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Papers by Thayer Scott

Military Medicine, Jun 10, 2023

ABSTRACT Introduction Veterans suffer from lower overall well-being than non-veterans because of ... more ABSTRACT Introduction Veterans suffer from lower overall well-being than non-veterans because of their unique life course. This study aims to compare the impact of depression on oral health for veteran and non-veteran populations. Materials and Methods Data from 11,693 adults (18+) participating in the National Health and Nutrition Examination Survey (2011-2018) were analyzed. The outcome variables were dichotomous (at/above mean) decayed, missing, and filled teeth due to caries (DMFT), as well as the components, namely, missing teeth, filled teeth (FT), and decayed teeth (DT). The primary predictor variable combined depression screening outcome and veteran status (veteran/depressed, veteran/not depressed, non-veteran/depressed, and non-veteran/not depressed). Covariates included socioeconomic factors, demographics, wellness factors, and oral health–related habits. Associations between outcome and predictor variables were assessed with a fully adjusted logistic regression analysis. Results Veterans, regardless of depression status, had more DMFT, FT, missing teeth, and DT compared to non-veterans. After controlling for covariates, veterans suffering from depression had higher odds of DT (1.5, 95% CI, 1.0-2.4) compared to non-veterans without depression. In general, veterans who screened negative for depression had better oral health compared to all groups, with lower odds of DT (0.7, 95% CI, 0.6-0.9) and higher odds of FT (1.4, 95% CI, 1.1-1.7) compared to non-veterans with and without depression. Conclusions This study found that not only veterans have higher odds of overall caries experience, but also veterans suffering from depression have higher odds of active caries compared to non-depressed veterans. Most veterans lack Veterans Health Administration dental benefits and face challenges maintaining oral health on top of medical and mental health burdens. Our results add further urgency to increasing dental care access for this vulnerable population because of the exacerbation of unmet oral health care needs attributable to the additional mental health challenges veterans face.

Annals of the New York Academy of Sciences, Nov 1, 1996

Atherosclerosis is more severe in blacks than in whites, but abdominal aortic aneurysms, which ha... more Atherosclerosis is more severe in blacks than in whites, but abdominal aortic aneurysms, which have traditionally been thought to have an atherosclerotic etiology, appear to be less common in blacks. Because of this incongruity, we compared risk factor profiles in patients undergoing abdominal aortic aneurysm repair and patients undergoing femoral bypass for atherosclerotic occlusive disease. A dual case-control study was conducted, first, comparing patients who had undergone aneurysmectomy to a control group of patients who had undergone appendectomy; and then comparing patients who had undergone femoral bypass surgery to the same appendectomy controls. We initially used hospital discharge data for the entire state of Massachusetts and, in a second phase, data obtained from a review of medical records from Boston University Medical Center Hospital and Boston City Hospital. The statewide database indicated that rates of femoral bypass surgery were higher in blacks than in whites, but after adjusting for differences in hypertension, diabetes, and low socioeconomic status, the black/white odds ratio for femoral bypass fell to 1.44 (95% confidence interval: 1.08, 1.92). A similar analysis based on the hospital chart review, provided better control of confounding and indicated that there was no racial difference in rates of femoral bypass after correcting for other risk factors (odds ratio = 0.94; 95% confidence interval: 0.40, 2.22; p = 0.90). In contrast, the statewide database found higher rates of abdominal aortic aneurysm surgery in whites, and particularly in white males. Smoking and hypertension were strong risk factors for aneurysmectomy, but diabetes mellitus and socioeconomic status were not. After adjusting for other variables, the black/white odds ratio for aneurysmectomy was 0.29 (95% confidence interval: 0.07, 1.23; p = 0.09). Substantial differences are found in the risk factor profiles for aneurysmal disease and femoral atherosclerotic occlusive disease. Diabetes is a particularly strong risk factor for femoral disease, but not for aneurysmal disease. In addition, blacks had higher rates of femoral bypass surgery in Massachusetts, but the apparent racial difference appeared to be due to a greater prevalence of hypertension, smoking, and diabetes in blacks. In contrast, abdominal aortic aneurysms occurred predominantly in white males, and adjustment for other risk factors further accentuated the greater risk in whites.

British Dental Journal, Jan 16, 2009

Journal of Gastrointestinal Surgery, Dec 1, 1999

Community Dentistry and Oral Epidemiology, Apr 4, 2022

This letter is a response to commentary by Dr. Smith on 'Examining the association between ca... more This letter is a response to commentary by Dr. Smith on 'Examining the association between cancer history in early life and dental care utilization'. We provided additional information and clarification regarding our analysis and results in response to Dr. Smith's questions and comments. Despite the limitations and weaknesses of our study, we still believe that it provides important information and further research questions.

Community Dental Health, Nov 8, 2021

Background: In recent years, the consumption of sugar sweetened beverages has been declining, whi... more Background: In recent years, the consumption of sugar sweetened beverages has been declining, while low calorie sweetener and diet beverage consumption is increasing. Evidence about the effect of diet drinks on dental caries is insufficient, and has not accounted for the complexity of beverage consumption patterns. Therefore, the aim of this study is to examine the association between consuming diet drinks and dental caries among US adults. Methods: We analyzed 2011-2014 NHANES dietary data of adults using cluster analysis, with individuals grouped based on their beverage consumption. Clusters were identified based on the R-square statistic and the local peak of the pseudo F statistic. Survey procedure and sample weights were used to account for the complex NHANES sampling design. Results: Four beverage consumption patterns were identified: "high soda", "high diet drinks", "high coffee/tea" and "high water". The "High soda" cluster was the only one associated with higher DMFT after controlling for confounders (β=1.02, 95% CI=0.42 - 1.63), whereas DT was associated with "high soda" (β=0.45, 95% CI=0.25 - 0.64) and "high coffee/tea" (β=0.24, 95% CI=0.01 - 0.47). On the other hand, the "high diet drinks" cluster was neither associated with DMFT (β=0.69, 95% CI=0.51 - -0.35) nor DT (β=0.07, 95% CI=-0.21 - 0.35). Conclusion: Diet drinks consumption may not be associated with increased risk of dental caries. However, more studies should be conducted in order to confirm this finding.

