Evaluation for an observation effect in a prospective cohort study of oral health outcomes

OBJECTIVES

Evaluation for changes in behavior due to research participants' knowledge that behavior is being observed (also referred to as a Hawthorne effect or reactivity) has received little attention in the dental literature. The Florida Dental Care Study, a prospective, non-randomized, longitudinal study of oral health outcomes, provides some inferential power to evaluate for an effect on dental care use due to participants' knowledge that this behavior was being observed. The purpose of this paper is to document that an observation effect can occur in dental studies, and to estimate its magnitude in four groups that were defined by their typical approach to dental care as stated at baseline: consistent regular attenders (CRAs); inconsistent regular attenders (IRAs); consistent problem-oriented attenders (CPOAs); and inconsistent problem-oriented attenders (IPOAs).

METHODS

At baseline, 873 respondents with at least one natural tooth and who were 45 years of age or older participated for an interview and clinical dental examination. Respondents were asked about their dental care use in general and check-up use in particular at 6-month intervals over a period of 24 months.

RESULTS

Dental care use in general and check-up use in particular varied across time points and across the four groups of the sample. There was some stimulation in dental care use for the sample overall, but by the 18-to-24-month period, use had returned to baseline levels. In a direction opposite from that hypothesized, results from the CRAs suggested decreased use of dental care over the course of the 24 months of observation. No consistent pattern was evident for the IRAs, CPOAs, or IPOAs.

CONCLUSIONS

An observation effect was evident, but was modest in magnitude and differed within and between sub-groups of the sample. While self-selection into dental care user groups is an expected and desirable feature of this design, the size of the user/non-user groups was affected for some subgroups. We conclude that dental care studies with the potential for an observation effect should evaluate for this effect by distinguishing sub-groups of the sample based on their propensity (as stated at baseline) to use dental care. These differential effects across sub-groups should be taken into account as inferences are made.

Multidimensionality of oral health in dentate adults

OBJECTIVES

An understanding of the validity and usefulness of self-reported measures (as distinct from clinically determined measures) of oral health is emerging. These self-reported measures include self-rated oral health (SROH). Three objectives were to: (1) describe self-rated oral health in dentate adults, (2) quantify associations between self-rated oral health and other measures of oral health (oral disease and tissue damage, pain and discomfort, functional limitation, and disadvantage), and (3) assess the construct validity of a model of oral health proposed herein.

METHODS

The Florida Dental Care Study is a longitudinal study of oral health, which included at baseline 873 subjects who had at least one tooth, were 45 years or older, and who participated for an interview and clinical examination.

RESULTS

The prevalence of self-rated oral health decrements was substantial; approximately one fourth of subjects reported their oral health as only fair or poor. Bivariate and multivariate results provided consistent evidence of the construct validity of the proposed model of oral health. Additionally, the salience of one measure of dental appearance suggests that persons may use esthetic cues when rating their oral health.

CONCLUSIONS

The proposed multidimensional model of oral health has construct validity. Self-rated oral health is affected by oral disease and tissue damage, oral pain and discomfort, oral functional limitation, and oral disadvantage. These self-reported measures and the proposed model should provide useful information for dental care effectiveness research. General health status has been disaggregated into the "physical" and the "mental;" an additional separation into the "oral" aspects of health seems warranted.

Orofacial pain symptom prevalence: selective sex differences in the elderly?

This study investigated sex differences in orofacial pain symptoms in a sample of elderly adults. Furthermore, differences across sex were tested on symptom continuity, overall duration, pain severity, activity reduction, and health care utilization, related to each specific symptom. Telephone interviews were conducted with a stratified random sample of community dwelling older (65+) north Floridians. A total of 5860 households were contacted and screened, with 75.3% participating to the point where their eligibility for the study could be determined. Of the remaining households, 1636 completed the interview. Of the total sample, 17.4% reported experiencing at least one of the four target orofacial pain symptoms (jaw joint pain, face pain, oral sores, burning mouth) during the past year, suggesting that orofacial pain symptoms are common in older adults. Our findings for prevalence of each specific symptom (jaw joint pain, 7.7%; face pain, 6.9%; oral sores, 6.4%; toothache, 12.0%; burning mouth, 1.7%) are similar to those estimated by the 1989 National Health Interview Survey, for the US adult population. Consistent with other epidemiological and clinical studies, we found that females were more likely to report jaw joint pain and face pain than males. In contrast to clinical studies, no differences were found on subjective ratings of pain severity, for any symptom. Differences across sex were most likely to be reported for jaw joint pain related variables, suggesting undetermined sex-uniqueness for these symptoms. In contrast to previous studies, older females tended to report lower levels of health care utilization than older males. This is the first study to our knowledge that reports orofacial symptom-specific sex differences among the elderly.

