Platelet factors attenuate inflammation and rescue cognition in ageing

Identifying therapeutics to delay, and potentially reverse, age-related cognitive decline is critical in light of the increased incidence of dementia-related disorders forecasted in the growing older population1. Here we show that platelet factors transfer the benefits of young blood to the ageing brain. Systemic exposure of aged male mice to a fraction of blood plasma from young mice containing platelets decreased neuroinflammation in the hippocampus at the transcriptional and cellular level and ameliorated hippocampal-dependent cognitive impairments. Circulating levels of the platelet-derived chemokine platelet factor 4 (PF4) (also known as CXCL4) were elevated in blood plasma preparations of young mice and humans relative to older individuals. Systemic administration of exogenous PF4 attenuated age-related hippocampal neuroinflammation, elicited synaptic-plasticity-related molecular changes and improved cognition in aged mice. We implicate decreased levels of circulating pro-ageing immune factors and restoration of the ageing peripheral immune system in the beneficial effects of systemic PF4 on the aged brain. Mechanistically, we identified CXCR3 as a chemokine receptor that, in part, mediates the cellular, molecular and cognitive benefits of systemic PF4 on the aged brain. Together, our data identify platelet-derived factors as potential therapeutic targets to abate inflammation and rescue cognition in old age.

The aged hematopoietic system promotes hippocampal-dependent cognitive decline

The aged systemic milieu promotes cellular and cognitive impairments in the hippocampus. Here, we report that aging of the hematopoietic system directly contributes to the pro-aging effects of old blood on cognition. Using a heterochronic hematopoietic stem cell (HSC) transplantation model (in which the blood of young mice is reconstituted with old HSCs), we find that exposure to an old hematopoietic system inhibits hippocampal neurogenesis, decreases synaptic marker expression, and impairs cognition. We identify a number of factors elevated in the blood of young mice reconstituted with old HSCs, of which cyclophilin A (CyPA) acts as a pro-aging factor. Increased systemic levels of CyPA impair cognition in young mice, while inhibition of CyPA in aged mice improves cognition. Together, these data identify age-related changes in the hematopoietic system as drivers of hippocampal aging.

Blood factors transfer beneficial effects of exercise on neurogenesis and cognition to the aged brain

Reversing brain aging may be possible through systemic interventions such as exercise. We found that administration of circulating blood factors in plasma from exercised aged mice transferred the effects of exercise on adult neurogenesis and cognition to sedentary aged mice. Plasma concentrations of glycosylphosphatidylinositol (GPI)-specific phospholipase D1 (Gpld1), a GPI-degrading enzyme derived from liver, were found to increase after exercise and to correlate with improved cognitive function in aged mice, and concentrations of Gpld1 in blood were increased in active, healthy elderly humans. Increasing systemic concentrations of Gpld1 in aged mice ameliorated age-related regenerative and cognitive impairments by altering signaling cascades downstream of GPI-anchored substrate cleavage. We thus identify a liver-to-brain axis by which blood factors can transfer the benefits of exercise in old age.

Platelets Give a Running Start to Adult Hippocampal Neurogenesis

Exercise boosts neural stem and progenitor cell proliferation and differentiation in the dentate gyrus region of the hippocampus. In this issue of Stem Cell Reports, Leiter et al. (2019) identify acute exercise-induced platelet activation and platelet factor-4 as novel systemic mediators of adult hippocampal neurogenesis.

Therapeutic potential of systemic brain rejuvenation strategies for neurodegenerative disease

Neurodegenerative diseases are a devastating group of conditions that cause progressive loss of neuronal integrity, affecting cognitive and motor functioning in an ever-increasing number of older individuals. Attempts to slow neurodegenerative disease advancement have met with little success in the clinic; however, a new therapeutic approach may stem from classic interventions, such as caloric restriction, exercise, and parabiosis. For decades, researchers have reported that these systemic-level manipulations can promote major functional changes that extend organismal lifespan and healthspan. Only recently, however, have the functional effects of these interventions on the brain begun to be appreciated at a molecular and cellular level. The potential to counteract the effects of aging in the brain, in effect rejuvenating the aged brain, could offer broad therapeutic potential to combat dementia-related neurodegenerative disease in the elderly. In particular, results from heterochronic parabiosis and young plasma administration studies indicate that pro-aging and rejuvenating factors exist in the circulation that can independently promote or reverse age-related phenotypes. The recent demonstration that human umbilical cord blood similarly functions to rejuvenate the aged brain further advances this work to clinical translation. In this review, we focus on these blood-based rejuvenation strategies and their capacity to delay age-related molecular and functional decline in the aging brain. We discuss new findings that extend the beneficial effects of young blood to neurodegenerative disease models. Lastly, we explore the translational potential of blood-based interventions, highlighting current clinical trials aimed at addressing therapeutic applications for the treatment of dementia-related neurodegenerative disease in humans.

Response of the rabbit isolated testicular capsule at hypothermic and hyperthermic temperatures to norepinephrine, acetylcholine and prostaglandin F2 alpha

Spontaneous contractions of the adult rabbit isolated testicular capsule were found to be influenced by moderate hyperthermic and hypothermic temperature changes. The decrease in testicular capsular spontaneous contractions resulting from an exposure to 32, 40 and 42 degrees C have been shown to be influenced by the addition of NE, ACh and PGF2 alpha. Of the three neurohumoral agents studied, NE was found to cause the greatest increase and re-initiation of testicular capsular tone during both hypothermia and hyperthermia. These data indicate that endogenous levels of neurohumoral agents may play an important role in the maintenance of testicular capsular tone during exposure to hyperthermic or hypothermic conditions.

Dental hygienists' knowledge, opinions, and practices related to oral and pharyngeal cancer risk assessment

METHODS

A pre-tested, validated 62-item survey was mailed to a 1% national random sample of licensed dental hygienists, (n = 960). Four complete mailings of the instrument resulted in a 74.4% percent return rate of which 65% percent were usable (n = 464). Respondents provided information on their knowledge of oral cancer risk assessment factors, their use of health history questions to assess patients' oral cancer risks, how they conduct oral cancer examinations, and their beliefs about their oral cancer training. Data were analyzed using descriptive and inferential statistics and evaluated at a significance level of p < or = 0.05.

