Publications by authors named "Kathy Phipps"

25 Publications

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Design of a home-based intervention for Houston-area African-American adults with asthma: Methods and lessons learned from a pragmatic randomized trial.

Contemp Clin Trials 2020 04 6;91:105977. Epub 2020 Mar 6.

U.S. Department of Housing & Urban Development, Washington, DC, United States.

A growing body of evidence demonstrates that home-based, multicomponent interventions can effectively reduce exposures to asthma triggers and decrease asthma symptoms. However, few of these studies have targeted adults. To address this and other research gaps, we designed and implemented a pragmatic randomized clinical trial, the Houston Home-based Integrated Intervention Targeting Better Asthma Control (HIITBAC) for African Americans, to assess the effectiveness of a home-based intervention to improve asthma control and quality of life in African-American adults-a population disproportionately affected by asthma. The primary goals were to help participants reduce allergens and irritants in their homes and better manage their disease through knowledge, improved medication use, and behavior change. HIITBAC had two groups: clinic-only and home-visit groups. Both groups received enhanced clinical care, but the home-visit group also received a detailed home assessment and four additional home visits spaced over roughly one year. We recruited 263 participants. Of these, 152 (57.8%) were recruited through electronic health record data, 51 (19.4%) through Emergency Medical Services data, and 60 (22.8%) through other efforts (e.g., emergency departments, community events, outreach). Seventy participants (26.6%) were lost to follow up, substantially more in the home-visit than in the clinic-only group. We describe the HIITBAC methodology and cohort, discuss lessons learned about recruitment and retention, and highlight adaptations we implemented to address these lessons.
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http://dx.doi.org/10.1016/j.cct.2020.105977DOI Listing
April 2020

Oral Health of Older Adults in Washington State.

J Dent Hyg 2020 Feb;94(1):39-48

An aging population, combined with increasing tooth retention, could significantly impact the dental care delivery system. The purpose of this study was to assess self-reported oral health and the factors associated with oral health outcomes among a random sample of older adults in Washington State. A telephone survey of adults 55+ years was used to collect information on factors associated with oral health, plus four outcome variables; substantial tooth loss (6+ teeth lost), oral problems, oral pain, and poor health of teeth. Data were weighted to reflect the state's age and gender statistics. A total of 2,988 older adults completed the survey during 2017. Substantial tooth loss (18%), oral problems (17%) and oral pain (13%) were the most frequently reported issues. Of the adults with teeth, 17% reported fair/poor health of teeth. Compared to adults with an income of $75,000 or more, adults with an income less than $25,000 were twice as likely to have substantial tooth loss and oral problems (OR=2.1 and 2.2, respectively) and were three times more likely to report oral pain and poor health of teeth (OR=3.1 and 3.3, respectively). The oldest old (adults 75+ years), as compared to those 55-64 years, were significantly more likely to have substantial tooth loss (OR=2.6) but were less likely to report oral problems (OR=0.6), pain (OR=0.3), or poor health of teeth (OR=0.5). Although the majority of Washington's older adults report having good oral health, a small subgroup has oral problems which may have a negative impact on quality of life.
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February 2020

Associations of fluoride intake with children's cortical bone mineral and strength measures at age 11.

J Public Health Dent 2018 09 29;78(4):352-359. Epub 2018 Aug 29.

Research Consultant, Morro Bay, CA, USA.

Objectives: There is strong affinity between fluoride and calcium, and mineralized tissues. Investigations of fluoride and bone health during childhood and adolescence show inconsistent results. This analysis assessed associations between period-specific and cumulative fluoride intakes from birth to age 11, and age 11 cortical bone measures obtained using peripheral quantitative computed tomography (pQCT) of the radius and tibia (n = 424).

Methods: Participants were a cohort recruited from eight Iowa hospitals at birth. Fluoride intakes from water, other beverages, selected foods, dietary supplements, and dentifrice were recorded every 1.5-6 months using detailed questionnaires. Correlations between bone measures (cortical bone mineral content, density, area, and strength) and fluoride intake were determined in bivariate and multivariable analyses adjusting for Tanner stage, weight and height.

Results: The majority of associations were weak. For boys, only the positive associations between daily fluoride intakes for 0-3 years and radius and tibia bone mineral content were statistically significant. For girls, the negative correlations of recent daily fluoride intake per kg of body weight from 8.5 to 11 years with radius bone mineral content, area, and strength and tibia strength were statistically significant. No associations between cumulative daily fluoride intakes from birth to 11 years and bone measures were statistically significant.