Dietary implications of oral health decrements among African-American and white older adults

OBJECTIVE

Older African-Americans are at disproportionate risk of chronic, nutritionally-related diseases. To begin to understand factors that may contribute to the disproportionate prevalence of life-threatening illnesses among African-Americans, this study investigates ethnic differences in the prevalence of oral health decrements.

DESIGN

The Florida Dental Care Study (FDCS), a longitudinal study of changes in the oral health of 873 subjects age 45+, was used to explore a broad range of oral health status differences between African-Americans and White adults in the United States. The FDCS consists of clinical and self-reported measures of oral health, sociodemographic information, and other indicators of oral functional status.

RESULTS

The prevalence of oral health decrements in this sample using a broad range of clinical and self-reported measures was substantial. African-American elders were at a heightened risk of poor oral health profiles, including having fewer teeth and being more likely to have a carious surface, fractured cusp or incisal edge, severely mobile teeth and severe periodontal levels than their White counterparts. Furthermore, the African-American respondents in our sample were significantly more likely to report a lower self-rated oral health and functioning than their White counterparts. These findings persist regardless of poverty status or educational level, two factors commonly thought to confound racial differences in health outcomes.

CONCLUSION

Our study provides evidence that the widespread prevalence of oral health decrements and accompanying functional disability among this sample of dentate older adults impacts their daily lives. Of particular concern is the oral heath status of older African-Americans who may be nutritionally vulnerable due, in part, to these oral health decrements and disabilities. We suggest enhancing the access of health services in order to prevent those oral health decrements that presumably undermine adequate dietary intake.

Taking dental self-care to the extreme: 24-month incidence of dental self-extractions in the Florida Dental Care Study

OBJECTIVE

A common response to health-related symptoms is to treat oneself in lieu of or prior to seeking formal health care. Among the more extreme forms of dental self-care is dental self-extraction. To our knowledge, no study of the incidence of this behavior has been conducted. The objective of this study was to determine if one form of dental self-care, dental self-extraction, is a real phenomenon, and if so, to determine its incidence.

METHODS

The Florida Dental Care Study is a longitudinal study of changes in oral health, whose subjects participated for an interview and clinical examination at baseline and 24 months after baseline.

RESULTS

Of the 739 persons who participated through 24 months 176 lost one or more teeth. Of these 176 persons, 13 (7%) extracted one or more of their own teeth. The clinical status at baseline of the self-extracted teeth was consistent with the ability to self-extract.

CONCLUSION

The phenomenon of dental self-extraction is real and is not limited to residents of developing nations or geographically isolated areas. Because of the potential for prolonged bleeding or bacterial endocarditis in certain population groups, community health clinicians and officials should be cognizant of this behavior.

Satisfaction with chewing ability in a diverse sample of dentate adults

The Florida Dental Care Study (FDCS) is a longitudinal study of changes in oral health, which included at baseline 873 subjects who had at least one tooth, were 45 years or older, and who participated for an interview and clinical examination. Two objectives of the FDCS were to: (i) describe satisfaction with chewing ability in a diverse sample of dentate adults; and (ii) quantify the associations between satisfaction with chewing ability and other measures of oral health. Approximately 16% of subjects reported that they were dissatisfied or very dissatisfied with their chewing ability. Bivariate and multivariate results provided consistent evidence of the construct validity of a proposed multi-dimensional model of satisfaction with chewing ability. Multiple regression analysis suggested that dissatisfaction with chewing ability was independently associated with 12 specific clinical and self-reported measures of oral disease/ tissue damage, pain, functional limitation, and disadvantage. The self-reported measures of oral health and the proposed model of satisfaction with chewing ability improve our understanding of this important oral health outcome in diverse population groups.

