H A Kiyak

University of Washington Seattle, Seattle, Washington, United States

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Publications (98)129.99 Total impact

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    ABSTRACT: Purpose: This study identifies clinical factors that predict multiple tooth loss in a socioculturally diverse population of older adults. Materials and Methods: A total of 193 participants from English-, Chinese-, or Punjabi-speaking communities in Vancouver, British Columbia, with low incomes and irregular use of dental services were followed for 5 years as part of a clinical trial of a 0.12% chlorhexidine mouthrinse. The participants were interviewed and examined clinically, including panoramic radiographs, at baseline and annually for 5 years. Binary logistic regression was used to test the hypothesis that there was no difference between incidence of multiple (≥ 3) tooth loss in older people with various biologic, behavioral, prosthodontic, and cultural variables over 5 years. Results: Multiple tooth loss, which was distributed similarly among the groups in the trial, occurred in 39 (20%) participants over 5 years. The use of removable prostheses was the best predictor of loss, followed by the number of carious surfaces and number of sites with gingival attachment loss > 6 mm. The pattern of prediction was consistent across the three linguocultural groups. Conclusion: The use of removable dentures was the dominant predictor of multiple tooth loss in the three communities, but that tooth loss was not significantly associated with the cultural heritage of the participants.
    The International journal of prosthodontics 03/2013; 26(2):127-34. · 1.63 Impact Factor
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    ABSTRACT: Comprehension of informed consent information has been problematic. The purposes of this study were to evaluate the effectiveness of a shortened explanation of an established consent method and whether customized slide shows improve the understanding of the risks and limitations of orthodontic treatment. Slide shows for each of the 80 subject-parent pairs included the most common core elements, up to 4 patient-specific custom elements, and other general elements. Group A heard a presentation of the treatment plan and the informed consent. Group B did not hear the presentation of the informed consent. All subjects read the consent form, viewed the customized slide show, and completed an interview with structured questions, 2 literacy tests, and a questionnaire. The interviews were scored for the percentages of correct recall and comprehension responses. Three informed consent domains were examined: treatment, risk, and responsibility. These groups were compared with a previous study group, group C, which received the modified consent and the standard slide show. No significant differences existed between groups A, B, and C for any sociodemographic variables. Children in group A scored significantly higher than did those in group B on risk recall and in group C on overall comprehension, risk recall and comprehension, and general risks and limitations questions. Children in group B scored significantly higher than did those in group C on overall comprehension, treatment recall, and risk recall. Elements presented first in the slide show scored better than those presented later. This study suggested little advantage of a verbal review of the consent (except for patients for risk) when other means of review such as the customized slide show were included. Regression analysis suggested that patients understood best the elements presented first in the informed consent slide show. Consequently, the most important information should be presented first to patients, and any information provided beyond the first 7 points should be given as supplemental take-home material.
    American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 02/2012; 141(2):174-86. · 1.33 Impact Factor
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    ABSTRACT: This study compares occlusal and psychosocial outcomes from comprehensive orthodontic treatment in Medicaid (MC) and privately financed (private pay, PP) patients. Two cohorts received comprehensive orthodontics: MC (n = 66); PP (n = 60). A calibrated, blinded examiner scored dental casts at baseline (pretreatment, T1) and after completing 2 years of treatment (posttreatment, T2) using the Peer Assessment Rating (PAR) and the Index of Complexity, Outcome, and Need (ICON). The prevalence of patients in the validated ICON categories for treatment need, complexity, and improvement were calculated. Questionnaires to assess body image (BI) and expectations/experiences were administered. Occlusal measures at T2 were compared after adjustment for baseline characteristics. Psychosocial measures were compared between and within groups. Occlusal and psychosocial associations were evaluated. MC was 1.3 years younger (P < 0.001) and had worse malocclusions at baseline (PAR 32 versus 25; P < 0.001); (ICON 64 versus 56; P = 0.06). After adjustment for age and initial severity, estimated average differences between groups at T2 (MC-PP) were slight: 1.5 [95 percent confidence interval (CI) -2.9, 5.9] and 2.4 (95 percent CI -4.4, 8.9) for PAR and ICON, respectively. More PP completed treatment under 2 years (85 percent versus 62 percent; P = 0.03). At baseline, both groups needed treatment, but MC malocclusions were more complex (P = 0.05). At T2, both groups were acceptable and there were no differences in ICON improvement categories. Group differences in psychosocial measures and associations between psychosocial and occlusal measures were evident in the "teeth" domain but weak or lacking elsewhere. Occlusal and psychosocial outcomes from orthodontics in MC and PP were comparable, despite worse MC malocclusions at baseline.