Conclusions: In this cohort of 11-year-old children, mostly living in optimally fluoridated areas, life-long fluoride intakes from combined sources were weakly associated with tibia and radius cortical pQCT measures.
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http://dx.doi.org/10.1111/jphd.12286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279557PMC
September 2018

A novel staging system for caries severity in the primary dentition.

J Public Health Dent 2017 Dec 16;77(1):6-12. Epub 2016 Jun 16.

Arctic Investigations Program, Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA.

Objectives: Caries in the primary dentition (CIPD) has a high prevalence in U.S. children compared to other diseases, with substantial disparities among different population groups. Few reports correlate CIPD prevalence with clinical impairment of children's quality of life, such as tooth pain, speech delay or trauma to the child from operative restorations, which we collectively term morbidity. Likewise, current case definitions (ECC, S-ECC) and disease metrics (mean dmfs/dmft) are not helpful in assessing morbidity for individual or groups of children. We describe a construct to stage caries severity for children ages 0 -5, called "CIPD Levels." This metric is based on small interval age-group dmft scores, and has a direct link to current and predicted morbidity for the child. It is modeled after staging systems for medical diseases in which the various stages or levels are correlated with the probability of morbidity or mortality.

Methods: We created a matrix in which CIPD Levels 0-4 are assigned for dmft scores 0-7 depending on a child's age. CIPD Level-4 is the highest level, and frequently results in clinical adverse outcomes, including pain and extensive restorations. We next tested this matrix with data from a high-risk population.

Results: Among children with any cavitated caries at age <24 months, 82.8% reached the adverse outcomes threshold (CIPD Level-4) at age 36 months. For children with dmft = 0 at 24 months, 71.4% did not reach CIPD Level-4 at age 36 months.

Conclusion: Our new metric is useful for quantifying disease burden from caries for high-risk children.
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http://dx.doi.org/10.1111/jphd.12164DOI Listing
December 2017

Timing of primary tooth emergence among U.S. racial and ethnic groups.

J Public Health Dent 2016 09 18;76(4):259-262. Epub 2016 Mar 18.

Morro Bay Consulting, LLC, Morro Bay, CA, USA.

Objectives: To compare timing of tooth emergence among groups of American Indian (AI), Black and White children in the United States at 12 months of age.

Methods: Data were from two sources - a longitudinal study of a Northern Plains tribal community and a study with sites in Indiana, Iowa and North Carolina. For the Northern Plains study, all children (n = 223) were American Indian, while for the multisite study, children (n = 320) were from diverse racial groups. Analyses were limited to data from examinations conducted within 30 days of the child's first birthday.

Results: AI children had significantly more teeth present (Mean: 7.8, Median: 8.0) than did Whites (4.4, 4.0, P < 0.001) or Blacks (4.5, 4.0, P < 0.001). No significant differences were detected between Black and White children (P = 0.58). There was no significant sex difference overall or within any of the racial groups.

Conclusions: Tooth emergence occurs at a younger age for AI children than it does for contemporary White or Black children in the United States.
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http://dx.doi.org/10.1111/jphd.12154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027172PMC
September 2016

Factors associated with dental caries in a group of American Indian children at age 36 months.

Community Dent Oral Epidemiol 2016 Apr 6;44(2):154-61. Epub 2015 Nov 6.

Dows Institute for Dental Research, University of Iowa, Iowa City, IA, USA.

Objectives: Early childhood caries (ECC) is rampant among American Indian children, but there has been relatively little study of this problem. This article reports on risk factors for caries for a group of American Indian children at age 36 months as part of a longitudinal study.

Methods: Pregnant women from a Northern Plains Tribal community were recruited to participate in a longitudinal study of caries and caries risk factors. Standardized dental examinations were completed on children, and questionnaires were completed by mothers at baseline and when children were 4, 8, 12, 16, 22, 28, and 36 months of age. Examinations were surface-specific for dental caries, and the questionnaires collected data on demographic, dietary, and behavioral factors. Nonparametric bivariate tests and logistic regression models were used to identify risk factors for caries at 36 months, and negative binomial regression was used to identify factors related to caries severity (dmf counts).

Results: Among the 232 children, and caries prevalence for cavitated lesions was 80%, with an additional 15% having only noncavitated lesions. The mean dmfs was 9.6, and of the total dmfs, nearly 62% of affected surfaces were decayed, 31% were missing, and 7% were filled. Logistic regression identified higher added-sugar beverage consumption, younger maternal age at baseline, higher maternal DMFS at baseline, and greater number of people in the household as significant (P < 0.05) risk factors. Negative binomial regression found that only maternal DMFS was associated with child dmf counts.