Oral functional limitation among dentate adults

OBJECTIVES

The purpose of this study was to measure the prevalence of oral functional limitation in adults and to identify clinical and sociodemographic factors associated with that limitation.

METHODS

The Florida Dental Care Study is a longitudinal study of risk factors for changes in oral health. Subjects (n = 873) with at least one tooth who were 45 years old or older participated in a baseline in-person interview and dental examination. Subjects were queried about oral functional limitations.

RESULTS

Twenty-three percent of subjects reported difficulty chewing one or more foods using a five-item chewing index, and 10 percent reported difficulty speaking or pronouncing words because of problems with the mouth. The covariates in a multiple logistic regression identified as being significantly associated with chewing difficulty were fewer pairs of occluding anterior teeth, fewer pairs of occluding posterior teeth, more posterior teeth that are root tips, more anterior teeth that are mobile, reporting tooth pain, reporting bad breath, having but not wearing prosthetic appliances, reporting dry mouth, and being female. Having fewer anterior teeth, reporting a sore and/or broken denture, reporting unattractive teeth, and being black were significantly associated with speaking difficulty/difficulty pronouncing words because of problems with the teeth, mouth, or dentures.

CONCLUSIONS

The findings in this study suggest a significant prevalence of oral functional limitation in dentate adults. Certain clinical and sociodemographic factors were strongly and independently associated with its presence.

Validity of self-reported tooth counts during a telephone screening interview

OBJECTIVES

Telephone screening has become a common method used in health services research to identify efficiently persons in specific populations of interest. In this research, we used a large-scale telephone screening survey to assess: (1) the effectiveness of the telephone method in gathering tooth count information by measuring response rate (cooperation) to specific questions and (2) the validity of subjects' reports of the number of remaining natural teeth.

METHODS

We used a telephone screening methodology to identify dentate persons (at least one natural tooth remaining) who were 45 years old or older and resided in one of four counties of north Florida. At a second stage, a sample of the telephone screening participants was selected for further study, which consisted of a baseline in-person interview and a clinical examination. We compared the number of remaining teeth reported during the telephone interview with the number determined at baseline examination.

RESULTS

The telephone method was effective at gathering tooth count information, although response rates varied with the level of specificity required. Almost all subjects reported the number of teeth at least at the nominal and ordinal levels, but fewer than three-fourths reported the number at the interval level. When the unit of analysis was the overall sample, self-reported number of teeth was a valid measure of the true number. When the unit of analysis was the individual subject, validity was associated with certain clinical and sociodemographic factors.

CONCLUSIONS

When the unit of analysis is the overall sample, these results suggest that self-reported tooth counts during a telephone interview are sufficiently valid to meet all but the most stringent data requirements. When the unit of analysis is the individual subject, these tooth counts may not be valid, depending upon the degree of specificity required and subject characteristics.

Oral disadvantage among dentate adults

Oral disadvantage can be defined as the avoidance of certain daily activities because of decrements in oral health. These decrements include oral disease and tissue damage, pain, and functional limitation. The Florida Dental Care Study (FDCS) is a longitudinal study of changes in oral health, which included at baseline 873 subjects who had at least 1 tooth, were 45 years old or older, and who participated for an interview and clinical examination. Three objectives of the FDCS are: (1) to describe selected psychometric properties of the measurement of oral disadvantage; (2) to describe oral disadvantage in a diverse sample of dentate adults; and (3) to describe the relationship between disadvantage and other aspects of oral health, such as disease/tissue damage, pain, and functional limitation. The prevalence of oral disadvantage within the previous 6 months, using eight self-reported measures, ranged from 5% to 25%, depending upon the measure. Factor analysis suggested that oral disadvantage is best described as three factors: disadvantage due to (1) oral disease/tissue damage, (2) oral pain, and (3) oral functional limitation. Irregular dental attenders, poor persons, and blacks had the highest prevalence of oral disadvantage. Clinical measures of oral disease/tissue damage, self-reported measures of oral disease/tissue damage, oral pain, and oral functional limitation were strongly associated with the presence of oral disadvantage. In multivariate analyses that accounted for differences in clinical measures of disease/tissue damage, self-reported disease/tissue damage, oral pain, and oral functional limitation, females were more likely to report disadvantage due to disease/tissue damage, and middle-aged persons and irregular dental attenders were more likely to report oral disadvantage due to pain. In these same regressions, differences in disadvantage due to race, poverty status, socioeconomic status, and rural/urban area of residence were not evident. These results have implications regarding the use of oral disadvantage to assess the long-term effectiveness of dental care.

