bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient satisfaction with dental care in a municipal hospital
Authors: Badner Victor , Bazdekis Thomas , Richards Candia
Published: March 2008

Quality assurance activities are an important part of a hospital dental department. This study reports the results of a patient satisfaction questionnaire distributed as part of the quality assurance activities at a municipal hospital. The results show patient satisfaction questionnaires are applicable to the hospital setting, patients report relative satisfaction with the care received, and they can identify specific areas of satisfaction and dissatisfaction. The number of visits, easy access and convenience to the clinic, and out‐of‐pocket payment for dental care are predictive of satisfaction with the dental care received at this clinic
A clinical comparative trial of saliva substitutes in radiation‐induced salivary gland hypofunction
Authors: Epstein Joel B. , Stevenson‐Moore Peter
Published: March 2008

Use of saliva substitutes may become necessary to manage xerostomia when no means of stimulating saliva production is effective. Few clinical trials have compared products that may act as salivary substitutes. Patients' preference of products depended on effect duration, lubrication, taste, delivery system, and cost. Many patients did not continue with the use of the products studied, and instead chose to rely on frequent use of water. Clinical trials of the products are recommended before prescription to indicate what may be the best choice for the individual patients.
Self‐assessment of dental health among Danish noninstitutionalized psychiatric patients
Authors: Hede Börge , Petersen Poul Erik
Published: March 2008

This survey provides a description of the living conditions, dental health self‐assessment, dental health behavior, and knowledge and attitudes to dental care in a population of noninstitutionalized psychiatric patients. A total of 84 individuals (70% of the persons selected) were interviewed using a pretested structured questionnaire. One of five participants did not perform oral hygiene as a daily routine and 45% had no regular dental visit habits. A proportion of about 40% reported symptoms from teeth or gingiva within the previous year. Despite an acceptable level of general knowledge on caries and periodontal problems, only a small proportion were aware of the caries‐inducing potential of psychotropic drugs. People with more than five admissions to the psychiatric ward more often reported symptoms from teeth and gingiva; irregular dental visit habits were also related to number of admissions and to manic‐depression. The survey indicates poor oral health among psychiatric patients compared with the general population and the need for specific oral care programs leveled at noninstitutionalized psychiatric patients is stressed.
Efficacy of chlorhexidine swabbing in oral health care for people with severe disabilities
Authors: Stiefel Doris J. , Truelove Edmond L. , Chin Mae M. , Mandel Lynn S.
Published: March 2008

Chlorhexidine is effective when used as an oral rinse, but many disabled people cannot use such a protocol. A double‐blind cross‐over study tested the efficacy of applying chlorhexidine with a sponge‐swab, in a sample of 76 severely disabled adults, drawn from diverse rehabilitation settings. Two randomly assigned groups applied 10 mL 0.12% chlorhexidine gluconate (Perldex™, Procter & Gamble) or 10 mL placebo, using a “Toothette™” (Halbrand) once daily, 5 times per week for 10 weeks. All subjects received 10 mL 0.05 % NaF, applied similarly but separately from the test/placebo agent. Pre‐ and post‐trial measures included perceived level of function and oral status, that is, DMFS, plaque, calculus, pocket depth, and tooth stain. The protocol received high levels of compliance and acceptance. Compared with placebo, swabbing with chlorhexidine resulted in consistent, and, In part, significant improvements in plaque, gingivitis, and periodontal pocket depth. Side effects of chlorhexidine, that is, tooth stain and calculus, were relatively minor. Perceived Improvements in dental health were associated with improved physical health, appearance, and mouth odor. The results Indicate that chlorhexidine swabbing is a useful oral disease preventive protocol for persons with disability.
Effect of medical status on dental procedure time
Authors: Hayes Catherine , Sonis Stephen T.
Published: March 2008

The purpose of this study was to determine if treatment of medically compromised patients requires more time than that of healthy patients. The time taken to complete diagnostic and manipulative procedures was studied and compared for both groups. After an evaluation of 160 procedures on 108 patients, it was determined that no differences existed In the time taken to complete technical procedures between the two groups. However, the diagnostic and evaluation phase for moderately to severely compromised patients required twice as much time as that of healthy individuals.
Effects of hyposalivatory medications on saliva flow rates and dental caries in adults aged 65 and older
Authors: Saunders Ralph H. , Handelman Stanley L.
Published: March 2008

Institutionalized adults aged 65 or older often receive medications that have been associated with decreased saliva flow. Flow rates depressed by hyposalivatory medications are thought to increase susceptibility to dental caries. In this study, a cross‐sectional comparison was made of stimulated whole saliva rates and coronal and root caries prevalence in a group of older adults, in a long‐term care facility, taking hyposalivatory medications vs. a control group. No significant differences were found between the two groups in masticatory or gustatory stimulated flow rates or in mean decayed coronal or root surfaces.
Surgical management of a patient with cleidocranial dysplasia: A case report
Authors: Quinn Peter D. , Lewis Jeffrey , Levin Lawrence M.
Published: March 2008