    Journal of Public Health Dentistry 10/2011; 72(2):94-103. · 1.21 Impact Factor
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    ABSTRACT: Objective: The shortage of orthodontists who are Medicaid providers contributes to disparities in access to orthodontic services for children from low-income families. Orthodontists cite poor patient compliance resulting in inferior outcomes as one reason for not accepting Medicaid patients. This study aims to compare outcomes from comprehensive orthodontic treatment in groups of Medicaid (MC) and privately financed (PP) patients. Methods: Two cohorts of children with permanent dentition malocclusion received comprehensive orthodontic treatment at the University of Washington: MC (n=62) and PP (n=60). Orthodontic casts were obtained at baseline (T1) and after completing active treatment or 2 years, whichever came first (T2). A calibrated and blinded examiner scored all casts using the Peer Assessment Rating (PAR) and the Index of Complexity, Outcome and Need (ICON). T1 and T2 values were compared, as was the proportion of patients in the various ICON need/acceptability, complexity and improvement categories. Results: PP patients were 1.1 years older (p<0.001). MC patients had worse malocclusion on PAR (p=0.001) and ICON (p=0.04) at baseline, but were not different from PP at T2 after adjusting for T1 differences (p=0.89). T1 need was equally high, and both groups had acceptable occlusal outcomes (82% PP vs. 69% MC, p=0.11). Treatment complexity at T1 tended to be less complex in PP, but this was NS. The majority of patients in both groups were rated as substantially improved (62% PP vs. 58% MC, p=0.30). Conclusions: There was no difference in outcomes from comprehensive orthodontic treatment between Medicaid and privately financed patients, despite worse malocclusion in the former group at baseline. Contrary to orthodontist assumptions, Medicaid-funded children can achieve equally successful treatment outcomes.
    IADR General Session 2011; 03/2011
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    ABSTRACT: Previous orthodontic informed consent research found low patient/parent recall and comprehension of treatment risks and expectations. Objectives: The purpose of this pilot study was to determine if customized informed consent documents with and without verbal explanation were equivalent for recall and comprehension of the risks and benefits of orthodontic treatment. Methods: 48 parent/patient pairs were randomly assigned to one of two groups. PowerPoint presentations (PPT) were generated for each subject-pair based on the most common risk factors (pain, enamel destruction, root resorption and post-treatment change) and up to four patient-specific risk factors. Group 1 listened to a resident case presentation of the treatment plan and the key points of informed consent. Each subject then read the Modified Informed Consent form, reviewed the customized PPT, and completed an interview with structured questions, two reading ability tests and a demographics questionnaire. Group 2 had the same intervention except subjects did not have the verbal explanation of the key points of consent. Child participants were compensated for their time with a gift certificate. The interviews were tape recorded, transcribed and scored using a previously developed codebook. Results: Test-retest reliability (codebook-response rating) was excellent: Kappa=0.86 (95% CI: 0.79, 0.92) and internal subject reliability for interview questions was fair: Kappa=0.39 (95% CI: 0.25, 0.53). There were no significant differences between the Groups for: recall; comprehension; recall/comprehension combined; the domains of treatment, risk and responsibility or any socio-demographic variables. Conclusions: This pilot study suggests no advantage to a verbal review of the informed consent form at the case presentation when other means of review such as the customized PPT are included. Eliminating this verbal review could increase provider efficiency during the orthodontic informed consent process. Supported by Delta Dental Master's Thesis Grant.
