Creating career pathways to facilitate current dental and other healthcare providers becoming den... more Creating career pathways to facilitate current dental and other healthcare providers becoming dental therapists can be an efficient means to expand the dental workforce and reduce barriers to access to oral health services. Career pathways are proposed to facilitate dental providers building on previously learned skills to broaden their scope of practice and become even more versatile and productive providers of oral health services. Creation of a unified and integrated curriculum will enable research to document the effectiveness of this new dental provider who will work as part of dental teams and with supervision by dentists. The goal of augmenting the current dental team and reducing barriers to access to dental services for underserved populations can be enhanced by offering alternative pathways to achieve the competencies required of dental therapists.
The inadequacy of access to oral health care is a complex problem facing society. Many in society... more The inadequacy of access to oral health care is a complex problem facing society. Many in society who need care are unable to obtain it or do not seek it for a variety of reasons. Most commonly, these are the unfunded, who simply have inadequate resources; the "unaccepted," who may not have dental coverage or have types of coverage that are not accepted by private practitioners; the inaccessible, who may be homebound or live in sparsely populated or low-income geographic areas without dental providers; the unconvinced, who may have resources but do not believe in or recognize the need for treatment; and the unmotivated, who may realize that they need care but for them it is not a priority. While the oral health care professions cannot be expected to shoulder the entire burden to "fix" inadequate access to care, we believe that they have important responsibilities. True professions have a unique relationship with society that places them in positions of trust. With this trust comes the responsibility for public policy advocacy and to actively participate in identifying realistic ways to reduce the access problem. The leadership of organized dentistry, as well as educational institutions, and practitioners themselves must be committed to improving access and thereby the health of those currently underserved.
This article describes the planning, sequential improvements, and outcomes of Indiana University ... more This article describes the planning, sequential improvements, and outcomes of Indiana University School of Dentistry's annual Oral Health Policy Forum. This one‐day forum for fourth‐year dental students was instituted in 2005 with the Indiana Dental Association and the Children's Dental Health Project to introduce students to the health policy process and to encourage their engagement in advocacy. Following a keynote by a visiting professor, small student groups develop arguments in favor and in opposition to five oral health policy scenarios and present their positions to a mock or authentic legislator. The “legislator” critiques these presentations, noting both effective and ineffective approaches, and the student deemed most effective by fellow students receives a gift award. During the afternoon, students tour the Indiana State House, observe deliberations, and meet with legislators. In 2009, 92 percent of students reported a positive impression of the forum, up from 60 ...
Objectives: This study assessed the knowledge of Indiana dentists and dental hygienists about flu... more Objectives: This study assessed the knowledge of Indiana dentists and dental hygienists about fluoride's predominant mode of action and their protocols for the use of fluoride for dental caries prevention. Methods: In 2000, questionnaires were mailed to 6,681 Indiana dentists and hygienists prior to the 2001 release of recommendations for the use of fluoride by the US Centers for Disease Control and Prevention. In 2005, the questionnaires were again sent to Indiana dental professionals to assess changes in knowledge and protocols. In addition, a 10 percent sample of Illinois dentists and hygienists were surveyed to determine the similarity of Indiana and Illinois responses. Results: Questionnaires were anonymously completed and returned. In 2000, a minority of Indiana health professionals (17 percent) correctly identified that remineralization was fluoride's predominant mode of action. There was a significant increase in Indiana respondents correctly identifying this
Objectives: To ascertain what proportion of dental hygienists and dentists in Indiana, United Sta... more Objectives: To ascertain what proportion of dental hygienists and dentists in Indiana, United States, support the application of fluoride varnish in medical offices, and to determine if support differed by dental provider characteristics, practice characteristics, a limited assessment of knowledge about fluoride, or use of fluoride. Methods: Practicing dental hygienists and dentists in 2005 were asked to fill out a mail questionnaire. Logistic regression models tested the association of independent variables with support for medical providers applying varnish. Results: Response rates were 36% (dental hygienists) and 37% (dentists); median year of graduation was 1988 and 1981. Sixty‐six percent of respondents were in solo practices, 82% of dentists in general practice, 5% in dental pediatrics, and 13% were other specialists. While 51.2% of dental professionals agreed that medical practices could apply fluoride varnish, 29% responded “none” should be allowed, and 19% were undecided. I...