Conclusions: By the age of 36 months, dental caries is nearly universal in this population of American Indian children. Caries risk factors included sugared beverage consumption, greater household size, and maternal factors, but further analyses are needed to better understand caries in this population.
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http://dx.doi.org/10.1111/cdoe.12200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777677PMC
April 2016

Experiences with the Streptococcus Mutans in Lakota Sioux (SMILeS) Study: Risk factors for Caries in American Indian Children 0-3 Years.

J Health Dispar Res Pract 2015 ;8(3):123-132

Oral Health Research Consultant, Morro Bay, CA.

Severe Early Childhood Caries (S-ECC) is a terribly aggressive and devastating disease that is all too common in lower socio-economic children, but none more so that what is encountered in American Indian Tribes. Nationwide, approximately 27% of 2-5 year olds have decay while 62% percent of American Indian/Alaska Native children in the same age group have a history of decay (IHS 2010, NHANES 1999-2002). We have conducted a study of children from birth to 36 months of age on Pine Reservation to gain a better understanding of the variables that come into play in the development of this disease, from transmission and acquisition of Streptococcus mutans genotypes from mother to child to multiple dietary and behavioral components. This article describes how we established a direct partnership with the Tribe and the many opportunities and challenges we faced in performing this 5-year field study.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5033124PMC
January 2015

The Indian Health Service Early Childhood Caries Collaborative: A Five-year Summary.

Pediatr Dent 2015 May-Jun;37(3):275-80

tribal health board, San Luis Obispo, Calif., USA.

Purpose: The purpose of this study was to assess a national initiative's effect on prevalence of early childhood caries and untreated decay in zero- to five-year-old Indian/Alaska Native preschool children.

Methods: The Indian Health Service (IHS) conducted a five-year Early Childhood Caries Collaborative from October 1, 2009 to September 30, 2014. The program used educational materials and routine communication with the 322 IHS and United States tribal dental programs, with an emphasis on early access to care, dental sealanth, fluoride varnish, and interim therapeutic restorations (ITRs). Prevalence and untreated decay data were obtained through the nationwide oral health survey (2010 and 2014). Data were also collected on access to care, sealants, fluoride, and ITRs.

Results: The number of zero- to five-year-olds with a dental visit increased seven percent: dental sealants placed increased 65 percent; and fluoride varnish applications increased 161.2 percent. Between 2010 and 2014, the percentage of one- to two-year-olds with decay experience and untreated decay declined, but the difference was not statistically significant.

Conclusions: Early childhood caries prevention strategies, such as early access to dental care, sealants, fluoride varnish, and interim therapeutic restorations, demonstrated some initial improvement in the oral health status of zero- to five-year-old Indian/Alaska Native children.
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December 2016

Relationship of Bone Metabolism Biomarkers and Periodontal Disease: The Osteoporotic Fractures in Men (MrOS) Study.

J Clin Endocrinol Metab 2015 Jun 9;100(6):2425-33. Epub 2015 Apr 9.

Context: Periodontitis is an inflammatory disease of tooth-supporting tissue leading to bone destruction and tooth loss. Periodontitis affects almost 50% of adults greater than 30 years of age.

Objective: This study evaluated the association between biomarkers linked to bone formation and resorption with the occurrence and progression of periodontal disease in older men (≥ 65 y).

Design: The Osteoporotic Fractures in Men (MrOS) study is a prospective, observational study among men 65 years of age and older.

Setting: This ancillary study, Oral and Skeletal Bone Loss in Older Men, was conducted at two of the six MrOS study sites (Birmingham, AL and Portland, OR).

Patients: Patients underwent medical and dental evaluation. Diagnoses of periodontitis were based on clinical attachment loss, pocket depth, calculus, plaque, and bleeding on a random half-mouth. Bone metabolism biomarkers included serum levels of calcium, phosphate (Pi), alkaline phosphatase, albumin, carboxy-terminal collagen crosslinks (CTX), N-terminal propeptides of type I procollagen, isoform 5b of tartrate-resistant acid phosphatase, and urine alpha- carboxy-terminal collagen crosslinks (alpha-CTX) and beta-CTX and serum levels of calciotropic hormones vitamin D (25(OH)D) and PTH.

Main Outcome Measures: The aim of this study is to correlate bone metabolism biomarkers with prevalence and progression of periodontal disease in older men.

Results: Patients with more severe periodontitis had significantly higher levels of PTH (P trend = .0004), whereas 25(OH)D was lower (P trend = .001). In a subset of men reevaluated at a second dental visit, improvement of periodontitis was associated with lower alpha-CTX, beta-CTX, and CTX levels at baseline after adjusting for age, site, and body mass index.