Cleidocranial dysplasia is associated with the formation of many supernumerary teeth which usually fall to erupt. In later life, cysts may form around the embedded teeth. The following report describes the management of such a case with a method which promotes satisfactory prosthodontic rehabilitation.
Metastatic colon carcinoma to oral soft tissues
Authors: Bhutani Manoop S. , Pacheco Jaime
Published: March 2008

Metastatic tumors to the oral cavity are uncommon. Most of these cases involve the mandible or the maxilla. Rarely, metastasis occurs to the oral soft tissues from a distant primary tumor. The lung and breast are the most common primary sites. It is extremely rare to have an oral soft‐tissue metastasis from a carcinoma of the colon. A case of primary adenocarcinoma of the colon with metastasis to the soft tissues of the mouth is described. Three similar case reports are reviewed. A metastatic lesion to the oral cavity could be the first indication of the presence of a primary tumor.
Pica: a peculiar behavior with oral involvement
Authors: Wakham M. Dean , Burtner A. Paul , McNeal Donald R. , Garvey Timothy P. , Bedinger Susan
Published: March 2008

Pica is a behavior commonly displayed by children, pregnant females, and Individuals with mental retardation. A population of Institutionalized adults with mental retardation was assessed for pica. Of this population, 10.8% were identified with this behavior. Also, this article discusses aspects of pica and describes how this behavior can affect the mouth.
Prosthetic rehabilitation of the oral cancer patient: A clinical report
Authors: Bredfeldt Glenn W.
Published: March 2008

A clinical report is presented describing the prosthodontic rehabilitation of an oral cancer patient, and the techniques involved.
Technique for construction of dental molds for high‐dose‐rate remote brachytherapy
Authors: Jolly Daniel E. , Nag Subir
Published: March 2008

High‐dose‐rate remote (HDR) brachytherapy eliminates radiation exposure hazard to personnel, allows for optimum dosage planning (dosimetry), and delivers high radiation dose close to the tumor in only a few minutes. The catheters can be Incorporated into a fixed geometry within a mold, allowing for repeated treatments without the need for repeated implantation of radioactive Isotopes or repeated dosimetry. This article presents the use of HDR brachytherapy in three patients to Illustrate the advantages of HDR brachytherapy for the treatment of head and neck cancers in the following circumstances: (a) for outpatient therapy, (b) as an addition to or potentiation of external beam irradiation, (c) for preservation of function of regional structures, (d) for optimization of dosimetry, and (e) for palliation. It requires close interaction among the radiation oncologist, head and neck surgeon, and the dental oncologist and/or maxillofacial prosthodontist in order for optimum benefit for the patient to be achieved.
When pharmacologic anesthesia is precluded: The value of hypnosis as a sole anesthetic agent in dentistry
Authors: Kleinhauz Moris , Eli Ilana
Published: March 2008

Occasionally, a dental patient presents his/her dentist with a history of hypersensitivity to local anesthetic agents. The symptoms may include immediate reactions to the injection procedure (dizziness, shortness of breath, tachycardia, etc), or delayed reactions to the anesthetic (swelling, urticaria, etc). Although the true incidence of local anesthetic allergy is low, such a history often involves the patient's anxiety regarding the use of the drug in question, and the dentist's apprehension to treat the “problematic” patient. In such cases, hypnosis can play a major role in controlling pain and the associated distress. In the present article, the method concerning the implementation of hypnosis to induce local anesthesia is described and illustrated through case demonstrations.
Use of the SADP for measurement of attitudes of Chinese dental students and dental surgery assistants toward disabled persons
Authors: O'Donnell David
Published: March 2008

The purpose of this study was to determine the attitudes of Chinese dental students and dental surgery assistants toward disabled persons using the Scale to Determine Attitudes Toward Disabled Persons, the SADP. A group of 99 Hong Kong University psychology students, 50 male and 49 female, was used as the control and to determine the internal consistency and reliability of the Chinese version of the scale. A group of 4th year (n = 25) and a group of 3rd year (n = 46) dental students and a group of in‐house dental surgery assistants (n = 86) at the Prince Philip Dental Hospital, Hong Kong, were asked to complete a Chinese translation of the SADP. Results showed that there was no significant difference between attitude scores of 3rd and 4th year dental students (p = 0.06). There was a significant difference in attitude scores between dental students and the dental surgery assistants (p < O.OOl), with those of dental students being lower. In the control group, there was no significant difference between female control and dental surgery assistant scores (p = 0.289). There was a significant difference between dental students and male control scores (p < 106). Not only did the dental students score lower than the dental surgery assistants, but they also scored significantly lower than a group of non‐dental students of the same University.
Communicating with the aphasic dental patient
Authors: Mowery Arthur J.
Published: March 2008

