bluuebunny/crossref_metadata_2025 huggingface dataset:
An efficacious oral health care protocol for immunocompromised patients
Authors: Solomon Charlene S. , Shaikh Amenah B. , Arendorf Trevor M.
Published: March 2008

A twice‐weekly oral and perioral examination was provided to 120 patients receiving antineoplastic therapy. Sixty patients were monitored while following the traditional hospital oral care protocol (chlorhexidine, hydrogen peroxide, sodium bicarbonate, thymol glycol, benzocaine mouthrinse, and nystatin). The mouth care protocol was then changed (experimental protocol = chlorhexidine, benzocaine lozenges, amphotericin B lozenges), and patients were monitored until the sample size matched that of the hospital mouth care regime. There was a statistically significant reduction in oral complications upon introduction and maintenance of the experimental protocol.
Dental health of children with cerebral palsy following sialodochoplasty
Authors: Hallett Kerrod B. , Lucas James O. , Johnston Timothy , Reddihough Dinah S. , Hall Roger K.
Published: March 2008

Drooling occurs commonly in children with cerebral palsy (CP). Surgical procedures, known as sialodochoplasties, are often performed for the control of drooling. These Include major salivary gland excision, parasympathetic nerve section, duct ligation, and duct re‐routing. Alterations in saliva amount, flow, and consistency occur following sialodochoplasty, and the resultant effect on dental homeostasis requires further investigation.

This controlled study investigated 19 children with CP following sialodochoplasty (surgery group) and 75 children with CP treated nonsurgically (control group) who attended our hospital. Dental caries experience—including dmft, DMFT, and partial DMFS scores of mandibular incisors and canines only—plaque index, and enamel developmental defects index were recorded. Saliva buffering capacity and bacterial counts were assessed.

The surgical group (median DMFT = 5.00) had significantly more dental caries when compared with the control group (median DMFT = 0.00), Wilcoxon Signed‐rank Test, P < 0.0001.

This study has shown that children with CP following sialodochoplasty have increased risk of dental caries when compared with those treated nonsurgically for drooling. Although no caries predictors were identified, alterations to the caries‐protective role of saliva are considered the likely cause. Children who undergo this procedure should receive intensive pre‐and postsurgical preventive dental therapy.
Growth of an ameloblastoma during pregnancy: Opportunity lost?
Authors: Gordy Frances M. , Holder Ray , Carroll M. Kevin O , Krolls Sigurds O.
Published: March 2008

A 19‐year‐old pregnant woman presented with an enlarging lesion in the right mandible. She was examined by a general dental practice resident in the hospital outpatient clinic and subsequently managed by the resident as an inpatient. Both moral and ethical questions arose because of the discovery of the lesion early in the patient's pregnancy. Delay on the part of the patient while she contemplated termination of the pregnancy, compounded by loss of contact with her, eliminated the possibility of removal of the lesion during the second trimester. The patient elected to continue the pregnancy, and an en bloc procedure was used to remove the ameloblastoma.
Focal dermal hypoplasia (Goltz‐Gorlin) syndrome with taurodontism
Authors: McNamara Triona , Dorth  , Hahessy A.M. , Kavanagh P.
Published: March 2008

This paper is a case report of a 10‐year‐old girl with focal dermal hypoplasia (FDH) who presented for dental care. She displayed many of the well‐documented oral features associated with this syndrome. Additionally, she had taurodontism of a permanent mandibular molar. Although taurodontism affected only one tooth in this patient, the presentation of taurodontism with FDH has not been reported previously.
Oral care planning and handling of immunosuppressed heart, liver, and kidney transplant patients
Authors: Somacarrera Maria Luísa , Lucas Míguel , Cuervas‐Mons Valentín , Hernandez Gonzalo
Published: March 2008

In order to provide dentists with specific guidelines regarding appropriate oral treatments for transplant patients, their timing, and the prophylactic steps that must be taken in their handling, a two‐phase study was undertaken. In the first phase, the effectiveness of an initial oral hygiene training and motivation program was evaluated by statistical testing of the observed differences in gingival overgrowth and plaque and gingivitis scores between a study group and a control group, each consisting of 46 heart and liver transplant patients. Significantly higher scores were observed in the control group. In the second phase, the effectiveness of a set of prophylactic measures was tested in 530 periodontal treatments and 380 dental treatments, applied in 120 heart, liver, and kidney transplant patients who showed no significant complications. It was concluded that all transplant patients should be monitored by a dentist, and that the recommended procedure is effective in preventing oral treatment complications.
Myasthenia gravis: Dental treatment considerations
Authors: Patton Lauren L. , Howard James F.
Published: March 2008

Myasthenia gravis is an autoimmune neuromuscular disorder that presents challenges for the dental practitioner. Facial and masticatory muscles may be involved and complicate dental treatment. Exacerbations of the skeletal muscle weakness and fatigabllity that characterize this disorder can be precipitated by certain medications used in dentistry. A review of 47 dental treatment episodes in 16 patients with myasthenia gravis was undertaken to identify neuromuscular responses to dental treatment and post‐dental treatment medical therapy required for control of resultant exacerbations of muscular weakness. Neuromuscular sequelae occurred in 5 treatment episodes for four different patients. Management considerations and drug precautions are discussed.
Education for geriatric oral health promotion
Authors: Reynolds Mark W.
Published: March 2008

