bluuebunny/crossref_metadata_2025 huggingface dataset:
Special Concern: Personality and dental care utilization: findings from the VA longitudinal study
Authors: Kennedy Betsy D. , Aldwin Carolyn M. , Bossé Raymond , Douglass Chester W. , Chauncey Howard H.
Published: March 2008

The personality traits of introversion/extraversion and neuroticism were investigated as determinants of the utilization of restorative dental care, controlling for socioeconomic status and restorative need. The VA Dental Longitudinal Study (DLS) provided information on the restorative treatment received by 593 healthy adult males during a 10–year period. Utilization of restorative services was measured by calculating the percentage of surfaces that needed and received treatment, as identified by the DLS examiners by clinical and radiographic examination. Oral examinations were initiated in 1969 with subsequent examinations occurring at approximately 3–year intervals. Personality measures for these individuals were obtained using the EPI‐Q, a shortened form of the Eysenck Personality Inventory.

A plot of neuroticism versus the utilization measure yielded a curvilinear relationship suggesting that participants seeking the most dental care scored moderately on the neuroticism scale while those scoring lowest and highest on this scale sought less treatment. In contrast, the introversion/extraversion scale showed no apparent relationship with dental care utilization. Results from the regression analysis suggest that dentition and socioeconomic status are strong determinants of utilization and that need for restorative treatment influences utilization.
Use of intraligamentary anesthesia in a patient with severe hemophilia and factor VIII inhibitor
Authors: Eigner Toni L.
Published: March 2008

This article reviews the therapeutic problems that arise in the dental management of hemophilia patients with inhibitor and suggests an anesthesia technique that may eliminate the need for factor replacement during restorative procedures. Intraligamentary anesthesia was used during restorative procedures that were performed throughout an 8–year period on a patient with factor VIII inhibitor. Multiple restorative procedures were accomplished without the use of replacement factor and with no postoperative bleeding. This technique, in consultation with the patient's physician, may be performed by most general practitioners in their private offices.
Appropriate responses by elders to oral symptoms: dentists' recommendations
Authors: Holtzrnan Joseph M. , Guttman Yvonne , Berkey Douglas B.
Published: March 2008

This paper reports the results of a study of dentists' recommendations regarding the appropriate health action of elders in response to certain oral common symp toms and problems. Previous studies have found that elders most commonly respond to oral symptoms by using nonprofessional means. This study found that, without exception, the recommendation to consult a dentist was the primary mode of response favored by dentists, even in response to symptoms and problems that are most often trivial and rarely indicative of serious health problems. The results of this pilot study suggest that the need exists for dentists to reach a more realistic consensus regarding alternatives to professional consultation in response to some symptoms and problems.
Dental conditions in patients with bipolar disorder on long‐term lithium maintenance therapy
Authors: Friedlander Arthur H. , Birch Nicholas J.
Published: March 2008

Bipolar disorder (manic depressive disease) affects 1% of the United States population. These persons suffer from episodes of extreme elation followed by long periods of depression. Dental screening examinations of 40 patients consecutively admitted to the medical center with this diagnosis were performed. Poor oral hygiene, accumulations of supragingival and subgingival calculus, extensive dental caries, and numerous missing teeth were commonly identified. The majority of patients with bipolar disorder are treated with lithium carbonate. The physiological effects of lithium, and its interaction with drugs used in dentistry are reviewed, and disease‐specific modifications in dental treatment are recommended.
Cri‐du‐chat syndrome: dental considerations and report of case
Authors: Boraz Robert A.
Published: March 2008

Cri‐du‐chat syndrome is a severe disease resulting from a deletion of the short arm of chromosome number 5. The basic medical disorder includes dysmorphic facies, mental retardation, and a striking catlike cry in infancy. Because of significant oral anomalies and difficulty in behavior management, the syndrome is of particular interest to the dental practitioner. A case with many of the typical medical findings and significant dental considerations is reported.

An aggressive preventive dentistry program is essential. A thorough understanding of the medical and developmental problems of the patient with cri‐du‐chat syndrome ensures safe and effective dental care.
The accuracy of oral self‐perceptions in a dentate older population
Authors: Drake Claude W. , Beck James D. , Strauss Ronald P.
Published: March 2008

A random sample of 1,016 subjects aged 65 and older were interviewed and examined in their own homes. The sample was stratified by race and place of residence. As part of the interview, the 821 dentate subjects were asked to rate their mouth appearance, chewing ability, and mouth health. Most subjects responded positively to these questions. The self‐perception of mouth health was most related to the presence of anterior teeth. Perception of chewing ability was most related to the number of anterior teeth present, total number of teeth present, and the need for extractions. Subjects also were asked about their perceived dental needs. A small proportion of subjects thought they needed restorations, periodontal treatment, or teeth replacement. Subjects generally were not able to define the extent of their treatment needs, but their self‐perceptions of mouth appearance, chewing ability, and mouth health had some relationship to their oral health.
A national survey of dentists' awareness of elder abuse and neglect
Authors: Holtzman Joseph M. , Bomberg Thomas
Published: March 2008

