Abstracts

Oral Health

1. Martin CA, McNeil DW, Crout RJ, Lawrence SM, Weyant RJ. Orthodontic treatment needs in Appalachian youth and their parents. Poster presentation, 80th General Session of the International Association of Dental Research/American Association of Dental Research, March 2002, San Diego, CA.

Objectives: Appalachian and other rural populations suffer in having a disproportionate amount of health and oral health problems. Relatively little is known about the occlusal status in this historically isolated, relatively homogenous population, including the youth. This study was designed to provide information about orthodontic treatment needs in this group. Methods: There were 42 youth (age range 12 - 17) and one or both of their biological parents (n=55) who were randomly selected from patients of an Appalachian health clinic for participation in a research protocol involving various behavioral and oral health measures, including an orthodontic examination. Angle's system was used to classify patients; an index of treatment need was recorded, as was current or past orthodontic treatment status. Results: Of the 42 youngsters, 25 were identified as needing orthodontic care. An additional 5 were either currently in treatment or had been in treatment in the past. Significantly more youngsters needed treatment than were receiving it, ?2(1)=13.3, p < .001. The remaining 17 youngsters were judged to have no orthodontic needs. Of the 25 young people requiring care, 13 were evaluated as having a Class I occlusion, and 12 as having a Class II occlusion. Of the 55 parents, only 1 had ever received orthodontic care. There were 14 of these adults who had full or partial dentures; an additional 5 were partially or completely edentulous, with no prosthodontic aids. Conclusions: There is a great deal of unmet orthodontic treatment need in this Appalachian sample. Less than 20% of those youngsters requiring treatment are receiving it. This disparity in receiving treatment has profound psychosocial and oral health implications, which potentially are lifelong.

2. Polk DE, Weyant RJ, McNeil DW, Crout RJ, Marazita ML. Socioeconomic status and number and treatment of caries. Oral platform presentation, 83rd Annual Meeting of the International Association for Dental Research/34th Annual meeting of the American Association of Dental Research, March 9-12, 2005, Baltimore, MD.

Background: Higher social status is usually associated with better oral health. Objectives: To examine the unique explanatory power of objective and subjective measures of social status in the number of missing teeth or teeth with filled or unfilled caries. Methods: Study participants were 212 adults from rural West Virginia. For each participant, standardized oral exams were performed; education level and household income were obtained; and self-perceived status in society and in the community were assessed using 10-point scales. Two measures of oral health were used in these analyses: 1) sum of missing teeth and teeth with filled or unfilled caries; and 2) number of teeth with filled caries minus number of missing teeth and teeth with unfilled caries. Multilevel regression was used, controlling for age and grouping by family unit. Results: All measures of social status showed good variability and were moderately related. Unexpectedly, social status was not associated with the number of missing teeth or teeth with filled or unfilled caries. Controlling for number of missingteeth or teeth with filled or unfilled caries, higher subjective status in society (B = 1.08, SE = 0.33, 95% CI = 0.41 – 1.75) and household income (B = 2.00, SE = 0.77, 95% CI = 0.46 – 3.54) were each associated with relatively more filled teeth than teeth with unfilled caries or missing teeth. Conclusion: Although higher social status is usually associated with better health, in this sample there was no difference by social status in the overall number of affected teeth. However, higher social status was associated with relatively more filled teeth than teeth with unfilled caries or missing teeth. Finally, these results are consistent with the hypothesis that subjective social status captures unique information about status that is important for oral health. Supported by NIH / NIDCR R01-DE014899.

3. Polk DE, Weyant RJ, McNeil DW, Crout RJ, Marazita ML. Socioeconomic disparity and periodontal disease. Poster presentation, 64th annual meeting of the American Psychosomatic Society, March 1-4, 2006, Denver, Colorado. Psychosom Med Jan-Feb;68(1):A102 – A103, 2006.