A significant proportion of older adults has communication impairments. Language disorders involve problems with the use of earned symbol systems, Including numbers, pictures, and words. Aphasia is one of the most common types of language disorders experienced by the elderly and is usually caused by a cerebrovascular accident or stroke, but can also be caused by head trauma and tumors. The growing number of dental patients with this language disorder will challenge the dental team to understand and evaluate aphasia and develop effective communication strategies. This paper describes the language impairments commonly experienced by stroke victims, and discusses assessment and communication strategies specifically for the aphasic dental patient.
Late effects of head and neck radiation therapy and patient/dentist compliance with recommended dental care
Authors: Cacchillo David , Barker Gerry J. , Barker Bruce F.
Published: March 2008

Head and neck radiation therapy patients have permanent damage to their salivary glands, tissue, and bone. This damage may result in late effects such as: xerostomia, rampant dental caries, demineralization, trismus, and osteoradionecrosis. Therefore, a pretherapy dental evaluation and treatment and compliance with a long‐term oral care regimen are necessary. This retrospective study was designed to assess the late effects of radiation therapy and compliance with long‐term care recommendations of patients seen in the Oncology Dental Support Clinic at the University of Missouri‐Kansas City School of Dentistry during 1981 to 1989. Telephone interviews of patients and their dentists were conducted, and a written questionnaire to the dentists provided further data. Late effects were consistent with those reported in the literature. A compliance rate of approximately 50% was reported. Several measures have been implemented in an attempt to increase compliance.
Use of medications with potential oral adverse drug reactions in community‐dwelling elderly
Authors: Lewis Ingrid K. , Hanlon Joseph T. , Hobbins Melody J. , Beck James D.
Published: March 2008

Prevalence and indicators of medication use with potential oral health implications among 4,163 people horn the Duke Established Populations for Epidemiologic Studies of the Elderly were studied. Medications were grouped into seven potential oral adverse drug reaction (POADR) Categories. Eighty percent of participants were taking at least one medication from any of the seven categories. Drugs with the potential to cause xerostomia were taken by 56.1%, abnormal hemostasis by 51.7%, soft tissue reactions by 23.4%, taste changes by 11.0%, alteration In host resistance by 8.7%, gingival overgrowth by 5.0%, and movement disorders by 2.4% of participants. Race‐stratified analyses revealed that medication use with any POADR was significantly associated (p ≤ 0.001) with being female for both races Among nonblacks, being ≥ 75 years old was associated with higher POADR use. Blacks who had a dental visit in the previous six months were more likely to take medications with POADR than those who did not. POADR medication use was not related to place of residence. Elderly often take medications with potential oral health impact.
Dental management of long‐term amyotrophic lateral sclerosis: Case report
Authors: Randall S , Alfred Terri
Published: March 2008

Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease. Methods of dental treatment of a young male patient with ALS are presented. This case is unusual in several respects: the early age of onset, the long survival time, and the period of time in which the case was followed in our dental clinic. Aspects of ALS which are of concern to dentistry, as related to clinical care and strategies for effective oral health delivery, are presented.
Dental managenment of the geriatric patient with major depression
Authors: Arthur H , Kawakami K. Kari , Ganzell Steven , Fitten L. Jaime
Published: March 2008

Major depression is a psychiatric disorder in which mood, thought content, and behavioral patterns are impaired, offen for an extended period of time. The condition is encountered among elderly persons admitted to the hospital and those residing in nursing homes. Major depression is predominantly biologic in origin and may arise from dysfunction of the limbic‐hypothalamicpituitary‐adrenal axis. it is associated with personal neglect, including a disinterest in performing appropriate preventive oral hygiene techniques. The majority of antidepressant medications cause xerostomia and magnify the incidence of dental disease. Appropriate dental management of patients with the disorder necessitates the use of anti‐caries agents containing fluoride, saliva substitutes, and special precautions when analgesics and local anes the tics are being prescribed or administered. Dental treatment helps to improve the patient's self‐image and quality of life.
Effects of medication on parotid salivary flow rates in an individual with dementia of the Alzheimer type
Authors: Fedele Denise J. , Jones Judith A. , Volicer Ladislav , Harz Lawrence R. , Oppenheim Frank G.
Published: March 2008

Effects of medication on parotid salivary flow rates in an individual with dementia of the Alzheimer type

Data available on the relationship between salivary function and specific drug therapy are sparse. We measured unstimulated and stimulated parotid salivary flow rates associated with the drug therapies. Our ancillary study design is an N = 1 double‐blind randomized controlled trial in which the patient undergoes a series of treatment blocks of either placebo or active treatment. The purpose of the parent N of 1 study was to find the “best single drug” treatment for a resistive patient diagnosed with dementia of the Alzheimer type.