RESULTS

Based on responses to 14 questions, the average score on knowledge of oral cancer risk factors was 7.92, with a significant difference found among age groups and year of graduation, (p = 0.006). On average, dental hygienists assessed five of eight risk assessment items with "use of alcohol" receiving the least attention. Although nearly 100% percent agreed that oral cancer examinations for adults 40 years of age or older should be provided annually, only 66% percent reported doing so for patients on their initial appointment. Seventy-four percent believed they were adequately trained to provide oral cancer examinations, while only 27 percent agreed that they were prepared to provide tobacco cessation counseling. There was no significant correlation between knowledge of oral cancer risk factors and probing these risk factors when conducting a health history.

CONCLUSIONS

Results from this study indicate that interventions are needed to increase dental hygienists' knowledge of oral cancer risk factors, correct misinformation, and close the gap between their knowledge and its application in providing prevention and early detection services. The majority believed that they are not as knowledgeable as they could be and are interested in attending an oral cancer continuing education (CE) course.

Oral cancer knowledge and opinions among Maryland nurse practitioners

OBJECTIVES

As part of a Maryland statewide oral cancer needs assessment, a census of adult and family practice nurse practitioners was conducted to determine their knowledge of oral cancer risk factors, diagnostic procedures and related opinions.

METHODS

Information was obtained through a pretested, 40-item, self-administered mail questionnaire of 389 nurse practitioners. A second complete mailing was sent three weeks after the initial mailing; two postal card reminders were mailed at 10 and 17 days after the second mailing, which yielded a response rate of 56 percent.

RESULTS

Most nurse practitioners identified the use of tobacco, alcohol, and prior oral cancer lesions as real risk factors. But only 35 percent identified exposure to the sun as a risk for lip cancer. Respondents were not overly knowledgeable about the early signs of oral cancer, most common forms, or sites for oral cancer. Only 19 percent believed their knowledge of oral cancer was current. Nurse practitioners who reported having a continuing education course on oral cancer within the past two to five years were 3.1 times more likely to have a high score on knowledge of risk factors and 2.9 times more likely to have a high score on knowledge of both risk factors and of diagnostic procedures than were those who had never had a continuing education course.

CONCLUSIONS

The reported knowledge of oral cancer, in conjunction with opinions about level of knowledge and training, point to a need for systematic educational updates in oral cancer prevention and early detection.

Perspectives of Maryland adult and family practice nurse practitioners on oral cancer

OBJECTIVES

Because oral and pharyngeal cancer mortality in Maryland ranks seventh among states and sixth for black males, a statewide oral cancer needs assessment was conducted. The purposes of this qualitative descriptive study were to obtain indepth information on nurse practitioners' awareness and opinions of oral cancer, oral cancer examinations, and related factors. These findings were intended to supplement a previous survey conducted among Maryland nurse practitioners.

METHODS

A professional focus group moderator conducted one face-to-face focus group with 11 nurse practitioners and one telephone focus group with eight nurse practitioners. Criterion-purposeful sampling and qualitative content analysis were employed.

RESULTS

Findings showed that oral cancer is a neglected public health problem and, based on their formal training, not one considered by nurse practitioners to be their responsibility. Although aware of other cancers, none of the nurse practitioners recognized that oral cancer was a public health problem in the state. Numerous barriers were cited for this neglect, including their lack of training and, in one case, unpleasant feelings about examining the mouth. Participants concluded that oral cancer is part of their responsibilities and that they are interested in related continuing education courses.

CONCLUSIONS

The focus groups of nurse practitioners provided rich and insightful suggestions for future strategies to help solve the oral cancer problem in Maryland, which supplemented the quantitative mail survey conducted earlier.

Professional and community efforts to prevent morbidity and mortality from oral cancer

BACKGROUND

Oral and pharyngeal cancers cause significant morbidity and mortality, yet there has been little improvement in survival rates in the past 30 years. Because early diagnoses significantly increase survival rates, the authors summarize several approaches to educating and mobilizing the dental profession and the public about this problem. Clinicians are invited to initiate similar programs to catalyze change in their own communities.

METHODS

The authors found that many approaches have been used to define the problem and initiate change. These include surveys, focus groups, development of consortia, media programs, flyers, leaflets, prescription pads, legislation and professional endorsements.

RESULTS

In Maryland in 1996, only 20 percent of adults reported receiving an oral cancer examination, and most oral cancers were diagnosed at late stages by physicians, not dentists. Results of the public educational campaigns in the regions of New York/New Jersey and Maryland have not been formally evaluated, but there is a developing consensus that oral cancer diagnostic practices in the regions with active educational programs are increasing.

CONCLUSIONS

Coalitions or partnerships among individuals and organizations from government, academia, private practice, industry, the general community and the media can affect awareness about oral cancer prevention and early detection on a regional basis.

CLINICAL IMPLICATIONS

By increasing awareness of oral cancer among the dental profession and the public, earlier diagnosis of these cancers with consequent improved cure rates is likely. Providing oral cancer diagnostic services as a routine part of an oral examination also may motivate patients to visit the dentist at least once a year.

Methods employed for other systematic reviews

Two separate groups of reviewers were involved in the Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life. The training of the independent reviewers and the methodology they used differed from that of the team at the Research Triangle Institute and the University of North Carolina at Chapel Hill (RTI/UNC).

A community participatory oral health promotion program in an inner-city Latino community

OBJECTIVES

This paper reports the planning, implementation, process evaluation, and refinement of an oral health community participatory project in Mount Pleasant, an inner-city Latino neighborhood of Washington, DC. The main goal was to explore the feasibility of implementing such a project.