Persons higher in socioeconomic status are less likely to develop periodontal disease than persons lower in socioeconomic status. This disparity may partially result from differential infection by periodontal pathogens and partially from differential disease progression after infection. We hypothesize that socioeconomic status, smoking, and oral health behaviors will distinguish disease developers from disease non-developers. Participants were 240 adults from 161 families in Western Pennsylvania and West Virginia. Standardized oral exams were performed and self-report of demographic and behavioral information was obtained. Measures of periodontal disease were obtained from primarily the 4 first molars. Teeth were included only if they showed evidence of infection with Bacteriodes forsythus, Porphyromonas gingivalis, or Treponema denticola. Disease was defined as the presence of infection plus either probing depth greater than 3mm or bleeding on probing. Absence of disease was defined as infection, probing depth less than 3mm, and no bleeding on probing. 56% of the teeth met criteria for having disease. Multilevel modeling was used, nesting teeth within person, and person within family. A higher probability of having disease was associated with having fewer years of education, OR = 1.81, 95% CI = 1.15 to 2.85. Once smoking and oral health behaviors were accounted for, the association between probability of disease and number of years of education was reduced, OR = 1.61, 95% CI = 1.01 to 2.56. This suggests that interventions targeting both smoking and oral health behaviors may help reduce the disparity due to socioeconomic status. Future research should examine the effectiveness of such interventions. Supported by NIH / NIDCR R01-DE014899.

4. Weyant RJ, Polk D, McNeil DN, Crout R, Marazita ML. Familial transmission of gingival bleeding risk. Poster presentation, Gordon Research Conference on Periodontal Disease, June 4-9, 2006, Il Ciocco, Barga, Italy.

Introduction: Aggregation of periodontal disease within families implies either genetic transmissibility or risk from shared environmental hazard. Understanding the means of transmission and the family-level disease risk posed to children informs prevention efforts. This study examines the degree of familial aggregation of periodontal inflammation in a rural, high-risk population between spouses and between mother and child to determine if there is evidence for either genetic or shared environmental risk. Methods: This study presently consists of 1178 individuals, representing 380 families from an ongoing cohort study of oral disease risk in families. The aim of the study was to identify family characteristics associated with increased disease risk for children. Children at least 11 years old and both parents were provided with an oral examination including an assessment of gingival inflammation (bleeding on probing). Adults also received a PSR examination. Results: Correlation of bleeding scores among spouses was 0.54 (p .01). Children of mothers with significant bleeding scores were at greatly elevated risk for gingival bleeding (odds ratio 5.4; 95% confidence interval 3.4 ¬ 9.8). Transmissibility analysis found no evidence of genetic transmission of disease risk between parents and children. The only significant predictors of bleeding in families were economic factors (e.g., income). Individual-level risks such as race, parental education, smoking and age were not predictive of gingival bleeding. Oral health behaviors showed a suggestive association. Discussion: This study provides evidence of aggregation of periodontal inflammation within families and implies the existence of “high risk” families. Although there was strong evidence that risk was “transmissible” to children, the transmission did not appear to be genetic. Rather, the increased risk for periodontal bleeding appeared to be the result of a shared (family-level) environmental risk related to socio-economic factors. These results demonstrate the importance of understanding the role of contextual factors when quantifying periodontal disease risk and modeling disease etiology. The ability to identify ³high risk² families provides the ability to target interventions to children most likely to develop periodontal disease, thus intervening before significant tissue destruction has occurred. The nature of the interventions will likely include an awareness of the increased risk faced by these children and the need for increased use of professional dental services and improved self-care. This study is continuing to accrue subjects and additional analysis is ongoing.

