bluuebunny/crossref_metadata_2025 huggingface dataset:
Target Outcomes for Long‐term Oral Health Care in Dementia: a Delphi Approach
Authors: Jones Judith A. , Brown Elizabeth J. , Volicer Ladislav
Published: May 2007

This study developed a list of target outcomes for long‐term oral health care in persons with dementia. A three‐round Delphi study was used to develop a list of target outcomes. Participants included 99 staff and 171 family members associated with the Dementia Special Care Unit in Bedford, MA. In Round 1 participants were asked to list five outcomes for long‐term oral health care. Items were grouped, redundancies removed, and fed back in Round 2, when participants scored the items from 1 (least important) to 10 (most important). Round 2 responses were tabulated and the top 20 were fed back for scoring in Round 3. The top 10 target outcomes in decreasing order of importance were: patient will be free from oral pain, patient will not be at risk for aspiration, emergency dental treatment will be available when needed, prevent mouth infections, daily mouth care is as much a part of daily care as shaving or brushing hair, prevent discomfort from loose teeth or sore gums, teeth will be brushed thoroughly once a day, staff will be able to provide oral hygiene care as needed, provide dental care to prevent problems eating, and recognize oral problems early. Family and professional caregivers were remarkably consistent in their identification of the top 10 outcomes. Further work is needed to ensure broad international and interdisciplinary acceptance (including families and the long‐term care residents themselves) of target outcomes for long‐term oral health care in persons with dementia.
Oral Cancer Knowledge and Opinions Among Maryland Nurse Practitioners
Authors: Siriphant Piya , Drury Thomas F. , Horowitz Alice M. , Harris Ruth M.
Published: May 2007

Objectives: As part of a Maryland statewide oral cancer needs assessment, a census of adult and family practice nurse practitioners was conducted to determine their knowledge of oral cancer risk factors, diagnostic procedures and related opinions. Methods: Information was obtained through a pretested, 40‐item, self‐administered mail questionnaire of 389 nurse practitioners. A second complete mailing was sent three weeks after the initial mailing; two postal card reminders were mailed at 10 and 17 days after the second mailing, which yielded a response rate of 56 percent. Results: Most nurse practitioners identified the use of tobacco, alcohol, and prior oral cancer lesions as real risk factors. But only 35 percent identified exposure to the sun as a risk for lip cancer. Respondents were not overly knowledgeable about the early signs of oral cancer, most common forms, or sites for oral cancer. Only 19 percent believed their knowledge of oral cancer was current. Nurse practitioners who reported having a continuing education course on oral cancer within the past two to five years were 3.1 times more likely to have a high score on knowledge of risk factors and 2.9 times more likely to have a high score on knowledge of both risk factors and of diagnostic procedures than were those who had never had a continuing education course. Conclusions: The reported knowledge of oral cancer, in conjunction with opinions about level of knowledge and training, point to a need for systematic educational updates in oral cancer prevention and early detection.
Dental Caries Experience, Tooth Loss, and Factors Associated with Unmet Needs of Haitian Immigrants in New York City
Authors: Cruz Gustavo D. , Xue Xiaonan , LeGeros Racquel Z. , Halpert Nandor , Galvis Diana L. , Tavares Mary
Published: May 2007

Objective: The aim of this study was to characterize the dental caries experience, tooth loss, and unmet need of a group of Haitian immigrant residents of New York City. Methods: A purposive sample of 523 adults was obtained through community outreach activities during 1997–98. Clinical examinations were performed by calibrated examiners, according to NIDCR criteria. A comprehensive survey also was administered to all the participants. Results: For the whole group, the mean number of missing teeth was 2.64 (SD=4.72), the mean DMFT=6.05 (SD=5.26), the mean DMFS=18.80 (SD=21.04), and the mean DFS=5.58 (SD=6.17). Seventeen percent of the subjects had all their teeth sound, 59 percent had at least one tooth missing, 60 percent had at least one decayed tooth, and only 38 percent had restorations. Multivariate analyses showed that age, sex, education, dental insurance, frequency of dental visits, and dental floss use were predictors of unmet need. Conclusions: Although results showed a relatively low caries experience among this group of Haitian immigrants, the unmet need was very high. Furthermore, the tooth loss experience was relatively high for all age groups, further denoting a lack of access to preventive and restorative services.
Developing Short‐form Measures of Oral Health‐related Quality of Life
Authors: Locker David , Allen P. Finbarr
Published: May 2007