JDR Clinical & Translational Research, 2019

Background: The Minamata treaty (2013) enacted a globally binding agreement to phase down amalgam... more Background: The Minamata treaty (2013) enacted a globally binding agreement to phase down amalgam use, which may significantly affect dental care for underserved populations. To comply with the Minamata treaty, strategic approaches need to be implemented to reduce amalgam use while imposing minimal risk on the dental care of the underserved. Objectives: To establish strategic approaches to reduce amalgam use, the aim of this study is to use a marketing research analysis to determine which patient-related factors influence pediatric dentists' choice of amalgam. Methods: A survey containing questions regarding amalgam use, perception about the environmental impact of amalgam waste, and hypothetical clinical scenarios of a child with dental caries with varying levels of caries risk and types of dental insurance was developed and pretested. Emails linked to an electronic survey were sent via Qualtrics to all active American Academy of Pediatric Dentistry members (n = 5,101), followed by 3 reminders. Descriptive analysis and choice-based conjoint analysis were performed to investigate trade-offs between selected factors, using SAS version 9.3. Results: Of 892 (17.6%) replies, 850 responses were eligible for analysis. Only 385 (45%) respondents indicated using amalgam, and their responses were analyzed in the conjoint model. Respondents' selection of amalgam varied between 8% and 28% across all the clinical scenarios, with most respondents choosing composite or stainless steel crowns. Conjoint analysis revealed that, while both caries risk and type of insurance affected respondents' decision about amalgam use, caries risk was the driving factor in decisionmaking for using amalgam. Conclusion: These results underscore the importance of prevention and management of risk factors to successfully phase down amalgam use. Knowledge Transfer Statement: Our study applied the marketing research tool, choice-based conjoint analysis, to investigate the relative importance of different factors on dentists' decisionmaking regarding amalgam use. This study should be of great interest to policy makers when developing strategic approaches to comply with the 2013 United Nations Environment Programme (a.k.a. Minamata treaty) policy recommendations for phasedown of dental amalgam.

JDR Clinical & Translational Research, 2021

Objective: The aim of this study is to examine the effect of diet drinks on dental erosion among ... more Objective: The aim of this study is to examine the effect of diet drinks on dental erosion among a representative sample of US adults. Methods: Adult dietary and dental data were analyzed from the 2003–2004 cycle of the National Health and Nutrition Examination Survey. Erosion was measured with a modified tooth wear index and was analyzed as a dichotomous variable. Cluster analysis was performed, and the cluster number was based on having a separate diet drink cluster and the R2 values. Survey procedure and sample weights were used. Results: Most of the population (80%) had some form of dental erosive lesions. When compared with the total sample, people with erosion were more likely to be male (52.5%) and older. People with no erosive lesions were younger (42.3%) and non-Hispanic Black (21.2%). Cluster analysis resulted in 4 distinct clusters: high water, high diet drinks, high coffee/tea, and high soda. The respective percentage of individuals in each cluster who had erosion was 78...

Community Dentistry and Oral Epidemiology, 2021

OBJECTIVES The purpose of this study was to examine the association between food insecurity and u... more OBJECTIVES The purpose of this study was to examine the association between food insecurity and untreated dental caries using a nationally representative sample of US adults. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014 on adults aged 18 years and older were analysed (n = 10 723). Primary predictors were overall food security (food-secure/ food-insecure) and household food security (full, marginal, low and very low). The main outcome was any untreated dental caries (none/ ≥ one). Multiple logistic regression analyses were done to estimate the adjusted odds ratio after controlling for confounders. RESULTS Food-insecure adults were more likely to have untreated dental caries than food-secure adults after adjusting for potential confounders (OR: 1.2; 95% CI: 0.9-1.5). Adults from households with marginal (OR:1.4; 95% CI:1.5-2.2), low (OR:1.3, 95% CI:1.3-2.0) and very low food security (OR:1.3; 95% CI:0.9-1.5) had higher odds of untreated caries than adults from households with full food security. Following age stratification, marginal, low and very low food-secure adults had higher prevalence of untreated dental caries than full food-secure adults across all age groups. CONCLUSIONS Our findings suggest that food-insecure adults had higher odds of untreated dental caries than food-secure adults. These findings highlight the importance of assessing food insecurity as a risk factor for dental caries. Longitudinal cohort studies are recommended to determine causal mechanisms.

Pediatric dentistry, 2019

Purpose: The purpose of this study was to evaluate dental care access and sealants prevalence amo... more Purpose: The purpose of this study was to evaluate dental care access and sealants prevalence among children with special health care needs. Methods: The authors utilized the publicly available National Health and Nutrition Examination Survey (NHANES) 2013 to 2014 datasets collected by trained dental examiners for the Centers for Disease Control and Prevention. This study included 2,651 six- to 19-year-olds who provided demographic, dental visit, disability, and sealants information. Weighted prevalence estimates and odds ratios (OR) were calculated for sealant use by disability, gender, age, race, and economic status. Results: Approximately 68 percent of participants had a dental visit in the past six months, with 84 percent of them being routine dental visits; each had approximately two sealed teeth (mean equals 2.37). Children with a physical disability have lower odds of having a sealant (OR equals 0.5; P=0.04) compared to nondisabled children. Six- to 11-year-olds have lower od...