Genes

1. Maher BS, Cooper ME, McNeil DW, Crout RJ, Weyant RJ, Marazita ML. Genetic segregation analysis of caries risk. Oral platform presentation, 83rd Annual Meeting of the International Association for Dental Research/34th Annual meeting of the American Association of Dental Research, March 9-12, 2005, Baltimore, MD. Objectives: The etiology of caries risk has been attributed to genetic and environmental factors. Although the genes involved in caries risk are not yet known, specific hypotheses regarding the transmission patterns of caries risk can be tested. Methods: Segregation analysis is a model-fitting approach to testing various Mendelian and non-Mendelian inheritance patterns in families. Herein, we apply segregation analysis to a sample of 49 nuclear families ascertained through the Center for Oral Health Research in Appalachia (COHRA), a consortium between the University of Pittsburgh and West Virginia University. We used indices of decayed, missing and filled surfaces (DMFS) and teeth (DMFT) as our phenotypes for segregation analysis using the regressive approach. Results: The "no familial transmission model" for DMFS and DMFT could be rejected by the Likelihood Ratio Test (LRT). Each specific Mendelian Model could also be rejected by LRT. Conclusions: Segregation analysis of caries risk, as indexed by DMFS and DMFT, supports a transmissible non-Mendelian major effect. Supported by NIH/NIDCR grant # R01-DE014899.

2. Wenger SL, Wise JL, Crout RJ, McNeil DW, Weyant RJ, Marazita ML. Utilization of a large dental genetic study for cryptic chromosomal rearrangements. Poster presentation, 83rd Annual Meeting of the International Association for Dental Research/34th Annual meeting of the American Association of Dental Research, March 9-12, 2005, Baltimore, MD. As part of a large dental genetic study involving 500 families from rural Appalachia to identify candidate genes in oral health, blood samples are also being processed for cytogenetic evaluation of this population for cryptic telomere rearrangements using fluorescent in situ hybridization (FISH) DNA probes. Over the past 7 years, reports have indicated that about 7% of individuals with unexplained mental retardation and normal chromosomes have a deletion and/or duplication at the very ends of chromosomes or telomeric region(s), half of which are inherited from a parent with a balanced cryptic rearrangement. Objectives: While the incidence of visible cytogenetic reciprocal translocations is 1/600, no studies have determined the prevalence of balanced cryptic telomere rearrangements in the general population. Methods: This study provides us with the opportunity to evaluate a potential 1000 unrelated individuals (parents among 500 families) for the incidence of cryptic telomere rearrangements. In addition, any individuals who have developmental delay or mental retardation will be evaluated by karyotype for a chromosome abnormality, and/or by DNA specific FISH probe for DiGeorge syndrome, a micro-deletion syndrome characterized by defects of the palate with an incidence of 1/4000. Results: To date 538 blood samples have been received and processed on family members enrolled in the dental study. Of these samples, 266 are adults, of which telomere evaluation has been completed on 41, all of which have been normal. Five children have been karyotyped, which have also been normal. Conclusion: The large number of families enrolled in this study provides a means to evaluate telomere rearrangements in order to determine their prevalence in the general population. Supported by NIH/NIDCR grant #R01-DE014899.

Microbes

2. Thomas J, Bretz WA, Crout RJ, McNeil DW, Weyant RJ, Marazita ML. Creating an oral microbial signature for a rural Appalachian population. Poster presentation, 83rd Annual Meeting of the International Association for Dental Research/34th Annual meeting of the American Association of Dental Research, March 9-12, 2005, Baltimore, MD.

OBJECTIVES:West Virginia's population exhibits severe dental disease with 31% of the adults under 35 being edentulous. Previous work in our laboratory on a 50 patient study focused on the identification of 3 periodontal pathogens, yeast and non-traditional oral isolates with susceptibility profiles to create a unique Oral Microbial Signature (OMS) in this state. The goal of this research was to further categorize OMS with throat culture microbes, S. mutans, and 3 periodontal pathogens in subjects recruited from a large oral disparities population in two Appalachian rural counties in WV.METHODS: Grandparents, parents and children were recruited on site as part of a 500 family set focus, followed over 5 years. Samples were collected as part of dental evaluation and included 1) viable culture techniques on selective/differential media (S. aureus, Group A Beta Strep, C. albicans) from the throat, 2) broth screening method (S. mutans) (Dentocult) from saliva and 3) enzymatic method (BANA) for 3 periopathogens P. gingivalis, B. forsythus and T. denticola from 1 representative tooth from each of the 4 quadrants and the tongue.RESULTS:From 560 patients, throat cultures 237 ( 44%) were positives for S. aureus, 174 (28%) for C. albicans and 161 (26%) for Group A beta Strep. Dentocult results for S. mutans indicated 102 negatives (ranked 0) with total positives (313) ranked by quantitation: 109 (35 %), 1, 124 (40 %), 2, and 138 (44 %), 3. BANA enzymatic assay indicated for the tongue (617 total), 471 positive and 138 negative. 4 tooth sites, 1,154 positive and 681 negative.CONCLUSIONS:We recovered an inordinate number of potential oral-pathogens in a variety of distinct combinations defining an Oral Microbial Signature (OMS). With a unique S. aureus antibiotic dentogram we hope to assess transmissibility within a closed community/family and correlate/predict clinical outcome. R01-DE014899