Dentate older adults need to be aware that restorative procedures completed in the past do not guarantee their oral health now or in the future. By building on the strengths of their current behaviors, the elderly may see change as more manageable and may accept it more readily. Educational approaches aimed at the edentulous older patient should focus on the need for preventative oral health care. Thirty thousand new cases of oral cancer are reported each year, and of those, 50% are in patients above the age of 65. Progressive bone resorption, decreased nutritional intake, and poor oral health affecting self‐esteem to the point of withdrawal from social circles can all be avoided through periodic assessment and timely intervention.

All health care professionals must be educated in the role that are required of them as health team members. Initial exams of elderly patients should include assessment of not only the patient's oral health but also his/her ability to perform oral hygiene. An accurate assessment of the patient's needs, desires, and abilities will help to eliminate many of the misconceptions that the care provider may harbor. Clinical training in more thorough oral exams and in methods of effectively educating patients concerning oral health is a prudent step for physicians, physician assistants, nurses, and nurse practitioners. Effective educational presentations must be tailored to the targeted group of older adults; not all strategies will work for all elderly people.
The level of cariogenic microlorganisms in patients with Sjögren's syndrome
Authors: Kolavic Shellie Ann , Gibson Gretchen , Al‐Hashimi Ibtisam , Guo Ingrid Y.
Published: March 2008

Sixteen patients with caries‐inacthe Sjögren's syndrome with low parotid salivary flow rates (≤ 0.25 mL/min) and 18 caries‐inactive control subjects with higher salivary flow rates were compared. Mutans streptococci (MS) and lactobacilll (LB) counts were measured by means of Dentocult® SM strip mutans and LB assays. The group with Sjögren's syndrome displayed higher counts of MS (P = 0.014) and LB (p = 0.003) when compared with controls. The results of this study indicate that patients with caries‐inactive Sjögren's syndrome and low salivary flow may have higher colonization of cariogenic mlcro‐organisms than healthy individuals.
The relationship of age and gender to fear and anxiety in response to dental care
Authors: Holtzman Joseph M. , Berg Robert G. , Mann Jonathan , Berkey Douglas B.
Published: March 2008

The apparent association in the published literature of gender and age with dental fear and anxiety is far from consistent or universal. A random, age‐stratified telephone survey of 398 adults was performed in a US metropolitan area: Denver, Colorado. Information collected included Kleinknecht's Dental Fear Survey (DFS). In addition to total DFS scores, values were also calculated for the sums of the five DFS. physiologic response items (PATRESP) and 12 DFS fear‐producing stimulus items (DENTSTIM). Tests for reliability of these three scales were performed (alpha = 0.804 to 0.936). In this sample population, significant age and gender differences were noted. In general, fear and anxiety decreased in importance with increased respondent age, with the largest difference noted between the 40–50 and 60–69 age groups. Increased fear and anxiety were most apparent among younger females (20–30 and 40–50) as compared with older females (60 and older). However, among males, the summary variable for physiologic response to fear and anxiety did not appear to be age‐related. Among the oldest respondents (ages 70+), 12.2% did report a “major” response to muscle tension when in the dental chair. Females reported more fear of some stimuli associated with dental care (e.g., “feeling the drill in the mouth”) than did males.
Aspiration of a primary tooth in a patient with a tracheostomy
Authors: Steelman Robert , Millman Eric , Steiner Marie , Gustafson Robert
Published: March 2008

Aspiration of a foreign object is uncommon in a patient with a tracheostomy. The following case history describes the consequences of failure to diagnose an aspirated object and how the aspiration of an exfoliated tooth can occur despite the presence of a tracheostomy tube. Dentists play an important role in preventing foreign body aspiration in debilitated patients.
Knowledge, opinions, and practices related to oral cancer: Results of three elderly racial groups
Authors: Yellowitz Janet A. , Goodman Harold S. , Farooq Naila S.
Published: March 2008

A study of 204 inner‐city, senior center participants (ages ranged from 41–96 years) was conducted to assess their knowledge, opinions, and practices related to oral cancer. Participants were either White, African‐American, or of Korean descent. The interview/questionnaire revealed this cohort to lack correct knowledge of the signs, symptoms, and risk factors of oral cancer, and to have had risk behaviors associated with oral cancer. Given that oral cancer is most frequently diagnosed in those aged 65 years and older, and that this cohort tends not to obtain routine preventive oral health care, it is imperative that these seniors be educated about the risks associated with oral cancer and their need for routine oral examinations.
Oligodontia: A radiographic comparison of subjects with Down syndrome and normal subjects
Authors: Kumasaka Satsuki , Miyagi Atsusi , Sakai Nobuaki , Shindo Junichi , Kashima Isamu
Published: March 2008