METHODS

The PRECEDE-PROCEED model was used to guide the planning and process evaluation of this project, in conjunction with community organizational methods. A steering committee, which met periodically, was formed to assist in program planning, implementation, and evaluation. The needs assessment of the community identified extensive dental health problems among children and deficiencies in their parents' oral health knowledge, opinions, and practices. In response, culturally appropriate health education and promotion activities were planned and implemented in collaboration with local community organizations, volunteers, and local practitioners. Process evaluation was used to provide feedback into the refinement of the community approach, which included record keeping and an inventory approach to activities completed and resources used. The overall impact and usefulness of this program were assessed informally using an anonymous open-ended questionnaire directed to members of the steering committee, and an outreach survey using a convenience sample at a local Latino health fair.

RESULTS

The implementation of such a community participatory approach was feasible and useful for building upon existing local resources and addressing oral health concerns in a community not reached by traditional dental care and health promotion initiatives. Individuals in this community showed a substantial interest in oral health matters and participated in a variety of oral health prevention activities. The community approach adhered to community-based research principles.

Parental perceptions of unmet dental need and cost barriers to care for developmentally disabled children

PURPOSE

The purpose of this investigation was to describe and assess the disparities, if any, in parental perceived cost barriers to oral health care among developmentally disabled children using a national data set.

METHODS

Data from the 1997 National Health Interview Survey (NHIS) were analyzed using a SUDAAN statistical package.

RESULTS

After adjusting for age and sex, parental perception of unmet need was significantly associated with developmentally disabled children 2-17 years in lower socioeconomic groups.

CONCLUSIONS

Though most children from lower socioeconomic groups are eligible for Medicaid coverage, parents of these children perceive cost barriers to dental care. Children with developmental disabilities face even more perceived barriers to care based on family income.

Maryland dental hygienists' assessment of patients' risk behaviors for oral cancer

PURPOSE

This study examined Maryland dental hygienists' knowledge of tobacco and alcohol use as oral cancer risk behaviors; the practice of obtaining comprehensive medical histories regarding patients' current, past, and type/amount of alcohol and tobacco used; and their opinions about the adequacy of their tobacco and alcohol cessation educational preparation in a state that ranks unusually high for oral cancer mortality rates.

METHODS

The data source was the Maryland Oral Cancer Survey of Dental Hygienists conducted in November 1997 (MDOCSDH, 1997) with a simple random sample of 700 dental hygienists selected from a registry of 2,677 licensed dental hygienists in Maryland. Data were collected with a 40-item self-administered mailed questionnaire. Unweighted data from 331 returned surveys (response rate = 60%) were analyzed using SAS and SUDAAN Software. Stratified and logistic data analysis techniques were utilized, and the results were evaluated statistically using a .05 level of significance.

RESULTS

Nearly all of the responding dental hygienists knew that tobacco is an oral cancer risk factor. Most probed their patients' present use of tobacco in medical histories; however, fewer assessed patients' past use and type/amount of tobacco used. Very few believed that they were adequately prepared to provide tobacco cessation education, although the majority agreed that dental hygienists should be prepared to provide this type of information. The majority of respondents also knew that alcohol use is an oral cancer risk factor; however, less probed their patients' present use of alcohol in medical histories compared to assessing present tobacco use. Even fewer assessed patients' past use and type/amount of alcohol used. A very small minority believed that they were adequately prepared to provide alcohol cessation education. Yet, in contrast to tobacco cessation counseling preparation, few respondents believed that dental hygienists should be prepared to provide alcohol cessation education. There was a significant relationship (p < .05) between screening for all three aspects of tobacco use and agreement of dental hygienists that they were adequately prepared to provide tobacco cessation education. Of seven background characteristics, practice setting was the only one found to be positively associated (p < .05) with even one of three complete medical history screening indices--the practice of assessing all three tobacco screening items.

CONCLUSION

There is a need to provide more complete and accurate information in tobacco and alcohol educational programs for Maryland dental hygienists. Additional research is needed to explore sources of noninterest or discomfort in assessing patients' use of these substances, since a substantial number of Maryland dental hygienists do not assess all aspects of patients' tobacco and alcohol usage and do not agree that dental hygienists should be prepared to provide tobacco and alcohol cessation education for their patients. Maryland dental hygienists' opinions regarding the adequacy of their tobacco and alcohol cessation education appear to accurately reflect their practice of obtaining comprehensive medical histories regarding these substances.

Caries preventive knowledge and practices among dental hygienists

PURPOSE

The aim of this study was to determine the knowledge, opinions, and practices of dental hygienists in the areas of dental caries etiology and prevention.

METHODS

A pretested, validated 35-question survey instrument was mailed to a one percent national, stratified random sample of dental hygienists in the United States (n = 960) in October 1996. Four complete mailings of the instrument resulted in a 67% response rate, of which 77% were useable (n = 498). Respondents were asked if they agreed or disagreed with statements on caries etiology and preventive procedures, and also asked to rate the effectiveness of procedures for preventing dental caries in children and adults. Data were analyzed using descriptive statistics, t-tests, and ANOVA.

RESULTS

Overall level of knowledge of caries etiology and preventive procedures was low. More than 40% of subjects did not recognize that remineralization is the most important mechanism of action of fluoride, and fewer than 50% recognized that dental caries is a chronic infectious disease. Analysis of four factors thought to be related to knowledge and practice showed that younger graduates, more recent graduates, and ADHA members were more knowledgeable about the effectiveness of caries preventive procedures for children (p < .01). Although an overwhelming majority correctly agreed that adults benefit from fluoride and that root caries is an emerging problem, this knowledge was inconsistent with practice (p = .02). Fewer than 35% reported that they provide fluoride to adults of any age, or they wait until the disease is present. For children and adults who did receive fluoride treatments, a one-minute application of an APF gel or foam was most often provided.