International Journal of Dental Hygiene, 2021

INTRODUCTION The Supplemental Nutrition Assistance Program (SNAP) is a federal program aims to al... more INTRODUCTION The Supplemental Nutrition Assistance Program (SNAP) is a federal program aims to alleviate hunger and improve food insecurity. The impact of SNAP participation on overall health has been studied. However, little is known about the effects of SNAP participation on oral health. We aimed to investigate the association between participating in SNAP and dental caries and to explore the role of food insecurity as a moderator in this relationship. METHODS We obtained data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014.The primary outcome was untreated dental caries (none vs. one or more). Self-reported SNAP participation status in the past 12 months was the predictor and food security was the moderator. Food security was measured as overall food security status (full food secure/ food insecure) and household-level food security (full, marginal, low, and very low). Bivariate and multiple logistic regression analyses were conducted to evaluate the relationship between SNAP and dental caries, and whether food insecurity moderates this relationship. Statistical analysis was carried out in September 2020. RESULTS Our results suggested that after adjusting for potential confounders, SNAP participants were more likely to have untreated dental caries than non-SNAP participants (odds ratio:1.6; 95% CI:1.2-2.0). Food security status didn't alter the relationship between SNAP participation and untreated dental caries. CONCLUSIONS Food security status didn't alter the relationship between SNAP participation and untreated dental caries. SNAP participation was associated with untreated dental caries among U.S. adults, and this was not affected by their food security status.

The Journal of Contemporary Dental Practice, 2021

Aim and objective: This study aims to investigate the association between parity and dental carie... more Aim and objective: This study aims to investigate the association between parity and dental caries among US women. Materials and methods: National Health and Nutrition Examination Survey (NHANES 2001-2004) data for parous women aged 20-45 years were used for our analysis (n = 1,914). The association between parity (number of pregnancies resulted in live births) and caries experience [the decayed, missing, and filling teeth (DMFT) index] was analyzed using bivariate and multivariate regression analyses. SAS software version 9.1 was used for the statistical analyses. We used survey procedures (e.g., SURVEYFREQ, SURVEYMEANS, and SURVEYREG) that incorporate information on the appropriate weights to account for NHANES's complex sampling design. Results: The bivariate analysis showed a trend of increase in dental caries experience among parous women as the number of live births increased (p = 0.007). After adjusting for confounders, such as age, socioeconomic status (SES), dental care coverage, and utilization, a significant association was still observed between parity level and dental caries experience (p = 0.009). Conclusion: Our results suggest that higher parity can be associated with dental caries experience among US women of reproductive age. Clinical significance: Clinicians should be aware of this finding to promote better oral health care and education among women with increased parity.

Community Dentistry and Oral Epidemiology, 2021

OBJECTIVES This study aims to examine associations between cancer history in early life (diagnose... more OBJECTIVES This study aims to examine associations between cancer history in early life (diagnosed at 20 years of age or younger) and utilization of dental care. METHODS We analysed data of 10,185 participants, aged ≥20 years, from the National Health and Nutrition Examination Survey cycles 2015-2018. The main predictor was self-reported past history of any type of cancer diagnosed at 20 years of age or younger (yes/no). The outcome variables were having a dental visit within the past year, treatment or preventative visit, urgent need for care, and unmet dental need. Covariates included gender, age, race, marital status, education, and income. Bivariate and multiple logistic regression were conducted, accounting for the complex sampling design. RESULTS There was no difference between early life cancer survivors in regards to dental visit within the past year (OR: 0.7; 95% CI: 0.3-1.6), visit for dental treatment (OR: 0.6; 95% CI: 0.3-1.6), urgent need for care (OR: 0.8; 95% CI: 0.3-2.0), or unmet dental need (OR: 0.6; 95% CI: 0.2-1.6) compared to cancer-free participants. CONCLUSIONS Cancer history in early life doesn't impact dental care visits, type of last dental visit, dental care recommendation, or unmet dental need. Future cohort studies are needed to confirm this association.

The Journal of the American Dental Association, 2021

BACKGROUND The aim of this study was to examine the association between food insecurity and untre... more BACKGROUND The aim of this study was to examine the association between food insecurity and untreated caries among US children and the potential role of diet quality as a mediator in this relationship. METHODS The authors analyzed data for 4,822 children aged 5 through 17 years from the National Health and Nutrition Examination Survey cycles from 2011 through 2014. The authors measured food security as household-level food security status (full, marginal, low, very low) and overall food security status (full food secure, food insecure). They measured diet quality using the Healthy Eating Index. The primary outcome measure was untreated caries (none, ≥ 1). The authors used multiple logistic regression analysis to evaluate the relationships among food insecurity, diet quality, and untreated caries. They conducted mediation analysis using the Baron and Kenny approach. RESULTS Food-insecure children were more likely to have untreated caries compared with their fully food-secure counterparts, after controlling for confounding variables (odds ratio [OR], 1.38; 95% [CI, 1.11 to 1.72). Specifically, children from marginal and very low food-secure households had significantly higher odds of untreated caries (OR, 1.48; 95% CI, 1.10 to 2.01) compared with children from fully food-secure households (OR, 1.59; 95% CI, 1.12 to 2.26). Diet quality was not significantly associated with untreated caries. CONCLUSIONS Food insecurity was negatively associated with untreated caries among US children. Diet quality was not associated with untreated caries. PRACTICAL IMPLICATIONS Social factors such as food insecurity should be taken into consideration when dental clinicians perform caries risk assessment because caries risk is shown to be associated with overall health and dental health.