Conclusion: This study suggests that a distinct set of biomarkers of bone metabolism are associated with more severe periodontal disease (PTH, 25(OH)D) and periodontal progression (alpha-CTX, beta-CTX, and CTX) over time.
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http://dx.doi.org/10.1210/jc.2014-4180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454801PMC
June 2015

Genotypic characterization of initial acquisition of Streptococcus mutans in American Indian children.

J Oral Microbiol 2015 1;7:27182. Epub 2015 Apr 1.

Dows Institute for Dental Research, University of Iowa, College of Dentistry, Iowa City, IA, USA;

Background: Severe-early childhood caries (S-ECC) is one of the most common infectious diseases in children and is prevalent in lower socio-economic populations. American Indian children suffer from the highest levels of S-ECC in the United States. Members of the mutans streptococci, Streptococcus mutans, in particular, are key etiologic agents in the development of caries. Children typically acquire S. mutans from their mothers and early acquisition is often associated with higher levels of tooth decay.

Methods: We have conducted a 5-year birth cohort study with a Northern Plains Tribe to determine the temporality and fidelity of S. mutans transmission from mother to child in addition to the genotypic diversity of S. mutans in this community. Plaque samples were collected from 239 mother/child dyads at regular intervals from birth to 36 months and S. mutans were isolated and genotyped by arbitrarily primed-polymerase chain reaction (AP-PCR).

Results: Here we present preliminary findings from a subset of the cohort. The focus for this paper is on initial acquisition events in the children. We identified 17 unique genotypes in 711 S. mutans isolates in our subset of 40 children, 40 mothers and 14 primary caregivers. Twelve of these genotypes were identified in more than one individual. S. mutans colonization occurred by 16 months in 57.5% of the children and early colonization was associated with higher decayed, missing and filled surface (DMFS) scores (p=0.0007). Children colonized by S. mutans shared a common genotype with their mothers 47.8% of the time. While multiple genotypes were common in adults, only 10% of children harbored multiple genotypes.

Conclusion: These children acquire S. mutans at an earlier age than the originally described 'window of infectivity' and often, but not exclusively, from their mothers. Early acquisition is associated with both the caries status of the children and the mothers.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385128PMC
http://dx.doi.org/10.3402/jom.v7.27182DOI Listing
April 2015

Permanent first molar eruption and caries patterns in American Indian and Alaska Native children: challenging the concept of targeting second grade for school-based sealant programs.

J Public Health Dent 2013 13;73(3):175-8. Epub 2013 Mar 13.

Oral Health Surveillance Consultant, Morro Bay, CA, USA.

Objective: To describe first permanent molar eruption and caries patterns among American Indian and Alaska Native (AI/AN) children in order to identify the appropriate target grade for school-based sealant programs.

Methods: We used data from the 2011-2012 Indian Health Service oral health surveillance survey of AI/AN children in kindergarten through third grade. Children were screened by trained examiners. Cavitated lesions were classified as decayed, and teeth with any portion of the crown exposed were considered erupted.

Results: We screened 15,611 AI/AN children in 186 schools. The percentage with four erupted first molars was 27 percent of kindergarten, 76 percent of first, 96 percent of second, and 99 percent of third-grade children. About 7 percent of kindergarteners had decayed, missing, or filled molars compared with 20 percent, 30 percent, and 38 percent of first, second, and third graders, respectively.

Conclusion: School-based sealant programs for AI/AN children should target kindergarten and first grade with follow-up programs for second-grade children.
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http://dx.doi.org/10.1111/jphd.12011DOI Listing
April 2014

No evidence to support the claim that amoxicillin causes molar-incisor hypomineralization.

Authors:
Kathy R Phipps

J Evid Based Dent Pract 2012 Sep;12(3 Suppl):73-5

Subjects: All children (n = 217) attending the second to fifth years of comprehensive schools in the nonfluoridated town of Lammi, Finland, were invited to participate in the study. Of those invited, 147 (67.7%) agreed to participate and study data were obtained for 141. The children ranged in age from 7.8 to 12.7 years with a mean of 10.7 years. Slightly more than half (53.9%) of the children were male. No other information was presented.

Key Risk/study Factor: The key study factor was antibiotic use during the first, second, third, and fourth years of life. Information on amoxicillin, penicillin V, cephalosporin, macrolides (erythromycin), sulfonamide, and trimethoprim use was obtained from the local health center medical records.

Main Outcome Measure: The outcome measure was hypomineralization of the permanent first molars. A tooth was considered to be hypomineralized if it had a demarcated opacity, broken-down hypomineralized enamel, or an atypical restoration. Lesions smaller than 2 mm in diameter were excluded. The potential issue of missing first molars and how they should be classified was not addressed.