This study demonstrates that thiothixene was associated with inconsistent effects on parotid flow. Oxazepam had no effect on his parotid function, and diphenhydramine hydrochloride had inconsistent but generally negative effects. The data also show that this individual with dementia of the Alzheimer type had lower baseline unstimulated and stimulated parotid salivary flow rates when compared with mean “normal” values; however, flow rates were above the lowest 10th percentile of “normal” volunteers.
Pediatric infection with the Human Immunodeficiency Virus (HIV): Head, neck, and oral manifestations
Authors: Asher Randall S. , McDowell John , Acs George , Belanger Gary
Published: March 2008

The increasing incidence of HIV infection in the pediatric population is of concern for the practicing dentist. Long incubation periods of the virus, combined with difficulty in detection, results in many undiagnosed cases of prenatal and natal infections with HIV. As a result, many dentists will unknowingly treat HIV‐positive children. This article presents most common features of pediatric HIV infection, placing special emphasis on manifestations which affect the head, neck, and oral tissues.
Toxic Shock and Down Syndromes in a dental patient: A case report and review of the literature
Authors: Navazesh Mahvash , Mulligan Roseann , Sobel Stephen
Published: March 2008

A literature review of Toxic Shock Syndrome is presented, including epidemiology, etiology, signs, symptoms and management, and its relationship to infection susceptibility in the Down Syndrome patient. A case of a Down Syndrome patient with Toxic Shock Syndrome is described, and the role of odontogenic infection is discussed.
Factors related to acceptance of dental treatment services in a nursing home population
Authors: Warren John J. , Kambhu Peter P. , Hand Jed S.
Published: March 2008

This study reports on factors related to acceptance of restorative, oral surgery, and prosthodontic dental treatment services by a population of nursing home residents. Lower cost treatment plans and eligibility for Medicaid benefits were associated with acceptance of all treatment, and for the categories of oral surgery and prosthodontic services. Acceptance of routine restorative procedures was more strongly associated with female residents. It is concluded that financial concerns appear to pose the greatest barrier in providing dental treatment services to nursing home residents.
Appliance therapy for chronic drooling in a patient with mental retardation
Authors: Asher Randall S. , Winquist Heidi
Published: March 2008

Multiple physical impairments are associated with chronic drooling. This case illustrates the use of a simple appliance to align the patient's lip to provide opportunity for a lip seal when swallowing or at rest in a patient with a Class II malocclusion. The appliance resulted in a significant decrease in drooling in this patient.
Oro‐dental management of patients with familial dysautonomia
Authors: Mass Eliyahu , Belostoky Leon , Gadoth Natan
Published: March 2008

Oro‐dental abnormalities are quite frequent in familial dysautonomia. The practitioner should be familiar with this disorder, which represents a “human model” for chronic progressive orodental denemation. Self‐injurious behavior is caused mainly by profound sensory loss. An appropriate preventive and therapeutic approach that was developed in our clinic and adapted for the special hazards of dentistry in youngsters with systemic autonomic dysfunction may improve the life quality of this particular population.
Four maxillary incisors: A case report
Authors: Trotman Carroll‐Ann , McNamara Triona
Published: March 2008

This case report describes the dentofacial morphology and treatment of a 9‐year‐old female who presented with four maxillary incisors, and a combination of rare oral and cervical vertebral anomalies. The patient had a Class II division I malocclusion which was complicated by the presence of supernumerary permanent teeth: two supplemental maxillary central incisors, and a supplemental mandibular central incisor. She also had abnormalities of the cervical vertebrae, which were symptom‐free. In addition, a number of surgical procedures had been performed in early childhood to treat a benign oral teratoma, cleft tongue, and an isolated cleft of the secondary palate. The dental treatment involved the extraction of the two most centrally placed maxillary central incisors, and the alignment of the maxillary arch with fixed orthodontic appliances.
A review of chlorhexidine and its use in special populations
Authors: Al‐Tannir Mohamad A. , Goodman Harold S.
Published: March 2008

The purpose of this paper is to review the mechanism of the action, safety, and side‐effects of chlorhexidine, and to provide guidelines for its use in special populations. Chlorhexidine has been used orally since 1959, primarily for the control of dental plaque. Chlorhexidine is a safe material, with low toxicity potential when used correctly. The most conspicuous side‐effects are the development of yellow‐brown stains on the teeth, tongue, and at the margins of anterior restorations, and an alteration in taste sensation. The use of chlorhexidine is indicated in developmentally disabled, medically compromised patients, and in dependent elderly populations, since these groups are often physically unable to remove plaque by mechanical means. Clinicians should not prescribe chlorhexidine indiscriminately for all patients, however, until analyzing its efficacy, safety, and side‐effects.
Surgical periodontal treatment in the radiotherapy‐treated head and neck cancer patient
Authors: Epstein J.B. , Corbett T. , Galler C. , Stevenson‐Moore P.
Published: March 2008

A series of clinical cases is presented in which surgical periodontal therapy was conducted within the high‐dose volume of prior radiation therapy. Close oral supervision is required in patients following head and neck radiation therapy. Non‐surgical periodontal management is crucial in the care of these patients following radiation therapy. Careful selection of patients for possible surgical therapy and care in performing the procedure may allow successful periodontal management, as is demonstrated in the cases reviewed.
Perception of oral health needs by Southeast Iowa non‐dental health care providers
Authors: Bolden Aljernon J. , Logan Henrietta L. , Jakobsen Jane R. , Evans Theora A.
Published: March 2008