Panoramic radiographs and clinical records were used to investigate developmentally absent permanent teeth in 98 subjects with Down syndrome (trisomy‐22). This retrospective study was based on the records and panoramic radiographs of subjects from approximately five years of age (the age at which mineralization of the permanent tooth germ could be identified) through to their most recent records. The time period covered by records ranged from 6 to 28 years. The majority of subjects with Down syndrome (63%) exhibited oligodontia, and many subjects were missing two or more teeth (53%). The most frequently absent teeth were the lower lateral incisors (23.3%), the upper second premolars (18.2%), the upper lateral incisors (26.5%), and the lower second premolars (25.3%). In general, the distribution of the developmentally absent teeth was similar for teeth in homologous positions (i.e., left and right canines, etc.) on either side of the middle or between the maxilla and the mandible. The only significant exceptions to this pattern were seen with the central Incisors and the second molar. This study's findings suggest a high risk of oligodontia In subjects with Down syndrome.
Patients with prosthetic joints: Are they at risk when receiving invasive dental procedures?
Authors: Little James W.
Published: March 2008

Most prosthetic joint infections (PJI) are due to wound contamination at the time of surgery. Some infections occur due to the hematogenous spread of bacteria from distant sites of infection. A review of the literature fails to associate PJI with transient bacteremias from invasive dental procedures. Several authors have described conditions which, they believe, render patients with prosthetic joints more at risk for infection. Prosthetic joint patients with these “high risk” conditions have the same types of infecting organisms as other patients with PJI. This indicates that the infecting bacteria are from wound contamination or distant sites of infection and not related to dental procedure bacteremias. Based on this review, antibiotic prophylaxis is not indicated for patients with prosthetic joints when receiving invasive dental procedures, since there is no proven benefit and there are known risks involved with the use of antibiotics. However, the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS), in an advisory statement, suggest prophylaxis for “high risk” patients. The ADA and AAOS recommend a single dose of amoxicillin, cephradine, or clindamycin when prophylaxis is selected. The dentist is ultimately responsible for making treatment recommendations for his or her patients.
The influence of pre‐radiation salivary flow rates and radiation dose on parotid salivary gland dysfunction in patients receiving radiotherapy for head and neck cancers
Authors: D'Hondt Eric , Eisbruch Avraham , Ship Jonathan A.
Published: March 2008

Radiotherapy (RT) used for head and neck cancers causes permanent salivary gland dysfunction (SGD). Previous short‐term studies have demonstrated that pre‐RT salivary flow rates and the amount of radiation exposure to parotid glands influence the amount of RT‐induced SGD. The purpose of this study was to determine which variables are related to the development of long‐term post‐RT SGD. Parotid flow rates (PFR) were assessed prior to and 1 year after completion of RT in spared parotid glands from 34 patients from 2 parotid‐sparing protocols. The results reveal that spared PFR were not significantly higher 1 year post‐RT in patients who had high pre‐RT PFR, when compared with patients with low pre‐RT PFR. However, patients who received higher doses of RT to spared parotid glands had lower PFR 1 year post‐RT, compared with patients who had received lower doses of RT. These one‐year findings suggest that high pre‐RT PFR do not provide protection against RT‐induced SGD. Conversely, reduced RT dosages to contralateral parotid glands are protective of PFR after completion of RT.
Subjective and clinical evaluation of oral lubricants in xerostomic patients
Authors: Furumoto Elizabeth K. , Barker Gerry J. , Carter‐Hanson Carrie , Barker Bruce F.
Published: March 2008

The purpose of this investigation was to evaluate and compare four oral lubricants in relation to oral mucosal status, perceived relief of dry mouth symptoms, and patient acceptance. Three commercial oral lubricants—two sprays and one gel—and a home remedy of margarine were evaluated. Twenty‐five xerostomic/salivary gland dysfunctional patients demonstrating < 0.20 mL/min of unstimulated whole saliva participated in the randomized, four‐phase, cross‐over study. Each phase included a ten‐day use of oral lubricants, followed by a four‐day washout period. On the first and tenth days of use, lip and buccal mucosa dryness and perceived oral dryness were evaluated. Patient acceptance of the oral lubricant was evaluated at the end of each ten‐day period. The Wilcoxon matched‐pairs signed‐rank test was used to analyze data over time and between‐group differences. The gel group reported a statistically significant improvement in perceived oral dryness from Day 1 to Day 10. No other significant with‐in‐group differences were found. Subjects rated the gel significantly better than margarine for convenience, perceived value, minutes of relief, and in the “overall” rating. No other significant between‐group differences were noted.
Canavan disease—An expanded role for dentists
Authors: Kupietzky Ari , Guedalia Judith S. , Tanenbaum Alexander
Published: March 2008