This paper reports the results of a national survey of 1,321 general practitioners regarding their level of awareness of and experiences with the treatment of older victims of abuse and neglect. Greater than 90% were aware of elder abuse and neglect as a social and medical problem. Greater than 10% had personal knowledge or had treated a victim of abuse or neglect. Data suggest that dentists will increasingly come in contact with victims and must be trained to recognize, treat, and report such incidents
A tongue shield appliance: design, fabrication, and case report
Authors: Wood A. Jeffrey
Published: March 2008

An intraoral tongue shield appliance for unconscious patients is described. This appliance has advantages over other such appliances in that it does not require impressions for its fabrication, can be made quickly, and placed and retained in a patient with a limited oral opening. Its use is demonstrated in a pharmacologically paralyzed and sedated patient with tongue trauma
Medications with dental significance: usage in a nursing home population
Authors: Baker Karen A. , Levy Steven M. , Chrischilles Elizabeth A.
Published: March 2008

The institutionalized elderly use more drugs per capita than do other segments of the population and are more likely than other population groups to have adverse drug reactions. Many of these drugs could affect oral health or dental treatment. This paper provides data on the frequency with which a population of nursing home residents took medications with possible oral effects. Information regarding prescription and nonprescription drug use was obtained from nursing home records of 481 subjects. Nine medication effect categories of possible significance in dentistry were established. Dentists treating institutionalized patients must be knowledgeable about patient drug use because 94% of this institutionalized population were taking medications that could alter oral health or dental treatment
General practice residency education in implant dentistry
Authors: Simons Alan M.
Published: March 2008

This paper originally was presented at the Second Annual National Conference on Special Care Issues in Dentistry, March 31‐April 1, 1990, at the American Dental Association Headquarters, Chicago
Oral yeasts, mucosat health, and drug use in an elderly denture‐wearing population
Authors: Kreher John Mitchell , Graser Gerald N. , Handelman Stanley L. , Eisenberg Arthur D.
Published: March 2008

Drug use among the elderly may be a factor in oral mucosal pathology and the prevalence of oral yeasts. This study was designed to evaluate the relationship between oral yeast, denture‐bearing mucosal health and drug use, especially drugs with known hyposalivatory side effects. There was an inverse relationship between denture‐bearing mucosal health, and hyposalivatory drug use r = ‐0.41P < 0.04. Use of drugs with a hyposalivatory side effect was related to increased numbers of Candida glabrata but not Candida albicans in saliva and at denture stomatitis and denture sore sites.
Common misconceptions about oral health in the older adult: nursing practices
Authors: Logan Henrietta L. , Ettinger Ronald , McLeran Hermine , Casko Roberta
Published: March 2008

A survey of nurses, director‐supervisors, and nursing home health aides who provide home care in Iowa showed that many misconceptions exist about what constitutes appropriate oral and dental care practices for the older adult. Despite differences in formal education among these nursing personnel, several misunderstandings about dental problems among older adults were common to all three employment groups. These misconceptions represented a broad range of topics from the characteristics of orai cancer lesions to the appropriate use of denture adhesives; two dealt specifically with the recognition of potential oral cancer lesions. This paper describes attitudes and misinformation held by the respondents, and suggests ways to correct these fallacies through in‐service training programs.

As a part of this funded project, a complete package for presenting a 3 1/2 hour continuing education program about oral health in the elderly was produced. This set entitled “Oral Health in the Elderly: A Workshop Curriculum and Teacher's Guide” includes color slides, 2 video tapes, teaching instructions, and a script and is available at cost. Other materials specifically designed for in‐service training of nursing home personnel are also available. For more information, please write the senior author.
An analysis of the supply of and demand for continuing education in geriatric dentistry
Authors: Kress Gerry
Published: March 2008

Continuing education directors at 158 sites were surveyed regarding their recent experience with geriatric dentistry courses. Of the 116 returns cited, 86 recorded offering courses with a total enrollment of 4,559 students. The courses tended to be of the survey type using a lecture format. Most directors thought that practitio ner demand for such courses fell short of their need for education. Several suggestions emanated from this project for improving course attendance. They included: targeting courses to specific clinical areas; providing separate courses for each segment of the geriatric population; and educating both elders and dentists regarding the appropriateness of dental care for the elderly patient.
Patient age and general dentists' treatment decisions
Authors: Dolan Teresa A. , McNaughton Clifford A. , Davidson Suzanne N. , Mitchell Gail S.
Published: March 2008

To test whether a patient's age plays a role in dentists' treatment planning decisions, a convenience sample of 159 general dentists attending a state dental society annual meeting was presented a vignette including intraoral photographs, a brief case history and clinical diagnosis of a patient. The patient was partially dentate, and was described as having irreversible pulpitis of tooth #19. Three versions of the vignette were developed, with identical materials and information except for the patient's age (either 44, 65, or 84 years), and were randomly assigned to the participating dentists who were asked to develop a treatment plan for the patient's mandibular arch. The dentists planned limited therapy for the 84 year old because of their assumptions about the patient's brief life expectancy, cost, concern about the inability of the patient to tolerate extensive treatment, and a low cost/benefit ratio. These findings suggest that a patient's age influences general dentists' treatment planning decisions, perhaps limiting the treatment options offered to older adults. Additional research is necessary to further test these associations.
A modified light‐cured denture identification technique
Authors: Richards E. Earl , Williams J. Earl , Gauthier Gilles
Published: March 2008