CONCLUSIONS

Correct information about the etiology and prevention of dental caries is a predisposing factor to making informed decisions. Overall, respondents overrated the effectiveness of flossing and toothbrushing while underrating the effectiveness of fluorides. In the majority of cases, efficiency rather than efficacy was given priority when providing a topical fluoride treatment. An improved understanding of dental caries etiology and the scientific evidence for appropriate caries preventive procedures will allow dental hygienists to prevent and manage this disease better.

Maryland dental hygienists' knowledge and opinions of oral cancer risk factors and diagnostic procedures

OBJECTIVES

To examine Maryland dental hygienists' (DHs) knowledge of oral cancer risk factors and diagnostic procedures, as well as opinions about the currency and adequacy of their oral cancer knowledge, educational preparation, interest in, and preferred types of, continuing education courses.

METHODS

Seven hundred DHs were randomly selected from a registry of 2677 Maryland licensed dental hygienists. A mailed survey instrument provided baseline data on 331 (RR = 60%) DHs. Stratified tabular and logistic analytical techniques were employed (alpha level < or =0.05).

RESULTS

Most correctly identified tobacco use (99.7%) and alcohol use (89%) as risk factors; however, 31% incorrectly identified poor oral hygiene as a risk factor. 64% of DHs correctly identified older age as a risk factor, yet only 16% identified that the majority of oral cancers are diagnosed in the 60+ year old age group. Nearly 91% correctly identified the examination procedures of the tongue for oral cancer detection; while only 16% of DHs correctly identified erythroplakia and leukoplakia as the conditions most likely associated with oral cancer.

CONCLUSIONS

Gaps in knowledge exist and strongly suggest the need for continuing education courses to clarify risk factors and diagnostic procedures associated with earlier oral cancer detection and prevention.

The prevalence of dental caries and fluorosis in Japanese communities with up to 1.4 ppm of naturally occurring fluoride

OBJECTIVES

The purpose of this study was to determine the relationship between the concentration of fluoride in drinking water and the prevalence of dental caries and fluorosis in seven Japanese communities with different concentrations of fluoride occurring naturally in the drinking water.

METHODS

A total of 1,060 10- to 12-year-old lifetime residents were examined to determine the prevalence of dental caries and fluorosis in communities with trace amounts to 1.4 ppm fluoride in the drinking water in 1987. Systemic fluorides (drops or tablets) have never been available in Japan and the market share of fluoride-containing toothpaste was 12 percent at the time of the study.

RESULTS

The prevalence of dental caries was inversely related and the prevalence of fluorosis was directly related to the concentration of fluoride in the drinking water. The mean DMFS in the communities with 0.8 to 1.4 ppm fluoride was 53.9 percent to 62.4 percent lower than that in communities with negligible amounts of fluoride. Multivariate analysis showed that water fluoride level was the strongest factor influencing DMFS scores. The prevalence of fluorosis ranged from 1.7 percent to 15.4 percent, and the increase in fluorosis with increasing fluoride exposure was limited entirely to the milder forms.

CONCLUSIONS

The findings of this study conducted in 1987 in Japan parallel those reported by Dean et al. in the early 1940s.

U.S. dental hygienists' knowledge and opinions related to providing oral cancer examinations

BACKGROUND

Because U.S. dental hygienists play a significant role in providing prevention and early-detection services, it is important to describe and evaluate their oral cancer knowledge and opinions.

METHODS

A pretested survey, cover letter, and prepaid return envelope were mailed to 960 dental hygienists, followed by three complete follow-up mailings.

RESULTS

The respondents were not as knowledgeable about oral cancer risk factors and diagnostic procedures as hypothesized. Although the respondents were well informed about certain key aspects of oral cancer risk factors and diagnostic procedures, there were many aspects of these topics in which they were deficient and in some cases misinformed.

CONCLUSIONS

Dental hygiene curricula should be updated and continuing education coursesabout oral cancer should be developed and implemented.

Perspectives of Maryland dentists on oral cancer

BACKGROUND

Maryland's mortality rate for oral and pharyngeal cancer is seventh highest overall in the United States, sixth highest for men and third highest for African-American men. As part of a statewide needs assessment and in follow-up to a mail survey of Maryland general dentists, focus groups were conducted to obtain more in-depth information about why dentists do not provide a comprehensive oral cancer examination for most of their patients and how to solve this problem from a dentist's perspective.

METHODS

A trained focus group moderator conducted two focus groups of general practice dentists in two locations in Maryland. Five major themes emerged from the two focus groups: inaccurate knowledge about oral cancer; inconsistency in oral cancer examinations; lack of confidence in when and how to palpate for abnormalities; lack of time to routinely provide oral cancer examinations; and recommendations to help resolve these issues.

CONCLUSIONS

The focus groups provided a rich source of ideas on how to best provide dentists with continuing education about oral cancer prevention and early detection. Participants also provided opinions about the need to improve the public's awareness of oral cancer and its prevention.

CLINICAL IMPLICATIONS

Dentists need to include comprehensive oral cancer examinations as part of their routine oral examinations for all appropriate patients.

Practices of Maryland dentists: oral cancer prevention and early detection--baseline data from 1995

OBJECTIVES

To investigate practices and opinions of general dentists in Maryland, USA, related to oral and pharyngeal cancer prevention and early detection.

DESIGN AND METHODS

A pre-tested, 34-item questionnaire, cover letter and addressed, stamped envelope were mailed in the summer, 1995, to a simple random sample of 800 members and non-members of the American Dental Association practicing in Maryland. A reminder postcard was sent 3 weeks after initial mailing; a second complete mailing to all non-respondents 6 weeks after first mailing.

RESULTS

Over 90% of dentists asked about patient's current use of tobacco but only 77% assessed patient's history of tobacco use and types and amounts used. Fewer (66%) asked about present use of alcohol. Ninety percent reported providing an oral cancer examination at the initial appointment for patients 40 years of age or older; only 6% provided the examination for edentulous patients and only 40% reported palpating lymph nodes of patients 80% or more of the time.