– Objectives: To identify risk factors for dental fluorosis that cannot be explained by drinking ... more – Objectives: To identify risk factors for dental fluorosis that cannot be explained by drinking water fluoride concentration alone. Methods: Two hundred eighty‐four Tanzanian children ages 9 to 19 (mean 14.0±SD 1.69), who were life‐time residents at differing altitudes (Chanika, 100 m; Rundugai, 840 m; and Kibosho, 1,463 m; Sites 1, 2, and 3 respectively) were examined for dental fluorosis and caries. They were interviewed about their food habits, environmental characteristics and use of a fluoride‐containing food tenderizer known locally as magadi. Meal, urine, water and magadi samples supplied by the participants were analyzed for fluoride content. Urine samples were also analyzed for creatinine concentration. Four magadi samples from Sites 1 and 3 were analyzed for complete element composition. Results: Of the 13 water samples from Site 2, 10 contained 4 mg/L F, ranging from 1.26 to 12.36 mg/L with a mean±SD of 5.72±4.71± mg/L. Sites 1 and 3 had negligible water fluoride of 0.05±0.05 and 0.18±0.32 mg/L respectively. Mean TFI fluorosis scores (range 0–9) for Site 2 were high: 4.44±1.68. In Sites 1 and 3, which both had negligible water fluoride, fluorosis scores varied dramatically: Site 1 mean maxi‐mum TFI was 0.01±0.07 and Site 3 TFI was 4.39±1.52. Mean DMFS was 1.39±2.45, 0.15±0.73 and 0.19±0.61 at Sites 1, 2, and 3, respectively. There were no restorations present. Urinary fluoride values were 0.52±0.70, 4.34±7.62, and 1.43±1.80 mg/L F at Sites 1, 2, and 3, respectively. Mean urinary fluoride values at Site 3 were within the normal urinary fluoride reference value range in spite of pervasive severe pitting fluorosis. Meal and magadi analyses revealed widely varied fluoride concentrations. Concentrations ranged from 0.01 to 22.04 mg/L F for meals and from 189 to 83211 mg/L F for magadi. Complete element analysis revealed the presence of aluminum, iron, magnesium, manganese, strontium and titanium in four magadi samples. There were much higher concentrations of these elements in samples from Site 3, which was at the highest altitude and had severe enamel disturbances in spite of negligible water fluoride concentration. An analysis of covariance model supported the research hypothesis that the three communities differed significantly in mean fluorosis scores (P < 0.0001). Controlling for urinary fluoride concentration and urinary fluoride:urinary creatinine ratio, location appeared to significantly affect fluorosis severity. Urinary fluoride:urinary creatinine ratio had a stronger correlation than urinary fluoride concentration with mean TFI fluorosis scores (r=0.43 vs r=0.25). Conclusions: The severity of enamel disturbances at Site 3 (1463 m) was not consistent with the low fluoride concentration in drinking water, and was more severe than would be expected from the subjects' normal urinary fluoride values. Location, fluoride in magadi, other elements found in magadi, and malnutrition are variables which may be contributing to the severity of dental enamel disturbances occurring in Site 3. Altitude was a variable which differentiated the locations.
Creating career pathways to facilitate current dental and other healthcare providers becoming den... more Creating career pathways to facilitate current dental and other healthcare providers becoming dental therapists can be an efficient means to expand the dental workforce and reduce barriers to access to oral health services. Career pathways are proposed to facilitate dental providers building on previously learned skills to broaden their scope of practice and become even more versatile and productive providers of oral health services. Creation of a unified and integrated curriculum will enable research to document the effectiveness of this new dental provider who will work as part of dental teams and with supervision by dentists. The goal of augmenting the current dental team and reducing barriers to access to dental services for underserved populations can be enhanced by offering alternative pathways to achieve the competencies required of dental therapists.
The inadequacy of access to oral health care is a complex problem facing society. Many in society... more The inadequacy of access to oral health care is a complex problem facing society. Many in society who need care are unable to obtain it or do not seek it for a variety of reasons. Most commonly, these are the unfunded, who simply have inadequate resources; the "unaccepted," who may not have dental coverage or have types of coverage that are not accepted by private practitioners; the inaccessible, who may be homebound or live in sparsely populated or low-income geographic areas without dental providers; the unconvinced, who may have resources but do not believe in or recognize the need for treatment; and the unmotivated, who may realize that they need care but for them it is not a priority. While the oral health care professions cannot be expected to shoulder the entire burden to "fix" inadequate access to care, we believe that they have important responsibilities. True professions have a unique relationship with society that places them in positions of trust. With this trust comes the responsibility for public policy advocacy and to actively participate in identifying realistic ways to reduce the access problem. The leadership of organized dentistry, as well as educational institutions, and practitioners themselves must be committed to improving access and thereby the health of those currently underserved.
This article describes the planning, sequential improvements, and outcomes of Indiana University ... more This article describes the planning, sequential improvements, and outcomes of Indiana University School of Dentistry's annual Oral Health Policy Forum. This one‐day forum for fourth‐year dental students was instituted in 2005 with the Indiana Dental Association and the Children's Dental Health Project to introduce students to the health policy process and to encourage their engagement in advocacy. Following a keynote by a visiting professor, small student groups develop arguments in favor and in opposition to five oral health policy scenarios and present their positions to a mock or authentic legislator. The “legislator” critiques these presentations, noting both effective and ineffective approaches, and the student deemed most effective by fellow students receives a gift award. During the afternoon, students tour the Indiana State House, observe deliberations, and meet with legislators. In 2009, 92 percent of students reported a positive impression of the forum, up from 60 ...