Removable dental prostheses are lost frequently or stolen in nursing homes. Dental personnel may not be routinely available to many nursing home residents to place identification labels, and nursing staff members are not trained to use traditional denture marking techniques. This article describes a modified simple marking technique that may be used by either dental personnel or nursing staff members. Using ordinary sandpaper, lead pencil or ball pen, art and craft brush, direct light, and a mono‐poly sealer of 1 part heat‐cured clear methylmethacrylate powder mixed with 10 parts of autopolymerizing clear orthodontic methylmethacrylate liquid, 26 dentures were labeled for 19 nursing home residents. The technique was quick, cheap, easily applied, nonirritating to mouth tissues, and permanent.
Perioperative hemodynamic changes in ischemic heart disease patients undergoing dental treatment
Authors: Leviner Ephraim , Tzukert Aaron A. , Mosseri Morris , Fisher Dan , Yossipovitch Orit , Pisanty Sara , Markitziu Alice
Published: March 2008

Twenty patients with stable ischemic heart disease in functional capacity Class II‐IV underwent dental treatment. Scaling was performed in seven patients without local anesthesia. In the remaining 13 patients, pain control for restoration placement was obtained by local anesthesia: in seven patients, the anesthetics contained epinephrine, while In six this drug was omitted. Heart rate, blood pressure, and electrocardiograph were continuously monitored during the dental session. All patients had elevated systolic blood pressure and rate pressure product during treatment. In the patients who received plain local anesthetics only, the elevation In systolic blood and rate pressures was, however, significantly lower than the ischemic threshold. Arrhythmia or ST segment depression of 1 millimeter were not recorded in any of the subjects. In severely compromised ischemic heart disease patients undergoing routine dental procedures of limited chair time, plain local anesthesia seems to be the preferred analgesic modality.
The lack of efficacy of a foam brush in maintaining gingival health: a controlled study
Authors: Addems Allison , Epstein Joel B. , Damji Shamin , Spinelli John
Published: March 2008

Foam brushes have been used in the oral care of hospitalized patients for many years. However, no controlled study of their efficacy has been conducted. A randomized crossover study, comparing the effectiveness of a foam brush with that of a toothbrush, was carried out. The gingival condition and presence of plaque in the mouths of 29 volunteers were followed. It was shown that a toothbrush was more effective in controlling plaque levels and gingivitis.
Dietary and salivary factors associated with root caries
Authors: Faine Mary P. , Allender Deborah , Baab David , Persson Rutger , Lamont Richard J.
Published: March 2008

In this pilot study, dietary habits, microbial factors, and salivary factors in 20 older adults who had active decay on root surfaces were compared with those of 20 adults who had inactive or no root caries. In this case‐control study, the groups were matched by sex and were of similar age. Subjects using medications known to induce dry mouth were excluded. Subjects completed a nutrition interview and a four‐day food diary. Stimulated whole saliva flow rate, buffering capacity, levels of salivary lactobacilli with use of the Dentocult method, and S. mutans cultured on MSB agar were determined. The root caries group had a greater mean number of eating occasions per day (6.1 vs. 4.6), more frequent exposures to fermentable carbohydrates (5.8 vs. 4.2), and higher average daily sugars intake (133 g/day vs. 105 g/day) than the control group. Root caries subjects had significantly higher lactobacilli counts and less salivary buffering capacity. Within the root caries group, significant correlations were found with Root Caries Index and lactobacilli (r = 0.56) and S. mutans counts (rS= 0.50). These results show that frequent intake of simple sugars, high lactobacilli counts, and low saliva buffering capacity may be risk factors associated with root caries in older adults.
An educational “treatment plan” model for the general practice residency
Authors: Grant William D. , Mayne Richard
Published: March 2008

The need to match residency program experiences with the Interests, skills, and personal goals of residents is Influenced by many factors. A structured system, the Individualized Educational Plan, is described which provides a formalized means of addressing each of these needs. The development of an educational plan, similar in concept to the development of a formal treatment plan for patients, provides the basis for the system. The system provides both the program director and the resident with the means to evaluate in detail the resident's progress and the program's performance in helping the resident achieve competency.
An in vitro analysis of a sustained release system for the treatment of denture stomatitis
Authors: Schneid Thomas R.
Published: March 2008

This study investigated the feasibility of a sustained‐release delivery system for the treatment of denture stomatitis using four antifungal agents (chlorhexidine, clotrimazole, fluconazole, and nystatin) incorporated into a tissue conditioner (Lynal®) at zero (control), low, medium, and high concentrations.

Hardness of all experimental groups increased with both concentration and time, but remained within the range of clinical acceptability (Shore A ≤ 49).