Race differences in the health of elders who live alone

This investigation was initiated to determine whether older African Americans who live alone are in poorer health than their White counterparts who live under the same circumstances. Data on 5 measures of health were collected in telephone interviews with a stratified random sample of community-dwelling elders (n = 1,189). Analysis of weighted data indicate that there were fewer differences in health by race among older persons who lived alone compared to elders who lived with others. Where racial differences in health did exist among older adults who lived alone, the differences could only sometimes be accounted for by population composition factors that are known to influence health.

Behavioral risk indicators of attachment loss in adult Floridians

This study investigated behavioral and sociodemographic risk indicators of attachment loss (AL) at baseline in subjects of the Florida Dental Care Study: 873 subjects with at least 1 tooth, and who were 45+ years or older, participated for an in-person interview and dental examination; 761 subjects were probed for AL. Calibrated examiners used a modified NIDR protocol from the 1985-86 Survey of US Employed Adults and Seniors. Results were weighted to reflect actual population proportions. 92% of subjects had at least 1 site of 4+ mm AL, and 35% had at least 1 severe site (7+ mm AL). In a single multivariate regression, not having a recent dental check-up, not using dental floss, being a current smoker, and being diabetic were significantly associated with a higher probability of having 1 or more severe sites. Blacks were less likely than whites to be regular users of dental care, use dental floss, and be non-smokers. Similar findings were found for low income adults and rural residents. Risk groups (low income, blacks, rural residents) were more likely to present with modifiable risk indicators for AL, suggesting the need for targeted interventions.

Dental health attitudes among dentate black and white adults

OBJECTIVES

Blacks and poor persons share a greater burden of oral disease and are less likely to seek dental care on a regular basis. The role of dental attitudes and knowledge of services on this circumstance is unclear. The authors quantified group differences in dental attitudes and knowledge of services and related them to regularity of dental care use.

METHODS

As part of the baseline phase of The Florida Dental Care Study, a longitudinal study of oral health, 873 respondents who had at least one tooth and who were 45 years or older participated for an interview and a clinical dental examination. Dental care use, seven dental attitudinal constructs, and knowledge of dental services were queried.

RESULTS

Forty-five percent of respondents reported going to a dentist only when they have a problem, and 17% of respondents had not seen a dentist in more than 5 years. Ten percent of respondents reported that they had at least one permanent tooth removed by someone other than a dentist (typically, the respondent himself). Blacks and poor persons had more negative attitudes toward dental care and dental health and were less knowledgeable of dental services. Multivariate analyses suggested that dental attitudes were important to understanding the use of dental care services for this diverse group of adults, and that race and poverty contributed independently to dental care use even with dental attitudes taken into account.

CONCLUSIONS

Dental attitudes contribute to race and poverty differences in dental care use among adults. The persistence of race and poverty effects with attitudes taken into account suggests that additional explanatory factors contribute as well. These differences may contribute to more prevalent and severe oral health decrements among the same adults who also are more likely to suffer from other health decrements.

Evaluation of bias and logistics in a survey of adults at increased risk for oral health decrements

OBJECTIVES

Designing research to include sufficient respondents in groups at highest risk for oral health decrements can present unique challenges. Our purpose was to evaluate bias and logistics in this survey of adults at increased risk for oral health decrements.

METHODS

We used a telephone survey methodology that employed both listed numbers and random digit dialing to identify dentate persons 45 years old or older and to oversample blacks, poor persons, and residents of nonmetropolitan counties. At a second stage, a subsample of the respondents to the initial telephone screening was selected for further study, which consisted of a baseline in-person interview and a clinical examination. We assessed bias due to: (1) limiting the sample to households with telephones, (2) using predominantly listed numbers instead of random digit dialing, and (3) nonresponse at two stages of data collection.