Objectives: Using the item‐impact method, we developed an alternative short‐form Oral Health Impact Profile (OHIP) that has good psychometric properties and minimal floor effects. Methods: OHIP data were collected from a sample of older Canadians at two points in time. Data from the first administration were used to develop a 14‐item short‐form measure; data from the second compare :he latter's psychometric properties with those of the original short form developed by Slade (1997), who used a controlled regression procedure. Results: The short form based on the item‐impact method had only two items in common with the short form derived from the regression approach and contained more high‐prevalence items. The regression short form was subject to marked floor effects, while the impact short form had floor effects comparable to those of the full 49‐item OHIP. The former discriminated between dentate and edentulous subjects, while the latter did not. Both discriminated between dentate subjects who did and did not wear dentures, those with and without dry mouth, and those with and without chewing problems. Both were also significantly associated with self‐ratings of oral health, satisfaction with oral health, and self‐perceived need for dental treatment. The strength of the associations was somewhat stronger with the regression short form, indicating that it performed better as a discriminatory instrument. However, because of its floor effects, it was markedly less sensitive to change than the impact short form. There was an indication that item‐impact methods of shortening oral health‐related quality of life measures produced more stable results across samples than the statistical approach. Conclusions: Because the content validity of shotf‐form measures is always compromised, different short forms are required for different purposes and different patient populations. The regression short form developed by Slade (1997) is likely to be better when the aim is to discriminate, while the impact short form developed here may be preferable when the aim is to describe the oral health‐related quality of life of populations or to detect change.
Risk Indicators for Periodontal Disease in a Remote Canadian Community—a Dental Practice‐based Study
Authors: Sbaraglia Mandy , Turnbull Robert S. , Locker David
Published: May 2007

Objectives: The purpose of this cross‐sectional study was to identify risk markers and risk indicators for periodontal attachment loss in a remote Canadian community. Of special interest was the association between smoking and periodontal disease experience. Methods: Data were collected from a convenience sample of 187 adult patients attending a dental office in a rural community located in Northern Ontario. Information was obtained via a questionnaire and a periodontal examination. The questionnaire included the use of dental services, self‐care behaviors, general health status, smoking, and personal characteristics. Periodontal health was assessed using the mean periodontal attachment loss (MPAL), measured at two sites on all remaining teeth and the proportions of sites examined with loss of 2 mm or more and 5 mm or more. Plaque scores and measures of the number of missing teeth also were obtained. The relationships between mean periodontal attachment loss, the proportion of sites with 5 mm or more of loss and independent variables such as age, sex, current smoking status, mean tooth plaque scores, flossing frequency, and regularity of preventive dental visits were examined in bivariate and multivariate analyses. Results: The data revealed a mean periodontal attachment loss of 3.9 mm (SD=1.5). The mean proportion of sites examined with loss of 2 mm or more was 0.89 and the mean proportion with loss of 5 mm or more was 0.35. In linear regression analysis, plaque scores, the number of missing teeth, age, current smoking status, regularity of dental visits, and flossing frequency had statistically significant independent effects and explained 60.0 percent of the variance in mean periodontal attachment loss. Just over 30 percent of subjects had severe periodontal disease, defined as 50 percent or more of sites examined with loss of 5 mm or more. In logistic regression analysis, missing teeth, dental visiting, smoking status, age, and flossing frequency had significant independent effects. The strongest association observed was with smoking, which had an odds ratio of 6.3. The logistic regression model correctly predicted 64.3 percent of cases with severe disease. Conclusions: The data indicate that the periodontal health of these patients is poor. Risk indicators or markers of poor periodontal health in the population studied included missing teeth, plaque scores, age, current smoking status, regularity of dental visits, and flossing frequency. This supports previous findings that behavioral factors play an important role in periodontal disease.
Translation and Validation of the Chinese Version of GOHAI
Authors: Wong May C. M. , Liu Jerry K. S. , Lo Edward C. M.
Published: May 2007

Objective: To translate and validate the Chinese version of General Oral Health Assessment Index (GOHAI) for elderly in Hong Kong and to investigate factors that possibly may influence the GOHAI scores. Methods: The English version of GOHAI was translated into Chinese. Persons aged 60–80 years were interviewed by two trained interviewers and clinically examined by a dentist. Information on subjects' demographic background and oral health conditions was collected. Results: Altogether 1,023 elderly were interviewed and clinically examined. The mean GOHAI score was 48.9 (SD=7.2). Cronbach's alpha of the translated GOHAI was 0.81; item‐scale correlation ranged from 0.28–0.61. It was found that the mean GOHAI scores were lower for subjects with poorer perceived oral health (rs=0.57, P<.001). Elderly who had perceived dental treatment need had a lower mean GOHAI score than those who did not (P<.001). It was also found that elderly who lived in elderly homes, those who received social welfare assistance, those who had recent dental visits, and those with higher DMFT scores had higher mean GOHAI scores. Conclusion: The translated Chinese version of GOHAI demonstrated acceptable reliability and validity. It is available for use by researchers in oral health‐related quality of life studies on Chinese elderly population.
Integrity of Powdered and Powder‐free Latex Examination Gloves
Authors: Calhoun Andrew J. , Rodrick Gary E. , Brown Frederic H.
Published: May 2007