Main Results: Eighty-five percent of the children had received at least one course of antibiotics. During the first year of life, 34.8% had taken either penicillin or amoxicillin or both, whereas 5.0% received erythromycin. Twenty-three children (16.3%) had one or more permanent first molars with hypo-mineralization. Of the children with molar hypomineralization (MH), 12 (52.2%) had taken antibiotics during the first year of life compared with 33.9% of the children without MH (P > .05). The unadjusted odds ratio (OR) for MH among children who received amoxicillin during the first year was 2.06 (95% confidence interval [CI] 1.01-4.17), whereas the unadjusted OR for MH was 4.14 (95% CI, 1.05-16.4) among children who received erythromycin during the first year.

Conclusions: The authors concluded that the early use of amoxicillin is among the causative factors of molar hypomineralization. STUDY 2 SUMMARY SUBJECTS: Mandibular molar explants from 27 mouse embryos in an organ culture.

Key Risk/study Factor: Exposure to amoxicillin at 100 mg/mL, 1 mg/mL, and 4 mg/mL.

Main Outcome Measure: Enamel and dentin thickness after 10 days of culture.

Main Results: In first molars with enamel, the enamel-dentin layer was thicker in explants exposed to amoxicillin at concentrations of 1 mg/mL or more compared with controls and those exposed to 100 mg/mL (P < .001). The enamel/dentin ratio also differed significantly (P < .007). The actual thickness data were not presented.

Conclusions: The authors concluded that the early use of amoxicillin is among the causative factors of molar hypomineralization.
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http://dx.doi.org/10.1016/S1532-3382(12)70018-0DOI Listing
September 2012

Dental caries in a cohort of very young American Indian children.

J Public Health Dent 2012 28;72(4):265-8. Epub 2012 Sep 28.

Department of Preventive & Community Dentistry, University of Iowa, Iowa City, IA 52242-1010, USA.

Objectives: This paper reports the prevalence and severity of caries in a group of 16-month-old American Indian children.

Methods: The study is an ongoing longitudinal study of risk factors for caries in children from a Northern Plains Tribal community. Children were examined for caries and risk factor data collected at approximately 1, 4, 8, 12, and 16 months of age. Surface-specific caries data were collected and the presence of precavitated "white spot" lesions was recorded at the subject level.

Results: The mean age was 15.4 months for the sample of 232 children. Caries prevalence was 31.9 percent, while an additional 29.3 percent had white spot lesions only. Mean dmfs was 1.57, and ranged from 0 to 44 surfaces. Nearly 3 percent of all erupted tooth surfaces were affected and maxillary central incisors had the highest prevalence of caries (22 percent).

Conclusions: Among the very youngest children, dental caries prevalence was very high among these American Indian children.
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http://dx.doi.org/10.1111/j.1752-7325.2012.00372.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509261PMC
May 2013

Using chlorhexidine varnish to prevent early childhood caries in American Indian children.

J Public Health Dent 2013 26;73(1):24-31. Epub 2012 Jun 26.

Pediatric Health Research Consultant, White Salmon, WA 98672, USA.

Objectives: To test the efficacy of 10% chlorhexidine (CHX) dental varnish applied to the mothers' dentition in preventing caries in American Indian children.

Methods: This was a placebo-controlled, double-blind, randomized clinical trial. Mother-child pairs were enrolled when the child was 4.5-6.0 months. Mothers received 4 weekly applications of the study treatment (CHX or placebo) followed by single applications when her child was age 12 and 18 months. Children received caries examinations at enrollment, 12, 18 and 24 months. Analyses were limited to the intent-to-treat (ITT) group: children whose mothers received the first study treatment and who received at least one post-baseline exam. The outcome variable was the number of new carious surfaces (NNCS) at the child's last visit. Wilcoxon nonparametric and Fisher's exact tests were used to test differences between the active and placebo groups.

Results: We randomized 414 mother-child pairs, with 367 (88.6%) included in the ITT group (active = 188, placebo = 179). The proportion of children caries-free at their final exam was 51.1% and 50.8% for the active and placebo groups (P > 0.99). The mean NNCS for the active and placebo groups was 3.82 (standard deviation [SD] = 8.18) and 3.80 (SD = 6.08), respectively (P = 0.54). The proportion with NNCS > 6 was 18.1% for active children versus 27.9% for placebo (relative risk [RR] = 0.65, P = 0.03). The number needed to treat to shift one child from NNCS > 6 to a lower severity was 10.2.

Conclusions: In this population CHX varnish did not reduce the mean NNCS or proportion of children with caries, but did reduce the proportion with severe caries.
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http://dx.doi.org/10.1111/j.1752-7325.2012.00348.xDOI Listing
August 2013

State oral health infrastructure and capacity: lessons learned from other states.