3. Thomas JG, Gray DM, Nakaishi LA, Crout R, McNeil DW, Weyant RJ, Marazita ML. 3 species oral microbial signature from two rural populations. Poster presentation, 35th annual meeting of the American Association of Dental Research, March 8-11, 2006, Orlando, Florida, J Dental Research 85 (Spec Issue A):2125, 2006.

OBJECTIVES: We previously reported a unique Oral Microbial Signature (OMS) based on combinations of cultures and enzymatic assays from throat, salvia, tongue, and tooth samples. The OMS concept was predicated upon the Ecological Hypothesis: oral flora reflect environmental pressures. We expanded analysis to 1152 subjects, focusing on 3 oral pathogens from throat cultures as liability indicators and linear transmissibility within closed families from two disparate rural communities in low-income populations: WV Appalachia and Western Pennsylvania. METHODS: Grandparents, parents and children from 325 families were recruited on site as part of a 500 family set focus, followed over 5 years. Samples were collected as part of dental evaluation, which included 1) viable culture techniques on selective/differential media (S. aureus (SA), Group A Beta Strep (BS), C. albicans (CA)) from the throat, 2) broth screening method (S. mutans) (Dentocult) from saliva and 3) enzymatic method (BANA) for 3 perio-pathogens. RESULTS: From the 836 WV subjects, ranking of % positives showed SA first, 197 positives (23.6%); CA second, 129 positives (15.4%) and BS third, 89 positives (10.6%). Data from Pennsylvania indicated a similar ranking and magnitude of positives. SA 81 positives (25.7%), CA 47 (14.9%) and BS 25 positives (7.8%). Combinations also showed similar ranking comparing WV and PA, respectively: SA/CA (6.6% vs. 5.4%); BS/CA (6.3% vs. 3.8%); SA/BS (5.4% vs. 3.8%) and all three isolets (3.2% vs. 1.6%). All isolates and combinations were more frequent than those routinely recovered by WVU-Hospital Laboratory. CONCLUSIONS: We recovered a higher than expected number of oral-pathogens in distinct combinations defining an OMS similar for two geographically distinct, low-income populations. With a unique SA antibiotic dentogram and the addition of Methicillin Resistant SA screening, we hope to assess transmissibility within a closed community/family and correlate/predict oral disease/outcome. (Liability Index) R01-DE014899

4. Polk DE, Weyant RJ, McNeil DW, Crout RJ, Thomas JG, Marazita ML. Socioeconomic status and oral pathogenic load. Poster presentation, annual meeting of the American Psychosomatic Society, March 2-5, 2005, Vancouver, British Columbia, Canada.