Objectives: The difference in permeability between one brand of powdered and another of powder‐free latex examination gloves was evaluated to determine leak rates. Methods: Thirty‐one of each type of glove were tested for each of three different conditions: usage by dental personnel (1) for 15 minutes or longer, (2) for less than 15 minutes, and (3) directly from the manufacturer's packaging (zero usage time). Each glove was evaluated in the fingers and the palm. The phiX‐174 viral solution in the glove was allowed to penetrate for 15 minutes. Powder (cornstarch) was subsequently added to 20 powder‐free gloves, and 15 of these were pierced with a 30‐gauge needle. Results: Powdered gloves showed no leakage rates. Because of this, 30‐, 27‐, and 25‐gauge needles were used to pierce five gloves each. One glove with 27‐ and 25‐gauge needle holes showed leakage. Leakage rates for powder‐free gloves: 45.1 percent for more than 15 minutes of use, 25.8 percent for less than 15 minutes of use, and 16.1 percent for zero minutes of use. Two of the 20 pierced and one of the five unpierced powder‐free gloves with added cornstarch leaked. Conclusion: Significant differences in leak results between powdered and powder‐free gloves suggest further study is needed.
A Systematic Review of the Performance of Methods for Identifying Carious Lesions
Authors: Bader James D. , Shugars Daniel A. , Bonito Arthur J.
Published: May 2007

This systematic review evaluates evidence describing histologically validated performance of methods for identifying carious lesions. A search identified 1,407 articles, of which 39 were included that described 126 assessments of visual, visuaVtactile, radiographic (film and digital), fiber optic transillumination, electrical conductance, and laser fluorescence methods. A subsequent update added four studies contributing 10 assessments. The strength of the evidence was judged to be poor for all applications, signifying that the available information is insufficient to supporf generalizable estimates of the sensitivity and specificity of any given application of a diagnostic method. The literature is problematic with respect to complete reporting of methods, variations in histological validation methods, the small number of in vivo studies, selection of teeth, small numbers of examiners, and other factors threatening both internal and external validity. Future research must address these problems as well as expand the range of assessments to include primary teeth and root surfaces.
Early Childhood Caries‐related Visits to Hospitals for Ambulatory Surgery in New York State
Authors: Wadhawan Sangeeta , Kumar Jayanth V. , Badner Victor M. , Green Elmer L.
Published: May 2007

Objectives: The objective of this study was to assess the utilization of ambulatory surgery at hospitals for the treatment of early childhood caries in New York State. Methods: Data for this study came from the Statewide Planning and Research Cooperative System in New York State. We analyzed 16,149 oral health‐related ambulatory surgeries performed between 1996 and 1999 in children younger than 6 years of age. Results: Between 1996 and 1999, the rate of hospitalization for dental caries in children younger than 6 years of age ranged from 180 to 193 cases per 100,000. Approximately two‐thirds of the visits by children younger than 6 years old were due to dental caries. The highest rate was observed in 3‐year‐old children (346.5). The most frequent type of procedure performed was placement of stainless steel crowns. Medicaid was the primary source of reimbursement. Conclusions: These data illustrate that, although dental caries is preventable, it continues to be a significant problem in young children and results in a large number of ambulatory surgery visits.
The Relationship Between Amalgam Restorations and Mercury Levels in Male Dentists and Nondental Health Professionals
Authors: Joshi Anil , Douglass Chester W. , Kim Hyun‐Duck , Joshipura Kaumudi J. , Park M. Chu , Rimm Eric B. , Carino Michael J. , Garcia Raul I. , Morris J. S. , Willett Walter C
Published: May 2007

Objectives: The objectives of this study were: (1) to compare the mercury levels in general dentists with the mercury levels in other health professionals using toenail clippings as a biomarker, (2) to identify risk factors associated with high mercury levels, and (3) to compare practice characteristics of dentists with high and low mercury levels. Methods: A sample of 579 men was randomly selected from the 33,737 men participating in the Health Professionals Follow‐up Study who had provided toenail samples in 1987. A questionnaire was sent to these male subjects in 1991 to obtain information on fish consumption, tooth‐brushing frequency, number of teeth, number of amalgam restorations, general practice or specialty status, number of amalgam restorations placed and removed per week, mercury storage and handling procedures, and mercury spillage incidents. A measure of long‐term mercury exposure was obtained from toenail samples using neutron activation analysis for the 410 respondents (71% response rate). The 90th percentile mercury level in toenails (0.88 ppm) was selected as the threshold for elevated toenail mercury level. Results: No relationship was found between the number of dental amalgams and toenail mercury levels among general dentists, dental specialists, and nondental health professionals. General dentists were found to have more than twice the level of mercury in toenails than nondental health professionals (mean level=0.94 vs 0.45) and 60 percent higher than dental specialists (mean=0.59). The combined use of disposable capsules and water storage of scrap amalgam appeared to reduce the risk of elevated mercury levels. Regardless of professional status, consumption of tuna and saltwater fish were the primary exposure factors that were positively associated with toenail mercury levels. Conclusions: As shown by the associations with dental profession and fish consumption, the mercury content of toenails is a stable biomarker of cumulative long‐term mercury exposure. The lack of association between nail mercury levels and number of amalgam restorations suggests that avoidance of mercury amalgam restorative materials cannot be justified by the presence of mercury released from dental amalgams.
Seropositivity of the Rapid Plasma Reagin (RPR) Test in a Dental School Patient Population: a Retrospective Study
Authors: Cade James E. , Boozer Charles H. , Leigh Janet E.
Published: May 2007