    IADR General Session 2011; 03/2011
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    ABSTRACT: Objectives: To estimate the prevalence of periodontal disease in older adults with diabetes mellitus and other systemic chronic diseases. Methods: Retrospective medical record review of low-income adults ≥60 years who visited the University of Washington Mobile Geriatric Dental Clinic from November 2004 to May 2010. The following data were collected: age, sex, race, insurance status, living situation, United States-born, English as second language (ESL); diabetes mellitus, cardiovascular disease (CVD), essential hypertension, depression, osteoporosis; medications; periodontal disease, gingivitis, tooth loss, or root/crown caries based on recorded dental examination. Statistical analysis was performed with STATA IC11. Results: One-hundred forty-four subjects were identified. Study subject characteristics are shown in Table 1. Table 1. Study Subject Characteristics (N=144) Value Age in years, mean SD (range) 74.48 (60-91) Gender, % female 60.8% Race/ethnicity: Caucasian Asian African-American/African Latino 93 (65%) 33 (23.1%) 16 (11.2%) 1 (0.7%) Insurance status: Dual-eligible Medicaid Medicare None 102 (73.4%) 27 (19.4%) 9 (6.5%) 1 (0.7%) Living situation: Alone With family AFH/group home 88 (64.2%) 41 (29.9%) 8 (5.8%) US-born 47 (35.1%) ESL 59 (41%) Systemic chronic disease: Essential hypertension Depression Diabetes mellitus CVD Osteoporosis 121 (84.6%) 70 (49%) 54 (37.5%) 53 (37.1%) 37 (25.9%) Oral disease: Tooth loss Caries Periodontal disease Gingivitis 121 (84%) 67 (46.5%) 52 (36.1%) 23 (16%) The prevalence of periodontal disease among 54 subjects (37.5%) with diabetes mellitus was 22.2%. Those with diabetes mellitus were more likely to have CVD (p=0.031, Fisher's exact test) and essential hypertension (p=0.056, Fisher's exact test). Conclusions: Oral and systemic chronic disease is common in older adults. Patients with complex health status pose a challenge to dental providers.
    IADR General Session 2011; 03/2011
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    ABSTRACT: Background: There is an increasing population of older adults in Brazil for whom tooth loss and edentulism are still real. Several studies have examined the impact of dentistry, oral health, and dentist preferences upon clinical decision-making, but without integrating the opinions of patients and dental providers. Objective: To explore perceptions of elders and dental professionals on psychosocial factors that influenced their behaviors and decisions regarding tooth extractions. Methods: In order to obtain information on oral health-related behaviors and community interactions, we conducted eight focus groups with 41 older adults (ages 66 to 84) and individual interviews with four dental professionals in a southern Brazilian community. The theory of symbolic interactionism framed the analyses. Results: Elders and dental providers attributed tooth extractions to limited availability and access to dental care, lack of oral hygiene supplies, technological limitations in dental materials and procedures in the past, and high costs of oral hygiene and dental treatment. Dental professionals felt overburdened by providing care for a large population in which teeth are not valued and public health services are lacking. Elders blamed dental providers who they believed preferred to extract teeth and make dentures in the past. Rarely did elders perceive themselves as the source of decisions to extract, even if they recognized that they had sought treatment only while in pain. Conclusion: Decisions on tooth extractions and dentures in this region of Brazil are part of an historical and interactional process in which patients and health care providers hold different values and knowledge. Symbolic interactionism proved valuable in the study of interactions among community members and between them and dental providers, allowing for the observation that teeth were seen as problems to be solved, while dentures were regarded as an ideal and predictable solution by participants.
