Caries risk in formerly sealed teeth.

Background: The authors examined the risk of caries development in teeth with partially or fully lost sealant (formerly sealed [FS] teeth) relative to the risk in teeth that never have received sealants (never-sealed [NS] teeth).

Methods: The authors searched the population of studies used in five reviews of sealant effectiveness as established in split-mouth design studies involving resin-based sealants with no reapplication of lost sealant. They required included studies to contain sufficient data to estimate the risk of caries in FS teeth relative to that in NS teeth (relative risk [RR] = % FS development caries% NS development caries) and its 95 percent confidence interval (CI).

Development and status of the National Oral Health Surveillance System.

During the last 2 decades of the 20th century, few national, state, or local oral health programs were able to conduct public health surveillance in a timely fashion. Under the leadership of the Association of State and Territorial Dental Directors and with substantial support from the Division of Oral Health at the Centers for Disease Control and Prevention, the National Oral Health Surveillance System was established as a first step in helping oral health programs routinely document population needs and program impact with standard, feasible methods. In 1999, the Council of State and Territorial Epidemiologists approved 7 oral health indicators for public health surveillance: 3 for adults (most recent dental visit, most recent dental cleaning, total tooth loss) using data from the Behavioral Risk Factor Surveillance System; 3 for third-grade students (presence of treated or untreated dental caries, untreated tooth decay, dental sealants) collected by states using a standard screening protocol; and the percentage of the population served by public water systems that receives optimally fluoridated water, tracked through the Water Fluoridation Reporting System.

A comparison of the effects of toothbrushing and handpiece prophylaxis on retention of sealants.

Background: Tooth surface cleaning before acid etching is considered to be an important step in the retention of resin-based pit-and-fissure sealants.

Methods: The authors reviewed and summarized instructions for cleaning tooth surfaces from five manufacturers of 10 unfilled resin-based sealants marketed in the United States. The authors also searched electronic databases for studies that directly compared the effects of different surface-cleaning methods on sealant retention and for systematic reviews of the effectiveness of sealants.

Exploring four-handed delivery and retention of resin-based sealants.

Background: To date, no trials have been published that examine whether four-handed delivery of dental sealants increases their retention and effectiveness. In the absence of comparative studies, the authors used available data to explore the likelihood that four-handed delivery increased sealant retention.

Methods: The authors examined data regarding the retention of autopolymerized resin-based sealants from studies included in systematic reviews of sealant effectiveness.

The role of evidence in formulating public health programs to prevent oral disease and promote oral health in the United States.

A major goal of federal, state, and local health agencies is to reduce the burden of disease in populations. To obtain sufficient resources to achieve this goal, they must document the importance of the health problems addressed and the impact and efficiency of programs. CDC supports core activities within state and local health departments to promote health and prevent disease.

Blood lead concentrations in children and method of water fluoridation in the United States, 1988-1994.

Some have hypothesized that community water containing sodium silicofluoride and hydrofluosilicic acid may increase blood lead (PbB) concentrations in children by leaching of lead from water conduits and by increasing absorption of lead from water. Our analysis aimed to evaluate the relation between water fluoridation method and PbB concentrations in children. We used PbB concentration data (n=9,477) from the Third National Health and Nutrition Examination Survey (1988-1994) for children 1-16 years of age, merged with water fluoridation data from the 1992 Fluoridation Census.

Promoting the oral health of older adults through the chronic disease model: CDC's perspective on what we still need to know.

The Centers for Disease Control and Prevention (CDC) has adopted a multicomponent approach to health promotion: the Chronic Disease Model. Among its underlying public health principles are 1) recognition of the universal preference for primary prevention of disease, 2) awareness that prevention often takes place outside of clinical settings and is influenced by behaviors that can be affected by social circumstances and institutional policies, 3) the need to base program efforts on the best available science, 4) the special responsibility of public health for at-risk populations, and 5) the need for population-based approaches. Such approaches require public health agencies to build programs that engage broad networks of partners; monitor diseases, risk factors, and behaviors; implement proven prevention strategies; and evaluate programs rigorously.

Dental care use among pregnant women in the United States reported in 1999 and 2002.

Introduction: The purpose of this study was to determine national and state-specific estimates of dental care use among adult pregnant women in the United States using data from two 12-month periods. The study also determined person-level characteristics that may predict a lack of dental care use within this subgroup.

Methods: Responses were analyzed from 4619 pregnant women aged 18 to 44 years who participated in the 1999 and 2002 state-based Behavioral Risk Factor Surveillance System.

Estimating prevalence and severity of caries in the mixed dentition: a comparison of two screening protocols.

Objective: Most oral health surveys examine and record data on individual teeth or surfaces (STD), providing valid estimates of caries prevalence and severity. Simplified screening protocols based on assessments at the person level (Stop-After-First-Encounter--SAFE) have been validated for assessment of prevalence. We developed an alternative protocol (SENTINEL), which examined the 12 teeth at highest risk for caries and compared how it performed to SAFE and STD for surveillance and evaluation.

Guidelines for infection control in dental health care settings--2003.