Objectives: The purpose of this retrospective study was to determine the seropositivity of the rapid plasma reagin (RPR) in a dental school patient population. Methods: Blood was drawn on 20,844 subjects registering for treatment at the Louisiana State University School of Dentistry. All subjects who are admitted to the dental school are submitted to RPR screening (Macro‐Vue‐RPR Card, Becton Dickinson), blood indices, and serum chemistries. Venereal Disease Research Laboratory (VDRL), microhemagglutination assay for Treponema pallidum (MHA‐TP) and/or fluorescent treponemal absorption test for Treponema pallidum (FTA‐ABS) were also run on the positive RPR results. Results: Two hundred seventy‐nine (1.34%) of the 20,844 were RPR‐positive. Sixty‐two subjects (0.30%) of this total population from the RPR‐positive findings were nonreactive (biological false positives or BFP) to the MHA‐TP and FTA‐ABS. This left 217(1.04%) subjects of the 20,844 screened who were seropositive on both the RPR and the FTA‐ABS or MHA‐TP. Conclusions: Since this study has not been performed in a dental school patient population setting, comparison with other institutions is difficult. The authors agree that routine RPR testing is helpful and cost effective to detect patients possibly infected with Treponema pallidum in a large patient population.
Dental Caries Experience in Northern Manhattan Adolescents
Authors: Mitchell Dennis A. , Ahluwalia Kavita P. , Albert David A. , Zabos Georgina P. , Findley Sally E. , Trinh‐Shevrin Chau B. , Marshall Stephen E. , Lamster Ira B. , Formicola Allan J.
Published: May 2007

Objective The study sought to document dental caries among adolescents residing in northern Manhattan, New York, by race, sex, and community. Methods: Clinical and demographic data were collected from children aged 12‐17 years at five school‐based dental clinics in northern Manhattan. Data on dental caries were collected by calibrated examiners using the National Institute of Dental and Craniofacial Research criteria for oral examinations. Results: A total of 566 children participated in the study. They were predominantly Hispanic (64%) or African American (28%). Compared to data from the National Health and Nutrition Examination Survey III, mean DMFT (3.36 vs 2.53; P<.01) and the prevalence of untreated disease (36% vs 16%; P<.01) were significantly higher for northern Manhattan adolescents. Of the adolescents evaluated, 13 percent had at least one severely carious tooth with pulpal in volvement that required either extraction or endodontic therapy. Conclusions: Adolescents in northern Manhattan have higher caries prevalence and higher levels of untreated caries than their national counterparts. Carious lesions progress to pulpal involvement in a high percentage of northern Manhattan children and require extraction or root canal therapy as treatment. There is an urgent need for affordable and available dental primary care services targeted to economically disadvantaged communities.
Australian Dental Students' Views about Smoking Cessation Counseling and Their Skills as Counselors
Authors: Rikard‐Bell Glenys , Groenlund Catherine , Ward Jeanette
Published: May 2007

Objective: This paper seeks to determine Australian dental students' views about and skills to provide smoking cessation counseling. Methods: In 2000, we surveyed dental students enrolled in all five years of the undergraduate degree course at the Faculty of Dentistry, University of Sydney, Australia. Results: We obtained 248 questionnaires (response rate=88%). Of our sample, 31 (13%) were self‐reported current smokers. Most students (n=203; 82%) indicated they were expected to give smoking cessation counseling to patients. While the majority responded they had been taught the risks from tobacco in the etiology of oral cancer (n=180; 73%), significantly fewer (n=111; 45%) indicated they were taught smoking cessation counseling (McNemars chi‐square=41.66; df=1; P<.001). Independent of their own smoking status, most planned to advise patients about tobacco use in their graduate careers (n=219;91%). However, significantly fewer (n=129; 54%) indicated that such counseling would be effective (McNemars chi‐square‐9.95; df=1; P<.04). Students' confidence to counsel smokers to quit was low and did not differ significantly by year (chi‐square=3.90; df=4; P=.42). Resources highly ranked for inclusion in the undergraduate curriculum were seminars with experts (50%) and practical skills training (49%). Conclusions: Dental students' low perception of the effectiveness of smoking cessation counseling and the inadequacies of the current evidence‐base invite more convincing research about dentists' role in tobacco control and better skills training in response.
The Dynamics of Toothache Pain and Dental Services Utilization: 24‐Month Incidence
Authors: Duncan R. Paul , Gilbert Gregg H. , Peek Chuck W. , Heft Marc W.
Published: May 2007