The purposes of this dental study were to identify, among non‐dental health care providers and administrators, (1) those reasons assessed to be most persuasive in adopting selected dental preventive practices, (2) barriers perceived to be present for their clients to obtain dental services, and (3) practices which would make dental services more available to their clients. A nine‐item dental care/attitude survey was completed by 82% (n = 68) of the health care and social services providers/administrators attending one of the United Way of East Central Iowa group meetings. The results of this survey indicated that, for these respondents, the most persuasive reasons for adopting preventive dental practice behaviors were based on susceptibility to disease and social and esthetic benefits. Further, the results of this survey showed that female respondents gave significantly higher scores than males to the importance of social benefits (self‐worth and employment marketability), health benefits, and the importance that authority figures (dentists and physicians) placed on the behavior. Fifty‐one percent of the respondents knew of patients who had problems obtaining dental services. The main reasons given for clients' access problems were the lack of money, the lack of insurance, and the lack of transportation.
Analysis of orthodontic anomalies in mentally retarded developmentally disabled (MRDD) persons
Authors: Vittek Jozef , Winik Sheldon , Winik Alan , Sioris Cleopatra , Tarangelo Anne Marie , Chou May
Published: March 2008

For this epidemiologic study, 458 individuals with mental retardation and developmental disability (MRDD), from 6 to 87 years old, from the Lower Hudson Valley region of New York, were evaluated for the occurrence of orthodontic anomalies. High occurrence of both anomalies of intermaxillary relation, as determined by Angle's classification, and the anomalies of occlusion were found in these individuals when compared with the general population. An increased incidence of both acquired (i.e., open bite) as well as hereditary (Le., prognathia) orthodontic anomalies correlated with the severity of mental retardation. In addition, an increased incidence of Angle class II malocclusion was found in persons with cerebral palsy and autism, and an increase of Angle class 111 malocclusion in persons with autism and Down syndrome. Moreover, it was found that 74% of MRDD persons had definitive malocclusion, while only 37% of the US general population of comparable age has definitive malocclusion. High incidence of malocclusion in this population remained present into old age, mainly due to a lack of treatment and the need to employ non‐conventional orthodontic treatment in this population.
Systemic dissemination as a result of oral infection in individuals 50 years of age and older
Authors: Navazesh Mahvash , Mulligan Roseann
Published: March 2008

The oral pathosis caused by systemic disorders in middle‐aged and elderly adults has been the focus of many publications in recent years. The intraoral soft and hard tissue changes associated with systemic disorders, medications, chemotherapy, and radiation treatment have been well‐investigated and‐documented. Far less attention has been paid to the role of oral Infection as the etiology of systemic disorders. A literature review (1980–1994) is provided here focusing on well‐documented cases in which systemic disorders were caused by oral foci of infections. This paper attempts to raise the level of awareness of practitioners in considering possible systemic complications caused by oral infection. It also emphasizes the need for further longitudinal studies in this field involving healthy and medically compromised elderly individuals.
The measurement of mandibular cortical bone height in osteoporotic vs. non‐osteoporotic postmenopausal women
Authors: Watson E. Lea , Katz R.V. , Adelezzi R. , Gift Helen C. , Dunn S.M.
Published: March 2008

The asymptomatic progression of osteoporosis, in conjunction with the possibility of catastrophic disability, makes this disorder a major public health priority.

Various body sites, including the mandible, have shown susceptibility to decreasing bone density. In 1986, Benson et al. proposed a radiomor‐phometric technique called the Panoramic Mandibular Index (PMI) as an inexpensive, noninvasive dental technique for osteoporosis screening, although no osteoporotic subjects were included in their study.

The purpose of our study was to determine whether osteoporotic postmenopausal women would show a decrease in mandibular cortical bone height, as measured by the PMI Index, when compared with nonosteoporotic postmenopausal women.

Seventy‐two Caucasian females (33 cases/39 controls), aged 54–71 years old, were selected through records and screening via a dual‐energy x‐ray absorptiometry scan (LUNAR‐DEXATM).

ANOVA analysis Indicated no differences in the mean PMI between case and control groups (0.37 ± 0.15 and 0.38 ± 0.13, respectively; p = 0.69). Other techniques, such as computer digitized radiography, should be explored to test the validity of the PMI.
Odor identification in young and elderly African‐Americans and Caucasians
Authors: Jones Robin E. , Brown Calvin C. , Ship Jonathan A.
Published: March 2008