    IADR General Session 2011; 03/2011
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    ABSTRACT: Objectives: To examine the association between oral health and five chronic systemic diseases and use of xerogenic medications among low-income older adults enrolled in a community mobile dental program. Methods: Retrospective medical and dental record review of low-income adults age 60+ who utilized the UW Mobile Geriatric Dental Clinic between 07/2009 and 09/2010. Data collected from patient charts included gender, age, systemic diseases (specifically diabetes [DM], cardiovascular disease[CVD], hypertension[HTN], osteoporosis, depression), medications, and oral conditions (caries, periodontal disease, pain, denture problems, poor oral hygiene) at the elder's first appointment in the mobile clinic. Results: Data on 237 patients were obtained. Subjects were age 60-91 at their first appointment; 65.4% were women. The most common systemic disease was HTN (78.9%), followed by DM (32.1%) and depression (30.4%). Caries was the most common oral condition (82.3%), followed by periodontal disease and poor oral hygiene (43% each); 30.4% had denture problems. Chi square tests revealed that gender was unrelated to oral health and most systemic diseases, but women were more likely to have osteoporosis (p=.001) and to use cholesterol medications (p=.03); men were more likely to use COPD meds (p=.03). Most systemic x oral disease associations were non-significant, but elders with DM or HTN or CVD were more likely to have caries (p=.055). Denture problems were more common in those with DM (p=.04) and HTN (p=.03). Oral hygiene was worse in those using GI meds (p=.02). Conclusion: Low income older adults with poor access to medical and dental care pose a challenge to dental providers, especially those with dentures. Prevention, medication reviews, and periodic dental visits can reduce complications of chronic systemic diseases on oral health. Longitudinal research is needed to assess oral health after chronic diseases are diagnosed.
    IADR General Session 2011; 03/2011
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    ABSTRACT: To compare the dental status of Brazilian and Canadian elderly populations with respect to socioeconomic and quality of life factors. A total of 496 adults aged 60-75 years, having four or more teeth, and physically and cognitively suitable for a clinical oral examination were included. Subjects answered questions concerning their lifestyle and completed the Geriatric Oral Health Assessment Index (GOHAI) questionnaire. In all populations, the majority were females, aged between 60 and 65 years and married. Although the Canadian New Immigrant population had lower mean income, they had more remaining teeth (23.04 ± 6.1), more functional teeth (sound and restored teeth) (14.92 ± 5.7), more sound teeth (15.40 ± 7.6), but more carious teeth (2.97 ± 3.0). The Brazilian population had higher numbers of restored teeth (12.26 ± 6.8) and fewer remaining teeth (17.80 ± 7.6). In all populations, females, married and younger (60-65 years old) adults were more likely to retain 20 or more teeth. The mean GOHAI scores were similar for Canadians (40.55 ± 5.7) and Canadian New Immigrants (39.28 ± 6.5), but were higher than that among Brazilians (31.97 ± 8.9). The numbers of remaining teeth were related to greater education and higher income status for Brazilian and Canadian populations. However, Canadian New Immigrants with lower income and education retained more teeth than the other populations.
    Gerodontology 12/2010; 27(4):258-65. · 1.83 Impact Factor
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    ABSTRACT: Patients enrolled in Medicaid have limited access to orthodontic services in the United States. No studies are available, to the authors' knowledge, regarding the clinical and psychosocial burdens of malocclusion on these patients from an economic perspective. The authors conducted a systematic review of the relevant economic literature. They identified issues from the perspectives of the various stakeholders (dentists, patients and parents, Medicaid programs) and developed a conceptual model for studying decision making focused on the strategy of providing early interceptive and preventive treatment rather than, or in addition to, comprehensive care in the patient's permanent dentition. Medicaid coverage and reimbursement amounts vary nationwide, and decision making associated with obtaining care can be complex. The perspectives of all relevant stakeholders deserve assessment. A conceptual framework of the cost-effectiveness of interceptive orthodontic treatment compared with comprehensive treatment illustrates the issues to be considered when evaluating these strategies. Policymakers and the dental community should identify creative solutions to addressing low-income families' limited access to orthodontic services and compare them from various perspectives with regard to their relative cost-effectiveness. Dentists should be aware of the multiple problems faced by low-income families in obtaining orthodontic services and the impact of stakeholder issues on access to care; they also should be proactive in helping low-income patients obtain needed orthodontic services.