CONCLUSIONS

Dentists' reporting on providing oral cancer examinations and taking appropriate health histories are disappointing. These results call for comprehensive educational interventions in terms of changes in dental curricula and as continuing education courses especially since most dentists were interested in continuing education courses on oral cancer prevention and early detection.

Oral cancer educational materials for the general public: 1998

OBJECTIVES

Previous studies have shown that US adults are not well informed about oral cancers and only 15 percent ever have had an oral cancer examination. This study sought to determine the quantity and adequacy of educational materials designed to inform or educate US adults about risks for, and signs and symptoms of, oral cancer and the need for an oral cancer examination.

METHODS

Letters requesting copies of oral cancer educational materials produced by the organization or agency--leaflets, fact sheets, pamphlets, videos, posters--were sent to 172 national and state organizations or agencies. To determine the adequacy of the items, a previously developed, tested, and used form based on current science was adapted for this study. In addition, the SMOG index was used to determine readability for printed items.

RESULTS

Seventy-seven percent or 132 of the selected organizations responded to queries. A total of 59 items were received that focused on or included the topic of oral cancer. Twenty of these 59 items focused specifically on oral cancer; the balance, on other topics, but mentioned oral cancer. The readability ranged from sixth to 13th grade.

CONCLUSIONS

This study demonstrates a dearth of educational materials about oral and pharyngeal cancers; most are written at too high a grade level for the general public. These findings may help to explain why the public is so uninformed about these neoplasms.

Survey of U.S. dentists' knowledge and opinions about oral pharyngeal cancer

BACKGROUND

Oral pharyngeal cancer constitutes the most life-threatening of all dental and craniofacial conditions. The U.S. five-year survival rate of 52 percent for these cancers is one of the lowest and has not changed in decades.

METHODS

The authors mailed a pretested survey to 7,000 randomly selected general dentists. They obtained information on 3,200 dentists' levels of knowledge about oral pharyngeal cancer risks and diagnostic procedures for providing an oral cancer examination, as well as about related opinions and interest in continuing education, or CE, courses on the topic. The authors carried out analyses using unweighted data; they used both bivariate and logistic analytical techniques and evaluated at a significance level of P < or = .01.

RESULTS

Based on responses to 14 questions, the average knowledge of oral cancer risks score was 8.4. About one-half of dentists surveyed knew the two most common sites of intraoral cancer and that most oral cancers are diagnosed at a late stage.

CONCLUSIONS

The reported knowledge of these dentists regarding oral cancer suggests that they are not as knowledgeable as they could be about cancer prevention and early detection and that they recognize these deficiencies. Most of the dentists were interested in oral cancer CE.

CLINICAL IMPLICATIONS

Dentists need to know where in the mouth to look and what types of lesions to look for to provide a comprehensive oral cancer examination.

Oral pharyngeal cancer prevention and early detection. Dentists' opinions and practices

BACKGROUND

The five-year survival rate for patients in the United States diagnosed with oral pharyngeal cancer is 52 percent, which suggests that these cancers are diagnosed at late stages. The authors conducted this study to determine U.S. dentists' opinions and practices regarding oral cancer prevention and early detection.

METHODS

The authors mailed a pretested survey to 7,000 randomly selected general practitioners. A total of 3,200 dentists provided information on how they conduct oral cancer examinations, their use of health history questions to assess patients' oral cancer risks and their oral cancer training and practices. The authors carried out analyses using unweighted data; both bivariate and logistic analytical techniques at a P < or = .01 level of significance were used.

RESULTS

On average, dentists assessed about five of the eight health history items on the survey. Eighty-six percent indicated that they did not conduct oral cancer examinations on edentulous patients 18 years of age or older; 81 percent, however, reported that they conducted oral cancer examinations for 100 percent of their patients 40 years of age or older on their initial appointment.

CONCLUSIONS

The reported practices of these dentists regarding oral cancer, in conjunction with their opinions about key aspects of these practices and their training, point to a need for systematic educational updates in oral cancer prevention and early detection.

CLINICAL IMPLICATIONS

Dentists need to determine their patients' risks for oral cancers and provide routine and comprehensive oral cancer examinations.

Challenges of and strategies for changing prescribing practices of health care providers

Problems related to inappropriate prescribing practices of physicians in general are well recognized. Dietary fluoride supplements have been implicated as one of the contributing factors in an increase in dental fluorosis. Inappropriate prescribing practices of providers have been cited as a major factor in this implication. Numerous studies of physicians and dentists have documented a lack of knowledge and inappropriate prescribing practices regarding fluoride supplements. The purpose of this paper is to identify barriers to changing fluoride-prescribing practices of health care providers and to suggest strategies for implementing change. To increase optimal and appropriate use of fluoride supplements, educational interventions are necessary for all user groups--detail men and women, physicians, dentists, pharmacists, nurse practitioners, dental hygienists, and the public. In addition, environmental supports for the educational activities in the form of policy, regulation, standards of care, and guidelines are recommended for consideration.

An evaluation of NHANES III estimates of early childhood caries

OBJECTIVES

The purposes of this study were to estimate and evaluate the prevalence for the United States of early childhood caries (ECC) among children 12 to 23 months of age.

METHODS

The 1988-94 National Health and Nutrition Examination Survey (NHANES III) public-use data set was analyzed using SUDAAN. Two ECC case definitions were used. Definition #1 was restricted to the caries score called by the examiner. Definition #2 liberally included children identified by definition #1 and those possibly having questionable caries scores.

RESULTS

The NHANES III six-year prevalence estimates of caries in the maxillary anterior incisors of children 12 to 23 months of age were 1.0 percent for definition #1 and 1.7 percent for definition #2. Mexican-American and economically disadvantaged children were disproportionally represented with ECC.

CONCLUSIONS

The prevalence of ECC among children 12 to 23 months of age is barely detectable at the national level. Alternative study designs and improved case definitions are needed for further advances in ECC.

Maryland veterans' knowledge of risk factors for and signs of oral cancers and their use of dental services

OBJECTIVES

The purpose of this study was to evaluate outpatient veteran'í knowledge about risk factors for and signs of oral cancers, and their utilization of dental services.