Objectives: The aims of this study were twofold: (1) to describe patterns of change in reported toothache pain, and (2) to examine the impact of toothache pain on dental care utilization and vice versa. Methods: Data from the Florida Dental Care Study (FDCS), a longitudinal study of oral health and dental service utilization conducted in north Florida, were used to measure self‐reported toothache pain among dentate adults at baseline and four subsequent times during a 24‐month period. Only persons 45 years of age or older with at least one remaining natural tooth at baseline were eligible. A total of 873 subjects participated, 764 of whom participated through 24 months. The analysis is focused on modeling transitions in the reported experience of toothache pain during intervals of six months. Results: At the time of the baseline interview, 11.5 percent of subjects reported current toothache pain. During subsequent six‐monthly interviews, from 13.4 percent to 21.6 percent of subjects reported having experienced toothache pain during the prior six‐month interval. Among those with no toothache pain at baseline (n=772), 31.2 percent experienced toothache pain at some time during the 24‐month study period. The six‐month incidence probability reflects the likelihood of developing toothache pain by estimating the conditional probability of reporting a toothache in a later interval given that this problem was not reported in the earlier one (for consecutive pairs of intervals). Overall, the six‐month incidence probability for toothache pain in this study was. 11. Significantly higher 24‐month incidence was observed for African‐American subjects, those with less formal education, those in poorer financial circumstances, and problem‐oriented dental attenders. Conclusions: In this diverse sample of adults, toothache pain occurs frequently and is quite variable overtime. Toothache occurs in conjunction with various forms of self‐reported oral disease (e.g., abscess, cavities) or tissue damage (e.g., loose tooth, broken tooth, bleeding gums). Subjects who experience toothache are slightly more likely than others to utilize dental services in the time period proximate to the toothache pain.
Associations of Ethnicity/Race and Socioeconomic Status with Early Childhood Caries Patterns
Authors: Psoter Walter J. , Pendrys David G , Morse Douglas E. , Zhang Heping , Mayne Susan T.
Published: May 2007

Objectives: The purpose of this project was to evaluate ethnicity/ace, household income and caregiver education level as predictors of 1) any early childhood caries, and 2) each of four proposed patterns of primary dentition caries. Methods: Between February 1994 and September 1995, five examiners visually examined Arizona pre‐school children ages 5–59 months old. Self‐reported demographic information including family income, caregiver education level and ethnicitylrace were obtained at the time of examination. Multivariate analyses were conducted to assess the association of income, education and ethnicity/race with a child having any caries and with each of the proposed caries patterns seen in 3,850 examinations. Results: Income and education were inversely associated with: 1) any early childhood caries, and 2) the maxillary incisor caries pattern. A positive association between these caries patterns and minority ethnicity/race status was also identified. Three additional caries intraoral patterns demonstrated more varied associations with socioeconomic status (SES), ethnicity/race and income and education. Conclusions: This study supports the association of both ethnicity/race and social status with any early childhood caries. The patterns of caries were each found to be associated with specific and different socioeconomic‐demographic indicators. The practical importance of these findings is that global measurement of ECC, without regard to specific caries pattern, leads to the potential for substantial non‐differential misclassification of disease. The consequence of this is the potential for important ECC‐SES‐ethnicity/race associations to be masked. This, in turn, decreases the ability of surveys and investigations to accurately identify sub‐groups of the population at greatest risk of developing ECC.
Longitudinal Study of Non‐cavitated Carious Lesion Progression in the Primary Dentition
Authors: Warren John J. , Levy Steven M. , Broffitt Barbara , Kanellis Michael J.
Published: May 2007

Objectives: This study reports changes in non‐cavitated tooth surface diagnoses after a 4‐year period. Methods: Dental examinations were conducted for Iowa Fluoride Study cohort children who had non‐cavitated lesions in the primary dentition and were also examined an average of 4 years later in the mixed dentition. Comparison of fluoride exposures, socioeconomic factors, and beverage consumption patterns were made between children who had lesions progress and those who did not. Results: Of 129 non‐cavitated pit and fissure lesions in the first exams, 40 (31%) progressed to either frank decay or filled status, while among 132 non‐cavitated smooth surface lesions, 7 (5%) were filled and none had frank decay in the second exam. No fluoride, socioeconomic status or beverage variables were significantly Associated with lesion progression. Conclusions: Non‐cavitated smooth surface lesions rarely progressed in this age group, but nearly one‐third of pit and fissure lesions progressed.
The Role of Location in Indigenous and Non‐Indigenous Child Oral Health
Authors: Jamieson Lisa M. , Armfield Jason M. , Roberts‐Thomson Kaye F.
Published: May 2007

Objective: To examine the role of location in Indigenous and non‐Indigenous child oral health in three Australian states and territories. The Association of Indigenous status and residential location with caries prevalence, severity and unmet treatment need was examined. Methods: Data were collected as part of a national monitoring suivey of 4–14‐year‐old children enrolled in school dental services in New South Wales, South Australia and the Northern Territory, Australia. Results: Of the 326,099 children examined, 10,473 (3.2%) were Indigenous. Fewer 4–10‐year‐old rural Indigenous children were caries‐free in the deciduous dentition than their non‐Indigenous counterparts and rural Indigenous children had almost twice the mean number of decayed, missing and filled teeth (dmft) of rural non‐Indigenous children. The % d/dmft was higher among rural Indigenous children than rural non‐Indigenous children. Fewer 6–14‐year‐old rural Indigenous children were caries‐free in the permanent dentition than their non‐Indigenous counterparts and rural Indigenous children had almost twice the mean DMFT of rural non‐Indigenous children. The % D/DMFT was higher in rural Indigenous than rural non‐Indigenous children. Living in a rural location was the strongest indicator of canes prevalence, severity and unmet treatment need in the deciduous dentition of Indigenous 4–0‐year‐olds while being Socially disadvantaged was the strongest indicator of poor oral health outcomes among older indigenous and all non‐Indigenous children. Conclusions: Living in a rural location exhibited the strongest Association with poor oral health outcomes for young Indigenous children but was also Associated with poorer oral health among older Indigenous and non‐Indigenous children.
Antibacterial Treatment Needed for Severe Early Childhood Caries
Authors: Zhan Ling , Featherstone John D.B. , Gansky Stuart A. , Hoover Charles I. , Fujino Tamaki , Berkowitz Robert J. , Besten Pamela K. Den
Published: May 2007

