- Email: [email protected]
Infection precautions
lower socioeconomic status significantly increased the chance that persons would report non-use of dental care related to cost.
Clinical Significance.—Dental non-attendance among older persons because of cost is a relatively small problem in the European countries. Thus health care decision-makers should be aware that the extension of social health insurance coverage for dental care may only help a small population subgroup and will not address the problems seen in the larger population that does not access dental care. Factors unrelated to costs must be at work, possibly
related to lower level of education, lower socioeconomic status, and poor general and oral health.
Listl S: Cost-related dental non-attendance in older adulthood: Evidence from eleven European countries and Israel. Gerodontology 33:253-259, 2016 Reprints available from S Listl, Dept of Conservative Dentistry, Heidelberg Univ, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; fax: þ49-6221-56-5074; e-mail: [email protected]
Emerging Infections Infection precautions Background.—Infectious diseases are considered emerging when the number of persons who are contracting them increases over the previous 20 years or when such an increase is threatened. Those that are readily transferred from person to person have the potential to spread rapidly throughout the world. Among the recent emerging infections are severe acute respiratory syndrome (SARS), MERS CoV, Ebola, and, most recently, Zika virus. These are largely coronaviruses or influenza viruses and are spread via droplets, aerosols, or direct contact with respiratory secretions of someone with the infection. Virus particles can survive in small droplets in the air for several hours. When influenza is circulating, dental practices may be an area where they can be transmitted because of the aerosol sprays generated by drills and ultrasonic scalers. Zika virus, however, is spread by mosquito bite and the current cases reflect patients who have traveled to areas where the mosquitoes are carrying the virus. With respect to emerging infectious diseases, the higher risk of a dental practice can be reduced by using masks and gloves, pre-procedure rinses, rubber dam, and high-volume suction. Dental Team Role.—The dental team should know what infections are emerging, be aware of incubation periods, and be informed about patients’ recent travel history. If a possibly or definitely infected person is scheduled for elective treatment, the treatment should be delayed until the incubation period or recovery period has passed to reduce the risk of transmission. If the
18
Dental Abstracts
treatment need is urgent, the dental professionals should seek advice from health protection colleagues before providing care and use full protective equipment during the procedure. The key information for the dental team is whether a new infection affects the respiratory or digestive tracts, what geographical regions are considered high-risk areas, and what the incubation period is. They should also search for any advice issued by health protection experts or government health departments. Often the dental health team is overlooked when new infections emerge and they do not routinely receive this information. Future Steps.—Public health organizations should consider appointing an individual who is responsible for emerging infections and dental practice notification and support. There should also be a strong link between health protection agencies and medical and dental professionals so that appropriate actions can be taken to minimize the spread of infection.
Clinical Significance.—Most emerging infections that have spread worldwide and cause significant loss of life affect the respiratory tract. Therefore dental professionals should be vigilant about obtaining up-to-date infection
information and know what precautions should be taken to keep themselves, the dental staff, and other patients safe.
Monaghan NP: Emerging infections – implications for dental care. Br Dent J 221:13-15, 2016 Reprints available from NP Monaghan, Public Health Wales, Temple of Peace and Health, Cathay’s Park, Cardiff, CF10 3NW; e-mail: [email protected]
Periodontal Disease Prevalence estimates in the US Background.—Nearly half of all adults age 30 years or older in the United States are affected by periodontitis. A Healthy People 2020 objective is to reduce the prevalence of moderate and severe periodontitis in US adults. To address the problem it’s important to know where the prevalence is highest and target effective programs for those populations. Currently the state and local levels of periodontitis are not well characterized, yet this is where most of the public health programs are instituted. Therefore, the Centers for Disease Control and Prevention (CDC) started a Periodontal Disease Surveillance Initiative in 2003 in association with the American Academy of Periodontology (AAP) to seek a valid, reliable, and minimally resource-requiring way to estimate the prevalence of periodontitis at subnational levels. Modeling of combined sociodemographic, poverty, and risk factor measures holds promise for predicting periodontitis prevalence in adults. A multilevel regression and poststratification (MRP) approach was undertaken in the United States that incorporates various individual-level risk factors and may accurately determine the prevalence of adult periodontitis at multiple political and geographic levels. Methods.—The assessment focused on obtaining an estimate of the prevalence of periodontitis among adults age 30 to 79 years at state, county, congressional district, and census tract levels based on data from the National Health and Nutrition Examination Survey (NHANES) 2009-2012, population counts from the 2010 US census, and smoking status estimates from the 2012 Behavioral Risk Factor Surveillance System. The small area estimation (SAE) method used age, race/ethnicity, gender, smoking status, and poverty factors to estimate periodontitis prevalence using the definition promoted by the CDC and AAP for census block levels. Larger administrative and geographic areas were estimated using aggregation. The estimates based on the models were validated against national estimates directly from NHANES 2009-2012. Results.—The model-based estimates were statistically similar to the NHANES estimates at the national level and within the subgroups of gender, age, race/ethnicity, smoking status, and poverty status. At the state level, the model