    Journal of the American Dental Association (1939) 10/2010; 141(10):1202-12. · 1.82 Impact Factor
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    ABSTRACT: The aim of this study was to assess oral health-related quality of life (OHQOL) in adolescents who sought orthodontic treatment. A comparison between these adolescents and their age-matched peers who were not seeking orthodontic treatment provided an assessment of the role of OHQOL in treatment seeking. The sample consisted of 225 subjects, 12 to 15 years of age; 101 had sought orthodontic treatment at a university clinic (orthodontic group), and 124, from a nearby public school, had never undergone or sought orthodontic treatment (comparison group). OHQOL was assessed with the Brazilian version of the short form of the oral health impact profile, and malocclusion severity was assessed with the index of orthodontic treatment need. Simple and multiple logistic regression analysis showed that those who sought orthodontic treatment reported worse OHQOL than did the subjects in the comparison group (P <0.001). They also had more severe malocclusions as shown by the index of orthodontic treatment need (P = 0.003) and greater esthetic impairment, both when analyzed professionally (P = 0.008) and by self-perception (P <0.0001). No sex differences were observed in quality of life impacts (P = 0.22). However, when the orthodontic group was separately evaluated, the girls reported significantly worse impacts (P = 0.05). After controlling for confounding (dental caries status, esthetic impairment, and malocclusion severity), those who sought orthodontic treatment were 3.1 times more likely to have worse OHQOL than those in the comparison group. Adolescents who sought orthodontic treatment had more severe malocclusions and esthetic impairments, and had worse OHQOL than those who did not seek orthodontic treatment, even though severely compromised esthetics was a better predictor of worse OHQOL than seeking orthodontic treatment.
    American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 08/2010; 138(2):152-9. · 1.33 Impact Factor
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    ABSTRACT: Objectives: Researchers have found that normative (objective) ratings of esthetics are unrelated to subjective esthetic ratings, and are moderated by treatment expectations and self-esteem. This report presents data from an ongoing randomized trial of children undergoing interceptive (IO) or comprehensive orthodontics (CO) with Medicaid funding. Methods: 168 children (9.3 + 1.5 years), primarily ethnic minorities (37% African American, 17% Asian, 14% Latino, 14% mixed, 17% Caucasian) were randomized to IO or CO. Calibrated examiners scored pre-treatment and post-treatment models using the Peer Assessment Rating (PAR) and Index of Complexity, Outcome and Need (ICON). Children rated their teeth, profile, facial and total body image (BI) pre and post-orthodontics. Results: Total BI, Facial and Profile BI were moderately high both pre and post-orthodontics and showed little change. Teeth BI was low at baseline but improved significantly, especially for CO patients. Correlations between BI, PAR and ICON, even the esthetic component of ICON (ICON-AC) were NS at all assessments for IO patients but significant for CO patients at post-orthodontics (PAR: r= -.59; ICON: r=-.61, p<.0001; ICON-AC: r=-.52, p<.001), reflecting greater improvements in this group on BI, PAR and ICON. Although both normative scores and subjective BI scores improved pre to post-orthodontics, correlations between change scores were NS. Conclusion: These interim data support previous research concluding that subjective esthetics is unrelated to objective indicators; orthodontic treatment improves both but large changes in PAR and ICON are uncorrelated with more modest improvement in BI. Supported by NIH Grant U54 DE14254.
    IADR General Session 2010; 07/2010
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    ABSTRACT: In the last decade, an increasing number of studies focusing on the impact of oral deformities and illnesses on quality of life have been published. Our goal was to evaluate the impact of oral problems on quality of life in 3 groups of adult patients in need of orthognathic-surgical treatment. A total of 117 patients were recruited from the Clinic of Oral and Maxillofacial Surgery of the State University of Rio de Janeiro in Brazil: 20 in the initial phase, 70 in the presurgical phase (presurgical orthodontic preparation), and 27 in the postsurgical phase. The impact of treatment phase on oral health-related quality of life was evaluated with the oral health impact profile (OHIP-14). OHIP-14 scores were calculated by an additive method, and the participants were divided on the basis of level of impact into 2 groups: high impact (scores, >11) and low impact (scores, < or =11). Compared with patients in the postsurgical phase, those who needed orthognathic surgical treatment but had not yet begun it and those who were in the presurgical phase of treatment were 6.48 and 3.14 times more likely, respectively, to experience a negative impact of their oral condition. Among those undergoing or anticipating orthognathic-surgical treatment, orthognathic surgery positively affects the patients' quality of life.