Canavan disease (CD) is a progressive neurodegenerative disease that occurs predominantly but not exclusively in Ashkenazi Jews. It is characterized by a normal birth, rapidly followed by signs of lack of interest, hypotonia, and megalencephaly, resulting in early death. Genetic studies suggest that among Ashkenazi Jews the carrier frequency is between 1/35 and 1/59. Dentists aware of CD can assist in the treatment of infants and children afflicted with this disorder. Early dental treatment may support parents and siblings in caring for the child with CD and help create good family dynamics.
Medical conditions associated with missing teeth and edentulism in the institutionalized elderly
Authors: Hamasha Abed Al‐Hadi , Hand Jed S. , Levy Steven M.
Published: March 2008

Several studies have reported the prevalence of medical conditions or investigated the relationships between the oral health status and general health conditions in the elderly. However, the relationship between medical conditions and oral health among the elderly is not well‐described. Previous studies have not clearly identified a consistent association between medical conditions and oral health, specifically edentuIism and tooth loss. The purpose of this study was to investigate the relationships between medical conditions and oral health, as assessed by edentulism and missing teeth, in an institutionalized elderly population. A systematic sample (n = 175), stratified by age and sex, was drawn from nursing home patients treated by the University of low'as Geriatric Mobile Unit (GMU) team. Data were extracted from GMU dental records, regarding history of medical conditions, medications, dental history, dentate status, and tooth‐by‐tooth conditions. Mean numbers of missing teeth were significantly higher among those who had a history of atherosclerotic vascular disease, heart failure, ischemic heart disease, and joint disease. Subjects who had a history of atherosclerotic vascular disease, heart failure, ischemic heart disease, and joint disease were more likely to be edentulous than subjects who did not have a history of those diseases. The biological basis for these relationships between dentate status and systemic medical conditions is unclear and warrants further study.
The effects of denture status on nutrition
Authors: Papas Athena S. , Palmer Carole A. , Rounds Maureen C. , Russell Robert M.
Published: March 2008

In Part I of this study, the Human Nutrition Research Center of the United States Department of Agriculture's Nutritional Status Study (NSS) of 691 independently living elderly people aged 60–98 found that poor dietary quality was associated with low educational attainment, low median family income, and self‐report of partial or full dentures. In Part I, further analysis was conducted on a random subsample of 181 subjects who were examined and divided into four groups according to dentate status: two dentures, one denture, partial dentures, and teeth. In this subgroup, significant correlations were found between the quality of nutrient intake and the degree of edentulousness. Analysis of 53 nutrients plus calories from three‐day food records showed a significantly higher nutritional quality of the diet in dentate volunteers than in the other groups. This difference was approximately 20% for 19 nutrients, bringing some nutrients (such as calcium) below the RDA for this age group. Although direct correlations cannot be made with actual nutritional status, the introduction of dentures could further compromise the precarious nutritional intake of the elderly population. With this in mind, dentists need to consider carefully the importance of their elderly patients' maintaining at least some natural dentition and should provide adequate information on nutritional adaptations to dentures.
The shortened dental arch: Prevalence and normative treatment needs in a sample of older Canadian adults
Authors: Hawkins R. J.
Published: March 2008

The concept of the shortened dental arch (SDA) was used to classify the dentition status and normative treatment needs of older adults. From 1982 to 1992, a descriptive survey was conducted in North York, Canada, of 1531 dentate adults aged 65 and over; 69% were nursing home residents. Based on the SDA concept, a “good” quadrant was defined as one which contained all premolar and anterior teeth. A “good” arch was defined as one which had two “good” quadrants. Only 6.3% of nursing home subjects and 7.5% of independently living subjects were classified as having “good” upper and lower arches; these subjects were considered to have a “functional dentition” by the criteria of the SDA concept. For subjects of both residence types, a higher percentage had a “good” lower arch (20%, 30%) as compared with a “good” upper arch (9%, 13%), and a higher proportion of non‐denture wearers had “good” arches and quadrants compared with denture wearers. The most common reason for failure to meet SDA criteria was due to the loss of one or more upper premolar teeth; loss of lower canines was least frequently the reason. For subjects of both residence types, normative need for tooth extraction and prosthetic care was significantly associated with having no “good” arches. This was found for both denture wearers and non‐denture wearers. Among non‐denture wearers of both residence types, the need for urgent care was significantly associated with having no “good” arches
Accreditation issues in post‐doctoral general dentistry programs
Authors: Glassman Paul , Meyerowitz Cyril , Redding Spencer
Published: March 2008

There has been increasing interest in the organization and accreditation of post‐doctoral general dentistry programs (PGD). Numerous national organizations have called for increases in the number of PGD positions and programs. At the same time, there has been a movement to incorporate concepts of competency‐based education into dental education programs to stress the outcomes of education rather then the process. These movements have coincided with the current accreditation standards revision cycles for GPR and AEGD programs. These events suggest that PGD educators have a major opportunity and responsibility to assess the goals and educational directions of PGD programs in light of the many changes in dental health care delivery, health policy, and dental education activities. These opportunities will be realized only if the organizations involved with PGD education can find common ground and pool their resources to promote the interests of PGD education.
The use of tricalcium phosphate to preserve alveolar bone in a patient with ectodermal dysplasia: A case report
Authors: Shankly Pamela E. , Mackie Iain C. , McCord Fraser J.
Published: March 2008