Background: The Centers for Disease Control and Prevention, or CDC, is the lead federal agency for disease prevention in the United States. It has been 10 years since CDC infection control guidelines for dental health care settings were last published. During those 10 years, new technologies and issues have emerged, and other CDC infection control guidelines for health care settings have been updated.

Guidelines for infection control in dental health-care settings--2003.

This report consolidates previous recommendations and adds new ones for infection control in dental settings. Recommendations are provided regarding 1) educating and protecting dental health-care personnel; 2) preventing transmission of bloodborne pathogens; 3) hand hygiene; 4) personal protective equipment; 5) contact dermatitis and latex hypersensitivity; 6) sterilization and disinfection of patient-care items; 7) environmental infection control; 8) dental unit waterlines, biofilm, and water quality; and 9) special considerations (e.g.

Updated comparison of the caries susceptibility of various morphological types of permanent teeth.

Unlabelled: In 1941, Klein and Palmer published a landmark study that ranked the relative susceptibility to dental caries of various morphological tooth types. Specifically, Klein and Palmer used a four-step approach, which included derivation of: (1) an eruption schedule; (2) posteruptive tooth age; (3) cumulative number of decayed, missing, and filled teeth and cumulative posteruptive tooth age; and (4) relative susceptibility values. Their study was conducted when dental caries prevalence and severity were generally high in the United States, prior to the introduction of preventive measures such as fluoride and dental sealants.

Oral health surveillance: past, present, and future challenges.

We reviewed and summarized the efforts in the United States to collect data on oral diseases, conditions, and behaviors implemented at the national and state level. The main characteristics of these efforts were: (1) systematic collection of data from representative samples, mostly at the national level; (2) one-time or sporadic experiences when data are collected at state and local levels; (3) use of visual-tactile protocols implemented at the tooth-surface or tooth-site level for data collection; (4) focus mainly on dental caries and periodontal diseases; and (5) leap-time from data collection to publication of results. Using the definition of surveillance in public health (the ongoing and systematic collection, analysis, and interpretation of outcome-specific data for use in planning, implementing, and evaluating public health practice), we show there is an impending need to develop new techniques to build up surveillance systems for oral diseases, conditions, and behaviors at the national, state, and local levels.

Oral health during pregnancy: an analysis of information collected by the pregnancy risk assessment monitoring system.

Background: Little is known about the use of dental services during pregnancy. Yet research suggests that a pregnant woman's oral health and her pregnancy outcome may be associated.

Methods: Four states collected oral health data a part of the Pregnancy Risk Assessment Monitoring System, or PRAMS, in 1998.

Oral health status of special athletes in the San Francisco Bay Area.

A standardized oral health screening protocol was developed for assessing the oral health status of athletes participating in annual Special Olympics events at sites across the country. This paper reports on results at the San Francisco Bay Area Special Olympics event, where 385 athletes participated in the oral health screening. Trained dental screeners determined the presence or absence of edentulism, untreated decay, filled teeth, missing teeth, tooth injury, fluorosis, and gingival signs, as well as treatment urgency.

Validity of two methods for assessing oral health status of populations.

Objective: This investigation assessed two methods for estimating epidemiologic indicators of oral health status among children: (1) a visual-only screening, performed independently by a dental hygienist and a registered nurse; and (2) a parent- or guardian-completed questionnaire. The indicators included dichotomous variables measuring dental caries and treatment needs, presence of sealants, injuries to the anterior teeth, and dental fluorosis.

Methods: Following training and calibration, data were collected over an eight-day period in April 1994 among 632 elementary schoolchildren (aged 5 to 12 years) in Monticello, Georgia.

Trends in state agency oral health and public health expenditures, 1984 through 1989.

This paper documents oral health and public health expenditures for fiscal years 1984, 1986, 1988, and 1989, as reported by state health agencies. During this period, reported national expenditures for public and oral health increased 68% and 46%, respectively; between successive fiscal years, fewer states (73%, 67%, 57%) reported increased oral health expenditures, while increasingly more states reported no categorical oral health expenditures. Block grant expenditures for oral health increased overall but decreased as a percentage of total oral health expenditures; 16 states reported no block grant expenditures for oral health in fiscal year 1989, perhaps reflecting either substantial state support, or marginal to nonexistent oral health programs in these states.

Practical infection control in oral health surveys and screenings.

Examinations for oral health surveys and screenings are performed by dentists or dental hygienists in a variety of settings. To date, CDC has made no recommendations for infection control specifically for these brief examinations. General principles for infection control can be applied during oral health surveys and screenings.

Assessment of a dental disease prevention program after three years.

This assessment compared routine data on selected clinical services provided within the Oklahoma City Area of the Indian Health Service during the first six months of fiscal year 1984, prior to implementation of a program emphasizing oral health promotion and disease prevention, to comparable data from 1987. The assessment revealed: similar absolute numbers of routine examinations and completed treatment among children; a 10 percent increase in total visits for persons of all ages, accomplished with comparable numbers of dental personnel; and an increase in the percent of services that were preventive, as well as a concomitant decrease in basic restorative services. The ratio of pit and fissure sealants to one-surface amalgam restorations was reversed dramatically.