Mean tensile strength increased in all experimental groups and was significantly stronger than the control for at least one concentration level of each drug, p ≤ 0.05.

All failures for tensile‐strength testing were characterized as cohesive.

All drugs demonstrated release from the tissue conditioner matrix and inhibition of growth of C. albicans that was either total, dose‐related, or related to incubation time prior to inoculation. All controls supported growth.
Modified orthodontic treatment goals in a patient with multiple complicating factors
Authors: Williams Bryan J.
Published: March 2008

This paper reviews orthodontic care in patients who are in non‐traditional categories. Specific orthodontic management of a patient who had severe hemophilia, seropositivity for anti‐HIV Ab, and Hepatitis B surface antigen is reviewed. The Importance of defining acceptable treatment goals in these patients is of paramount Importance.
A review of liver transplantation for the dentist and guidelines for dental management
Authors: Glassman Paul , Wong Christine , Gish Robert
Published: March 2008

The number of recipients of liver transplants has grown rapidly in the last few years and is likely to continue to do so in the future. The dentist should be prepared to see individuals who are contemplating or have had liver transplants.

The major goal of dental intervention, before and after liver transplantation, is the prevention of bacteremia from an oral source that could lead to systemic infection. In addition, pre‐transplant medical conditions of concern to the dentist include poor drug metabolism, bleeding disorders, poor wound healing, and an inability to metabolize swallowed blood. Post‐transplant dental treatment must take into consideration immunosuppressive drugs and the potential for infections.

Dental treatment should include a thorough dental examination, elimination of dental problems that could cause medical problems, and an intensive preventive dentistry program to minimize the occurrence of dental disease.
Congenital diaphragmatic hernia: Implications for nitrous oxide use in dentistry
Authors: Durham Timothy M. , Green James G. , Hodges Eric D. , Nique Thomas A.
Published: March 2008

The development of diaphragmatic hernias, their associated physical and diagnostic signs and symptoms, and the potential complications with nitrous oxide use are presented with a case report. Depending upon the location and extent of the diaphragmatic defect, portions of the stomach, omentum, liver and/or intestine can occupy a portion of the thoracic cavity. Nitrous oxide's solubility properties allow for rapid expansion of the herniated bowel, resulting in compression of the thoracic organs or strangulation of the herniated abdominal viscera. The presence of a diaphragmatic hernia may necessitate a change in sedation or anesthesia plans to eliminate the use of nitrous oxide during prolonged procedures.
A prospective survey of hospital ambulatory dental emergencies Part 2: Follow‐up to emergency treatment
Authors: Gibson Gary B. , Blasberg Bruce , Altom Rhonda
Published: March 2008

Two hundred and fifty‐three patients treated for dental emergencies at the University Hospital dental clinic over a three‐month period were surveyed by telephone 24 to 48 hours and one year after treatment. The purpose was to investigate the success of treatment in resolving the chief complaint of pain and to determine the compliance with further dental care for the original dental problem. The results of the telephone survey showed that: patients available for questioning totaled 49.1% at 24 to 48 hours and 28.9% at one year; an 80.7% success rate was recorded in resolving pain within 24 to 48 hours; and the original emergency problem did not motivate a large number of these patients to seek further dental care.
Standardized patients for teaching geriatric dentistry
Authors: Kay Charles J. , Johnson Judy A. , Kopp Kevin C.
Published: March 2008

Effectively managing geriatric dental patients requires behavioral, communication, and assessment skills which are not easily taught or evaluated by traditional methods. Standardized patients (SPs) are persons trained to simulate real patients. The advantages of using SPs instead of real patients are that student experiences can be realistic, yet predetermined and controlled. In a program at the University of Illinois College of Dentistry, SPs are used to provide practice and to evaluate dental students regarding their performance in managing specific geriatric dental patients. In the past three years, over 1500 student‐SP interactions specific to geriatric dentistry have been conducted with a wide variety of cases, including examination, diagnosis, and treatment planning. Additionally, program outcomes are discussed.
Patients with chronic hepatitis—potential risks when undergoing dental surgery: Review and case report
Authors: Reddi Sanjay , Garg Arun K.
Published: March 2008

This is a case report of a 17‐year‐old male patient with chronic autoimmune active hepatitis (CAAH) who was referred to our clinic for dental treatment prior to his undergoing liver transplant surgery. Coagulation problems and the implications of long‐term corticosteroid usage in patients with chronic hepatitis are presented. Differences in the etiology, histology, clinical features, laboratory findings, treatment, and prognosis are reviewed for the three separate but related forms of chronic hepatitis — persistent, lobular, and active hepatitis.

It is important to be aware of a patient's total medical picture, and how any preexisting conditions and their treatments might affect the dental care to be provided, especially in cases of invasive dental procedures. Such procedures, like any surgery of similar magnitude, have inherent risks, and the preoperative medical evaluation and postoperative care of these patients should be the same as those provided for other comparable surgeries, thus minimizing the risks of the operative procedure.