The prosthodontic management of the child with ectodermal dysplasia is made difficult because of the underdevelopment of the alveolar ridges. This paper describes a case where tricalcium phosphate was placed in sockets immediately following the extraction of the primary incisor teeth to help maintain alveolar bone width, offering a valuable alternative treatment option in the prosthodontic management of the child patient with ectodermal dysplasia.
Facial attractiveness and the aged
Authors: York Jill , Holtzman Joseph
Published: March 2008

This study examined the relationship between dentofacial appearance and judgments of facial attractiveness in a sample of 60 subjects between ages 65 and 75. Subjects completed questionnaires regarding their current dental appearance and level of satisfaction with their facial attractiveness. Subjects then viewed and ranked four sets of five photographs that had been digitally manipulated to simulate common dental defects. Regardless of background facial attractiveness or gender of stimulus photographs, a specific ranking order for dental defects emerged with rank‐order correlations in the 90% range. Findings suggest that dental appearance affects judgments of facial attractiveness regardless of gender or background facial attractiveness.
Evaluation of a mucosal‐plaque index (MPS) designed to assess oral care in groups of elderly
Authors: Henriksen Birgitte M. , Ambjørnsen Eirik , Axéll Tony E.
Published: March 2008

An index, called the mucosal‐plaque score (MPS), was tested for intra‐ and inter‐examiner agreement at an institution for elderly individuals with mental disabilities. This index was designed to evaluate oral health and oral hygiene in groups of individuals, particularly in hospitals or at other institutions. MPS consists of the sum of a four‐point mucosal score (MS) and a four‐point plaque score (PS). Intra‐examiner agreement was assessed for one dentist (BMH), who examined 24 individuals twice with a one‐week interval. Weighted kappa values were 0.60 for MS, 0.62 for PS, and 0.62 for MPS. Inter‐examiner agreement between two dentists was conducted by duplicate examinations on 20 persons. Weighted kappa values were 0.47 for MS, 0.71 for PS, and 0.70 for MPS. In a second assessment of Inter‐examiner‐agreement, eight individuals were each examined by a dentist, two dental hygienists, and one medical nurse. Weighted kappa values were 0.79 for MS, 0.80 for PS, and 0.77 for MPS. These results support the conclusion that the MPS can serve as a reliable measure for the assessment of oral health care in groups of older Individuals.
Blood pressure measurement by community dentists
Authors: Pyle Marsha A. , Sawyer Danny R. , Jasinevicius T. Roma , Ballard Richard
Published: March 2008

The benefit and implications of blood pressure (BP) measurement in dental patients are a standard curricular component of most physical evaluation courses in dental schools. However, previous research has indicated that preventive procedures such as oral cancer examinations frequently are not completed or documented. A survey of practicing dentists was conducted in a Midwest metropolitan area to determine the frequency of BP measurement and conditions under which this vital sign is likely to be measured. Two hundred four responses were obtained from a telephone survey which included questions characterizing BP measurement on the basis of patient age and medical diagnosis. The results of the survey indicated that 57.4% of respondents do not check the BP of new patients over the age of 65, while 74% do not check the BP of new patients under 30 years of age. Fourteen percent admitted never measuring BP. The results varied by graduation years and by dentist's completion of AEGD or GPR programs. The results suggest great variation in the recording of BP and the criteria which are applied to those decisions. Further study should investigate factors contributing to low compliance with screening procedures such as the clinical measurement of BP and other health‐promotion measures.
Prophylactic antibiotic therapy prior to dental treatment for patients with end‐stage renal disease
Authors: Werner Carlos W. , Saad Theodore F.
Published: March 2008

In the United States, there is a large and growing population of patients undergoing dialysis because of end‐stage renal disease (ESRD). These patients present special management considerations for dentists, including antibiotic prophylaxis for the prevention of bacterial endocarditis (BE). ESRD patients, particularly those with an arteriovenous shunt for hemodialysis access, are predisposed to valvular endocarditis. Thus, BE prevention is the primary goal of antibiotic prophylaxis prior to dental or other invasive procedures in these patients. Bacteremia may predispose to infection of synthetic vascular access grafts, although this form of endovascular infection in ESRD patients has not been as well‐characterized as BE. Antibiotic prophylaxis may be of some benefit for prevention of synthetic graft Infections as well as BE. Poor dentist and physician compliance with BE prophylaxis regimens, as well as errors in dosing, timing, or duration of prophylaxis, have been reported. These problems are of particular concern in the treatment of chronically ill patients. In this article, we review the rationale for prophylactic antibiotic therapy prior to dental procedures in ESRD patients with vascular access. We also elaborate on the current American Heart Association guidelines for BE prophylaxis, and address special considerations for ESRD patients.
Geriatric dentistry in long‐term‐care facilities: current status and future implications
Authors: Ellis Angela G.
Published: March 2008