Objectives: To assess the effects of a single 10% povidone iodine application as an adjunct to extensive surgical procedures in the clinical treatment of children with early childhood caries. Methods: Twenty‐two children scheduled for dental treatment under general anesthesia were randomized into either an intervention group (10% povidone iodine), or a control group (phosphate buffered saline). Either povidone iodine or phosphate buffered saline was applied to teeth and soft tissues after prophylaxis and all operative dental procedures, followed by 1.23% acidulated phosphate fluoride gel. Saliva samples taken at baseline, and after I hour, 3 weeks and 3 months were assayed for mutans streptococci, lactobacilli and total viable bacteria. Caries lesions were recorded at baseline and at one year. Results: Mutans streptococci and lactobacilli levels in the povidone iodine group were significantly reduced relative to baseline at I hour, 3 weeks and 3 months. At one year at least 60% of subjects had new caries lesions in each group, and there was no significant difference in caries increment between the two groups. Conclusions: Even prophylaxis, fluoride gel application and complete surgical treatment of caries at baseline were insufficient to prevent new caries in over 60% of the patients in these high caries risk infants. Although the one‐time treatment with povidone iodine reduced mutans streptococci and lactobacilli levels for up to 3 months this therapy failed to additionally reduce future caries formation over one year, indicating that repeated antibacterial treatments will be needed to control high levels of cariogenic bacteria.
Occupational Exposure to Acidic Chemicals and Occupational Dental Erosion
Authors: Kim Hyun‐duck , Hong Yun‐Chul , Koh Dae‐ho , Paik Dai‐ll
Published: May 2007

Objective: This study investigated the association between occupational acidic chemicals (ACs) exposure and occupational dental erosion. Methods: A cross‐sectional study was conducted in which three dentists surveyed 951 subjects from 42 factories using five types of ACs below Korean Threshold Limit Values (K‐TLVs). Subjects agreed to participate by a written consent; 519 were acid exposed workers and 431 were non‐exposed. The modified ten Bruggen Cate's criteria was used to classify erosion. Length and type of exposure to ACs were assessed using questionnaires. Logistic regression analysis including interaction terms was applied. Results: ACs exposure was associated with erosion severity. Multiple exposures to ACs were found to be strongly associated with severe erosion. Interaction between wearing masks and AC exposure was significant. Conclusions: This study showed a clear association between AC exposure below K‐TLVs and erosion. Hence, the authors propose to lower K‐TLVs of five types of ACs.
Healthy Smiles Healthy Growth 2004 ‐ Basic Screening Survey of Migrant and Seasonal Farmworker Children in Illinois
Authors: Lukes Sherri M. , Wadhawan Sangeeta , Lampiris Lewis N.
Published: May 2007

Objectives: To obtain baseline data for caries prevalence, use of dental sealants, and dental treatment needs for children of migrant and seasonal farmworkers (MSFWs) enrolled in the Illinois Summer Migrant Education Program, 2004. Methods: This study adapted the methodology of Healthy Smiles Healthy Growth 2003–2004, by Illinois Depattment of Public Health (IDPH), Division of Oral Health. Oral screenings were conducted for children of migrant and seasonal farmworkers at participating schools. Results: Of the 840 eligible children 58%participated in the assessment. Overall caries experience was 64%. Untreated decay was observed in 42%, 8% urgently needed treatment, and sealant prevalence was 51%. Among those 6–9 years old (n=254), 47% had cavitated lesions, 12% urgently needed treatment, and 45% had dental sealants. For children 10–15 years old (n=198), 34% had cavitated lesions, 4% urgently needed treatment, and 65% had dental sealants. Conclusions: The population's mobility suggests need for more frequent surveillance for effective programmatic planning.
H+‐coupled nutrient, micronutrient and drug transporters in the mammalian small intestine
Authors: Thwaites David T. , Anderson Catriona M. H.
Published: April 2007