In our case, the patient's condition had been previously diagnosed, and we were able to develop our treatment plan accordingly. Sometimes, though, a patient presents with problems that may be a manifestation of a more serious systemic disorder (e.g., bleeding gums in the absence of obvious periodontal disease). Thus, the dentist should be alert to the possible presence of other underlying medical disorders and, if any are suspected, should consult with a physician prior to undertaking elective dental procedures.
Periodontal conditions in medically compromised elderly subjects: Assessments of treatment needs
Authors: Persson Rigmor E. , Persson G. Rutger , Odont D. , Robinovitch Murray
Published: March 2008

Periodontal conditions were studied in 42 dentate elderly subjects (mean age, 84.1 ± 8.0 years). None of them had received recent dental care or was routinely seen by a dentist. Overall, they had 20.2 ± 7.1 teeth (range, 6–32). The CPITN was used to assess periodontal status. Twenty‐nine percent of all sextants were either edentulous or had only one remaining tooth. The overall oral hygiene was poor (Plaque Index, 1.8 ± 0.5) and gingival inflammation severe (Gingival Index, 1.9 ± 0.8). Significant correlations were found between: Gingival and Plaque Indices (r = 0.82, p < 0.001), and pocket depth and Gingival Index (r = 0.38, p < 0.05). Plaque Index was negatively correlated to the number of remaining teeth (r = 0.43, p < 0.050). Age and remaining teeth were negatively correlated (r = 0.38, p < 0.05). Thirty percent of the posterior sextants had a CPITN score of “4,” and 75% of the posterior sextants had at least one site with a pocket depth 4 mm. Only 2.9% of all sites demonstrated pocket depth 6 mm and these sites were distributed among 67% of the subjects. The CPITN index was correlated to the mean pocket depth for the various sextants, the correlation varying between r = 0.67, p < 0.001 (upper right posterior) and 0.36, p < 0.05 (upper left posterior) sextants. The total manpower estimated to complete initial therapy for 42 patients was approximately 63 hours by a dentist and 85 hours by a dental hygienist.
Recognizing and reporting domestic violence: A survey of dental practitioners
Authors: McDowell John D. , Kassebaum Denise K. , Fryer George E.
Published: March 2008

A survey was sent to 1,000 Colorado dentists to evaluate their recognition and reporting of child, elder, and spouse abuse. Approximately 40% of the dentists returned the survey. In answering questions about suspected and reported cases of child abuse, 29% of the respondents indicated that they had suspected at least one of their patients to be a victim of child abuse, while 14% of the respondents had actually reported at least one case. Only 7% of the responding dentists had ever suspected a case of elder abuse, while just over 1% indicated that they had reported at least one suspected elder abuse case to authorities. When asked about their recognition and reporting of spouse abuse, 30% of the responding practitioners had suspected at least one case, while only 3% had ever actually reported a case to authorities. The overwhelming majority of responding dentists indicated that they needed to know more about child, elder, and spouse abuse.
Informed consent and the elderly dental patient
Authors: Woodman Ryan C. , Malz Victoria L.
Published: March 2008

The fastest growing segment of the population is currently comprised of those people 65 and older. The competency of these elderly individuals is often called into question when decisions about medical care are to be made. This article explores the concepts of a valid informed consent and provides an overview of competency assessment for the practitioner as it pertains to the geriatric dental patient.
A preventive dentistry training program for caretakers of persons with disabilities residing in community residential facilities
Authors: Glassman Paul , Miller Christine , Wozniak Thom , Jones Clay
Published: March 2008

People with disabilities develop more dental disease than the average population and have a harder time accessing and using resources for dental treatment. It is therefore critical to prevent dental problems in this population. This article discusses the development and use of a preventive dentistry training program consisting of a videotape, workbook, instructions for trainers, and pre‐ and post‐tests. The training program was designed to facilitate integration of dental and behavioral information into daily routines.

Participants were able to demonstrate that they could learn the information in the training materials using the methodology that was employed. Further work remains to be done to revise and disseminate the materials and to demonstrate that the knowledge that the participants gained can be effectively applied in community care settings.
Relationship of oral microflora with oral health status in Parkinson's disease
Authors: Kennedy Michelle A. , Rosen Sam , Paulson George W. , Jolly Daniel E. , Beck F. Michael
Published: March 2008

Parkinson's disease (PO) patients report an increased craving for sweets, which may have an effect on microflora. We compared patients of PD who crave sweets with PD patients who do not. Age‐ and sex‐matched control subjects were used, with 14 subjects in each group. A plaque sample was taken from tooth #18 with a curette and placed into RTF, homogenized, and plated onto selective and non‐selective media. Microflora were expressed as % CFU's of total anaerobes. Statistical analysis was performed by ANOVA and Newman‐Keuls on log‐transformed data. No statistical difference was observed among the three groups for lactobacilli, bacteroides, fusobacteria, veillonella, and actinomyces. S. mutans was lower in controls than in PD patients. Apparently, the craving for sweets in PD patients does not result in a significant increase in % of total anaerobes of certain microflora. PD patients showed a significant increase in mucositis compared with the control groups.
Clinical and radiographic evaluation of Juvenile Rheumatoid Arthritis: Report of a case
Authors: Zifer Sally A. , Sams Deirdre R. , Potter Brad J. , Jerath Rita
Published: March 2008