    American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 06/2010; 137(6):790-5. · 1.33 Impact Factor
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    ABSTRACT: Objective: To assess the link between specific systemic diseases and oral conditions among elders with diabetes, hypertension, osteoporosis, depression or cardiovascular disease, and who used medications for these conditions. Method: Records of elders who had received dental exams and treatment from a mobile clinic at least twice within the past four years were reviewed, those aged 55+ and whose health history included one or more of these systemic diseases or had none (control group) were selected. The former used at least one xerogenic medication. Results: This chart review revealed 82 cases with one or more diseases and only 5 without; on average the former was older than the latter (age 75.69.4 vs. 659.6). Gender differences emerged in rates of heart disease (p=.03), soft tissue problems (p=.04), denture use at baseline (T1) (p=.01) and follow up (T2) (p=.04). Men had more heart disease and soft-tissue-problems; women were more likely to use dentures. Elders with hypertension, depression, arthritis, and using xerogenic drugs were more likely to wear dentures than those without (p=.01, .03, .001, and .05 respectively). Elders using antihypertensive and GI drugs had more soft tissue problems (p=.03 each). The total number of xerogenic drugs used related only to soft-tissue lesions at T1 (p=.02) and T2 (p=.07). Conclusion: Contrary to previous studies, heart disease, diabetes, hypertension and osteoporosis were unrelated to and did not predict most oral conditions in this sample. However, elders with hypertension, depression, arthritis, and using xerogenic drugs were more likely to wear dentures, suggesting a historical pattern of poor oral health in patients with these systemic conditions. The study was limited by a small sample size, clinicians' inconsistent recording of oral conditions, and patients' poor recall of medications. NIH/NIDCR Grant #:T32 DE007132
    AADR Annual Meeting 2010; 03/2010
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    ABSTRACT: There are disparities in access to orthodontic treatment for children from low-income families. Systematic programs of limited-care interceptive and preventive orthodontics have been proposed as a solution. The purpose of this randomized clinical trial was to compare dental outcomes and funding eligibility from a group of Medicaid patients randomized to receive interceptive orthodontics (IO) in the mixed dentition or observation (OBS). One hundred seventy Medicaid-eligible children were randomized to receive IO or OBS and followed for 2 years, when complete data were available on 72 and 74 children, respectively. The 2-year changes in the peer assessment rating (PAR) were compared using the Student t test. The proportions of children no longer eligible for Medicaid funding as defined by handicapping labiolingual deviation (HLD) scores less than 25 at the 2-year follow-up were compared with the chi-square test. The IO patients had significantly greater decreases in the PAR scores--50%-compared with the OBS subjects, -6% (P <0.001). Negative and positive overjet and maxillary alignment were the components most affected by IO; they decreased by 11.0, 7.2, and 3.7 PAR points, respectively (P <0.001). Overbite showed little change. At the 2-year follow-up, 80% of the IO patients' malocclusions that qualified initially were no longer deemed medically necessary by the HLD index, compared with 6% in the OBS group (P <0.001). IO significantly reduces the severity of malocclusions and moves most from the "medically necessary" category to elective but does not produce finished results for most patients. Overjet and alignment were most readily corrected by interceptive treatment. Deep overbites were the least susceptible to IO correction.