The H+‐electrochemical gradient was originally considered as a driving force for solute transport only across cellular membranes of bacteria, plants and yeast. However, in the mammalian small intestine, a H+‐electrochemical gradient is present at the epithelial brush‐border membrane in the form of an acid microclimate. Over recent years, a large number of H+‐coupled cotransport mechanisms have been identified at the luminal membrane of the mammalian small intestine. These transporters are responsible for the initial stage in absorption of a remarkable variety of essential and non‐essential nutrients and micronutrients, including protein digestion products (di/tripeptides and amino acids), vitamins, short‐chain fatty acids and divalent metal ions. Proton‐coupled cotransporters expressed at the mammalian small intestinal brush‐border membrane include: the di/tripeptide transporter PepT1 (SLC15A1); the proton‐coupled amino‐acid transporter PAT1 (SLC36A1); the divalent metal transporter DMT1 (SLC11A2); the organic anion transporting polypeptide OATP2B1 (SLC02B1); the monocarboxylate transporter MCT1 (SLC16A1); the proton‐coupled folate transporter PCFT (SLC46A1); the sodium–glucose linked cotransporter SGLT1 (SLC5A1); and the excitatory amino acid carrier EAAC1 (SLC1A1). Emerging research demonstrates that the optimal intestinal absorptive capacity of certain H+‐coupled cotransporters (PepT1 and PAT1) is dependent upon function of the brush‐border Na+–H+ exchanger NHE3 (SLC9A3). The high oral bioavailability of a large number of pharmaceutical compounds results, in part, from absorptive transport via the same H+‐coupled cotransporters. Drugs undergoing H+‐coupled cotransport across the intestinal brush‐border membrane include those used to treat bacterial infections, hypercholesterolaemia, hypertension, hyperglycaemia, viral infections, allergies, epilepsy, schizophrenia, rheumatoid arthritis and cancer.
ATP release and hydrolysis contribute to rat pial arteriolar dilatation elicited by neuronal activation
Authors: Xu Hao‐Liang , Pelligrino Dale A.
Published: April 2007

Owing to their intimate anatomical relationship with cerebral arterioles, astrocytes have been postulated as signal transducers, transferring information from activated neurones to the cerebral microcirculation. These forwarded signals may involve the release of vasoactive factors from the end‐feet of astrocytes. This mechanism is termed ‘neurovascular coupling’ and its anatomical components (i.e. neurone, astrocyte and vascular cells) are termed the ‘neurovascular unit’. The process of neurovascular coupling often involves upstream dilatation. This is necessary during periods of increased metabolic demand, in order to permit more blood to reach dilated downstream vessels, thereby improving nutrient supply to the activated neurones. Without it, that downstream dilatation might be ineffective, placing neurones at risk, especially during episodes of intense neuronal activity, such as seizure. In the brain, pial arterioles represent important ‘upstream’ vascular segments. The pial arterioles overlie a thick layer of astrocytic processes, termed the glia limitans. This essentially isolates pial arterioles, anatomically, from the neurones below. Vasodilating signals that originate in the neurones therefore reach the pial arterioles via indirect pathways, primarily involving astrocytes and the glia limitans. Here we discuss a process whereby purinergic mechanisms play a key and neuronal activity‐dependent role in astrocyte to astrocyte communication, as well as in glia limitans to pial arteriolar signals leading to vasodilatation.
A novel role for P450 eicosanoids in the neurogenic control of cerebral blood flow in the rat
Authors: Iliff Jeffrey J. , Close Liesl N. , Selden Nathan R. , Alkayed Nabil J.
Published: April 2007

The P450 eicosanoids epoxyeicosatrienoic acids (EETs) are endogenous lipid mediators produced in the brain by P450 epoxygenases and metabolized through multiple pathways, including soluble epoxide hydrolase (sEH). Epoxyeicosatrienoic acids play important functions in the brain, including regulation of cerebral blood flow and protection from ischaemic brain injury. We previously demonstrated that ischaemic preconditioning induces cytochrome P450 2C11 epoxygenase (CYP2C11) expression in the brain, and that pharmacological inhibition and genetic deletion of sEH increases EETs and protects against stroke‐induced brain damage. However, the expression profiles of CYP2C11 and sEH in normal brain remain unknown. In agreement with previous reports in peripheral vessels, we here demonstrate by immunofluorescence double‐labelling that within cerebral parenchymal microvessels, sEH‐immunoreactivity (IR) is localized to the vascular smooth muscle layer. Unexpectedly, however, analysis of large cerebral conduit arteries such as the middle cerebral artery revealed CYP2C11 and sEH expression in extrinsic perivascular nerves. Double‐labelling studies revealed that CYP2C11‐ and sEH‐IR predominantly colocalized with neuronal nitric oxide synthase‐IR within perivascular nerve fibres. Significant colocalization for CYP2C11 and sEH was also observed with the parasympathetic markers vasoactive intestinal peptide and choline actetyltransferase, in addition to the sensory fibre markers calcitonin gene‐related peptide and substance P. No colocalization was observed for either CYP2C11 or sEH with the sympathetic nerve markers dopamine β‐hydroxylase or neuropeptide Y. The presence of enzymes involved in production and inactivation of EETs within extrinsic parasympathetic and sensory vasodilator fibres suggests a novel role for EETs in the neurogenic control of cerebral arteries.
Activation of paraventricular nucleus neurones by the dorsomedial hypothalamus via a tachykinin pathway in rats
Authors: Womack Matthew D. , Barrett‐Jolley Richard
Published: April 2007