Rheumatoid arthritis (RA) is an inflammatory disease of the synovium which may lead to proliferative and degenerative changes in the body's joints, including the temporomandibular joint (TM Joint). Although the exact etiology of rheumatoid arthritis remains unknown, it is suspected that the disease is often initiated by an infectious organism, or by genetic and/or environmental factors. Juvenile rheumatoid arthritis (JRA) is a chronic disease of childhood with a spectrum of joint involvement and associated systemic and other organ involvement. Five percent of all rheumatoid arthritis patients are children. In the United States, approximately 150,000 children are affected by IRA. With upper limb involvement, routine oral hygiene procedures become difficult. Dental evaluations/screenings may not be included in the initial team assessment of these patients until the TM Joint is affected; however, prior to this time, the patient may have had years of poor oral hygiene which could contribute to severe decay and early tooth loss. This case report describes the oral health status of a child with polyarticular juvenile rheumatoid arthritis and the specific recommendations for dental management.
Response to patients' death and bereavement in dental practice
Authors: Henry Robert G. , Johnson Helen Arleen , Holley Maureen M. , Kaplan Alan L.
Published: March 2008

Coping with patient deaths and family bereavement has received minimal attention in dental education and literature. This study was conducted to determine how frequently dentists experience patient deaths, how they cope with the knowledge of a patient's death, and if they demonstrate need for emphasis in the dental curricula in the areas of death and bereavement. A survey adapted from Chiodo and Tolle (1988) was sent to all 2091 dentists in the State of Kentucky. The response rate was 47.68% (997 returned surveys). Findings include: (1) General dentists (GDs) have a significantly higher number of patients who die each year than do specialists (S) (GD = 7, S = 1.5); (2) coping behaviors range from sending sympathy cards (63%) to attending the funeral (23%); (3) patient deaths cause stress, most stress occurring when patients die unexpectedly; (4) the greatest stress was encountered when talking with the patient's family; and (5) most dentists (58%) believed that bereavement education should occur in dental school. In conclusion, this research adds to the limited literature on appropriate coping behaviors by dentists when patients die and suggests that death and bereavement education should occur in the dental school setting to prepare practicing dentists for coping with patient loss due to death, and to provide family bereavement support mechanisms.
Tobacco and the institutionalized mentally retarded: Usage choices and ethical considerations
Authors: Burtner A. Paul , Wakham M. Dean , McNeal Donald R. , Garvey Timothy P.
Published: March 2008

Patterns of tobacco use were observed among 749 people diagnosed with mental retardation residing in a state‐operated facility. Specifically, Individual preference for tobacco products and frequency of use were documented. Subjects were observed using several types of tobacco products: cigarettes, cigars, chewing tobacco, snuff, and cigarette butts. Approximately 7% (n = 52) used at least one form of tobacco; ten individuals used more than one tobacco product. Interestingly, 20.5% of the Individuals diagnosed with mild or moderate mental retardation (n = 122) consumed tobacco products, a pattern of behavior that closely approximates that of the general population (20–24%). Ethical considerations pertaining to the availability of tobacco products to this special population are presented.
Ethical issues encountered by dentists in the care of institutionalized elders
Authors: Bryant S. Ross , MacEntee Michael I. , Browne Alister
Published: March 2008

Increasing numbers of Institutionalized elders have very poor oral health. It has been suggested that ethical problems may influence dentists who attempt to provide oral care for these people, but little attention has been given to research in this area. A qualitative Interview method was used to Investigate the views and experiences of dentists working with institutionalized elders. Particular attention was given to the ethical difficulties encountered and how the dentists resolved them. Ten dentists experienced in long‐term care were interviewed individually by means of open‐ended questions. Thematic analysis identified ethical problems focused on the difficulty of identifying the wishes of patients or predicting the outcome of treatment. The participants reported few difficulties in making clinical decisions in this setting. However, analysis revealed that the ethical perspectives of the dentists varied substantially. Variation was notable, particularly in their preference for ideal or practical treatment and in their preference for autonomy or beneficence.
A retrospective review of a service to provide comprehensive dental care under general anesthesia
Authors: Nunn June H. , Davidson Gaynor , Gordon Peter H. , Morth  , Storrs John
Published: March 2008

Day‐stay general anesthesia is indicated for a number of dental reasons, not least for those patients who are unable to accept routine dental care. Since 1979, the Dental Hospital of the University of Newcastle upon Tyne, UK, has provided a weekly day‐stay service for the dental care of such patients. Reviews of this service were undertaken in 1983 and again in 1993. The latter study Investigated the provision of care for 265 patients and compared this with that for the 96 patients reviewed in the earlier study. This paper presents the results of the review and underlines the need for a very aggressive approach to preventive dental care for patients treated by this modality.
Panoramic radiography: The differential diagnosis of carotid artery atheromas
Authors: Friedlander Arthur H.
Published: March 2008