    American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 03/2010; 137(3):324-33. · 1.33 Impact Factor
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    ABSTRACT: Objectives: Our purpose was to identify clinical factors that help to predict multiple tooth-loss in a multi-cultural population of elders. Methods: 107 men and 86 women (age at baseline: 60-75yrs; mean age: 674yrs) of low income who were irregular users of dental services participated in the 5-year Trials to Enhance Elderly Teeth Health (TEETH). Each obtained a standardized interview and clinical examination yearly, a panoramic radiograph at baseline and after 5 years, and received a regimen of either 0.12% chlorhexidine (CHX) or a placebo during the trial (Wyatt et al. Caries Research, 2007). Binary logistic regression was used to test associations between loss of 3 or more teeth during the 5 years and various demographic (including sex, age, cultural-ethnicity, education, income, and tobacco-use) and clinical variables (including radiographs) of crowned teeth, endodontic treatments, fixed partial dentures and removable dentures (RDs), carious lesions and periodontal attachment loss (AL) ≥6mm. Results: Multiple tooth-loss occurred in 39 (20%) of the participants during the 5 years, and was similarly distributed in both treatment groups. Caries, AL, and use of RDs were all significantly (p<.05) associated with tooth-loss (odds ratios: 6.3 for RDs; 1.4 for caries; and 1.3 for AL). Conclusion: Previous replacement of missing teeth with RDs was the best predictor of continued tooth-loss, which supports the hypothesis that clinical problems of the past continue into old age without regard to gender or ethnocultural origins. This research was supported by NIDCR grant number RO1 DE12215.
    IADR General Session 2009; 04/2009
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    ABSTRACT: Introduction: Disparities in access to orthodontic services for disadvantaged groups are common. The wider use of interceptive orthodontics has been suggested as a partial solution to decrease these disparities. The primary objective of this study was to compare treatment outcomes from a group of Medicaid patients who receive interceptive orthodontic treatment (IO) compared to no treatment group (OBS) during the mixed dentition. Methods: 130 Medicaid-eligible children were randomized to receive IO or OBS (mean age 9.5 and 9.3, respectively) and followed for 2 years, at which point complete data were available on 65 children per group. The dental outcomes were quantified using the Index of Complexity, Outcome and Need (ICON). The two-year changes in ICON were compared using Student's t-test. The proportions of the children's post-treatment complexity and improvement categories were compared using the Chi-Squared test. Results: IO patients had a significantly greater decrease in ICON score (41%), compared to OBS (<1%; p < 0.001). With respect to improvement scores, 86% of IO patients were rated as improved, 12% same and 2% worse while OBS were rated 28%, 40%, and 32%, respectively (p < 0.001). In the IO group, > 80% were categorized as "difficult" or "very difficult" pre-treatment and >70% as "mild" or "easy" post-treatment (p<0.001). The preponderance of the OBS subjects remained in the "difficult" to "very difficult" categories post-observation.(15.41%) Conclusions: IO was highly effective at improving malocclusions and reducing their treatment complexity in Medicaid-eligible patients. Funded by: Northwest/Alaska Center to Reduce Oral Health Disparities NIDCR U54-DE 014254
    IADR General Session 2009; 04/2009
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    ABSTRACT: Objectives: To evaluate outcomes from interceptive orthodontic treatment (IO) compared to observation only (OBS) in Medicaid patients during mixed dentition. Methods: 170 children were randomly assigned to either IO or OBS groups (mean age 9.5 and 9.3, respectively). Of these, 158 sets of dental casts (IO=83; OBS=75) and 118 sets of radiographs (IO=60; OBS=58) were available initially (T1) and after two years (T2). Radiographs were scanned and measured to assess interincisal angle, overjet, overbite, ANB angle, anterior face height, and mandibular plane angle. Dental casts allowed assessment of incisor irregularity, Curve of Spee, horizontal tooth malposition, anterior and posterior crossbites, molar relationships, arch form and symmetry, arch length discrepancy, midline difference, and ectopic eruptions. Within and between group analyses allowed comparison between IO and OBS. Two-tailed t-tests with p-values <0.05 were used. Results: Radiographically, children with either Class II or Class III malocclusion in IO showed normalization of skeletal and dental parameters, with statistically significant improvements for overjet (p<0.05), overbite (p<0.01), mandibular plane angle (p<0.01), anterior face height (p<0.01), ANB angle (p<0.01), and interincisal angle (p<0.01). OBS children showed no statistically significant changes, except for an increased overbite in Class III subjects (p<0.01). Significant improvement was found in IO children for midline difference (p<0.05), incisor irregularity (p<0.01), anterior crossbite (33% reduction), and ectopic eruptions (27% reduction). Conclusions: Results indicate that early interceptive orthodontic treatment is effective in mixed dentition Medicaid patients, specifically to address maxillary and mandibular incisor irregularity, anterior crossbites, ectopic eruptions, arch midline difference, A-P and vertical relationships. It was less effective for treatment of horizontal tooth malposition and molar relationships, and not effective for treatment on Curve of Spee, posterior crossbite, and arch form and symmetry. Acknowledgements: Supported by NIH/NIDCR T32DE007132, TL1RR025016, and U54-DE 014254 grants.