The Journal of the American Dental Association, 2020

BACKGROUND The effect of sugared beverages on dental caries has been widely studied in dental lit... more BACKGROUND The effect of sugared beverages on dental caries has been widely studied in dental literature. A major limitation of these studies was examining the beverages as a single source. To overcome this limitation, a few studies used cluster analysis to group people into similar beverage consumption patterns. These studies did not differentiate between sugared beverages and diet drinks. Therefore the aim of this study is to examine the effect of consuming diet drinks on dental caries among US children by using cluster analysis. METHODS In this cross-sectional study, the authors analyzed the dietary data of children aged 3 through 10 years, using 2 24-hour recall interviews in the 2011-2014 National Health and Nutrition Examination Survey data. Cluster analysis has been used to overcome the limitations of examining the beverages as a single source. Clusters were identified based on the R2 statistic and the local peak of pseudo-F statistics. Survey procedure and sample weights were used to account for the complex National Health and Nutrition Examination Survey sampling design. RESULTS Six beverage consumption clusters were identified: high soda, high 100% juice, high juice drinks, high diet drinks, high milk, and high water. Regression analysis showed that the high soda cluster had a tendency to increase caries risk (odds ratio [OR], 1.69, 95% confidence interval [CI], 0.9 to 3.1), while the high diet drinks cluster had neutral effect compared with the high water cluster (OR, 0.94, 95% CI, 0.5 to 1.8). CONCLUSIONS The results of this study suggest that diet drinks have no adverse effect on teeth among US children. Additional well-designed longitudinal studies should be conducted to establish the effect of diet drinks on caries when consumed during childhood. PRACTICAL IMPLICATIONS Although this study did not show an association between caries and diet drinks, dental practitioners should be cautious about recommending these drinks, as they have been linked to systemic diseases. In addition, the American Academy of Pediatrics and National Academy of Medicine do not recommend that children consume these beverages.

Journal of Public Health Dentistry, 2017

Objectives: In 2013, the United Nations Environment Programme (UNEP) reached a binding agreement-... more Objectives: In 2013, the United Nations Environment Programme (UNEP) reached a binding agreement-a.k.a. the Minamata treaty-to decrease dental amalgam use. This study aims to investigate US dentists' current practice and opinions about amalgam use, and to determine factors affecting their amalgam use and opinions. Methods: A total of 45,557 general dentists and 5,101 pediatric dentists were invited to participate in a pre-tested electronic survey. The survey consisted of 12 close-ended questions using a 5-point Likert Scale. The Qualtrics TM software was used to distribute the survey, followed by three reminders. Results: Response rate was 5.2 percent for general dentists, and 17.6 percent for pediatric dentists. Sixty-two percent of general dentists and 56 percent of pediatric dentists reported using amalgam. Most dentists disagreed with banning amalgam, while agreeing with installing amalgam separators. Environmentally conscious dentists were more likely to agree with banning amalgam and installing amalgam separators. Conclusion: Responding dentists favor the continued use of dental amalgam. Their perspectives vary by several factors including dentists' environmental consciousness. Policies toward minimizing amalgam's environmental impact need to be implemented.

ABSTRACT Intimate partner violence (IPV) in immigrant communities is influenced by stereotypes, c... more ABSTRACT Intimate partner violence (IPV) in immigrant communities is influenced by stereotypes, cultural stigmas, lack of knowledge and trust in available services. Prevalence reports of IPV in Muslim populations in the US are scarce. This study investigates Muslim women's knowledge about IPV and need for services in MA. This exploratory mixed-methods study assessed the need for Muslim-specific IPV services in Massachusetts. Muslim women, who were in an intimate relationship, aged 18 and 64 years, English or Arabic speakers, resided in the United States for at least six months, and were MA residents were eligible. Convenience and snowball sampling techniques were used, and paper-based and web-based surveys administered. Descriptive and bivariate analyses were performed. Logistic regression models were used to predict categorical outcomes, and negative binomial regressions were used where appropriate. Abuse prevalence was 44.3% for any abuse, and 26.1% for severe abuse. Religiously observant women had 20% greater agreement with seeking outside help as the last option compared to less observant women (OR=1.2, p-value=0.02). Arabs were 22 times more likely to agree with this statement compared to non-Arabs (OR=21.9, p-value=0.002). For every unit increase in religious observance score, abuse score increased by 20%. Muslim-specific barriers to seeking outside help included: the shelter misunderstanding their culture/religious background, and the complexity of the Muslim situation. The abuse prevalence of the MA Muslim women population is lower than in other studies, but is still high. Religious observance was a significant but not a strong predictor of preferences of services used, and abuse score.

Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 2008

A bioterrorism attack could overwhelm medical personnel and facilities, suggesting a need for aid... more A bioterrorism attack could overwhelm medical personnel and facilities, suggesting a need for aid from nonmedical personnel. The American Dental Association suggests that dental professionals should assist in such cases, utilizing their strong scientific and technical skills. This study describes New England dental professionals' willingness, potential roles, motivators, and barriers to providing this aid. This cross-sectional study used a self-administered survey to collect data addressing the knowledge and opinions of dental professionals concerning acting as responders. The survey was distributed to 370 attendees of the 2005 Yankee Dental Conference, in Boston, Massachusetts. Most dental professionals expressed willingness to help during an attack (N = 340, 92%), reporting that dental professionals, in general, should perform a mean number of 6 roles. Three-quarters of dentists and dental students were personally willing, with proper training, to give immunizations, and 54% would perform triage. Knowledge was weak, but most dental professionals were interested in obtaining further education (83%). Since dental professionals are willing to assist during a bioterrorism attack and are motivated to obtain disaster response training, government officials and local directors and managers of disaster/emergency response agencies should consider incorporating dental professionals into their disaster management plans.

Purpose: Childhood caries is a highly prevalent disease that is intricately connected to diet and... more Purpose: Childhood caries is a highly prevalent disease that is intricately connected to diet and other social and behavioral factors. While it has been established that breastfeeding confers many health benefits for children, previous research found no consensus on the relationship between breastfeeding and caries. The purpose of this study was to examine the relationship between early childhood caries (ECC) and the length of time breastfeeding using the National Health and Nutrition Examination Survey (NHANES). Methods: Four cycles of NHANES (2011 to 2018) were analyzed, including 3,234 children ages two to five years. The association between breastfeeding duration and incidence of ECC and severe earlychildhood caries (S-ECC) was evaluated using logistic regression, adjusting for age, ethnicity, education, income, last dental visit, and sugar-sweetened beverages. Results: In the study population, 16.9 percent had ECC and 12.2 percent had S-ECC. Breastfeeding six months to one year...