Olfactory function is affected by age and gender. However, there are few data on smell function in various racial/cultural groups, in particular, in different‐aged African‐Americans. Therefore, this study sought to determine if there is a relationship among age, gender, and race for smell identification. Sixty healthy African‐Americans and 60 Caucasians between the ages of 20–40 and 60–80 years were administered the University of Pennsylvania Smell Identification Test (UPSIT). Older persons, regardless of race, had lower UPSIT scores, were more likely to be microsmic and anosmic, and had increased chemosensory complaints. Smell performance among females was better compared with males. Overall, African‐Americans had lower UPSIT scores and age‐and gender‐adjusted percentile rank scores compared with Caucasians, but these differences were significant only among younger subjects. In addition, both young and old African‐Americans had no smell complaints. The results from this study suggest that age, gender, and race have an influence on smell identification.
A pilot study comparing three salivary collection methods in an adult population with salivary gland hypofunction
Authors: Mulligan Roseann , Navazesh Mahvash , Wood Gary J.
Published: March 2008

The purpose of this pilot study was to compare the reliability of three collection methods (draining, chewing of gum base, and the Saxon test) for whole saliva using a sample of middle‐aged and older ambulatory adults (n = 18) with proven salivary gland hypofunction. The results demonstrated high reliability (r values ranging from 0.91 to 0.80, p < 0.001) for all three methods. MANO‐VA analysis revealed significant (p < 0.001) differences in flow rates among the draining, chewing‐stimulated, and Saxon methods.
Chlorhexidine swabbing applications under various conditions of use in preventive oral care for persons with disabilities
Authors: Stiefel Doris J. , Truelove Edmond L. , Chin Mae M. , Zhu Xianglian C. , Leroux Brian G.
Published: March 2008

A sample of 44 adults with severe disabilities completed a randomized single‐blind cross‐over study testing chlorhexidine swabbing under various conditions: with/without prior dental prophylaxis, reduced frequency of application (2 vs. 5 times per week), and prolonged use (42 weeks). All subjects received therapeutic doses of 10 mL 0.12% chlorhexidine gluconate (Peridex, Procter & Gamble) and 10 mL 0.05% NaF applied with a Toothette®xs (Sage Products). Clinical effectiveness of chlorhexidine swabbing compared with placebo was previously reported. In the present study, while initial benefits were observed to be independent of dental prophylaxis, significant reductions in periodontal scores were sustained by a combination of dental prophylaxis and swabbing protocol, at reduced frequency of application and over prolonged time. High levels of acceptance and compliance by subjects/caregivers were maintained. Subjects/caregivers reported improvements in dental health as well as in attitude, quality of life, and smile. Chlorhexidine swabbing at maintenance frequency, combined with periodic dental prophylaxis, may offer an effective and pragmatic long‐term preventive regimen for persons with disabilities.
Compliance with fluoride gel use in irradiated patients
Authors: Epstein Joel B. , van der Meij Erik H. , Emerton Sue M. , Le Nhu D. , Stevenson‐Moore Peter
Published: March 2008

Patients who undergo radiation therapy that includes the salivary glands frequently experience severe xerostomia. The standard of care for these patients who have natural teeth has become daily application of fluoride by means of custom‐fabricated carriers. The purpose of this study was to determine patient compliance with fluoride gel application using carriers.

Using a structured verbal questionnaire, we interviewed 76 patients who had completed radiation therapy for head and neck cancer. Thirty of these patients were seen regularly in the dental clinic of the Cancer Agency (group 1); the remaining 46 were not seen on a regular basis (group 2).

Overall, 43% of patients reported using fluoride gel regularly (once a day). In group 1, 67% of patients used fluoride regularly, as did 28% of patients in group 2 (p = 0.001). There were no significant differences between the groups in frequency of toothbrushing and use of dental floss. Compliance with the use of fluoride in carriers was not associated with differences in other oral care measures in the two groups, which suggests that fluoride application in carriers achieves limited compliance in relation to daily oral health care measures. Regular follow‐up of patients after radiation therapy is needed to assess their need for, and compliance with, daily fluoride application.
Administration of chlorhexidine to persons with mental retardation residing in an institution: Patient acceptance and staff compliance
Authors: Burtner A. Paul , Smith Robert G. , Tiefenbach Stephen , Walker Clay
Published: March 2008

Chlorhexidine is beneficial in maintaining the oral health of persons diagnosed with mental retardation. Proper daily oral administration, however, depends upon the compliance of Caregivers as well as patient acceptance. If caregivers are non‐compliant or if patients are overly resistant to daily applications of chlorhexidine, its proven benefits will not be realized. This study evaluated two methods of chlorhexidine administration for patient acceptance and direct‐care staff compliance among 44 institutionalized individuals diagnosed with mental retardation.
Nurses' oral health assessments of nursing home residents pre‐ and post‐training: A pilot study
Authors: Arvidson‐Bufano Ulla Britt , Blank Lawrence W. , Yellowitz Janet A.
Published: March 2008