J Public Health Dent 2012 ;72 Suppl 1:S41-4

Association of State and Territorial Dental Directors, Davis, CA, USA.

This paper discusses some preliminary findings from the Infrastructure Enhancement Project conducted by the Association of State and Territorial Dental Directors (ASTDD), which focuses on state oral health programs and their roles in addressing core public health functions and essential public health services. Findings from analysis of state data since 2000, surveys, reports, and key informant interviews substantiate the value of the following: a) state oral health surveillance; b) oral health improvement plans; c) collaborations and coalitions; d) evidence-based practices and evaluation; e) diversified funding; f) placement and authority of the programs and directors; and g) competencies versus staffing formulas. No single program model fits all the unique populations and political and economic variations among states. Each state is encouraged to use the many tools, resources, and best practices/lessons learned available through ASTDD, federal agencies, and national organizations to design effective and sustainable programs.
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http://dx.doi.org/10.1111/j.1752-7325.2011.00308.xDOI Listing
May 2012

Prevalence and severity of dental caries among American Indian and Alaska Native preschool children.

J Public Health Dent 2012 20;72(3):208-15. Epub 2012 Apr 20.

Oral Health Surveillance Consultant, Morro Bay, CA 93442, USA.

Objectives: To describe the Indian Health Service (IHS) oral health surveillance system and the oral health status of American Indian and Alaska Native (AI/AN) children aged 1-5 years.

Methods: A stratified probability sample of IHS/tribal sites was selected. Children were screened by trained examiners at community-based locations including medical clinics, Head Start, preschools, kindergarten, and Women, Infants, and Children (WIC). Data collection was limited to the primary dentition and included number of teeth present plus number of teeth with cavitated lesions, restorations, and extracted because of decay. Number of molars with sealants and urgency of need for dental care data were also obtained. Statistical analyses were performed with SAS (SAS Institute Inc., Cary, NC, USA). Sample weights were used to produce population estimates based on selection probabilities.

Results: A total of 8,461 AI/AN children 12-71 months of age were screened at 63 IHS/tribal sites, approximately 7 percent of the estimated IHS user population of the same age. Overall, 54 percent of the children had decay experience, 39 percent had untreated decay, 7 percent had primary molar sealants, 36 percent needed early or urgent dental care, and 6 percent needed urgent dental care. The mean of decayed, missing, or filled teeth was 3.5 (95 percent confidence interval, 3.1-3.9). The prevalence of decay experience increased with age; 21 percent of 1-year-olds and 75 percent of 5-year-olds had a history of caries. When stratified by IHS area, there were substantial differences in the oral health of preschool children.

Conclusions: The results confirm that in the United States, AI/AN children served by IHS/tribal programs are one of the racial/ethnic groups at highest risk of caries.
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http://dx.doi.org/10.1111/j.1752-7325.2012.00331.xDOI Listing
January 2013

California's state oral health infrastructure: opportunities for improvement and funding.

J Calif Dent Assoc 2012 Jan;40(1):31-7

Diringer and Associates, San Luis Obispo, CA 93406, USA.

California has virtually no statewide dental public health infrastructure leaving the state without leadership, a surveillance program, an oral health plan, oral health promotion and disease prevention programs, and federal funding. Based on a literature review and interviews with 15 oral health officials nationally, the paper recommends hiring a state dental director with public health experience, developing a state oral health plan, and seeking federal and private funding to support an office of oral health.
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January 2012

Language and literacy relate to lack of children's dental sealant use.

Community Dent Oral Epidemiol 2011 Aug 29;39(4):318-24. Epub 2010 Dec 29.

Preventive and Restorative Dental Sciences, Division of Oral Epidemiology and Dental Public Health, University of California, San Francisco, CA, USA.

Objectives: This study aimed to determine the percent of California's third grade public school children lacking sealants by child and family factors and to measure social disparities for lacking sealants.

Methods: The study analyzed data from the California Oral Health Needs Assessment (COHNA) 2004-2005, a complex stratified cluster sample of children (n = 10,450) from 182 randomly selected public elementary schools in California. The dependent variable was absence of sealants in first permanent molars. The independent variables included child race/ethnicity; socio-economic position (SEP) measured as child's participation in the free or reduced-price lunch program at the individual and school level; acculturation measured as language spoken at home and school level percent of English language learners; and parent functional health literacy measured as correctly following questionnaire instructions. Absolute differences and health disparity indices (i.e. Slope Index of Inequality, Relative Index of Inequality-mean, Absolute Concentration Index) were used to measure absolute and relative disparities.

Results: The percent of children lacking sealants was high in all racial/ethnic groups; no child or school level SEP differences in lacking sealants were seen, but significant differences existed by acculturation (child and school level) and parental functional health literacy.