Military Medicine, Jun 10, 2023

ABSTRACT Introduction Veterans suffer from lower overall well-being than non-veterans because of ... more ABSTRACT Introduction Veterans suffer from lower overall well-being than non-veterans because of their unique life course. This study aims to compare the impact of depression on oral health for veteran and non-veteran populations. Materials and Methods Data from 11,693 adults (18+) participating in the National Health and Nutrition Examination Survey (2011-2018) were analyzed. The outcome variables were dichotomous (at/above mean) decayed, missing, and filled teeth due to caries (DMFT), as well as the components, namely, missing teeth, filled teeth (FT), and decayed teeth (DT). The primary predictor variable combined depression screening outcome and veteran status (veteran/depressed, veteran/not depressed, non-veteran/depressed, and non-veteran/not depressed). Covariates included socioeconomic factors, demographics, wellness factors, and oral health–related habits. Associations between outcome and predictor variables were assessed with a fully adjusted logistic regression analysis. Results Veterans, regardless of depression status, had more DMFT, FT, missing teeth, and DT compared to non-veterans. After controlling for covariates, veterans suffering from depression had higher odds of DT (1.5, 95% CI, 1.0-2.4) compared to non-veterans without depression. In general, veterans who screened negative for depression had better oral health compared to all groups, with lower odds of DT (0.7, 95% CI, 0.6-0.9) and higher odds of FT (1.4, 95% CI, 1.1-1.7) compared to non-veterans with and without depression. Conclusions This study found that not only veterans have higher odds of overall caries experience, but also veterans suffering from depression have higher odds of active caries compared to non-depressed veterans. Most veterans lack Veterans Health Administration dental benefits and face challenges maintaining oral health on top of medical and mental health burdens. Our results add further urgency to increasing dental care access for this vulnerable population because of the exacerbation of unmet oral health care needs attributable to the additional mental health challenges veterans face.

Annals of the New York Academy of Sciences, Nov 1, 1996

Atherosclerosis is more severe in blacks than in whites, but abdominal aortic aneurysms, which ha... more Atherosclerosis is more severe in blacks than in whites, but abdominal aortic aneurysms, which have traditionally been thought to have an atherosclerotic etiology, appear to be less common in blacks. Because of this incongruity, we compared risk factor profiles in patients undergoing abdominal aortic aneurysm repair and patients undergoing femoral bypass for atherosclerotic occlusive disease. A dual case-control study was conducted, first, comparing patients who had undergone aneurysmectomy to a control group of patients who had undergone appendectomy; and then comparing patients who had undergone femoral bypass surgery to the same appendectomy controls. We initially used hospital discharge data for the entire state of Massachusetts and, in a second phase, data obtained from a review of medical records from Boston University Medical Center Hospital and Boston City Hospital. The statewide database indicated that rates of femoral bypass surgery were higher in blacks than in whites, but after adjusting for differences in hypertension, diabetes, and low socioeconomic status, the black/white odds ratio for femoral bypass fell to 1.44 (95% confidence interval: 1.08, 1.92). A similar analysis based on the hospital chart review, provided better control of confounding and indicated that there was no racial difference in rates of femoral bypass after correcting for other risk factors (odds ratio = 0.94; 95% confidence interval: 0.40, 2.22; p = 0.90). In contrast, the statewide database found higher rates of abdominal aortic aneurysm surgery in whites, and particularly in white males. Smoking and hypertension were strong risk factors for aneurysmectomy, but diabetes mellitus and socioeconomic status were not. After adjusting for other variables, the black/white odds ratio for aneurysmectomy was 0.29 (95% confidence interval: 0.07, 1.23; p = 0.09). Substantial differences are found in the risk factor profiles for aneurysmal disease and femoral atherosclerotic occlusive disease. Diabetes is a particularly strong risk factor for femoral disease, but not for aneurysmal disease. In addition, blacks had higher rates of femoral bypass surgery in Massachusetts, but the apparent racial difference appeared to be due to a greater prevalence of hypertension, smoking, and diabetes in blacks. In contrast, abdominal aortic aneurysms occurred predominantly in white males, and adjustment for other risk factors further accentuated the greater risk in whites.

British Dental Journal, Jan 16, 2009

Journal of Gastrointestinal Surgery, Dec 1, 1999

Community Dentistry and Oral Epidemiology, Apr 4, 2022

This letter is a response to commentary by Dr. Smith on 'Examining the association between ca... more This letter is a response to commentary by Dr. Smith on 'Examining the association between cancer history in early life and dental care utilization'. We provided additional information and clarification regarding our analysis and results in response to Dr. Smith's questions and comments. Despite the limitations and weaknesses of our study, we still believe that it provides important information and further research questions.

Community Dental Health, Nov 8, 2021

Background: In recent years, the consumption of sugar sweetened beverages has been declining, whi... more Background: In recent years, the consumption of sugar sweetened beverages has been declining, while low calorie sweetener and diet beverage consumption is increasing. Evidence about the effect of diet drinks on dental caries is insufficient, and has not accounted for the complexity of beverage consumption patterns. Therefore, the aim of this study is to examine the association between consuming diet drinks and dental caries among US adults. Methods: We analyzed 2011-2014 NHANES dietary data of adults using cluster analysis, with individuals grouped based on their beverage consumption. Clusters were identified based on the R-square statistic and the local peak of the pseudo F statistic. Survey procedure and sample weights were used to account for the complex NHANES sampling design. Results: Four beverage consumption patterns were identified: "high soda", "high diet drinks", "high coffee/tea" and "high water". The "High soda" cluster was the only one associated with higher DMFT after controlling for confounders (β=1.02, 95% CI=0.42 - 1.63), whereas DT was associated with "high soda" (β=0.45, 95% CI=0.25 - 0.64) and "high coffee/tea" (β=0.24, 95% CI=0.01 - 0.47). On the other hand, the "high diet drinks" cluster was neither associated with DMFT (β=0.69, 95% CI=0.51 - -0.35) nor DT (β=0.07, 95% CI=-0.21 - 0.35). Conclusion: Diet drinks consumption may not be associated with increased risk of dental caries. However, more studies should be conducted in order to confirm this finding.