We investigated possible pathways through which social status is associated with the quality of oral health. We hypothesize that higher social status is associated with a lower oral load of microbial agents. Using an observational, cross-sectional design, we examined the association of objective and subjective measures of social status with the microbial load of pathogens that contribute to caries and periodontal disease. Study participants were 178 adults from 121 households in rural West Virginia. For each participant, standardized oral exams were performed; education level and household income were obtained; and self-perceived status in society and in the community were assessed using 10-point scales. Scores on the two measures of self perceived status were averaged. Two measures of microbial load were examined: 1) the BANA measure of Bacteriodes forsythus, Porphyromonas gingivalis, and Treponema denticola; and 2) Streptococcus mutans. Multilevel regression was used grouping by household unit. Higher combined perceived status was associated with both lower levels of BANA, B = -0.05, SE = 0.02, 95% CI = -0.09 to -0.01, F(1,55) = 5.28, p < .03, and S. mutans, B = -0.07, SE = 0.03, 95% CI = -0.13 to -0.01, F(1,42) = 6.00, p < .02. Higher levels of the measure of status in society were associated with lower levels of BANA, B = -0.04, SE = 0.02, 95% CI = -0.07 to -.001, F(1,50) = 4.34, p < 0.04, and lower levels of S. mutans, B = 0.06, SE = 0.02, 95% CI = -0.11 to -0.0, F(1,42) = 5.06, p < .03. Higher levels of household income were associated with lower levels of S. mutans, B = 0.06, SE = 0.03, 95% CI = -0.11 to -0.001, F(1,43) = 4.21. Higher levels of education were marginally associated with lower levels of BANA, p < .07, and higher levels of perceived status in the community were marginally associated with lower levels of S. mutans, p < .06. Consistent with the hypothesis, higher social status measured in several different ways was associated with lower loads of those oral pathogens that are associated with caries and periodontal disease. Future research should examine psychosocial factors influencing host resistance in the oral cavity. Supported by NIH / NIDCR R01-DE014899.

5. Thomas, JG, Gray, D, Nakaishi, L, Crout, R, & Marazita, M Unmasking Candida albicans as an Emerging Oral Microbial Signature. Submitted to IADR 2007 Conference.

OBJECTIVES: We previously reported a unique Oral Microbial Signature (OMS) based on combinations of oral cultures and enzymatic assays from throat, salvia, tongue, and tooth samples. The OMS concept was predicated upon the Ecological Hypothesis: oral flora reflect environmental pressures. We were surprised by the frequency of viable, culturable Candia alibans and its combinations with Staph. aureus and Group A Beta Strep. We expanded analysis to 1594 subjects, focusing on emerging C. albicans from throat cultures as liability indicators and linear transmissibility within closed families from two disparate rural communities in low-income populations: WV Appalachia and Western Pennsylvania. METHODS: Grandparents, parents and children were recruited on site as part of a 500 family set focus, followed over 5 years. Samples were collected as part of dental evaluation which included 1) viable culture techniques on selective/differential media for S. aureus (SA), Group A Beta Strep (BS), and C. albicans (CA)) from the throat.

RESULTS: From the 1130 WV subjects, ranking of % positives showed SA first, 322 positives (28.0%); CA second, 237 positives (21.0%) and BS third, 138 positives (12.0%). Data from Pennsylvania indicated a similar ranking and magnitude of positives. SA 127 positives (27.0%), CA 102 (22.0%) and BS 54 positives (12.0%). Combinations also showed similar ranking comparing WV and PA, respectively: SA/CA (8.5% vs. 7.3%); BS/CA (8.4% vs. 7.3%); SA/BS (6.2% vs. 3.7%) and all three isolets (4.2% vs. 2.2%). All isolates and combinations were more frequent than those routinely recovered by WVU-Hospital Laboratory.

CONCLUSIONS: We recovered a higher than expected number of oral-pathogens in distinct combinations defining an OMS similar for two geographically distinct, low-income populations. With a unique CA anti-mycotic antibiogram and the addition of Methicillin Resistant SA screening, we hope to assess transmissibility within a closed community/family and correlate/predict oral disease/outcome. (Liability Index) R01-DE014899