Conclusions: NonEnglish language and poor parental functional health literacy are potential barriers that need to be addressed to overcome disparities in sealant utilization.
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http://dx.doi.org/10.1111/j.1600-0528.2010.00599.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136547PMC
August 2011

The assessment of nursing caries and its relationship to high caries in the permanent dentition. 1992.

J Indiana Dent Assoc 2010 ;89(2):20-4

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November 2010

Periodontal conditions in elderly men with and without osteoporosis or osteopenia.

J Periodontol 2010 Oct;81(10):1396-402

Faculty of Dentistry, Periodontology, The University of Hong Kong, Hong Kong, China.

Background: The purpose of this case-control study is to investigate the periodontal conditions in elderly men with and without osteoporosis or osteopenia and to determine their possible association with periodontal destruction.

Methods: A total of 200 community-dwelling Chinese males (age range: 69 to 78 years; mean ± SD age: 71.9 ± 3.3 years) were recruited from the Jockey Club Center for Osteoporosis Care and Control, The Chinese University of Hong Kong, including 67 subjects with osteoporosis, 66 subjects with osteopenia, and 67 age-matched normal control subjects based on bone mineral density at the hip, spine, and whole body measured by dual-energy x-ray densitometry. All subjects were interviewed using questionnaires and received a full-mouth periodontal examination.

Results: Subjects with osteoporosis exhibited a significantly higher percentage of sites with clinical attachment loss (AL) > or= 6 mm compared to subjects with osteopenia (P <0.05); subjects with osteoporosis also showed a greater percentage of sites with interproximal gingival recession (GR) > or = 5 mm than did control subjects (P <0.05) after excluding smokers. Subjects with osteoporosis were more likely (odds ratio = 3.3; P <0.05) to exhibit interproximal GR > or = 5 mm than were control subjects. Osteoporosis remained significantly associated with severe clinical AL and interproximal GR after adjusting for age, supragingival plaque, and number of teeth lost.

Conclusion: This study suggests that osteoporosis is associated with severe clinical AL and interproximal GR in elderly Chinese men.
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http://dx.doi.org/10.1902/jop.2010.100052DOI Listing
October 2010

No evidence to support the claim that amoxicillin causes molar-incisor hypomineralization.

Authors:
Kathy R Phipps

J Evid Based Dent Pract 2010 Jun;10(2):112-4

Oral Health Research Consultant, 255 Bradley Avenue, Morro Bay, CA 93442, USA.

Article Title And Bibliographic Information: Amoxicillin may cause molar incisor hypomineralization. Laisi S, Ess A, Sahlberg C, Arvio P, Lukinmaa PL, Alaluusua S. J Dent Res 2009;88(2):132-6.

Reviewer: Kathy R. Phipps, MPH, DrPH PURPOSE/QUESTION: Does exposure to antibiotics, specifically amoxicillin, increase a child's risk of having hypomineralized permanent first molars?

Source Of Funding: The Academy of Finland (government) and the Finnish Dental Society Apollonia (nonprofit)

Type Of Study/design: Two studies were presented, one was laboratory the other was a retrospective cohort

Level Of Evidence: Level 2: Limited-quality, patient-oriented evidence

Strength Of Recommendation Grade: Not applicable.
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http://dx.doi.org/10.1016/j.jebdp.2010.02.015DOI Listing
June 2010

Periodontal health of older men: the MrOS dental study.

Gerodontology 2009 Jun;26(2):122-9

Oregon Health & Science University, Portland, OR, USA.

Objective: The purpose of this study was to evaluate the prevalence and severity of periodontitis in men of 65+ years and identify demographic and lifestyle factors associated with its presence.

Methods: Participants were recruited from the Osteoporotic Fractures in Men Study, a longitudinal study of risk factors for fractures in older men. Dental measures included clinical attachment loss (CAL), pocket depth (PD), calculus, plaque and bleeding on a random half-mouth, plus a questionnaire regarding access to care, symptoms and previous diagnosis.

Results: 1210 dentate men completed the dental visit. Average age was 75 years, 39% reported some graduate school education, 32% smoked 20 + pack years and 88% reported their overall health as excellent/good. In terms of periodontal health, 38% had sub-gingival calculus, 53% gingival bleeding, 82% CAL > or =5 mm and 34% PD > or =6 mm. The prevalence of severe periodontitis was 38%. Significant demographic and lifestyle factors associated with severe periodontitis in multivariate analyses included age > or =75 (OR 1.4, 95% CI 1.1-1.7) non-white race (OR 1.9, 95% CI 1.3-2.8), less than an annual dental visit (OR 1.5, 95% CI 1.1-2.0), and 20 + pack years (OR 2.1, 95% CI 1.6-2.7).