The status of oral health care of geriatric patients in long‐term‐care facilities is reviewed. Barriers to improving the dental management of institutionalized geriatric patients are discussed. The elderly population segment Is the fastest‐growing population, which presents a great burden to dental health professionals. Institutionalized geriatric patients are currently not receiving adequate care, and the number of these patients will double by the year 2020. The future implications are of considerable importance. Commitment by dental professionals to meet the oral health needs of this underserved population is key to the improvement of and change in the current status of this population.
Development and evaluation of a multimedia resource pack for oral health training of medical and nursing staff
Authors: Sweeney M. Petrina , Bagg Jeremy , Kirkland George , Farmer Timothy A.
Published: March 2008

A resource pack has been devised for training medical and nursing staff and other carers in order that they may recognize oral disease and carry out routine oral care and treat common oral disorders. The customdesigned folding pack contains a videotape, a CD‐ROM disc, and an A5‐sized spiral‐bound booklet, together with wall posters and a list of useful addresses. One hundred of the packs were distributed across Scotland to medical, nursing, and dental staff involved in postgraduate medical and nursing education. The packs were independently evaluated by an external organization through a questionnaire and also by telephone interviews. The pack received very positive responses, and 35% of the respondents reported making changes to their current practice. A long‐term measure of success, beyond the scope of this paper, will depend on the measurement of improved quality of oral health care of the patients in those institutions where the pack has been used in training.
Recent advances in diabetes mellitus of interest to dentistry
Authors: Little James W.
Published: March 2008

Significant changes were made in 1997 by The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus of the American Association of Diabetes regarding the diagnosis and classification of diabetes mellitus. The terms “insulin‐dependent diabetes mellitus” (IDDM) and “non‐insulin‐dependent diabetes mellitus” (NIDDM) were dropped. The new classification is, in general, based on etiology rather than on treatment and includes four groups: Type I (autoimmune), Type 2 (non‐autoimmune), Other specific types, and Gestational diabetes. The fasting blood glucose level for diagnosis was lowered from 140 mg/dL to 126 mg/dL A random blood glucose of 200 mg/dL or greater in a patient with symptoms of diabetes is diagnostic. Each of these diagnostic tests needs to be repeated on a separate day. The glucose tolerance test is no longer recommended for routine diagnostic use. Recommendations for the screening of diabetes mellitus in presumably healthy individuals are presented. New advances in insulin and its delivery to the diabetic patient are discussed. The impact of diabetes mellitus on the oral cavity is updated.
Malocclusions and traumatic injuries in disabled schoolchildren and adolescents in Kuwait
Authors: Shyama Maddi , Al‐Mutawa Sabiha A. , Honkala Sisko
Published: March 2008

The present study was carried out to determine the prevalence of malocclusion and traumatic injuries in disabled children and adolescents attending the special‐needs schools in Kuwait. Included in the study were 818 children (438 males and 380 females), in the age groups of 3–20 years, who have visual impairment, hearing impairment, physical handicaps, or developmental disorders. The mean age of participants was 11.9 years. The survey was carried out according to the methods of WHO. The prevalence of severe malocclusion was 23.6%, and that of slight malocclusion was 37.0%. Children with Down syndrome (OR = 2.3; 95% CI = 1.51‐3.52), those of increasing age (OR = 1.1; 95% CI = 1.01‐1.10), and males (OR = 1.5; 95% CI = 1.05‐2.07) had higher risk for the occurrence of severe malocclusion. Less than one‐fifth of the subjects (16.9%) had traumatized anterior teeth. Severe malocclusion (OR = 1.8; 95% CI = 1.17‐2.77) and increasing age (OR = 1.2; 95% CI = 1.13‐1.26) were significant risk factors for the occurrence of traumatic injuries. We concluded that malocclusion and traumatic injuries are more prevalent among these subjects with disabilities than among the healthy population in Kuwait.
Use of dental implants in patients with Down syndrome: a case report
Authors: Lustig Joseph P. , Yanko Robert , Zilberman Uri
Published: March 2008

Down syndrome is caused by trisomy of the 21st chromosome and is associated with well‐described physical and systemic problems. Most people with Down syndrome have some degree of mental retardation as well as malformation of head and neck. Oral structures that are commonly affected include the tongue (microglossia), abnormalities in the number and shape of teeth, and poor quality (osteoporotic‐like) of alveolar bone and jaw. These oral malformations as well as a tendency toward poor cooperation in the dental office contribute to the belief among dentists that people with Down syndrome are not good candidates for oral rehabilitation with dental implants. This article describes the use of dental implants in the oral rehabilitation of a 16‐year‐old boy with Down syndrome. Although more experience is needed before dental implants can be considered a suitable option during oral rehabilitation in people with Down syndrome, this case report shows a promising beginning.
Oral hygiene, gingivitis, and periodontitis in persons with Down syndrome
Authors: López‐Pérez Rubén , Borges‐Yáñez S. Aída , Jiménez‐García Gustavo , Maupomé Gerardo
Published: March 2008