Behavior

3. Davis B, McNeil DW, Crout RJ, Cohen LL, Casto GT, Weyant RJ. Fear of pain relates to patient comfort, satisfaction, and desire for information among Appalachia youth and their parents. Poster presentation, 80th General Session of the International Association of Dental Research/American Association of Dental Research, March 2002, San Diego, CA. J of Dental Research 81: A-269. Objectives: Information provided before and during dental procedures has been found to affect patient comfort and satisfaction. Also, while level of general dental fear has similarly been shown to be related to these constructs, there is little evidence regarding their association with fear of pain, specifically including fear of dental and medical pain. Moreover, relatively little data exist regarding these oral health issues (and others) in Appalachian and other rural populations. It was hypothesized that comfort, satisfaction, and desire for information would be significantly and positively correlated with fear of pain in both Appalachian youth and their parents. Methods: There were 39 pairs of youth (ages 12 - 17) and one parent who were randomly selected from patients of an Appalachian health clinic for participation in a research protocol involving behavioral, oral microbiological, caries, and other oral health measures. Comfort and satisfaction with the procedures, and desire for information, were assessed with Likert-type ratings. The Fear of Pain Questionnaire-III was used to assess fear of pain generally, and dental and medical pain in particular. Results: A high degree of satisfaction was reported for the various examinations. Patient ratings of comfort and satisfaction were found to be directly and strongly correlated (r=.74, p < .01). Desire for information was related only to fear of dental and medical pain (r=.23, p < .05), which in turn was related to comfort (r=.27, p < .05) and satisfaction (r=.26, p < .05). Conclusions: Higher fear of dental and medical pain is associated with a greater desire for information in Appalachian youth and their parents. Fear of pain may even have a mediational role among comfort, satisfaction, and desire for information. Patient comfort and satisfaction are highly and directly related; desire for information is indirectly related to both these constructs via fear of pain.

4. McNeil DW, Crout RJ, Weyant RJ, Widoe RK, Marting RK, Marazita ML. Toward an understanding of dental fear in Appalachia. Poster presentation, 83rd Annual Meeting of the International Association for Dental Research/34th Annual meeting of the American Association of Dental Research, March 9-12, 2005, Baltimore, MD. Objectives: Dental fear and its independent and interactive effects on oral health care utilization is only beginning to be understood in rural communities, including Appalachia. As part of a larger study on oral health in families, dental fear was examined in two rural West Virginia counties. While dental fear levels were expected to be similar to national norms, it was predicted that dental fear would be predicted by fear of pain, age, gender, and socioeconomic status (SES). Methods: There were 107 adults who participated as household groups. As part of a battery of dental and behavioral assessments, the Dental Fear Survey (DFS) and the Fear of Pain Questionnaire – Short Form were completed. Participants' mean age was 35.7 years (SD = 9.3, range 18 – 67), with 37% males and 63% females. Results: Analysis of DFS total scores, separated by gender, for this Appalachian sample were consistent with published norms for other populations (males, t = -.26, p = .80; females, t = -.55, p = .59). Regression analysis with the total DFS score as the dependent variable revealed age (r = - .25) and SES (r = .29) as significant predictors; in addition, fear of pain (r = .58) was the strongest single contributor (model R2 = .42, F (5, 90) = 12.9, p < .001). Conclusion: As predicted, overall dental fear levels in this Appalachian sample were similar to national norms for other populations. Consistent with past research, fear of pain was the single best predictor of dental fear levels; age and SES also significantly contributed to the model. The disproportionate burden of oral disease suffered by Appalachian populations must be understood in a multifactorial fashion, considering dental fear as one component interacting with other factors such as oral health values, generational status, and economics. Supported by NIH/NIDCR grant #R01-DE014899.

5. McNeil DW, Crout RJ, Widoe RK, Martins RK, Weyant RJ, Marazita ML. Toward an understanding of the relation between oral health and Appalachia identity. Poster presentation, 2005 National Oral Health Conference, American Association of Public Health Dentistry, May 1-5, 2005, Pittsburgh, PA. Objective: To relate oral health values and identification as a West Virginian with oral health status. Methods: There were 236 adults from two rural West Virginia counties who participated as household groups. As part of a battery of dental and psychosocial assessments, including the Dental Neglect Scale, the West Virginia Identity Scale was utilized to assess identification with Appalachian culture. Results: Greater identification with traditional West Virginia identity was related to less positive oral health values. Moreover, such identification was associated with poorer self-perceived oral health status. Conclusions: Oral health values and identification with traditional Appalachian values may be associated with poorer oral health status among rural West Virginians.