Conclusion: A high proportion of healthy older men have evidence of periodontal destruction which could, given the growing ageing population, have a significant impact on the dental profession's ability to provide preventive and therapeutic care. The population at highest risk of periodontitis in MrOS is older minority men who smoke and do not have annual dental visits.
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http://dx.doi.org/10.1111/j.1741-2358.2008.00231.xDOI Listing
June 2009

Development and status of the National Oral Health Surveillance System.

Prev Chronic Dis 2009 Apr 16;6(2):A66. Epub 2009 Mar 16.

Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.

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. The Web site that describes the National Oral Health Surveillance System (http://www.cdc.gov/nohss/) and provides access to current indicators was launched in 2001 with adult and water fluoridation data for all states; child indicators were added later. Data are now available electronically for 35 to 51 states (including the District of Columbia), depending on the indicator, indicating progress toward state-specific monitoring of these oral health indicators.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687872PMC
April 2009

Testosterone and estradiol among older men.

J Clin Endocrinol Metab 2006 Apr 20;91(4):1336-44. Epub 2005 Dec 20.

CR113, Oregon Health & Science University, 3181 SW Sam Jackson Park, Portland, Oregon 97239, USA.

Context: Testosterone and estradiol levels decline with age in men. This change may affect multiple clinical outcomes, but there have been few reports of the distribution and correlates of testosterone and estradiol concentrations in elderly men.

Objective: The purpose of these studies was to assess sex steroid levels in a large cohort of older men.

Design: We conducted a cross-sectional cohort evaluation.

Setting: Community-dwelling men were studied at six academic medical centers in the United States.

Participants: The Osteoporotic Fractures in Men Study is a prospective cohort of men aged at least 65 yr. In these studies, a randomly selected stratified subsample of 2623 participants was analyzed.

Main Outcome Measures: We assessed levels of total and free testosterone and estradiol and SHBG.

Results: Age was inversely associated with free testosterone and free estradiol levels (P for trend = 0.001 for both). Notably, at any age, there was substantial variation in levels of each hormone. Free testosterone levels were lower in men with greater body mass index, lower SHBG, and poorer self-reported health status and in those of Asian race. Free estradiol concentrations were lower in men with lower body mass index and higher SHBG levels. Free estradiol and free testosterone were modestly correlated (r = 0.20; P < 0.001), but at any level of free testosterone, there was considerable variation in free estradiol levels.

Conclusions: This is the largest cohort of older men in which sex steroid levels are available, and it demonstrates that testosterone and estradiol, and their free fractions, tend to decline with age even among older men. However, substantial variation is also present. The relationships between sex steroid levels and their consequences in aging are likely to be complex.
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http://dx.doi.org/10.1210/jc.2005-1830DOI Listing
April 2006

Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study--a large observational study of the determinants of fracture in older men.

Contemp Clin Trials 2005 Oct;26(5):569-85

Oregon Health and Science University, CR 113, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.

Very little information is available to direct the prevention or management of osteoporosis in men. The Osteoporotic Fractures in Men (MrOS) Study is a prospective cohort study designed to examine the extent to which fracture risk is related to bone mass, bone geometry, lifestyle, anthropometric and neuromuscular measures, and fall propensity, as well as to determine how fractures affect quality of life in men. The study is also designed to understand how osteoporosis is related to prostate disease. At baseline, participants completed questionnaires regarding medical history, medications, physical activity, diet, alcohol intake, and cigarette smoking. Objective measures of anthropometric, neuromuscular, vision, strength, and cognitive variables were obtained. Skeletal assessments included DEXA, calcaneal ultrasound, and vertebral radiographs. Vertebral and proximal femoral QCT was performed on a subset (65%). Serum, urine, and DNA specimens were collected. After the baseline assessments, a questionnaire is mailed to participants every 4 months to ascertain incident falls, fractures, prostate cancer, and deaths. After an average of 4.5 years, participants are scheduled to return for a second comprehensive visit. Men were eligible if > or =65 years. 5995 men enrolled with a mean (+/-SD) age of 73.7 (+/-5.9) years, 11% of which were minorities. Most rated their health as good/excellent. Few were current smokers, although 59% had smoked previously, and 35% reported no alcohol intake, while 47% consumed at least 2 drinks per week. The mean (range) body mass index was 26.9 kg/m2 (17-56). A non-traumatic fracture after age 50 was reported by 17% of the cohort. The MrOS cohort should provide valuable information concerning the determinants of fracture in men and should help set the stage for the development of effective methods to identify those at risk.
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http://dx.doi.org/10.1016/j.cct.2005.05.006DOI Listing
October 2005