RESULTS

While this approach apparently created some biases in the sample, they were small in magnitude. Specifically, limiting the sample to households with telephones biased the sample overall toward more females, larger households, and fewer functionally impaired persons. Using predominantly listed numbers led to a modest bias toward selection of persons more likely to be younger, healthier, female, have had a recent dental visit, and reside in smaller households. Blacks who were selected randomly at a second stage were more likely to participate in baseline data gathering than their white counterparts. Comparisons of the data obtained in this survey with those from recent national surveys suggest that this methodology for sampling high-risk groups did not substantively bias the sample with respect to two important dental parameters, prevalence of edentulousness and dental care use, nor were conclusions about multivariate associations with dental care recency substantively affected.

CONCLUSIONS

This method of sampling persons at high risk for oral health decrements resulted in only modest bias with respect to the population of interest.

Root caries and root defects in urban and rural adults: the Florida Dental Care Study

As part of the Florida Dental Care Study--a longitudinal study of risk factors for changes in dental health--the authors examined and interviewed 873 adults aged 45 years and older. During the examination, clinicians noted the number of teeth present and the participant's dental condition, including presence of root caries and fillings or noncarious defects on the roots. The interview was conducted to collect demographic and other information such as the adults' perceptions about dental care and their perceptions about their own dental health. The authors found that men, African-Americans, adults living in rural areas and those living in poverty were significantly more likely to have root caries than other participants. The data reported in this article will serve as baseline information for subsequent research.

Coronal caries, root fragments, and restoration and cusp fractures in US adults

The Florida Dental Care Study is a longitudinal study of changes in oral health that included at baseline 873 subjects (Ss) who had at least 1 tooth, were 45 years or older, and participated for an interview and examination. Forty-five percent of Ss had active coronal caries; 94% of the coronal carious surfaces were primary decay, and only 6% were secondary/recurrent. Ten percent of Ss had 1 or more root fragments, 16% of Ss had 1 or more teeth with restoration fractures, and 14% of Ss had 1 or more teeth with cusp fractures. Blacks, poor persons, and irregular attenders had more caries, root fragments, and cusp fractures, even though they had significantly fewer teeth. Blacks, poor persons, and irregular attenders were not at increased risk for restoration fractures, probably because fractures were associated with dental care use. These findings regarding caries and restorative treatment needs are consistent with a substantial burden in adult high-risk groups, and are relevant for dental primary health care policy.

Access to and patterns of use of oral health care among elderly veterans

Utilization of The Department of Veterans Affairs (VA) dental care system is best understood in the context of the health care system at large. Veterans' use of dental care is apparently influenced by a wide variety of factors that include: barriers to access to non-VA systems (such as a lack of health insurance and the inability to afford non-VA care); ineligibility for VA services (such as absence of a service-connected disability); characteristics of the VA delivery system itself (such as eligibility priorities, geographic distribution of VA facilities, and quality of VA care); and characteristics of the veteran population (such as veterans' illness level, their perceived need for care, and their satisfaction with and perceived quality of VA care). The Department of Veterans Affairs offers a unique opportunity to study the effect of certain delivery system characteristics on utilization behavior and veterans' use of specific dental services. Health services research on the VA oral health care system will 1) provide information useful to improve veterans' oral health and the effectiveness and efficiency of VA dental care delivery and 2) improve our understanding of utilization behavior in large public sector health care systems that are surrounded by private sector health care settings. The following topics should be included in a VA oral care health services research agenda: development of a uniform, system-wide dental care data base; an understanding of the long-term benefits that result from the use of specific dental services and determination of the services that are the most cost-effective; an understanding of the characteristics of delivery systems and of the dental care providers who promote the most appropriate, effective, and efficient care; a better understanding of how VA makes veterans aware of their eligibility; an understanding of the relationship between medical and dental care use in the VA system; and an understanding of the degree to which discontinuity exists in dental care services of veterans.