The purpose of this study was to determine if instruction in how to perform the MDS (Minimum Data Set) oral health assessment and RAP (Resident Assessment Protocol) Summary required by federal regulations will improve nurses' accuracy of the assessments. Fifty residents, admitted within 90 days before a training lecture, were assessed by 18 nurses. A 30‐minute training session demonstrated how to perform an oral examination, including hands‐on practice under a dentist's supervision. Seven to ten days after the lecture, the nurses reexamined the same residents. These assessments were compared with the admission assessments and a dentist's findings (reference). The results of this study indicate that a 30 minute training session made a significant difference in improving nurses' accuracy in completing the assessments with regard to oral health status and treatment need.
Factors influencing nurses' aides' provision of oral care for nursing facility residents
Authors: Chalmers Jane M. , Levy Steven M. , Buckwalter Kathleen C. , Ettinger Ronald L. , Kambhu Peter P.
Published: March 2008

Nurses' aides provide the majority of direct care for nursing facility residents. This study investigated aides' self‐reported oral care activities and personal, job, organizational, and resident factors associated with oral care. A 30‐item questionnaire was completed by 488 aides, and interviews were conducted with 65 of these aides. Aides were performing oral care activities for residents. Associations between some of the four groups of factors proposed and aides' oral care provision were found. Aides' attitudes toward oraI care, lack of time and staff to complete oral care, and behavioral and physical difficulties with residents may have affected the time spent by these aides in providing oral care. The study highlighted the need for further investigation and assessment of (1) aides' CNA training courses and (2) continuing oral health educational interventions in nursing facilities. Personal interviews were found to be a useful qualitative instrument for conducting dental research in nursing facilities. Further investigation is needed of interviews and other methodologies, such as observation, to supplement self‐report as a measure of aides' oral care activities.
Serum antibody response to Actinobacillus actinomycetemcomitans in Down's syndrome
Authors: Santos Rosemeire , Shanfeld Joseph , Casamassimo Paul
Published: March 2008

Persons with Down's syndrome (DS) are susceptible to severe and precocious periodontal disease. Several organisms have been implicated in the etiology of periodontal disease, including Actinobacillus actinomycetemcomitans (Aa). It is unknown whether circulating antibodies correlate with the severity of periodontal disease in DS. This study determined the circulating antibody titers to Aa in sera of DS and normal patients. Eleven DS patients with periodontal disease (pocket depth > 4 mm), five DS patients with gingivitis (inflammation and pocket depth < 3 mm), and 10 non‐DS healthy subjects had blood drawn and analyzed for antibody response to Aa. Conventional enzyme‐linked immunosorbent assay (ELISA) with goat anti‐human IgG was performed for Aa‐reactive serum diluted 1:200 to 1:12,800. Geometric mean titer was calculated, and significant differences were noted between the control group and the DS groups (p = 0.05), with the DS periodontal group having the highest response, followed by the DS gingivitis and normal controls, respectively. The DS groups were not significantly different. DS patients may exhibit a higher Aa antibody response, due to the presence of the organism, previous exposure, or in proportion to the extent of their periodontal condition.
Medical and functional status changes among nursing facility residents: Implications for dentistry
Authors: Kambhu Peter P. , Warren John J. , Hand Jed S. , Levy Steven M. , Cowen Howard J.
Published: March 2008

This paper reports the results of a study that investigated changes in the medical and functional status of nursing facility residents over a 2.9‐year period. Sixty‐seven residents from 10 nursing facilities were included in the study, which demonstrated that the residents' medical and functional status deteriorated during this period. These changes adversely affected the residents' ability to receive recommended dental treatment, suggesting that early, definitive, and often aggressive treatment approaches be used in providing services to these individuals.

This study found that the health status of 67 residents of a long‐term care facility declined markedly over a three‐year period. Based on these findings, we recommend that dental care for institutionalized older adults be provided as soon as possible after problems are diagnosed, and that treatment planning should account for the likelihood that opportunities for the provision of care may decrease with time. However, in the treatment of individual nursing facility patients, the experience and professional judgment of the dentist will continue to be critical in determining an appropriate course of action.
Nurses' dental assessments and subsequent care in Minnesota nursing homes
Authors: Thai Paul H. , Shuman Stephen K. , Davidson Gestur B.
Published: March 2008

Concerns about the quality of care in US nursing homes led to 1987 federal regulations mandating a national standardized resident assessment. This assessment, or Minimum Data Set (MDS), is performed by nurses on all residents and includes items to detect oral health problems. As yet, however, there are few data on the utility of these MDS oral health evaluations. In this study, we analyzed data from Minnesota nursing homes to determine the prevalence of oral health problems (“triggers”) requiring dental referral from the MDS, version 1 (Items L and M). We also analyzed the relationship between these MDS assessments and subsequent dental care. Data came from a 1994 Minnesota nursing home dental utilization study containing information on 466 residents (dental users and non‐users) sampled from 21 nursing homes. Nurses identified 3.2% of residents as having oral debris, 3.0% with broken, loose, or carious teeth, and only four (0.9%) residents with gum inflammation/soft tissue problems. Only one resident (0.2%) was identified with mouth pain. Regression analyses of data from 135 residents admitted since 1992 revealed no relationship between the presence of MDS “triggers” and subsequent utilization measured in visits/year and gross charges/year. Nurses' MDS assessments identified few oral health problems, and those problems identified did not translate into dental treatment, raising questions about the utility of the current approach.
Assessing the patient at risk for oral squamous cell carcinoma
Authors: Epstein Joel B. , Scully Crispian
Published: March 2008