Cervical carotid artery atherosclerosis, a major cause of stroke (cerebrovascular accident, CVA), commonly occurs in older individuals with a history of hypertension and smoking. These atheromatous plaques, when calcified, may be imaged on conventional panoramic dental radiographs. Dentists caring for “at‐risk patients” must be able to identify these lesions and to differentiate them from anatomical and other pathological radiopacities frequently observed in the carotid artery territory. Prompt referral of these individuals to a physician may preclude a stroke.
Strategies for conducting dental examinations among cognitively impaired nursing home residents
Authors: Kayser‐Jones Jeanie , Bird William F. , Redford Maryann , Schell Ellen S. , Einhorn Sheri H.
Published: March 2008

Many nursing home residents have poor oral health and are in need of treatment. A major barrier to pre viding care is the difficulty of examining cognitively impaired elders. In two research studies, 625 exams were conducted on 181 nursing home residents, the majority of whom suffered severe cognitive impairment. Qualitative data collected during the course of these two studies revealed strategies that permitted examiners to conduct the examinations successfully, including developing rapport with the residents, providing a quiet environment, and enlisting the help of the primary caregiver. The importance of interdisciplinary collaboration among health professionals, especially dentists and nurses, is discussed.
Factors which influence the oral condition of chronic schizophrenia patients
Authors: Thomas Alex , Lavrentzou Evanthia , Karouzos Charis , Kontis Costas
Published: March 2008

The oral health status of 249 individuals with chronic schizophrenia was evaluated by means of the Oral Hygiene Index (OHI‐S) and Decayed, Missing and Filled Teeth scores (DMFT). The patients were subdivided as to chronicity of illness and venue of psychiatric treatment (158 inpatients ≥ 10 years' hospitalization, 34 inpatients ≤ 10 years' hospitalization, and 57 outpatients). The severity of schizophrenia was determined by: the Brief Psychiatric Rating Scale (BPRS), the intensity of negative symptoms of schizophrenia [as measured by the Brief Psychiatric Rating Scale, Negative Symptoms (BPRSNEGS)], and the equivalent dose of chloropromazine (EDC).

This study demonstrated that inpatients had greater amounts of dental disease than outpatients. The extent of dental disease among inpatients as measured by both the OHI‐S and DMFT scores was directly related to the intensity of schize phrenia (BPRS), magnitue of negative symptoms associated with schizophrenia (BPRSNEGS), and length of hospitalization. DMFT scores were directly related to EDC value.
Practice guidelines and quality: Is there a connection?
Authors: Van Ostenberg Paul R.
Published: March 2008

Yes! Practice guidelines are clearly connected to quality. To characterize that connection adequately, however, is a more formidable task and is the subject of this paper.

This paper will capture, in a few words, the essence of my perspective and experience related to quality issues and then attempt to establish a connection between practice guidelines and quality from two perspectives: first, by suggesting a series of assumptions that would lead to a decision on what should be the focus of an appropriate guideline for an older adult, since there are many possibilities and agreeing on assumptions is a logical first step; and second, by suggesting a framework for the content of such guidelines.
Ethical issues in nursing home care: Practice guidelines for difficult situations
Authors: Shuman Stephen K. , Bebeau Muriel J.
Published: March 2008

Dental professionals encounter a number of challenging ethical and legal dilemmas when caring for nursing home residents. Questions may arise in determining a patient's capacity to make decisions, securing consent for treatment, choosing the most appropriate from among several treatment options, and when and how to use restraints. When securing consent for treatment, practitioners must consider both the patient's legal competence and his/her decision‐making capacity, and adopt roles appropriate to the patient's circumstances. If legal competence has been retained but decision‐making seems impaired, practitioners must involve others in the process of determining appropriate care. The capacity to consent to treatment can be assessed by questions designed to evaluate the patient's ability to understand relevant information, appreciate the situation and consequences, manipulate information rationally, and communicate choices. When faced with a choice of several treatment options and patient preferences are unclear or unknown, the principle of substituted judgment should be used to attempt to provide care in keeping with the patient's values. To maximize patient safety and dignity, ten guidelines are presented for the use of restraints to provide dental care for individuals with behavior problems.
Clinical and radiographic presentations of HIV‐1 necrotizing ulcerative periodontitis
Authors: Barr Charles E. , Robbins Miriam R.
Published: March 2008

HIV‐1‐associated periodontal diseases have been reported in the literature for several years. Criteria for the diagnosis of these diseases have not been universally accepted, although there are numerous papers describing the clinical entity. These case reports provide clinical and radiographic evidence of a type of periodontal disease with bone and soft tissue destruction which differentiates it from “conventional” periodontal diseases found in both HIV‐1‐infected patients and those not infected by the virus. It is important, from both diagnostic and therapeutic aspects, for clinicians to be able to make this distinction. The appropriate use of clinical and radiographic findings is extremely helpful in the diagnosis, particularly in the case of defining HIV‐1 necrotizing ulcerative periodontitis (NUP). Whether the patterns of gingival changes and bone loss described in these case reports are specific to HIV‐1‐seropos‐itive persons or rather represent severe immunosupp ression requires further investigation.
Interrelationship among degree of mental retardation, living arrangements, and dental health in adults with mental retardation
Authors: Gabre Pia , Gahnberg Lars
Published: March 2008