JDR Clinical & Translational Research, 2019

Background: The Minamata treaty (2013) enacted a globally binding agreement to phase down amalgam... more Background: The Minamata treaty (2013) enacted a globally binding agreement to phase down amalgam use, which may significantly affect dental care for underserved populations. To comply with the Minamata treaty, strategic approaches need to be implemented to reduce amalgam use while imposing minimal risk on the dental care of the underserved. Objectives: To establish strategic approaches to reduce amalgam use, the aim of this study is to use a marketing research analysis to determine which patient-related factors influence pediatric dentists' choice of amalgam. Methods: A survey containing questions regarding amalgam use, perception about the environmental impact of amalgam waste, and hypothetical clinical scenarios of a child with dental caries with varying levels of caries risk and types of dental insurance was developed and pretested. Emails linked to an electronic survey were sent via Qualtrics to all active American Academy of Pediatric Dentistry members (n = 5,101), followed by 3 reminders. Descriptive analysis and choice-based conjoint analysis were performed to investigate trade-offs between selected factors, using SAS version 9.3. Results: Of 892 (17.6%) replies, 850 responses were eligible for analysis. Only 385 (45%) respondents indicated using amalgam, and their responses were analyzed in the conjoint model. Respondents' selection of amalgam varied between 8% and 28% across all the clinical scenarios, with most respondents choosing composite or stainless steel crowns. Conjoint analysis revealed that, while both caries risk and type of insurance affected respondents' decision about amalgam use, caries risk was the driving factor in decisionmaking for using amalgam. Conclusion: These results underscore the importance of prevention and management of risk factors to successfully phase down amalgam use. Knowledge Transfer Statement: Our study applied the marketing research tool, choice-based conjoint analysis, to investigate the relative importance of different factors on dentists' decisionmaking regarding amalgam use. This study should be of great interest to policy makers when developing strategic approaches to comply with the 2013 United Nations Environment Programme (a.k.a. Minamata treaty) policy recommendations for phasedown of dental amalgam.

JDR Clinical & Translational Research, 2021

Objective: The aim of this study is to examine the effect of diet drinks on dental erosion among ... more Objective: The aim of this study is to examine the effect of diet drinks on dental erosion among a representative sample of US adults. Methods: Adult dietary and dental data were analyzed from the 2003–2004 cycle of the National Health and Nutrition Examination Survey. Erosion was measured with a modified tooth wear index and was analyzed as a dichotomous variable. Cluster analysis was performed, and the cluster number was based on having a separate diet drink cluster and the R2 values. Survey procedure and sample weights were used. Results: Most of the population (80%) had some form of dental erosive lesions. When compared with the total sample, people with erosion were more likely to be male (52.5%) and older. People with no erosive lesions were younger (42.3%) and non-Hispanic Black (21.2%). Cluster analysis resulted in 4 distinct clusters: high water, high diet drinks, high coffee/tea, and high soda. The respective percentage of individuals in each cluster who had erosion was 78...

Community Dentistry and Oral Epidemiology, 2021

OBJECTIVES The purpose of this study was to examine the association between food insecurity and u... more OBJECTIVES The purpose of this study was to examine the association between food insecurity and untreated dental caries using a nationally representative sample of US adults. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014 on adults aged 18 years and older were analysed (n = 10 723). Primary predictors were overall food security (food-secure/ food-insecure) and household food security (full, marginal, low and very low). The main outcome was any untreated dental caries (none/ ≥ one). Multiple logistic regression analyses were done to estimate the adjusted odds ratio after controlling for confounders. RESULTS Food-insecure adults were more likely to have untreated dental caries than food-secure adults after adjusting for potential confounders (OR: 1.2; 95% CI: 0.9-1.5). Adults from households with marginal (OR:1.4; 95% CI:1.5-2.2), low (OR:1.3, 95% CI:1.3-2.0) and very low food security (OR:1.3; 95% CI:0.9-1.5) had higher odds of untreated caries than adults from households with full food security. Following age stratification, marginal, low and very low food-secure adults had higher prevalence of untreated dental caries than full food-secure adults across all age groups. CONCLUSIONS Our findings suggest that food-insecure adults had higher odds of untreated dental caries than food-secure adults. These findings highlight the importance of assessing food insecurity as a risk factor for dental caries. Longitudinal cohort studies are recommended to determine causal mechanisms.

Pediatric dentistry, 2019

Purpose: The purpose of this study was to evaluate dental care access and sealants prevalence amo... more Purpose: The purpose of this study was to evaluate dental care access and sealants prevalence among children with special health care needs. Methods: The authors utilized the publicly available National Health and Nutrition Examination Survey (NHANES) 2013 to 2014 datasets collected by trained dental examiners for the Centers for Disease Control and Prevention. This study included 2,651 six- to 19-year-olds who provided demographic, dental visit, disability, and sealants information. Weighted prevalence estimates and odds ratios (OR) were calculated for sealant use by disability, gender, age, race, and economic status. Results: Approximately 68 percent of participants had a dental visit in the past six months, with 84 percent of them being routine dental visits; each had approximately two sealed teeth (mean equals 2.37). Children with a physical disability have lower odds of having a sealant (OR equals 0.5; P=0.04) compared to nondisabled children. Six- to 11-year-olds have lower od...