DESIGN

Patients receiving primary health care services were surveyed during August 1997.

SETTING

Primary health care services at three medical centres within the VA Maryland Health Care System (VAMHCS).

SUBJECTS

A total of 135 outpatient veterans were interviewed.

INTERVENTION

Questionnaire administered by trained interviewers.

MAIN OUTCOME MEASURES

Fifteen percent of the sample were eligible for dental care at the VA, while over 40% of those veterans participating in the study were unaware of their VA eligibility for dental services. Fifty six percent of the total sample received dental services from a private dentist, while 13% reported they had no provider of dental care. Of those not eligible for dental care at the VA (n = 115), the majority (67%) received dental care from a private dentist. Current use of tobacco and alcohol was reported by 27% of the sample. Nonsmokers were more likely to visit the dentist in the previous year than smokers (OR = 2.39, 95% C.I. 1.11,5.12). Although 84% correctly identified tobacco use as a risk factor, only 39% correctly identified regular alcohol use as a risk factor.

CONCLUSIONS

Veterans at higher risk for oral cancers were less likely to have visited the dentist in the previous year, and, overall, were ill informed and misinformed about these cancers.

Maryland adults' knowledge of oral cancer and having oral cancer examinations

OBJECTIVES

This study sought to determine (1) knowledge of risk factors for oral cancer, (2) knowledge of signs and symptoms of oral cancers, and (3) factors associated with having had an oral cancer examination among 916 Maryland adults 18 years of age and older.

METHODS

A statewide, random-digit dial, computer-assisted telephone survey was conducted. The pretested instrument consisted of 32 questions that required 12 minutes to complete.

RESULTS

Overall, level of knowledge about risk factors for and signs and symptoms of oral cancers was low; misinformation was high. Although 85 percent reported hearing about oral or mouth cancer, only 28 percent of the respondents reported having had an oral cancer examination. Of these, 20 percent had the exam during the past year--the recommended frequency for persons 40 years of age or older. In logistic regression analysis, adults more likely to have had an oral cancer examination included those who thought personal behavior causes more cancer than environmental factors; had more knowledge about risk factors for oral cancer; and were 40-64 years of age, white, and better educated than their counterparts (P < .05). The primary reasons for not having an exam were "no reason/didn't know I should" and "doctor/dentist didn't recommend."

CONCLUSIONS

These results demonstrate a need for interventions designed to increase knowledge levels of risk factors for, signs, and symptoms of oral cancers and the need for oral cancer examinations; and to increase oral cancer examinations.

Oral health knowledge, practices, and status among outpatient veterans at the VA Maryland Health Care System

Poor oral health can have a significant impact on overall health and quality of life. Yet few studies have established the oral health needs of outpatient veterans. The purpose of this study was to assess the oral health knowledge and practices, the dental status, and the periodontal treatment needs of outpatient veterans seeking primary care services at a statewide healthcare system. Veterans were interviewed and received an oral examination by a trained examiner using NIDCR criteria for dental caries detection and the Community Periodontal Index of Treatment Needs (CPITN). The mean age of the study participants' (n = 135) was 57.7 (SD = 14.1) years. Ninety-five percent of the sample was male and 44% African-American. Untreated coronal and root caries was present in 57% and 36% of veterans, respectively. Sixty-nine participants received the periodontal examination, with 29% of them in Category III. An interpretation of these findings shows a high need for preventive and restorative oral health care among outpatient veterans receiving primary services in an integrated and comprehensive VA health care system.

Coverage and quality of oral cancer information in the popular press: 1987-98

OBJECTIVES

National data show a lack of knowledge and misinformation about oral cancer and its early detection among the general public. A major source of health information is the popular press. For that reason this study reviewed coverage and quality of news items on the topic of oral cancer in the popular press. In addition, the number and types of tobacco advertisements in women and men's magazines were recorded for a one-year period.

METHODS

Articles from magazines and newspapers were retrieved from the Magazine Index (1987 to April 1998), Newspaper Abstract (1989 to April 1998) and the Health & Wellness (1987 to April 1998) databases. The articles were analyzed both for adequacy of content and information.

RESULTS

A total of 50 articles and news items including oral cancer were identified and analyzed, 18 from newspapers and 32 from magazines. Ninety-four percent of the articles mentioned at least one risk factor for oral cancer. More than half of the articles (56%) identified spit tobacco (chewing tobacco or snuff) as the major risk factor for oral cancer, while far fewer mentioned either cigarettes (32%) or cigars (12%). Over 50 percent of the articles did not mention warning signs for oral cancers. Fourteen percent suggested clinical oral cancer examinations by a health professional; only 8 percent advised the use of self-examination. A total of 417 tobacco advertisements (482 pages) were found among 22 magazines for the one-year period. They included 410 cigarette ads, seven cigar ads, and no spit tobacco ads.

CONCLUSIONS

This study demonstrates the lack of coverage about oral cancer in the popular press in the past decade and provides a partial explanation of the public's lack of knowledge and misinformation about oral cancers.

Caries conditions among 2-5-year-old immigrant Latino children related to parents' oral health knowledge, opinions and practices

OBJECTIVES

To collect baseline data prior to initiating a community-based, oral health promotion program in an inner city Latino community in Washington DC, populated by Central American immigrants.

METHODS

In 1995, an oral survey of a convenience sample of children 2-5 years of age (n = 142) and a survey of the knowledge, opinions and practices (KOP) of their parents (n = 121) were completed. Clinical data of children were matched with parent respondents of the KOP survey. Data were analyzed for statistical associations using univariate odds ratios, Fisher's exact tests, and multiple logistic regression.

RESULTS

Only 53% of the children were caries free. Eighteen percent of all children were in need of immediate dental care and 26% were in need of early or non-urgent dental care. Only 7% of the parents knew the purpose of sealants and 52% knew the purpose of fluorides. Further, only 9% thought that brushing with toothpaste can prevent tooth decay The strongest predictors of dental caries in this population, after adjusting for child's age and mother's education, were recency of mother's residence in the United States and report of an uncooperative child when attempting toothbrushing.