Family

1. Crout RJ, McNeil DW, Wenger SL, Wearden S, Weyant RJ. Cardiovascular risk evaluation of families in a rural WV population. 81st General Session of the International Association of Dental Research, June 2003, Goteborg Sweden.

West Virginia leads the nation in mortality from coronary heart disease (CHD) among men and women age 35-74 (D. Sturgill et al. WV Med J 1990 Jan:86(1):9-11). An evaluation of selected risk factors was performed on 60 families in two rural WV counties. The burden of oral disease, suggested as a possible CHD risk factor by the recent Surgeon General's Report, has been reported in this population previously (W. Bretz et al. J Public Health Dent 2001, 6(1): 231). Objectives: The purpose of this study is to report on the prevalence of high serum cholesterol and glucose levels in this same population. The families consisted of 132 participants of whom 55 were children and 77 adults. With the exception of 5 individuals who had no other family members, all participating families had at least one parent and one biological child. Methods: 5ccs of non-fasting blood was drawn, placed in a serum separator tube, spun in a centrifuge at 3000 rpm for 15 minutes, then transported to a commercial laboratory. Upon arrival, the serum was run on an Olympus 5000 instrument. The laboratory's abnormal levels for glucose were > than 109 mg/dl, and for cholesterol > 200 mg/dl. Results: Of the participants, 40.9% (with a 95% confidence interval of ±8.4) had elevated cholesterol and 13.6% (±5.8) had elevated glucose. Of the children, 12.7% had high glucose while an additional 12.7% had elevated cholesterol levels. Among their parents, 63.1% had high cholesterol, 36.8% had elevated glucose, and 10.5% exhibited both increased levels of cholesterol and glucose. In 4 of 39 families, both parents and children had elevated cholesterol while one family had both a parent and child with elevated glucose. Conclusions: Further evaluation of fasting cholesterol and glucose determinations on this population would seem warranted and if confirmed, intervention strategies considered.

2. Marazita ML, Weyant RJ, Tarter R, Crout RJ, McNeil DW, Thomas J. Family-based paradigm for investigations of oral health disparities. Oral platform presentation, 83rd Annual Meeting of the International Association for Dental Research/34th Annual meeting of the American Association of Dental Research, March 9-12, 2005, Baltimore, MD.

Objective: The objective of this presentation is to synthesize the results of a systematic review of methods for investigating oral health disparities, and to present the resulting family-based paradigm for such investjgations. Methods: Systematic review of oral health disparities literature. Results: There are many approaches in the literature for determining the causes of oral health disparities. There is no doubt that there are genetic, environmental and behavioral components to the expression of oral health status in all populations, and hence contributions of each of these three factors to oral health disparities. Furthermore, it is clear that there will be interactions between these components and that each of these components may be transmissible (in a broad sense) within families. Biological (genetic and microbiological) contributions to oral health status cluster within families. An individual's genotype, and the genotypes of his/her oral flora, influence oral health. Furthermore, each of these (individual's genes, and oral flora) are transmissible within families. Health beliefs, attitudes and behaviors play major roles in oral health status, and are strongly influenced by the milieu of the family. Environmental factors and access to care are further components that influence oral health and are shared within the family/household unit. Therefore, in developing strategies for addressing disparities in oral health status it is necessary to determine the relative importance of each of those components, as well as interactions among factors and transmissibility patterns. Conclusions: Review and synthesis of disparities literature (in both oral and systemic health) leads to our proposed family-based paradigm for disparities research, i.e. with the family (or household) as the unit of analysis, and with assessments of oral health, environment, behavior, microbiology, and genes within the family. An application of this paradigm to Appalachian families will be presented. Supported by NIH/NIDCR grant # DE-014899.