International Journal of Dental Hygiene, 2021

INTRODUCTION The Supplemental Nutrition Assistance Program (SNAP) is a federal program aims to al... more INTRODUCTION The Supplemental Nutrition Assistance Program (SNAP) is a federal program aims to alleviate hunger and improve food insecurity. The impact of SNAP participation on overall health has been studied. However, little is known about the effects of SNAP participation on oral health. We aimed to investigate the association between participating in SNAP and dental caries and to explore the role of food insecurity as a moderator in this relationship. METHODS We obtained data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014.The primary outcome was untreated dental caries (none vs. one or more). Self-reported SNAP participation status in the past 12 months was the predictor and food security was the moderator. Food security was measured as overall food security status (full food secure/ food insecure) and household-level food security (full, marginal, low, and very low). Bivariate and multiple logistic regression analyses were conducted to evaluate the relationship between SNAP and dental caries, and whether food insecurity moderates this relationship. Statistical analysis was carried out in September 2020. RESULTS Our results suggested that after adjusting for potential confounders, SNAP participants were more likely to have untreated dental caries than non-SNAP participants (odds ratio:1.6; 95% CI:1.2-2.0). Food security status didn't alter the relationship between SNAP participation and untreated dental caries. CONCLUSIONS Food security status didn't alter the relationship between SNAP participation and untreated dental caries. SNAP participation was associated with untreated dental caries among U.S. adults, and this was not affected by their food security status.

The Journal of Contemporary Dental Practice, 2021

Aim and objective: This study aims to investigate the association between parity and dental carie... more Aim and objective: This study aims to investigate the association between parity and dental caries among US women. Materials and methods: National Health and Nutrition Examination Survey (NHANES 2001-2004) data for parous women aged 20-45 years were used for our analysis (n = 1,914). The association between parity (number of pregnancies resulted in live births) and caries experience [the decayed, missing, and filling teeth (DMFT) index] was analyzed using bivariate and multivariate regression analyses. SAS software version 9.1 was used for the statistical analyses. We used survey procedures (e.g., SURVEYFREQ, SURVEYMEANS, and SURVEYREG) that incorporate information on the appropriate weights to account for NHANES's complex sampling design. Results: The bivariate analysis showed a trend of increase in dental caries experience among parous women as the number of live births increased (p = 0.007). After adjusting for confounders, such as age, socioeconomic status (SES), dental care coverage, and utilization, a significant association was still observed between parity level and dental caries experience (p = 0.009). Conclusion: Our results suggest that higher parity can be associated with dental caries experience among US women of reproductive age. Clinical significance: Clinicians should be aware of this finding to promote better oral health care and education among women with increased parity.

Community Dentistry and Oral Epidemiology, 2021

OBJECTIVES This study aims to examine associations between cancer history in early life (diagnose... more OBJECTIVES This study aims to examine associations between cancer history in early life (diagnosed at 20 years of age or younger) and utilization of dental care. METHODS We analysed data of 10,185 participants, aged ≥20 years, from the National Health and Nutrition Examination Survey cycles 2015-2018. The main predictor was self-reported past history of any type of cancer diagnosed at 20 years of age or younger (yes/no). The outcome variables were having a dental visit within the past year, treatment or preventative visit, urgent need for care, and unmet dental need. Covariates included gender, age, race, marital status, education, and income. Bivariate and multiple logistic regression were conducted, accounting for the complex sampling design. RESULTS There was no difference between early life cancer survivors in regards to dental visit within the past year (OR: 0.7; 95% CI: 0.3-1.6), visit for dental treatment (OR: 0.6; 95% CI: 0.3-1.6), urgent need for care (OR: 0.8; 95% CI: 0.3-2.0), or unmet dental need (OR: 0.6; 95% CI: 0.2-1.6) compared to cancer-free participants. CONCLUSIONS Cancer history in early life doesn't impact dental care visits, type of last dental visit, dental care recommendation, or unmet dental need. Future cohort studies are needed to confirm this association.

The Journal of the American Dental Association, 2021

BACKGROUND The aim of this study was to examine the association between food insecurity and untre... more BACKGROUND The aim of this study was to examine the association between food insecurity and untreated caries among US children and the potential role of diet quality as a mediator in this relationship. METHODS The authors analyzed data for 4,822 children aged 5 through 17 years from the National Health and Nutrition Examination Survey cycles from 2011 through 2014. The authors measured food security as household-level food security status (full, marginal, low, very low) and overall food security status (full food secure, food insecure). They measured diet quality using the Healthy Eating Index. The primary outcome measure was untreated caries (none, ≥ 1). The authors used multiple logistic regression analysis to evaluate the relationships among food insecurity, diet quality, and untreated caries. They conducted mediation analysis using the Baron and Kenny approach. RESULTS Food-insecure children were more likely to have untreated caries compared with their fully food-secure counterparts, after controlling for confounding variables (odds ratio [OR], 1.38; 95% [CI, 1.11 to 1.72). Specifically, children from marginal and very low food-secure households had significantly higher odds of untreated caries (OR, 1.48; 95% CI, 1.10 to 2.01) compared with children from fully food-secure households (OR, 1.59; 95% CI, 1.12 to 2.26). Diet quality was not significantly associated with untreated caries. CONCLUSIONS Food insecurity was negatively associated with untreated caries among US children. Diet quality was not associated with untreated caries. PRACTICAL IMPLICATIONS Social factors such as food insecurity should be taken into consideration when dental clinicians perform caries risk assessment because caries risk is shown to be associated with overall health and dental health.

