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infrequent rubber-cup prophylaxis was the general pattern. Again, there is substantial variation in provision rates across sites. Mean number of fluoride treatments: Receipt of fluoride was more frequent than prophylaxis for both adults and children at all but one site. At that site, the rates were equal and low, suggesting that the two procedures were always provided together. At all other sites, the mean number of applications suggests a receipt frequency of twice a year or more, which is in keeping with ADA’s recent recommendation for fluoride applications for elevated caries risk patients (ADA, Council on Scientific Affairs, 2006). Percentage receiving oral hygiene instruction: Two-thirds of children and slightly less than one-half of adults received oral hygiene instruction during the course of a year. For children, rates at two sites exceeded 90%, but the rate was 22% at another site. Variation was also present, but less extreme for adults, with the same sites displaying the highest and lowest rates. Oral cancer examinations: Rates also varied widely across sites for oral cancer exam. The sites displaying the highest and lowest rates for this procedure were the same sites recording the highest and lowest rates for oral hygiene instruction. Overall, rates for oral cancer examinations were higher for children than for adults despite the fact that the incidence of oral cancer increases with increasing age. These overall rates for both children and adults exceeded goals set in Healthy People 2010 (U.S. Department of Health and Human Services, 2000).

4.4.5 Gingival Bleeding Assessment (Table 4-32) Recording the presence/absence of gingival bleeding was infrequent. At two sites, no such notations appeared in patient records. At two sites, a little less than one-half of adult records had such a notation, with smaller percentages for child records. The remaining sites noted this assessment for one child record (2%).


Consultation (Table 4-32)

Consultations were noted at all but one site, generally involving less than 10% of patients seen. Of 21 consultations noted, 18 involved assistance with treatment decisions or implementation.