Dental research paper

Family doctors' fluoride savvy, effects of childhood cavities on quality of life are among topics U-M researchers will discuss at national meeting.

University of Michigan School of Dentistry researchers will present papers on a wide range of topics at a meeting of the International Association for Dental Research in San Diego, Calif., March 6-9. Here are highlights of some of their presentations:

TESTING DOCTORS' FLUROIDE SAVVY. Because most children don't visit a dentist until around age 3, family physicians and pediatricians have an important role to play in assessing youngsters' oral health and educating their parents about tooth decay prevention. Professor Amid Ismail and colleagues surveyed about 2,400 physicians nationwide to find out how well they're able to carry out that role. In particular, the researchers wanted to know whether doctors consider a child's risk of developing dental caries (tooth decay) when recommending fluoride supplements.

They gave the doctors a questionnaire that included two case scenarios---one for an upper middle class child with no dental problems, the other for a child in a low-income family with visible dental caries---and asked what they would recommend. The researchers then compared the physicians' answers with "gold standard" answers provided by the Centers for Disease Control and Prevention's Division of Oral Health.

Of the 1,045 physicians who filled out and returned the questionnaire, most had a general understanding of the importance of fluoride in preventing tooth decay, but they failed to base their recommendations on the individual child's current needs or risk of developing caries in the future.

"Even though we had two scenarios---one child who doesn't need much care right now and one who really does need immediate care---their answers were not that different, especially with regard to fluoride supplement use. It was kind of automatic," says Woosung Sohn, who collaborated with Ismail on the project. "So we think doctors should be re-informed about how to assess a child's dental caries risk before recommending fluoride supplements."

As a first step, the researchers have developed an educational CD-ROM to help physicians make appropriate recommendations about fluoride use and other oral health matters. The CD-ROM will be used as part of a continuing medical education course at Wayne State University in Detroit and will be distributed to physicians at federally funded health care centers in the Detroit area.

KIDS AND CAVITIES---MORE THAN A TOOTHACHE. Children who get cavities in their baby teeth---known as early childhood caries or baby bottle tooth decay---suffer more than just an occasional toothache, a study by pediatric dentistry graduate student Sara L. Filstrup has found. They often suffer loss of sleep, impaired concentration, and even a poorer social life.

Filstrup and colleagues interviewed children ages 2� to 6 years who had severe dental caries. The children reported that mouth pain frequently kept them awake at night, interfered with their ability to pay attention in school, and prevented them from eating. In fact, research shows that such children typically weigh only 80 percent as much as other children their age. Their parents, too, reported that the children's oral health problems kept them from playing with other kids and disrupted their sleep. When dentists examined the children's mouths, they found that kids whose parents reported the most quality of life problems had the most severe dental problems.

The children's tooth decay was treated; then their parents were quizzed again four weeks later. "The difference was like night and day," says Associate Professor Marita Inglehart, who collaborated with Filstrup on the work. "The parents said their kids were happier, could play better, and slept through the night."

Inglehart has submitted a proposal for a three-year study aimed at finding ways to educate parents and teachers about the impact of dental problems on children's lives. She hopes to create a Web site for teachers and intervention workshops for parents.

"If you tell a parent their child has 61 percent decayed surfaces in the mouth, they'll say, 'Um-hmm. OK.' But if you tell them, 'The reason your child can't concentrate in school and gets bad grades isn't because they have ADD; it's because they have a toothache,' they'll understand how serious the problem is."

HOW HEALTHY? IT DEPENDS. Significant numbers of people who consider their overall health to be good or excellent rate their oral health as only fair to poor, a study of 560 adults in the Detroit metropolitan area showed.

"Oral health and general health are actually quite closely related, but people separate them in their minds," says assistant research scientist Woosung Sohn, who will present the study results on March 8. "In this study, among those who thought they were healthy, one-third perceived their oral health as fair to poor."

Those who considered their oral health to be under par had higher dental anxiety, lower educational levels, and lower incomes and were less likely to receive regular dental care than those who rated their oral health as good to excellent. The researchers also measured the patients' well-being and quality of life using a standard scale and found that those in the poor oral health group had significantly lower scores. (More research is needed to separate out cause and effect, says Sohn.) In addition, African Americans were more likely to be in this group, but age and gender appeared to have no effect on perceived oral health.

DENTURE DISTRESS. What impact does wearing dentures have on a person's life? In a study of patients fitted with dentures over the past decade, dentistry student Steven A. Gray found that about half reported no problems at all; one quarter said the dentures didn't work quite as well as their natural teeth did, and another quarter were absolutely miserable. Gray and colleagues had thought that the patients who reported the most denture distress might be older people who were fitted years ago, but that turned out not to be true. They did find, however, that the most miserable patients also reported the most general health problems.

Now Gray and colleagues are looking at the patients' X-rays to find out whether there's a physical explanation for their agony. It may be that they have lost too much bone for conventional dentures to fit properly. If so, they may be candidates for a new type of denture that is held in place by dental implants. It's also possible that these patients are suffering from untreated depression. Another study is planned to examine this possibility.

The U-M School of Dentistry is one of the nation's leading dental schools engaged in oral health care education, research, patient care, and community service. General dental care clinics and specialty clinics providing advanced treatment enable the School to offer dental services and programs to patients throughout Michigan. Classroom and clinic instruction train future dentists, dental specialists, and dental hygienists for practice in private offices, hospitals, academia, and public agencies. Research seeks to discover and apply new knowledge that can help patients worldwide. More information is available on the Web at http://www.dent.umich.edu.

or Jerry Mastey, 734-615-1971, [email protected]

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