    IADR General Session 2009; 04/2009
  • Eva F. Kahana, H. Asuman Kiyak
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    ABSTRACT: Interviews were conducted with 302 elderly persons residing in two ethnic urban communities to determine their problems as well as their needs for diverse community services. Sex and living arrangements were found to be critical mediators of the demand for and use of various services. A greater proportion of women than men (particularly women living alone) reported needs for household, self-maintenance, and community services. Older women living alone were also more likely to report that they had experienced neighborhood problems. Implications for designing community-based services to better meet the needs of older persons in diverse living situations are discussed.
    Journal of Gerontological Social Work 10/2008; 3(2):17-29.
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    ABSTRACT: There is limited information on infectious and host responses distinguishing older people with or without active periodontitis. This study measured bacterial and serum cytokine and high-sensitivity C-reactive protein (hsCRP) levels in older persons. Elders (mean age: 67 years), whose periodontal status had declined most or least (20% worst or 20% best) over 5 years, were enrolled. Two years later, they were classified as periodontally declining (active periodontitis [AP]), if they had at least five teeth with probing depth (PD) > or =5 mm, or stable (stable periodontally [SP]), if they did not. Groups were compared with respect to demographics, PD, clinical loss of attachment, subgingival bacteria, serum hsCRP, interleukin (IL)-1beta and -6, and chronic diseases. Ten AP and 24 SP subjects were identified; 13% of women and 44% of men from the original sample were in the AP group (P <0.05). Most Asians were SP; most whites and all African Americans were classified as having AP (P <0.01). More AP elders had osteoporosis (P <0.01), but the AP and SP groups did not differ with respect to IL-1beta and -6 or hsCRP. Bacterial counts were higher in the AP group for Parvimonas micra (previously Peptostreptococcus micros or Micromonas micros) (7.7 x 10(5) cells versus 3.8 x 10(5) cells; P <0.05), Prevotella intermedia (25.7 x 10(5) cells versus 9.8 x 10(5) cells; P <0.01), Tannerella forsythia (previously T. forsythensis) (16.2 x 10(5) cells versus 8.0 x 10(5) cells; P <0.05), and Streptococcus mutans (6.2 x 10(5) cells versus 2.0 x 10(5) cells; P <0.01). Three risk factors were most predictive of periodontal decline: PD, osteoporosis, and being white or African American. Periodontal decline was associated with osteoporosis, ethnicity, PD, gender, serum hsCRP, and levels of four bacterial species.
    Journal of Periodontology 10/2008; 79(10):1920-6. · 2.40 Impact Factor

Publication Stats

2k Citations
129.99 Total Impact Points


  • 1981–2012
    • University of Washington Seattle
      • • School of Dentistry
      • • Department of Oral and Maxillofacial Surgery / Oral Pathology
      • • Department of Periodontics
      • • Department of Oral Medicine
      Seattle, Washington, United States
  • 2010
    • University of São Paulo
      • Departamento de Prótese (FOB) (Baurú)
      São Paulo, Estado de Sao Paulo, Brazil
  • 2007
    • University of British Columbia - Vancouver
      • Faculty of Dentistry
      Vancouver, British Columbia, Canada
  • 2005
    • CUNY Graduate Center
      New York City, New York, United States
  • 2002
    • American University Washington D.C.
      Washington, Washington, D.C., United States
  • 1999
    • University of California, Berkeley
      Berkeley, California, United States
  • 1986
    • Center For Oral & Maxillofacial Surgery
      Georgia, United States