CONCLUSIONS

Regimens of caries prevention have been successful in reducing dental decay for a large segment of the US population, yet this disease remains prevalent especially among low socioeconomic groups. The oral health status of the children and the oral health KOP of the parents in this community are disturbingly deficient.

Korean dental hygienists' knowledge and opinions about etiology and prevention of dental caries

OBJECTIVES

Because of their formal education Korean dental hygienists have the potential to be the primary source of information on caries prevention for patients and the general public, and influence the use and adoption of caries preventive procedures. The purposes of this study were to determine the knowledge and opinions about caries etiology and prevention among Korean dental hygienists, and to describe associated factors.

METHODS

A pre-tested, 20-item questionnaire was mailed to 1120 dental hygienists selected by stratified random sampling and allocated proportionately. A postcard reminder was sent to all dental hygienists after 1 week. Non-respondents were sent additional complete mailings after 3 and 7 weeks. The response rate was 77% (n=863).

RESULTS

Analysis of six factors thought to be related to knowledge about caries etiology and prevention showed that dental hygienists who were taught to provide oral health education and believe that it is desirable to practice oral health education during dental hygiene school and those employed in health centers were likely to be more knowledgeable about caries etiology and prevention than other hygienists (P<0.05). In regression analysis of the perceived effectiveness of caries preventive procedures, hygienists who provided oral health education during their formal training tended to rate caries preventive procedures as being more effective than other dental hygienists (P<0.05).

CONCLUSIONS

Overall, the results of this study suggest that most dental hygienists do not have up-to-date information on the etiology and prevention of dental caries, mechanisms of action of fluoride and effectiveness of preventive procedures. Efforts to increase the level of knowledge of Korean dental hygienists about caries prevention should focus on strategies to educate dental hygienists who have not been taught to provide oral health education, who do not have favorable opinions about the desirability of oral health education, and who had no experience with providing oral health education as part of their work, especially hygienists working in private clinics. Further, these efforts should include the revision of dental hygiene curricula and continuing education courses.

Response to Weinstein: public health issues in early childhood caries

Dr Weinstein's thoughtful overview of public health issues in early childhood caries (ECC) provides an excellent basis for further exploration. For public health to focus on a given problem several factors must be addressed: the disease must be widespread; the etiology or the prevention of the disease or condition must be known; this knowledge is not being applied; and resources for interventions must be available. Currently, appropriate data are not available for ECC and the problem is exacerbated because there is no case definition for the disease. Therefore it is difficult to make public health policy to address this disease. With the knowledge of case definition, prevalence, and efficacy of treatment, we are more likely to engender interest and funding for ECC. Studies in other countries have demonstrated that children who are malnourished, have low birth-weight or both, likely will have hypomineralized primary teeth and thus at risk of ECC. Low birth-weight infants (less than 2500 g) currently constitute over 7% of all US births. The impact of low birth-weight on oral health is not known. Weinstein favors the use of operator-applied preventive agents, yet little evidence is available on the safety and effectiveness of these agents among infants and young children. Further, they are unlikely to be cost-effective and they require frequent appointments, which is often difficult for poor families to manage. Community interventions hold the greatest promise for preventing ECC because larger numbers of people can be reached than in private practice clinical settings.

National survey of Korean dentists' knowledge and opinions: dental caries etiology and prevention

OBJECTIVE

Dentists have the potential to influence what their patients know and do regarding dental caries prevention. The practices of dentists and what they tell their patients are influenced, in part, by their own knowledge and opinions. The purposes of this study were to determine the level of knowledge and opinions about caries etiology and prevention among Korean dentists and to describe related factors.

METHODS

A pretested, 27-item questionnaire was mailed to 2,047 dentists, selected by a stratified random sampling allocated proportionately. A postcard reminder was sent to all dentists after one week. Nonrespondents were sent additional complete mailings after three, seven, and nine weeks. The response rate was 83 percent (n = 1,700 dentists).

RESULTS

Analysis of six factors thought to be related to knowledge about caries etiology and prevention showed that recent graduates and dentists who worked in public health centers were likely to be more knowledgeable about caries etiology and prevention than their counterparts (P < .05). In regression analysis of perceived effectiveness of caries-preventive procedures for children, recent graduates, males, and dentists who worked in public health centers tended to rate caries-preventive procedures more effective than other dentists (P < .05). Dentists who had experience with school-based preventive programs and dentists in rural areas were likely to rate caries-preventive procedures for adults more effective than other dentists (P < .05).

CONCLUSIONS

Overall, results of this study suggest that the majority of dentists do not know current information concerning etiology and prevention of dental caries, mechanisms of action of fluoride, and effectiveness of preventive procedures for children and adults. Efforts to enhance the level of knowledge and practices of Korean dentists about caries prevention should focus on strategies to educate older graduates and female dentists, especially those in private practice.

Scientific progress in understanding oral and pharyngeal cancers

Oral and pharyngeal cancers result from a complex interaction between genetic susceptibility and behavioral factors. Improved understanding of the underlying genetic events has led to insights about how oral and pharyngeal cancers develop and suggests promising new treatments. Tobacco and alcohol consumption are associated with most oral and pharyngeal cancers. Dental professionals' efforts to modify their patients' tobacco and alcohol use and to detect oral lesions at an early stage, together with scientific advances, will help reduce the impact of these cancers.