Pilot study comparing parents' and third-grade schoolchildren's attitudes toward braces and perceived need for braces

An instrument developed for third-grade schoolchildren and their parents was pilot-tested for its ability to measure orthodontic attitudes and perception of the child's need for braces. Seventy-eight children and 54 parents were surveyed. Forty-six percent of the children wanted braces while 61% believed that they needed braces. Correlation between desire for braces and perceived need was 0.47, suggesting that desire and perceived need were only moderately correlated in children. Sixty-three percent of the parents believed that their child needed braces. Despite such proportions of children and parents perceiving a need for treatment, three-fourths of the children and two-thirds of the parents were satisfied with the appearance of the child's teeth. Attitude subscales, derived from the attitude survey, and clinical orthodontic parameters were used to model children's and parents' perceived need for braces in the child. No clinical parameter was a significant correlate in either children's or parents' model of perceived need. Neither race nor gender contributed significantly to either model. The subscales Concern for Appearance and Social Aspects of Braces were the strongest covariates of children's perceived need for braces. Concern for Appearance was the most important correlate in the parents' model. These data suggest that parents' perceived need for orthodontic treatment for their third-grade children is determined primarily by a concern for appearance rather than clinical status. In third-graders, perceived aesthetics and social aspects apparently have more influence than clinical status in creating a perception of need for braces.

Perceived need for dental care in dentate older adults

Previous studies have observed a substantial difference between need for dental care as determined by professional dental examiners (determined by disease presence) and that reported by potential dental patients (which may or may not be based on perceived disease presence). In this study of community-dwelling dentate older adults a substantial difference was also observed. To explore the role that factors other than disease presence may have in determining perceived current need for dental care, subjects were queried about their current oral signs, oral symptoms, psychosocial impacts from oral disease, and other factors hypothesised as affecting current need for dental care. When reporting perceived current need, subjects apparently were not responding to overall assessments of their dental health or periodontal health; rather, they were responding to specific oral signs and symptoms, and their effects. In a multivariate model, dental pain was most strongly associated with perceived need, followed by the psychosocial effects of oral diseases, reported presence of cavities, and reported presence of loose teeth. However, substantial percentages of persons reported oral signs, symptoms, and effects that would be judged professionally as sufficient for reporting a current need for dental treatment, yet did not report a need. With oral signs and symptoms accounted for, persons with less discretionary income and those who were less satisfied with their last dental visit were actually more likely to perceive a current need for dental care.(ABSTRACT TRUNCATED AT 250 WORDS)

Older Floridians' attitudes toward and use of dental care

Older Floridians (mean age 78 years) were interviewed regarding their use of dental care, attitudes toward dental care, and other characteristics hypothesized as being explanatory of dental care use. Fifty-two percent of respondents reported having been to a dentist within the past year, and 31% had not been within the previous 5 years. Five constructs measured attitudes toward dental care and dental health: (a) the importance placed on regular dental care and oral hygiene, (b) the importance of avoiding tobacco to prevent oral cancer, (c) the value of dental care, (d) negative aspects of dental care, and (e) satisfaction with the last dental visit. In a multivariate model, the value of dental care and importance of regular care and oral hygiene wer significantly correlated with dental care use. These findings are consistent with the conclusion that attitudes contribute to understanding dental care use in later life, a contribution that is independent of the direct effects of socioeconomic status and dentate status.

Attitudinal and behavioral characteristics of older Floridians with tooth loss

In this cross-sectional study of Floridians aged 65 yr or older, 600 persons were interviewed to identify the characteristics of individuals who survived into old age with an intact or nearly intact dentition. Persons with total or partial tooth loss reported less frequent dental care, less ability to pay dental care fees, less frequent dental hygiene, and were more likely to have been smokers or diabetic. Persons with tooth loss also had less positive attitudes toward dentists and dental care. These cross-sectional findings are consistent with tooth loss being the result of disease-, behavior-, and attitude-related causes, and/or their interactions. Tobacco use, diabetes, and infrequent oral hygiene and dental care may increase risk for dental disease; decreased ability to pay for dental treatment may impair utilization of non-extraction treatment options, and negative attitudes toward dental treatment may influence the desire for non-extraction treatment options. Research targeted toward modifying attitudes toward dental treatment may be useful in preventing or delaying tooth loss, and measurement of attitudes may be a useful way to identify individuals at the greatest risk for tooth loss for intervention studies.