This study was conducted to determine and compare the prevalence, severity, and extent of gingivitis and periodontitis in patients with Down syndrome and patients who did not have Down syndrome. The authors also assessed the relationship of these conditions and compared them to the age, gender, and oral hygiene profiles in both groups. Using a case‐control study design, the authors examined 32 individuals with Down syndrome (DS) and matched each with a participant from the control group (CG) according to age and gender. Researchers determined the Simplified Oral Hygiene Index, Gingival Index, and measured the level of gingival attachment for each participant. The authors found that the relationship between the presence of dental plaque and the severity of gingivitis was moderate among participants with DS. While the overall characteristics of the periodontal and gingival health status were not markedly different between the two groups, the extent and severity of gingivitis and the extent of periodontitis were greater in the group with DS than in the CG.
Clinical and microbiological analysis of periodontally diseased sites after renal transplant
Authors: Vieira Mara L.S.O. , Martins Walter , Grisi Marcio F.M. , Novaes Arthur B. , Souza Sergio L.S. , Salvador Sérgio L.
Published: March 2008

This study compared the clinical and microbiological status of periodontally diseased sites in 42 patients who had a renal transplant and were undergoing immunosuppressive therapy (21 taking azathioprin and corticosteroids [Az‐C] and 21 taking cyclosporin‐A [Cy‐A] with those of 21 systemically healthy matched controls. Probing pocket depth (PPD), bleeding on probing (BOP) and gingival hyperplasia (GH) were measured at 339 sites. Subgingival plaque samples were analyzed for the presence of Porphyromonas gingivalis, Treponema denticola and/or Bacteroides forsythus using the BANA test. Our findings suggest that immunosuppressed patients showed significantly less inflammation and fewer putative anaerobic pathogens using the BANA test, and that patients undergoing therapy with cyclosporin‐A have a higher frequency of sites with gingival hyperplasia when compared with patients medicated with azathioprin or corticosteroids.
CONFERENCE PRESENTATION:Changing perceptions of oral health and its importance to general health: provider perceptions, public perceptions, policyma ker perceptions
Authors: Pyle Marsha A.
Published: March 2008

He first ever Surgeon General's Report on Oral Health1 emphasizes that oral health is essential to the general health and well‐being of all Americans, and that oral health can be achieved. But it will require that we think about and approach oral health activities in a different manner. If we desire to influence the mind‐set of health care providers, the public, policymakers, and institutions, how do we get from what we know about the relationship of oral health and general health to integrating the notion into everyday actions? The Surgeon General's Report on Oral Health has elevated this issue to the forefront of health care and provided us with an extraordinary opportunity. The challenge: Lead with action and catalyze integration into multiple forum‐public, private, and professional‐and engage in activities that will change how oral health is perceived broadly. Ultimately, geriatric oral health and the health of all access‐limited populations should benefit.

To continue preserving the oral health of the millions of older individuals who now enjoy it and to ensure it for those who lack it will require change on multiple societal levels: the health care providers, the neighborhood, the community; Federal, state, and local governments; and the nation as a whole. It means addressing and overcoming multiple barriers to oral health care, which may include problems or disparities in: education, economics, the environment, cultural and social issues, and the health care system itself1 To change perceptions, we must remove the barriers to care, educate the stakeholders who can influence or benefit from training programs, conduct broader, population‐based research, build public and private partnerships, develop a stronger health care infrastructure, and expand initiatives that target specific risks for declining oral health. In addition to seeking new answers to these problems, it is imperative that we apply what we already know.
Explorer probing of root caries lesions: an in vitro study
Authors: Warren John J. , Levy Steven M. , Wefel James S.
Published: March 2008

Probing with a dental explorer is the preferred method of root caries diagnoses. However, studies suggest that use of a dental explorer in coronal caries detection may damage tooth structure. This pilot study investigated the effect of probing on remineralization of root surface lesions in vitro.

Root‐surface lesions were created on 10 extracted teeth by exposing them to a demineralizing solution for 21 days. One side of each lesion was then randomly selected and probed with an explorer, while the other side was not probed. The teeth then were placed in a remineralizing solution containing 10 parts per million (ppm) fluoride for 21 days.

Of the 9 teeth with usable sections, all showed frank evidence of defects on the probed halves. Sites of remineralization were seen in the non‐probed halves and adjacent to the probed defects, but not within or at the base of these defects. These results suggest that probing of root surfaces may create defects that do not fully remineralize.
Assessing prosthodontic dental treatment needs in older adults in Thailand: normative vs. sociodental approaches
Authors: Srisilapanan Patcharawan , Korwanich Narumanas , Sheiham Aubrey
Published: March 2008

The authors compared the estimated prosthodontic treatment needs of edentulous older adults when using normative and sociodental approaches. This cross‐sectional study involved a non‐random sample of 158 edentulous adults, aged 60 to 74 years, who were living independently in metropolitan Chiang Mai, Thailand. Each subject was given an oral examination and was interviewed. The dental questionnaire and the clinical criteria were adapted from the National Diet and Nutritional Survey for People Aged 65 and Older and included the Oral Impacts on Daily Performances sociodental indicator. Of the 158 subjects, we found using a normative assessment that 79.7% had a treatment need for complete dentures; 60.5% of those adults had impact‐related treatment needs. Estimated treatment need dropped by about 40% when subjects were assessed using the sociodental approach. We concluded that large reductions in normative need estimates for complete dentures were apparent using a sociodental approach to assess prosthodontic dental treatment needs of older people.
Practical protocols for the prevention of dental disease in community settings for people with special needs: preface
Authors: Glassman Paul
Published: March 2008