The dorsomedial hypothalamus (DMH) innervates the paraventricular nucleus (PVN) with substance P (SP) immunoreactive neurones. The PVN itself powerfully influences both the neuroendocrine and the cardiovascular systems. In this in vitro study, we examine the DMH‐to‐PVN pathway electrophysiologically. Glutamate application to the DMH increased action current frequency in the PVN. This effect was prevented by the glutamate antagonist kynurenic acid or by synaptic block with a high‐Mg2+ low‐Ca2+ buffer solution. Crucially, the selective tachykinin NK1 receptor antagonist L‐703606 also inhibited DMH‐to‐PVN neurotransmission. Thus we show, for the first time, an excitatory connection between the DMH and PVN that uses tachykinin NK1 receptors. This pathway may be important for the hypothalamic control of neuroendocrine and/or cardiovascular function.
Angiotensin II‐based hypertension and the sympathetic nervous system: the role of dose and increased dietary salt in rabbits
Authors: McBryde Fiona D. , Guild Sarah‐Jane , Barrett Carolyn J. , Osborn John W. , Malpas Simon C.
Published: April 2007

There is accumulating evidence that angiotensin II may exert its hypertensive effect through increasing sympathetic drive. However, this action may be dependent on the dose of angiotensin II as well as salt intake. We determined the effect of different doses of angiotensin II and different levels of salt intake on neurogenic pressor activity. We also examined the effect of renal denervation. New Zealand White rabbits were instrumented to continuously measure arterial pressure. The depressor response to the ganglionic blocker pentolinium tartrate (5 mg kg−1) was used to assess pressor sympathetic drive on days 0, 7 and 21 of a 20 or 50 ng kg−1 min−1 continuous i.v. angiotensin II infusion. A 50 ng kg−1 min−1 infusion caused an immediate increase in pressure (23 ± 5 mmHg), whereas a 20 ng kg−1 min−1 infusion caused a slow increase in pressure, peaking by day 12 (17 ± 4 mmHg). The ganglionic blockade profiles indicated sympathoinhibition in the 50 ng kg−1 min−1 group by day 7 and sympathoinhibition in the 20 ng kg−1 min−1 group at day 21, corresponding to the development of hypertension. Animals receiving increased dietary salt (0.9% NaCl in drinking water), however, showed a similar slow increase in pressure with 20 ng kg−1 min−1 angiotensin II (16 ± 5 mmHg) but no sympathoinhibition at day 21. Bilateral renal denervation delayed the onset but not the extent of hypertension in this group. We conclude that different doses of angiotensin II produce distinct profiles of hypertension and associated changes in pressor sympathetic drive and that increased dietary salt intake disrupts the normal sympathoinhibitory response to angiotensin II‐based hypertension.
Wavelet analysis of autonomic outflow of normal subjects on head‐up tilt, cold pressor test, Valsalva manoeuvre and deep breathing
Authors: Ducla‐Soares J. L. , Santos‐Bento M. , Laranjo S. , Andrade A. , Ducla‐Soares E. , Boto J. P. , Silva‐Carvalho L. , Rocha I.
Published: April 2007

Non‐invasive autonomic evaluation has used fast Fourier transform (FFT) to assign a range of low (LF) and high frequencies (HF) as markers of sympathetic and parasympathetic influences, respectively. However, FFT cannot be applied to brief transient phenomena, such as those observed on performing autonomic tests where the acute changes of cardiovascular signals (blood pressure and heart rate) that represent the first and most important stage of the autonomic performance towards a new state of equilibrium occur. Wavelet analysis has been proposed as a method to overcome and complement information taken exclusively in the frequency domain. With discrete wavelet transform (DWT), a time–frequency analysis can be done, allowing the visualization in time of the contribution of LF and HF to the observed changes of a particular signal. In this study, we evaluate with wavelets the acute changes in R–R intervals and systolic blood pressure that are observed in normal subjects during four classical autonomic tests: head‐up tilt (HUT), cold pressor test (CPT), deep breathing (DB) and Valsalva manoeuvre (VM). Continuous monitoring of ECG and blood presure was performed. Also LF, HF and LF/HF were calculated. Consistent with previous interpretations, data showed an increase of sympathetic activity in HUT, CPT and VM. On DB, results reflected an increase in parasympathetic activity and frequencies. In conclusion, when compared with FFT, wavelet analysis allows the evaluation of autonomic variability during short and non‐stationary periods of time and may constitute a useful advance in the assessment of autonomic function in both physiological and pathological conditions.
Insights into the uterus
Authors: Wray Susan
Published: April 2007

A better understanding of the mechanisms that generate and modulate uterine contractility is needed if progress is to be made in the prevention or treatment of problems in labour. Dysfunctional labour describes the condition when uterine contractility is too poor to dilate the cervix, and it is the leading cause of emergency Caesarean sections. Recently, insight has been gained into a possible causal mechanism for dysfunctional labour. Study of the physiological mechanisms that produce excitation in the uterus, the subsequent Ca2+ signals and biochemical pathway leading to contraction has underpinned this progress. In this review, I give an account of excitation–contraction signalling in the myometrium and explore the implications of recent findings concerning lipid rafts for these processes. I also discuss how changes of pH are fundamentally enmeshed in uterine activity and biochemistry and explore the effect that pH changes will have on human myometrium. Finally, I present the evidence that acidification of the myometrium is correlated with dysfunctional labour and suggest the processes by which it is occurring. It is only by gaining a better understanding of uterine physiology and pathophysiology that progress will be made and research findings translated into clinical benefit for women and their families.