The Journal of the American Dental Association, 2020

BACKGROUND The effect of sugared beverages on dental caries has been widely studied in dental lit... more BACKGROUND The effect of sugared beverages on dental caries has been widely studied in dental literature. A major limitation of these studies was examining the beverages as a single source. To overcome this limitation, a few studies used cluster analysis to group people into similar beverage consumption patterns. These studies did not differentiate between sugared beverages and diet drinks. Therefore the aim of this study is to examine the effect of consuming diet drinks on dental caries among US children by using cluster analysis. METHODS In this cross-sectional study, the authors analyzed the dietary data of children aged 3 through 10 years, using 2 24-hour recall interviews in the 2011-2014 National Health and Nutrition Examination Survey data. Cluster analysis has been used to overcome the limitations of examining the beverages as a single source. Clusters were identified based on the R2 statistic and the local peak of pseudo-F statistics. Survey procedure and sample weights were used to account for the complex National Health and Nutrition Examination Survey sampling design. RESULTS Six beverage consumption clusters were identified: high soda, high 100% juice, high juice drinks, high diet drinks, high milk, and high water. Regression analysis showed that the high soda cluster had a tendency to increase caries risk (odds ratio [OR], 1.69, 95% confidence interval [CI], 0.9 to 3.1), while the high diet drinks cluster had neutral effect compared with the high water cluster (OR, 0.94, 95% CI, 0.5 to 1.8). CONCLUSIONS The results of this study suggest that diet drinks have no adverse effect on teeth among US children. Additional well-designed longitudinal studies should be conducted to establish the effect of diet drinks on caries when consumed during childhood. PRACTICAL IMPLICATIONS Although this study did not show an association between caries and diet drinks, dental practitioners should be cautious about recommending these drinks, as they have been linked to systemic diseases. In addition, the American Academy of Pediatrics and National Academy of Medicine do not recommend that children consume these beverages.

Journal of Public Health Dentistry, 2017

Objectives: In 2013, the United Nations Environment Programme (UNEP) reached a binding agreement-... more Objectives: In 2013, the United Nations Environment Programme (UNEP) reached a binding agreement-a.k.a. the Minamata treaty-to decrease dental amalgam use. This study aims to investigate US dentists' current practice and opinions about amalgam use, and to determine factors affecting their amalgam use and opinions. Methods: A total of 45,557 general dentists and 5,101 pediatric dentists were invited to participate in a pre-tested electronic survey. The survey consisted of 12 close-ended questions using a 5-point Likert Scale. The Qualtrics TM software was used to distribute the survey, followed by three reminders. Results: Response rate was 5.2 percent for general dentists, and 17.6 percent for pediatric dentists. Sixty-two percent of general dentists and 56 percent of pediatric dentists reported using amalgam. Most dentists disagreed with banning amalgam, while agreeing with installing amalgam separators. Environmentally conscious dentists were more likely to agree with banning amalgam and installing amalgam separators. Conclusion: Responding dentists favor the continued use of dental amalgam. Their perspectives vary by several factors including dentists' environmental consciousness. Policies toward minimizing amalgam's environmental impact need to be implemented.

ABSTRACT Intimate partner violence (IPV) in immigrant communities is influenced by stereotypes, c... more ABSTRACT Intimate partner violence (IPV) in immigrant communities is influenced by stereotypes, cultural stigmas, lack of knowledge and trust in available services. Prevalence reports of IPV in Muslim populations in the US are scarce. This study investigates Muslim women's knowledge about IPV and need for services in MA. This exploratory mixed-methods study assessed the need for Muslim-specific IPV services in Massachusetts. Muslim women, who were in an intimate relationship, aged 18 and 64 years, English or Arabic speakers, resided in the United States for at least six months, and were MA residents were eligible. Convenience and snowball sampling techniques were used, and paper-based and web-based surveys administered. Descriptive and bivariate analyses were performed. Logistic regression models were used to predict categorical outcomes, and negative binomial regressions were used where appropriate. Abuse prevalence was 44.3% for any abuse, and 26.1% for severe abuse. Religiously observant women had 20% greater agreement with seeking outside help as the last option compared to less observant women (OR=1.2, p-value=0.02). Arabs were 22 times more likely to agree with this statement compared to non-Arabs (OR=21.9, p-value=0.002). For every unit increase in religious observance score, abuse score increased by 20%. Muslim-specific barriers to seeking outside help included: the shelter misunderstanding their culture/religious background, and the complexity of the Muslim situation. The abuse prevalence of the MA Muslim women population is lower than in other studies, but is still high. Religious observance was a significant but not a strong predictor of preferences of services used, and abuse score.

Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 2008

A bioterrorism attack could overwhelm medical personnel and facilities, suggesting a need for aid... more A bioterrorism attack could overwhelm medical personnel and facilities, suggesting a need for aid from nonmedical personnel. The American Dental Association suggests that dental professionals should assist in such cases, utilizing their strong scientific and technical skills. This study describes New England dental professionals' willingness, potential roles, motivators, and barriers to providing this aid. This cross-sectional study used a self-administered survey to collect data addressing the knowledge and opinions of dental professionals concerning acting as responders. The survey was distributed to 370 attendees of the 2005 Yankee Dental Conference, in Boston, Massachusetts. Most dental professionals expressed willingness to help during an attack (N = 340, 92%), reporting that dental professionals, in general, should perform a mean number of 6 roles. Three-quarters of dentists and dental students were personally willing, with proper training, to give immunizations, and 54% would perform triage. Knowledge was weak, but most dental professionals were interested in obtaining further education (83%). Since dental professionals are willing to assist during a bioterrorism attack and are motivated to obtain disaster response training, government officials and local directors and managers of disaster/emergency response agencies should consider incorporating dental professionals into their disaster management plans.

Purpose: Childhood caries is a highly prevalent disease that is intricately connected to diet and... more Purpose: Childhood caries is a highly prevalent disease that is intricately connected to diet and other social and behavioral factors. While it has been established that breastfeeding confers many health benefits for children, previous research found no consensus on the relationship between breastfeeding and caries. The purpose of this study was to examine the relationship between early childhood caries (ECC) and the length of time breastfeeding using the National Health and Nutrition Examination Survey (NHANES). Methods: Four cycles of NHANES (2011 to 2018) were analyzed, including 3,234 children ages two to five years. The association between breastfeeding duration and incidence of ECC and severe earlychildhood caries (S-ECC) was evaluated using logistic regression, adjusting for age, ethnicity, education, income, last dental visit, and sugar-sweetened beverages. Results: In the study population, 16.9 percent had ECC and 12.2 percent had S-ECC. Breastfeeding six months to one year...