Community

2. Crout RJ, McNeil DW, Casto G, Wallace J, Weyant RJ, Marazita ML. Desire for periodontal/endodontic therapy in an Appalachian community. Poster presentation, 83rd Annual Meeting of the International Association for Dental Research/34th Annual meeting of the American Association of Dental Research, March 9-12, 2005, Baltimore, MD.

Objectives: West Virginia consistently has one of the highest rates nationally of edentulism by age 65, with approximately 1/3 of adults having lost 6 or more teeth. Little research, however, has explored to what degree this Appalachian population would utilize treatments that may help in the retention of teeth, and what factors may affect such choices. It was predicted that demographic variables and oral health values would affect the desire for endodontic and periodontal therapies as opposed to extraction. Methods: Participants were 107 adults from two rural counties in WV, who are part of a larger investigation on oral health in families. Participants were presented with a hypothetical question about choosing endodontic therapy versus extraction, and a similar question about periodontal therapy; there was follow-up inquiry about reasons for the choice. Demographic variables included age, gender, income, socioeconomic status, and education. Value placed on maintaining good oral health was measured by the Dental Neglect Scale. Results: There were 28 (26.2%) who would chose extraction rather than either endodontics, or periodontics, or both. Reasons for preferring extractions included fear (24.3%) and expense (29.7%). Regression analysis revealed that educational level (r = .27) and the Dental Neglect Scale (r = .30) significantly predicted these choices, with greater education and greater value placed on oral health status associated with preference for endodontics and periodontics (model R2 = .14, F (3, 95) = 5.3, p < .002). Conclusions: Oral health values and educational level are significant factors which predicted choices for extraction versus endodontics or periodontics in this Appalachian sample. Over one-fourth of this sample would choose extraction over such procedures that may save the natural dentition. Educational interventions to reduce fear and enhance oral health values may be helpful in reducing edentualism in this population. Supported by NIH/NIDCR grant #R01-DE014899.

3. Crout RJ, McNeil DW, Weyant RJ, Widoe RK, Marazita, ML. Toward an understanding of periodontal status in an Appalachian community. Poster presentation, 91st annual meeting, American Academy of Periodontics, September 24-27, 2005, Denver, Colorado. 2005

West Virginia consistently has one of the highest rates nationally of edentulism by age 65, with approximately 1/3 of adults having lost 1/3 of their teeth. Recent findings have revealed that age, education level, socioeconomic status, income, and dental neglect significantly predicted the desire for extraction over periodontal therapy and endodontic treatment utilizing a hypothetical question for treatment options (Crout et al, J Dent Res 84, Spec Iss A: 1961, 2005). The objective of this study was to examine the periodontal status of this rural Appalachian population and to evaluate any relationship to gender, income, education, socioeconomic status and oral health values. Participants were 236 adults from two rural counties in West irginia who are part of a larger investigation on oral health in families. Demographic variables included age, gender, income, socioeconomic status, and education. Value placed on maintaining good oral health was measured by the Dental Neglect Scale. Periodontal status utilized sextant periodontal probing depths where a score of 1 = = 3.5mm; 2= 3.5mm - 5.5mm; 3 = >5.5mm. A summation score for all sextants was then utilized for analysis. Ages ranged from 18 to 74 (M = 34.1, SD = 9.4) with 36% males and 64% females. There were 39.7% who had an annual income of $35,000 or less. Correlation analyses identified that gender (r = -.17, p = .02), income (r = -.33, p < .001), education (r = -.31, p < .001), socioeconomic status (r = -.15, p = .04), and oral health values (r = -.23, p = .001) were negatively associated with total periodontal screening scores, such that higher periodontal disease scores were more likely for male participants with lower education, income, socioeconomic status, and oral health values. Regression analyses with total scores (summed across the 6 sextants) revealed income and gender as significant predictors, model R2 = .16, F (2, 150) = 14.4, p < .001. Periodontal disease prevalence is related to a variety sociodemographic factors in cross sectional analysis. Determination of causal associations will require further longitudinal investigation. Supported by NIH/NIDCR grant # R01-DE014899




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