The aim of the present investigation was to study the Inter‐relationship among the degree of mental retardation, the way of living, and dental health in adults with mental retardation. One hundred and thirty‐ two adults between the ages of 21 and 40 years who were mentally retarded were examined on two occasions, one year apart. All subjects had had regular dental care for at least 10 years. The clinical examinations included bite‐wing radiographs and were made by the same dentist. The degree of mental retardation was assessed by a professional psychologist. The results show that the degree of mental retardation as well as living arrangements are factors Influencing the dental health of persons with mental retardation. Subjects who were mildly retarded had higher carles incidence and caries prevalence compared with subjects with moderate or severe mental retardation. From a preventive dental health perspective, special attention should be focused on subjects with mild mental retardation who are not living in Institutions.
The physical and adhesive properties of dental cements used for atraumatic restorative treatment
Authors: Ewoldsen Nets , Covey David , Lavin Marshall
Published: March 2008

Atraumatic Restorative Treatment (ART), a recently reported field dentistry technique, involves removal of carious debris using only hand instruments and placement of a glassionomer cement (GIC) restoration. While small ART‐GIC restorations are effective short‐term replacements for lost tooth form, many larger ART‐GIC restorations are defective after two years. Presently, resin‐modified GICs (R‐M GIC) are available which require no special activation equipment and handle easily in field settings. This study measured the com‐ pressive, tensile, and shear bond strengths to enamel and dentin of a conventional ART‐GIC (Fuji IX) and two R‐M GICs (Fuji Plus and Advance) at a powder‐to‐liquid ratio of 3.6:1. The compressive strengths of the GICs tested were significantly different. Fuji IX had the highest compressive strength, and Advance had the lowest strength (p < 0.05). The tensile strength of the R‐M GICs was greater than that of the ART‐GIC. Fuji Plus showed the highest shear bond strength to enamel and dentin and was significantly different from both Fuji IX and Advance. A clinical protocol is presented followed by case reports where the ART technique was used for management of acute caries in a modern dental setting.
Oral health of persons with and without dementia attending a geriatric clinic
Authors: Warren John J. , Chalmers Jane M. , Levy Steven M. , Blanco Valerie L. , Ettinger Ronald L.
Published: March 2008

This study of 230 hospital geriatric clinic patients compared the oral health of individuals with dementias with that of persons with no dementing illnesses. Data collected included dental examinations, subject questionnaires and review of hospital records. There were kw differences among groups of patients based on categorization into groups of those diagnosed with (1) no dementia, (2) dementia of the Alzheimer's type, and (3) other dementias. However, there were significant differences based on degree of cognitive impairment regardless of dementia diagnosis. Those with severe dementia had poorer gingival health and oral hygiene, but better self‐perceived mouth health. There are numerous limitations and inherent dimculties in studies involving persons with dementia, and overcoming these in the future will likely require long‐term, interdisciplinary approaches.
Complicating mucosal reactions in patients receiving radiation therapy for head and neck cancer
Authors: Epstein Joel B. , Van der Meij Erik H.
Published: March 2008

Radiation mucositis is characterized by erythema, pseudomem‐branes, and ulceration of mucosa in the irradiated field. We present two cases of oral mucosal changes in patients treated with radiotherapy in the head and neck region, which included mucosal erythema and ulceration outside of the radiated fields. One case was confirmed as herpes virus infection, and the other was diagnosed as Sweet's syndrome. When mucositis extends beyond the radiation fields, the clinician should consider other causes of mucosal inflammation and erythema in order to begin appropriate management.
Challenges in geriatric oral health research methodology concerning caregivers of cognitively impaired elderly adults
Authors: Blanco Valerie L. , Levy Steven M. , Ettinger Ronald L. , Logan Henrietta , Buckwalter Kathleen C.
Published: March 2008

Little is known about oral health care behaviors of community‐dwelling, cognitively impaired elderly (CIE) persons. Few studies have been conducted regarding the actual provision of oral care for CIE persons or the attitudes and concerns about oral health among their caregivers. The CIE person's ability to perform self‐care decreases over time, and the role of the caregiver in daily oral care becomes increasingly important. The purpose of this pilot study was to explore the attitudes toward oral health and identify related concerns among caregivers who care for community‐dwelling CIE persons. Caregivers were surveyed by means of a self‐administered, mailed questionnaire. To maintain confidentiality, an intermediary was used for recruitment and data collection. Overall, 148 caregivers were invited by an intermediary to participate in the survey; only 21 (14%) consented to participate and returned the questionnaire. This paper discusses some of the numerous methodological challenges identified when an attempt was made to survey caregivers' attitudes toward and barriers to providing oral care for a dependent CIE.