CI, 1.36-2.62). CONCLUSIONS: Pacifier use and digit sucking were associated with cessation of breastfeeding, with results dependent on the level of childcare attendance. The strongest associations were found for those not attending childcare and for combined use of pacifier with digit sucking.

Child Day Care Centers↗

PubMedDate not supplied

Oral health: perceptions of need in a rural Iowa county.

Several studies have shown that oral health problems impact the quality of life of older adults. However, few data are available to describe the oral health status, barriers to care, and patterns of care for adults and older populations living in rural areas. The purpose of this study was to evaluate the perceived need for treatment of oral health problems by adult residents in a rural county in Iowa. The oral health component was part of a larger longitudinal health study of the residents. The sample was stratified into three groups by residence, that is, farm households, rural non-farm households and town households. The sample was subsequently post-stratified by gender and age group into young elderly, 65-74 years old, and old elderly, 75 years and older. Dentition status varied according to age and was related to the perception of treatment needs. Edentulous persons had fewer perceived treatment needs and utilized a dentist less frequently. Place of residence, education, and marital status were not associated with the subjects' perceived problems with eating and chewing. However, persons with difficulty chewing were more likely to have some missing upper teeth, have a perceived need to have denture work, and have smoked for a number of years. The results suggest that this rural population is retaining more teeth and consequently may need and may seek dental services more often than previous more edentulous cohorts.

Aged↗

PubMedDate not supplied

Coronal and root caries in the older Iowans: 9- to 11-year incidence.

This study reports on coronal and root caries incidence in elderly Iowans between 1987 and 1998. The sample consisted of 74 survivors of the Iowa 65+ Oral Health Study cohort who received oral examinations both in 1987 and between 1996-98. The study found that average untreated coronal and root increments were 0.96 and 0.69 surfaces, filled increments were 18.22 and 1.28 surfaces, and combined increments were 18.3 and 1.27 surfaces, respectively. Therefore, annualized untreated coronal and root increments were 0.10 and 0.07 surfaces, filled were 1.80 and 0.13 surfaces, and combined increments were 1.81 and 0.12 surfaces, respectively. The annualized attack rates were 2.13 for coronal and 0.80 for root caries. Approximately 93% of the subjects developed some new coronal and 43% some new root caries increment. Dental caries still constitute a significant problem since a large proportion of the elderly developed caries during this period. This suggests a need for improved preventive and treatment strategies for this aged population.

Aged↗

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

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

Tooth-brushing and dentifrice use among children ages 6 to 60 months.

PURPOSE: Tooth-brushing and fluoride dentifrice use are the primary oral health activities for young children. Fluoridated dentifrice has had an important impact on the reduction in children's caries lesion rates, but no studies have focused on patterns of use at multiple time points early in life. The purpose of this paper is to describe tooth-brushing and fluoride dentifrice use in a cohort of children from ages 6 to 60 months. METHODS: The data are from the Iowa Fluoride Study, a longitudinal investigation of fluoride intake from birth. Questionnaires assessed tooth-brushing patterns and fluoride dentifrice use at age 6 months, and at 3-, 4-, or 6-month intervals thereafter. RESULTS: At 6 months of age, 28% of the children's teeth were brushed or cleaned, and 3% of these used fluoridated dentifrice, increasing to 95% at 20 months (83% of them with fluoridated dentifrice). Use of dentifrice flavored for children increased from 40% of those brushing at 9 months to 71% at 60 months. From 9 to 32 months, about 55% of the children were using approximately the recommended amount of dentifrice. However, the percentage using more than recommended increased from 12% at 9 months to 64% at 60 months. Mothers placed the dentifrice on the toothbrush 85% of the time at 9 months, 81% at 20 months, 49% at 36 months, and 31% at 60 months. CONCLUSIONS: By age 2, almost all children were brushing with fluoridated dentifrice, but less than half brushed twice a day, even at age 5. Mothers played the most important role in the children's home care habits.