estimated a low prevalence of 37.7% in Utah up to a high of 52.7% in New Mexico, which represented an estimated 15% disparity among the states. At the county level, the low was 33.7% and the high was 68%, with a mean of 46.6% and a median of 45.9%. The disparity among states was much greater at 34%. Considering severe periodontitis prevalence at the state level, New Hampshire had the lowest prevalence at 6.4% and Louisiana had the highest at 11.3%. County-level prevalence was a low of 5.2% and a high of 17.9%. Aggregation to the national level yielded a mean and median state prevalence of 45.1% and 44.9%, respectively. For counties the mean was 46.6% and the median 45.9%. The NHANES 2009-2012 data estimated a national prevalence among US adults of 44.8%. The summary measures for severe periodontitis at state and county levels were also comparable to the estimated national prevalence. Considered geographically, the highest estimated prevalence of periodontitis was noted in southeastern and southwestern states, with pockets of higher concentrations along the Southeast, in the Mississippi delta region, along the border between the United States and Mexico, and on Native American reservations. Southern Florida, Hawaii, and remote areas of western Alaska also had high prevalence estimates. Severe periodontitis prevalence data were similar. Discussion.—The use of MRP modeling of individualand community-level data can provide a practical and valid way to predict the prevalence of adult periodontitis at state and local levels in the United States. It also allows the incorporation of individual-level risk factors such as poverty and smoking status to predict population health outcomes.
Clinical Significance.—Understanding where periodontitis is most common should help to inform oral health policy decisions and guide the development of interventions at both state
Volume 62
Issue 1
2017
19
Clinical Significance.—Dental non-attendance among older persons because of cost is a relatively small problem in the European countries. Thus health care decision-makers should be aware that the extension of social health insurance coverage for dental care may only help a small population subgroup and will not address the problems seen in the larger population that does not access dental care. Factors unrelated to costs must be at work, possibly
related to lower level of education, lower socioeconomic status, and poor general and oral health.
Listl S: Cost-related dental non-attendance in older adulthood: Evidence from eleven European countries and Israel. Gerodontology 33:253-259, 2016 Reprints available from S Listl, Dept of Conservative Dentistry, Heidelberg Univ, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; fax: þ49-6221-56-5074; e-mail: [email protected]
Emerging Infections Infection precautions Background.—Infectious diseases are considered emerging when the number of persons who are contracting them increases over the previous 20 years or when such an increase is threatened. Those that are readily transferred from person to person have the potential to spread rapidly throughout the world. Among the recent emerging infections are severe acute respiratory syndrome (SARS), MERS CoV, Ebola, and, most recently, Zika virus. These are largely coronaviruses or influenza viruses and are spread via droplets, aerosols, or direct contact with respiratory secretions of someone with the infection. Virus particles can survive in small droplets in the air for several hours. When influenza is circulating, dental practices may be an area where they can be transmitted because of the aerosol sprays generated by drills and ultrasonic scalers. Zika virus, however, is spread by mosquito bite and the current cases reflect patients who have traveled to areas where the mosquitoes are carrying the virus. With respect to emerging infectious diseases, the higher risk of a dental practice can be reduced by using masks and gloves, pre-procedure rinses, rubber dam, and high-volume suction. Dental Team Role.—The dental team should know what infections are emerging, be aware of incubation periods, and be informed about patients’ recent travel history. If a possibly or definitely infected person is scheduled for elective treatment, the treatment should be delayed until the incubation period or recovery period has passed to reduce the risk of transmission. If the
18
Dental Abstracts
treatment need is urgent, the dental professionals should seek advice from health protection colleagues before providing care and use full protective equipment during the procedure. The key information for the dental team is whether a new infection affects the respiratory or digestive tracts, what geographical regions are considered high-risk areas, and what the incubation period is. They should also search for any advice issued by health protection experts or government health departments. Often the dental health team is overlooked when new infections emerge and they do not routinely receive this information. Future Steps.—Public health organizations should consider appointing an individual who is responsible for emerging infections and dental practice notification and support. There should also be a strong link between health protection agencies and medical and dental professionals so that appropriate actions can be taken to minimize the spread of infection.