Mouth dryness as reported by older Floridians

Thirty-nine percent of 600 community-dwelling older Floridians (mean age of 78 yr) reported having mouth dryness. Seventy-nine percent of respondents reported at least one medical condition, 57% were taking at least one prescribed or over-the-counter medication, and 33% were taking at least one potentially xerostomic medication. Reported mouth dryness was highly associated with the number of potentially xerostomic medications. After stratification by medication usage, age, diabetes, arthritis, perceived medical health, and dependence in physical functioning were significantly associated with mouth dryness. Persons with dry mouth were also more likely to have reported dental symptoms, signs of dental disease, sensory changes, and other oral symptoms. Ten percent of those who reported mouth dryness also said that their mouths felt dry when eating a meal, 10% said that they had difficulties swallowing foods, and 15% of persons with dry mouth also said that the amount of saliva in their mouths was too little. Sixty-five percent of persons with dry mouth reported doing one or more dryness-related behaviors. These results suggest that the prevalence of xerostomia was high, and the impact of dry mouth on individuals' daily behaviors was significant.

Oral signs, symptoms, and behaviors in older Floridians

Six hundred community-dwelling older Floridians were interviewed regarding the presence of reported signs of dental conditions, dental and oral symptoms, behavioral impact from dental conditions, and orofacial sensory changes. The prevalence of any single oral sign, symptom, or behavioral impact was generally low. A notable exception was the 39 percent prevalence of dry mouth. However, from 10 percent to 29 percent of persons had at least one of these dental signs, dental symptoms, dental behavioral impacts, or sensory changes. These findings are consistent with a noteworthy burden from nonoptimal oral health status, and these burdens were significantly more prevalent in irregular dental attenders, persons with lower household incomes, and persons who reported poorer general health. Inclusion of these non-disease items in an assessment of oral health status seems warranted, and would allow a broader evaluation of oral health outcomes.

Dental care use by U.S. veterans eligible for VA care

Military veterans eligible for dental care in U.S. Department of Veterans Affairs (VA) facilities cooperated for a mailed survey about their dental care utilization. Subjects were selected because of their eligibility for continuing dental care in VA facilities at no monetary cost. However, only 48% reported the VA as their only or primary source of dental care; this allowed us the opportunity to compare dental care frequency by those who received dental care at no monetary cost with those who did not, as well as measure delivery system effects on dental care use. Consequently, we tested respondent-level and delivery system-level hypotheses regarding determinants of veterans' dental care use. Predisposing characteristics (dentate status, usual reason for dental visits, and the importance placed on dental care and oral health) were the strongest determinants of interval since last dental visit. Enabling determinants (current source of dental care, and having a regular source of care) were also significant, but measures of need for dental care (perceived oral health and perceived need for treatment) were not. More recent dental care use by veterans who used the VA delivery system as their source of dental care, even with dental care payment source and other determinants accounted for, suggests that the VA delivery system may have promoted more regular use compared to other systems.

Eligible veterans' choice between VA-covered and non-VA-covered dental care

Veterans who were eligible for dental care in Department of Veterans Affairs (VA) facilities at no monetary cost responded to a mailed questionnaire. Seventy-one percent were aware that they were actually eligible for VA dental care. However, only 48 percent reported the VA as their only or primary source of dental care. Eligibility status, perceived quality of VA dental care, use of VA medical care, perception that one's income meets expenses, and perceived need for dental care were significant correlates of using the VA as one's current source of dental care. Level of formal education, perception that one's income meets expenses, transportation pattern, geographic distance from a VA facility, and eligibility status were significant correlates of using the VA as one's current medical care source. Research on VA utilization offers the opportunity to study issues of access to, and use of, a large public health care system whose patients largely receive care at no monetary cost. Veterans' use of VA dental and medical care is apparently influenced by a wide variety of factors, ranging from barriers to access to non-VA systems, to characteristics of the VA delivery system itself, to need for treatment.