Faculty Bibliography

OBJECTIVE: The study sought to document dental caries among adolescents residing in northern Manhattan, New York, by race, sex, and community. METHODS: Clinical and demographic data were collected from children aged 12-17 years at five school-based dental clinics in northern Manhattan. Data on dental caries were collected by calibrated examiners using the National Institute of Dental and Craniofacial Research criteria for oral examinations. RESULTS: A total of 566 children participated in the study. They were predominantly Hispanic (64%) or African American (28%). Compared to data from the National Health and Nutrition Examination Survey III, mean DMFT (3.36 vs 2.53; P<.01) and the prevalence of untreated disease (36% vs 16%; P<.01) were significantly higher for northern Manhattan adolescents. Of the adolescents evaluated, 13 percent had at least one severely carious tooth with pulpal involvement that required either extraction or endodontic therapy. CONCLUSIONS: Adolescents in northern Manhattan have higher caries prevalence and higher levels of untreated caries than their national counterparts. Carious lesions progress to pulpal involvement in a high percentage of northern Manhattan children and require extraction or root canal therapy as treatment. There is an urgent need for affordable and available dental primary care services targeted to economically disadvantaged communities

OBJECTIVES: Profound and growing disparities exist in oral health among certain US populations. We sought here to determine the prevalence of oral health complaints among Harlem adults by measures of social class, as well as their access to oral health care. METHODS: A population-based survey of adults in Central Harlem was conducted from 1992 to 1994. Two questions on oral health were included: whether participants had experienced problems with their teeth or gums during the past 12 months and, if so, whether they had seen a dentist. RESULTS: Of 50 health conditions queried about, problems with teeth or gums were the chief complaint among participants (30%). Those more likely to report oral health problems than other participants had annual household incomes of less than $9000 (36%), were unemployed (34%), and lacked health insurance (34%). The privately insured were almost twice as likely to have seen a dentist for oral health problems (87%) than were the uninsured (48%). CONCLUSIONS: There is an urgent need to provide oral health services for adults in Harlem. Integrating oral health into comprehensive primary care is one promising mechanism

This study examined whether costs associated with tuberculosis (TB) screening and directly observed preventive therapy (DOPT) among drug injectors attending a syringe exchange are justified by cases and costs of active TB cases prevented and examined the impact of monetary incentives to promote adherence on cost-effectiveness. We examined program costs and projected savings using observed adherence and prevalence rates and literature estimates of isoniazid (INH) preventive therapy efficacy, expected INH hepatoxicity rates, and TB treatment costs; we conducted sensitivity analyses for a range of INH effectiveness, chest X-ray (CXR) referral adherence, and different strategies regarding anergy among persons affected with human immunodeficiency virus (HIV). For 1,000 patients offered screening, incorporating real observed program adherence rates, the program would avert $179,934 in TB treatment costs, for a net savings of $123,081. Assuming a modest risk of TB among HIV-infected anergic persons, all strategies with regard to anergy were cost saving, and the strategy of not screening for anergy and not providing DOPT to HIV-infected anergic persons resulted in the greatest cost savings. If an incentive of $25 per person increased CXR adherence from the observed 31% to 50% or 100%, over a 5-year follow-up the net cost savings would increase to $170,054 and $414,856, respectively. In this model, TB screening and DOPT at a syringe exchange is a cost-effective intervention and is cost-saving compared to costs of treating active TB cases that would have occurred in the absence of the intervention. This model is useful in evaluating the cost impact of planned program refinements, which can then be tested. Monetary incentives for those referred for screening CXRs would be justified on a cost basis if they had even a modest beneficial impact on adherence

In spite of the direct referral system and family-centered model of primary oral health care linking medical and dental care providers, most HIV-positive patients at the Columbia Presbyterian Medical Center received only emergency and episodic dental care between 1993 and 1998. To improve access to dental care for HIV/AIDS patients, a mobile program, called WE CARE, was developed and colocated in community-based organizations serving HIV-infected people. WE CARE provided preventive, early intervention, and comprehensive oral health services to minorities, low-income women and children, homeless youths, gays and lesbians, transgender individuals, and victims of past abuse. More efforts to colocate dental services with HIV/AIDS care at community-based organizations are urgently needed

Currently, research institutions are not mandated to provide free medical care or compensation to research participants for research-induced injuries. Research studies offering financial compensation or the possibility of treatment often attract more of the working poor who are less likely to have health insurance. Thus uninsured or underinsured participants face a heavier burden and greater risk than those with insurance. Based on a theoretical examination of the Belmont principles of beneficence and justice, the authors' IRB analysis, and an analysis of the changing health care and research arenas, the authors provide reasons to amend the Federal Code of Regulations