This issue of Special Care in Dentistry presents protocols that were designed during a conference, Practical Protocols for the Prevention of Dental Disease in Community Settings for People with Special Needs, which was held at the University of the Pacific School of Dentistry on February 1, 2002. After each expert reviewed and reported on one area of the literature, which included risk assessment; chlorhexidine mouth rinses; xylitol chewing gum; topical fluoride and fluoride varnish applications; and methods to control or treat periodontal disease, practical protocols were developed. Next, a strategy of implementation and dissemination will be designed using nurses, case managers, social workers, caregivers, and others to encourage people with special needs to use these protocols. A plan will also be implemented to increase social and health care provider awareness about these interventions through professional publications and educational opportunities. The goal is to reduce dental disease in special needs populations and thereby decrease the need for difficult and costly treatment.
Clinical study of anesthetic management during dental treatment of 25 patients with cardiomyopathy
Authors: Shibuya Makiko , Kamekura Nobuhito , Kimura Yukifumi , Fujisawa Toshiaki , Fukushima Kazuaki
Published: March 2008

This retrospective study analyzed the management of 25 patients with hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), or dilated phase of hypertrophic cardiomyopathy (dHCM) treated in the outpatient clinic of the Department of Dental Anesthesiology at Hokkaido University. A total of 87 dental treatment sessions were completed. Intravenous sedation was used significantly more often for patients with HCM than those who had DCM. This seemed to be because dental anesthesiologists expected sedative drugs to suppress hyperdynamic circulatory changes caused by mental stress. Intraoperative complications occurred during 19 treatments. The incidence of circulatory complications increased when participants with DCM also reported dental fear. For participants with HCM who reported dental fear, circulatory complications occurred only when sedation was not used. It is not clear whether complications were related to cardiac function or dental treatment. Therefore, it is important to continually monitor patients with these conditions and to be prepared to handle complications that may arise during dental treatment.
Management of a patient with Mobius syndrome: a case report
Authors: Ha Chungyoon Y. , Messieha Zakaria S.
Published: March 2008

Mobius syndrome is a rare congenital disorder with the primary diagnostic criteria of congenital facial and abducent nerve palsy. Orofacial anomalies and limb malformations may be associated with the disorder. Involvement of other cranial nerves also is common. Occasionally, the V, X, XI, and XII cranial nerves are involved, resulting in difficulty of chewing, swallowing, and coughing, which often leads to respiratory complications. Mental retardation and autism have been reported in some cases. An 18–year‐old Hispanic male came to the General Practice Residency clinic at the University of Illinois at Chicago for dental treatment. The patient had a history of Mobius syndrome, mental retardation, and behavioral problems. Because of acute situational anxiety and violent behavior, we arranged for the patient to have general anesthesia while we provided complete oral rehabilitation. This article discusses the treatment of a patient, including special considerations taken during anesthesia and dental management. A review of the special challenges concerning patients with such a condition are reviewed.
Predictors of oral health quality of life in older adults
Authors: Swoboda Jessica , Kiyak H. Asuman , Persson Rigmor E. , Persson G. Rutger , Yamaguchi David K. , MacEntee Michael I. , Wyatt Christopher C.L.
Published: March 2008

There is limited information regarding oral health status and other predictors of oral health‐related quality of life. An association between oral health status and perceived oral health‐related quality of life (OHQOL) might help clinicians motivate patients to prevent oral diseases and improve the outcome of some dental public health programs. This study evaluated the relationship between older persons' OHQOL and their functional dentition, caries, periodontal status, chronic diseases, and some demographic characteristics. A group of 733 low‐income elders (mean age 72.7 ISD=4.71, 55.6% women, 55.1% members of ethnic minority groups in the U.S. and Canada) enrolled in the TEETH clinical trial were interviewed and examined as part of their fifth annual visit for the trial. OHQOL was measured by the Geriatric Oral Health Assessment Index (GOHAI); oral health and occlusal status by clinical exams and the Eichner Index; and demographics via interviews. Elders who completed the four‐year assessment had an average of 21.5 teeth (SD=6.9). with 8.5 occluding pairs (SD=4.6), and 32% with occlusal contacts in all four occluding zones. Stepwise multiple regressions were conducted to predict total GOHAI and its subscores (Physical, Social, and Worry). Functional dentition was a less significant predictor than ethnicity and being foreign‐bom. These variables, together with gender, years since immigrating, number of carious roots, and periodontal status, could predict 32% of the variance in total GOHAI, 24% in Physical, 27% in Social, and 21 % in the Worry subscales. These findings suggest that functional dentition and caries influence older adults' OHQOL, but that ethnicity and immigrant status play a larger role.