Reducing the burden of oral and pharyngeal cancers

In the United States, oral and pharyngeal cancers continue to result in significant morbidity and mortality. Dental professionals play a pivotal role in all facets of controlling the burden of oral and pharyngeal cancer-from efforts to prevent its occurrence, to ensuring that oral cancers are detected at the earliest possible stage, to treating these cancers, and to ensuring maximum quality of life and function for oral and pharyngeal cancer survivors. Individually and by making linkages within the community and beyond, dentists can help patients modify their risk of these cancers and can take steps to screen for them, thereby potentially improving survival and function of those who develop oral cancer. Creative partnerships between community dentists and academic and other research centers will help move knowledge of the biological processes involved in carcinogenesis and innovations in treatment into clinical practice. Partnerships between dental and medical professionals may also help efforts to reduce the morbidity related to oral and pharyngeal cancers. Local, state and national multidisciplinary initiatives are emerging that focus more broadly on risk factor control or oral and pharyngeal cancer issues. These many forms of cooperative approaches offer excellent opportunities to make a significant impact on reducing the incidence of and in treating these debilitating and disfiguring malignancies.

Knowledge, opinions and practices of general dentists regarding oral cancer: a pilot survey

The authors mailed a pilot survey to 500 randomly selected general dentists. Although most dentists reported their knowledge of oral cancer to be current, their actual knowledge of oral cancer risk factors and signs and symptoms was inconsistent. Conflicting data were also found between their level of knowledge and their provision of oral cancer examinations. Most respondents agreed that patients should undergo an oral cancer examination annually, yet many do not provide this service.

An assessment of oral cancer prevention curricula in U.S. medical schools

BACKGROUND

Oral cancer is readily detectable through routine examination, but five-year survival rates remain low. Physicians bear the same responsibilities as dentists in the early detection of oral cancers, because high-risk patients utilize medical services more often than dental services.

METHODS

Because physicians' practices are largely influenced by their training, this study assessed the level of oral cancer education provided to undergraduate U.S. medical students. Health history and physical diagnosis course curricula were assessed for relevant content.

RESULTS

The response rate from the U.S. medical schools was 63.2%. When compared with the "gold standard," the average score was 43% of the optimum. Seven percent of the schools did not require inspection of the mouth, 29% required inspection of all oral structures, and intraoral palpation was advocated by 43% of the schools. Although most schools included questions about alcohol and tobacco use, only 13% asked about sunlight exposure.

CONCLUSION

Preliminary oral cancer training in medical schools regarding physical assessment and elicitation of signs, symptoms, and high-risk behaviors lacks both adequacy and comprehensiveness.

Factors associated with having oral cancer examinations among US adults 40 years of age or older

OBJECTIVES

This study describes factors associated with having an oral cancer examination among US adults 40 years of age or older.

METHODS

Data used in this study are from the Cancer Control supplement of the 1992 National Health Interview Survey, which included questions about having had an oral cancer screening examination and knowledge of risk factors for oral cancers. The survey was administered to a national sample 18 years of age and older (n = 12,035). Questions regarding beliefs and opinions about cancers in general also were asked and their associations with responses to having had an oral cancer examination studied. Analyses are limited to those respondents 40 years of age and older (n = 6,538).

RESULTS

Fifteen percent of the adults reported having had an oral cancer examination. Of these, 48 percent had the exam during the past year and 31 percent had an exam one to three years ago. Respondents who were above the poverty level, white, non-Hispanic, 40 to 64 years of age, and who had more than a high school education and a higher level of knowledge about risk factors for oral cancer were more likely to have had an oral cancer examination.

CONCLUSIONS

These findings demonstrate the need for vigorous health education and health promotion interventions aimed at health care providers and the public to increase knowledge about risk factors for oral cancers and to increase oral cancer examinations.

The need for health promotion in oral cancer prevention and early detection

OBJECTIVES

This review paper provides a rationale for using health promotion to help reduce morbidity and mortality due to oral cancers by identifying barriers to prevention and early detection of these cancers and discussing strategies for change.

METHODS

A literature review of the following areas was conducted: epidemiology of and risk factors for oral cancers; knowledge, opinions, and practices of health care providers and the public regarding prevention, early detection, and control of oral cancers; and policies and regulations that either enhance or act as barriers to the prevention and early detection of oral cancers.

RESULTS

Overall, the public is ill-informed about risk factors for and signs and symptoms of oral cancers and relatively few US adults have had an oral cancer examination. Further, health care providers are remiss in providing oral cancer examinations and detecting early oral cancers.

CONCLUSIONS

To achieve the 13 oral cancer objectives contained in "Healthy People 2000," health care providers and the public must know the risk factors for these cancers as well as their signs and symptoms. Further, health care providers need to provide oral cancer examinations routinely and competently. Equally important, the public needs to know that an examination for oral cancer is available and that they can request one routinely. Thus, a vigorous agenda that includes education, policy, and research initiatives is needed to enhance oral cancer prevention and early detection.

Introduction to the symposium on minimal intervention techniques for caries

Although dental caries has declined precipitously in many industrialized countries, this disease has escalated in less developed countries. Moreover, dental caries remains a public health problem even in most industrialized countries because the disease frequently is more prevalent among subpopulations without access to preventive regimens and treatment. In some developing countries where dental facilities and providers are rare, alternative measures for managing frank lesions are being used. One example of these minimal intervention techniques is "Atraumatic Restorative Treatment" (ART). This procedure, endorsed and actively promoted by the World Health Organization, requires no anesthetic and its costs are minimal. This symposium addresses several aspects and issues of minimal intervention techniques for caries management.

Assessment of alcohol and tobacco use in dental schools' health history forms

Health history forms are an integral component of students' clinical and didactic training in physical assessment and often serve as a model for students to use in their future practices. This study examined how alcohol and tobacco use are assessed in patient health history forms used in the dental schools of the United States and Canada (n = 63). Deans of schools were requested to send a copy of their health history and other supplemental forms used for patient care. The response rate was 98 percent. Almost 25 percent of the schools' forms did not address either alcohol or tobacco use; 37 percent failed to address one or both risk behaviors; 25 percent did not request tobacco information; and 36 percent did not address alcohol use. Major inconsistencies regarding the inclusion, content, and quantity of alcohol and tobacco questions were noted. Consensus among dental schools as to which questions to include in their health forms was not apparent.