Patients and health care workers require continuing education to promote knowledge of the signs, symptoms, and risk factors for oral cancer. This paper reviews the literature assessing diagnostic tools that are currently available or being developed, in order to assist in the biopsy site selection and subsequent diagnosis of patients at risk for oral cancer. There is a general consensus that oral examination of patients at risk for oral squamous cell carcinoma (SCC) should be conducted on a routine basis. However, there can be false‐positive and false‐negative findings. Toluidine blue has been shown to be useful as an adjunct to the clinical examination when used by experienced clinicians. Exfoliative cytology is not currently used as a routine measure for the evaluation of lesions of the oral mucosa, but further development and the application of biologic markers to cytologic specimens may increase its value. Fluorescent imaging of malignant lesions of the oral mucosa has been shown to be sensitive and specific in animal models but thus far has been reported in only one human trial.

The sensitivity and specificity of these techniques when used by general practitioners need to be assessed. Further, none of the above procedures has yet been shown to be a cost‐effective public health measure in screening for oral cancer.
Comparison of incoming dental school patients with and without disabilities
Authors: Stiefel Doris J. , Truelove Edmond L. , Martin Michael D. , Mandel Lynn S.
Published: March 2008

A survey of incoming dental school patients compared 64 adult patients (DECOD) and 73 patients without disability (ND), regarding past dental experience, current needs, and basis for selecting the school's clinics. The responses indicated that, for DECOD patients, clinic selection was based largely on Medicaid acceptance, staff experience, and inability of other dentists to manage their disability; for ND patients, selection was based on lower fee structure. Both groups expressed high treatment need, but the rate was lower for DECOD than for ND patients. More DECOD patients reported severe dental anxiety and adverse effects of dental problems on general health. Chart records revealed that clinical findings exceeded perceived need for both DECOD and ND patients. While both groups had high periodontal disease rates (91%), DECOD patients had significantly poorer oral hygiene and less restorative need than ND patients. The findings suggest differences between persons with disabilities and other patient groups in difficulty of access to dental services in the community, reasons for entering the dental school system, and in presenting treatment need and/or treatment planning.
Outcomes assessment in general practice residency programs
Authors: Binkley Catherine J.
Published: March 2008

In 1988, the Commission on Dental Accreditation implemented outcomes assessment as an accreditation standard for all programs it accredits. This paper describes outcomes assessment for general practice residency programs and provides a basic plan suitable for adaptation to individual program goals. Examples of goals, objectives, outcome measurement Instruments, data collection, and documentation requirements are provided.
Comparison of hospitals' dental consultation rates for head and neck cancer patients
Authors: Pyle Marsha A. , Sawyer Danny R.
Published: March 2008

Significant morbidity can result in patients being treated for head and neck cancer (H&NC) if dental disease is not under control before medical therapy is initiated. This study compared the rates of dental consultation in three teaching hospitals in a midwestern metropolitan area for patients being treated for H&NC. One of the hospitals has an oral and maxillofacial surgery (OMFS) clinic, while the other two hospitals have general dental and OMFS clinics. The medical records of 104 H&NC patients were retrospectively examined for a rate of referral to dental professionals, type of medical treatment, and oral complications with medical/surgical therapies. The results of the study showed statistically significant differences between hospitals related to the rates of dental consultation and oral complications. The dental consultation rates were low overall, ranging from 12.1 to 39.5%. These rates were not influenced by the presence of a general dental clinic. Because dental interventions can reduce the severity or prevent oral complications in H&NC patients, efforts to explain these results and enhance cooperative protocols represent a significant need.
Dental findings in an adult with Lowe's syndrome
Authors: Tsai Shin Ju Jennie , O'Donnell David
Published: March 2008

This paper describes the dental findings and care of a Chinese adult affected with oculo‐cerebrorenal syndrome—Lowe's syndrome—a rare, X‐linked recessive disorder, whose clinical manifestations include cataracts, mental retardation, and renal tubular dysfunction. Approximately 150 cases have been reported in the last 45 years. Little has been reported in the dental literature. This patient is described with particular reference to the dental findings, which include gross periodontal disease with severe bone loss, impaction of teeth In the permanent dentition, taurodontism, and underdevelopment of the maxilla and mandible. Dental treatment was aimed at arresting the periodontal disease and preseiving the remaining dentition.
Alternative therapies in the treatment of oral self‐injurious behavior: a case report
Authors: Romer Maureen , Dougherty Nancy , Fruchter Merav
Published: March 2008

This paper presents the case of a child with severe mental retardation and a history of oral self‐injurious behavior (SIB). While the behavior was refractory to a number of dental interventions, some success was achieved through a combination of behavioral therapy techniques and therapeutic touch (a relaxation technique). Etiologies of SIB are discussed, along with descriptions of alternatives to traditional dental therapy for this difficult problem.