Objectives: This study assessed the knowledge of Indiana dentists and dental hygienists about flu... more Objectives: This study assessed the knowledge of Indiana dentists and dental hygienists about fluoride's predominant mode of action and their protocols for the use of fluoride for dental caries prevention. Methods: In 2000, questionnaires were mailed to 6,681 Indiana dentists and hygienists prior to the 2001 release of recommendations for the use of fluoride by the US Centers for Disease Control and Prevention. In 2005, the questionnaires were again sent to Indiana dental professionals to assess changes in knowledge and protocols. In addition, a 10 percent sample of Illinois dentists and hygienists were surveyed to determine the similarity of Indiana and Illinois responses. Results: Questionnaires were anonymously completed and returned. In 2000, a minority of Indiana health professionals (17 percent) correctly identified that remineralization was fluoride's predominant mode of action. There was a significant increase in Indiana respondents correctly identifying this
Objectives: To ascertain what proportion of dental hygienists and dentists in Indiana, United Sta... more Objectives: To ascertain what proportion of dental hygienists and dentists in Indiana, United States, support the application of fluoride varnish in medical offices, and to determine if support differed by dental provider characteristics, practice characteristics, a limited assessment of knowledge about fluoride, or use of fluoride. Methods: Practicing dental hygienists and dentists in 2005 were asked to fill out a mail questionnaire. Logistic regression models tested the association of independent variables with support for medical providers applying varnish. Results: Response rates were 36% (dental hygienists) and 37% (dentists); median year of graduation was 1988 and 1981. Sixty‐six percent of respondents were in solo practices, 82% of dentists in general practice, 5% in dental pediatrics, and 13% were other specialists. While 51.2% of dental professionals agreed that medical practices could apply fluoride varnish, 29% responded “none” should be allowed, and 19% were undecided. I...
– Objectives: To identify risk factors for dental fluorosis that cannot be explained by drinking ... more – Objectives: To identify risk factors for dental fluorosis that cannot be explained by drinking water fluoride concentration alone. Methods: Two hundred eighty‐four Tanzanian children ages 9 to 19 (mean 14.0±SD 1.69), who were life‐time residents at differing altitudes (Chanika, 100 m; Rundugai, 840 m; and Kibosho, 1,463 m; Sites 1, 2, and 3 respectively) were examined for dental fluorosis and caries. They were interviewed about their food habits, environmental characteristics and use of a fluoride‐containing food tenderizer known locally as magadi. Meal, urine, water and magadi samples supplied by the participants were analyzed for fluoride content. Urine samples were also analyzed for creatinine concentration. Four magadi samples from Sites 1 and 3 were analyzed for complete element composition. Results: Of the 13 water samples from Site 2, 10 contained 4 mg/L F, ranging from 1.26 to 12.36 mg/L with a mean±SD of 5.72±4.71± mg/L. Sites 1 and 3 had negligible water fluoride of 0.05±0.05 and 0.18±0.32 mg/L respectively. Mean TFI fluorosis scores (range 0–9) for Site 2 were high: 4.44±1.68. In Sites 1 and 3, which both had negligible water fluoride, fluorosis scores varied dramatically: Site 1 mean maxi‐mum TFI was 0.01±0.07 and Site 3 TFI was 4.39±1.52. Mean DMFS was 1.39±2.45, 0.15±0.73 and 0.19±0.61 at Sites 1, 2, and 3, respectively. There were no restorations present. Urinary fluoride values were 0.52±0.70, 4.34±7.62, and 1.43±1.80 mg/L F at Sites 1, 2, and 3, respectively. Mean urinary fluoride values at Site 3 were within the normal urinary fluoride reference value range in spite of pervasive severe pitting fluorosis. Meal and magadi analyses revealed widely varied fluoride concentrations. Concentrations ranged from 0.01 to 22.04 mg/L F for meals and from 189 to 83211 mg/L F for magadi. Complete element analysis revealed the presence of aluminum, iron, magnesium, manganese, strontium and titanium in four magadi samples. There were much higher concentrations of these elements in samples from Site 3, which was at the highest altitude and had severe enamel disturbances in spite of negligible water fluoride concentration. An analysis of covariance model supported the research hypothesis that the three communities differed significantly in mean fluorosis scores (P < 0.0001). Controlling for urinary fluoride concentration and urinary fluoride:urinary creatinine ratio, location appeared to significantly affect fluorosis severity. Urinary fluoride:urinary creatinine ratio had a stronger correlation than urinary fluoride concentration with mean TFI fluorosis scores (r=0.43 vs r=0.25). Conclusions: The severity of enamel disturbances at Site 3 (1463 m) was not consistent with the low fluoride concentration in drinking water, and was more severe than would be expected from the subjects' normal urinary fluoride values. Location, fluoride in magadi, other elements found in magadi, and malnutrition are variables which may be contributing to the severity of dental enamel disturbances occurring in Site 3. Altitude was a variable which differentiated the locations.
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