Adolescent↗

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

Patterns of fluoride mouthrinse and gel use by children 6 to 96 months of age.

PURPOSE: The purpose of this paper was to report longitudinally on parental reports of mouthrinse/gel use at home and at preschool/elementary school until age 8. METHODS: A cohort recruited at birth was followed in the Iowa Fluoride Study (IFS). Demographic data were collected at baseline. Pretested questionnaires were sent to participants at 3- to 6-month intervals, from ages 6 to 96 months, concerning many aspects of fluoride exposures and intake--including home use of fluoride mouthrinse/gel and participation in fluoride mouthrinse programs at preschool/elementary school. Summary statistics were computed for each period. Associations between home fluoride mouthrinse/gel use and demographic covariates were assessed. RESULTS: There were 1,388 participants. However, the number of respondents for each study interval varied from 549 to 800. Most participants were white, with about two thirds of parents having some college education. The percentage with use at home/preschool/elementary school during the period increased from less than 1% for 12 months to 3% at 48 months, 11% at 72 months, and 25% at 96 months. Fluoride mouthrinse use at preschool/elementary school was consistently less common than mouthrinse use at home. There were no significant associations between fluoride mouthrinse/gel use and demographic covariates. Patterns of fluoride mouthrinse use among users (N=205) indicated that, when children became older, higher proportions used fluoride mouthrinse and used them more consistently over time. CONCLUSIONS: A relatively small percentage of children used fluoride mouthrinse/gel, and this proportion increased with age.

Age Factors↗

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

Factors associated with parents' esthetic perceptions of children's mixed dentition fluorosis and demarcated opacities.

PURPOSE: With the increasing prevalence of dental fluorosis, improved understanding about esthetic perceptions of dental fluorosis is warranted. The purpose of this report was to present results concerning parents' overall satisfaction with the appearance of their children's teeth and factors related to dissatisfaction, comparing subjects with and without fluorosis and demarcated opacities. METHODS: Data were obtained from 577 parents in the Iowa Fluoride Study who answered a questionnaire concerning their satisfaction with the appearance of their children's teeth at age 9 years, as well as several components of dissatisfaction. Concurrent assessment of the mixed dentition was made by 1 of 2 trained dentist examiners. RESULTS: Overall, 31% of parents were very satisfied, 51% somewhat satisfied, 16% somewhat dissatisfied, and 3% very dissatisfied with appearance. Parents of children without fluorosis were more likely to be very satisfied (46%) than were parents of children with questionable fluorosis (31%) or definitive fluorosis (22%). Among the 401 not "very satisfied," 50% of those with fluorosis vs 40% with no fluorosis were concerned about color, 60% of both groups were concerned about alignment, 44% and 51%, respectively, were concerned about crowding, and 44% and 9%, respectively, were concerned about blotchiness. CONCLUSIONS: Fluorosis was associated with increased parental dissatisfaction with overall appearance, color, and blotchiness of their children's teeth.

Child↗

PubMedDate not supplied

Dental visits and professional fluoride applications for children 72 to 108 months old.

PURPOSE: The purpose of this study was to report patterns of dental visits and fluoride applications longitudinally during ages 7 to 9. METHODS: A cohort recruited at birth was followed in the Iowa Fluoride Study, with pretested questionnaires-sent to participants at 3- to 6-month intervals--concerning children having a dental (or dental hygiene) appointment or a fluoride application during the period. RESULTS: The percentages with dental visits were stable during these years (92%-93%), however, the percentages reporting fluoride applications increased from 68% (seventh year) to 74% (ninth year). Among children with complete data for 72 to 108 months of age, 99% visited the dentist and 84% received fluoride applications. Dental visits were significantly more frequent with a higher socioeconomic status, and fluoride applications were significantly more frequent in children with primary dentition caries experience. CONCLUSIONS: The prevalence of visits and fluoride applications during these years are stable, with most children having at least 1 visit per year.

Cariostatic Agents↗

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↗