Clinical Significance.—Most emerging infections that have spread worldwide and cause significant loss of life affect the respiratory tract. Therefore dental professionals should be vigilant about obtaining up-to-date infection
information and know what precautions should be taken to keep themselves, the dental staff, and other patients safe.
Monaghan NP: Emerging infections – implications for dental care. Br Dent J 221:13-15, 2016 Reprints available from NP Monaghan, Public Health Wales, Temple of Peace and Health, Cathay’s Park, Cardiff, CF10 3NW; e-mail: [email protected]
Periodontal Disease Prevalence estimates in the US Background.—Nearly half of all adults age 30 years or older in the United States are affected by periodontitis. A Healthy People 2020 objective is to reduce the prevalence of moderate and severe periodontitis in US adults. To address the problem it’s important to know where the prevalence is highest and target effective programs for those populations. Currently the state and local levels of periodontitis are not well characterized, yet this is where most of the public health programs are instituted. Therefore, the Centers for Disease Control and Prevention (CDC) started a Periodontal Disease Surveillance Initiative in 2003 in association with the American Academy of Periodontology (AAP) to seek a valid, reliable, and minimally resource-requiring way to estimate the prevalence of periodontitis at subnational levels. Modeling of combined sociodemographic, poverty, and risk factor measures holds promise for predicting periodontitis prevalence in adults. A multilevel regression and poststratification (MRP) approach was undertaken in the United States that incorporates various individual-level risk factors and may accurately determine the prevalence of adult periodontitis at multiple political and geographic levels. Methods.—The assessment focused on obtaining an estimate of the prevalence of periodontitis among adults age 30 to 79 years at state, county, congressional district, and census tract levels based on data from the National Health and Nutrition Examination Survey (NHANES) 2009-2012, population counts from the 2010 US census, and smoking status estimates from the 2012 Behavioral Risk Factor Surveillance System. The small area estimation (SAE) method used age, race/ethnicity, gender, smoking status, and poverty factors to estimate periodontitis prevalence using the definition promoted by the CDC and AAP for census block levels. Larger administrative and geographic areas were estimated using aggregation. The estimates based on the models were validated against national estimates directly from NHANES 2009-2012. Results.—The model-based estimates were statistically similar to the NHANES estimates at the national level and within the subgroups of gender, age, race/ethnicity, smoking status, and poverty status. At the state level, the model
estimated a low prevalence of 37.7% in Utah up to a high of 52.7% in New Mexico, which represented an estimated 15% disparity among the states. At the county level, the low was 33.7% and the high was 68%, with a mean of 46.6% and a median of 45.9%. The disparity among states was much greater at 34%. Considering severe periodontitis prevalence at the state level, New Hampshire had the lowest prevalence at 6.4% and Louisiana had the highest at 11.3%. County-level prevalence was a low of 5.2% and a high of 17.9%. Aggregation to the national level yielded a mean and median state prevalence of 45.1% and 44.9%, respectively. For counties the mean was 46.6% and the median 45.9%. The NHANES 2009-2012 data estimated a national prevalence among US adults of 44.8%. The summary measures for severe periodontitis at state and county levels were also comparable to the estimated national prevalence. Considered geographically, the highest estimated prevalence of periodontitis was noted in southeastern and southwestern states, with pockets of higher concentrations along the Southeast, in the Mississippi delta region, along the border between the United States and Mexico, and on Native American reservations. Southern Florida, Hawaii, and remote areas of western Alaska also had high prevalence estimates. Severe periodontitis prevalence data were similar. Discussion.—The use of MRP modeling of individualand community-level data can provide a practical and valid way to predict the prevalence of adult periodontitis at state and local levels in the United States. It also allows the incorporation of individual-level risk factors such as poverty and smoking status to predict population health outcomes.
Clinical Significance.—Understanding where periodontitis is most common should help to inform oral health policy decisions and guide the development of interventions at both state
Volume 62
Issue 1
2017
19