bluuebunny/crossref_metadata_2025 huggingface dataset:
Preventive dental prosthesis for the patient with bulimia
Authors: RUFF JESLEY C. , ABRAMS RICHARD A.
Published: March 2008

Bulimia is a distinct diagnostic eating disorder with its most noted manifestation being the rapid ingestion of large quantities of food followed by its elimination through the mouth. Because of the dental implications of highly acidic stomach contents chronically being regurgitated, the dentist is in a unique position to help identify the patient with bulimia. Dental erosion is not only the most easily noted but also the most destructive of the many oral problems caused by bulimia. This report of case describes a preventive dental prosthesis that can be used by the patient with bulimia to protect those teeth that are most affected by dental erosion. The construction of the prosthesis is easily completed with materials in the dental office and provides a great service to the patient with bulimia.
Dental caries and administrative status occurrence in Finnish children with mentally handicapping conditions
Authors: PALIN‐PALOKAS TUIJA
Published: March 2008

Caries prevalence was recorded in 204 Finnish children, aged 9 to 10 years (125 had mentally handicapping conditions, 79 had no mentally handicapping conditions—identified in this paper as “normal”). The children with mentally handicapping conditions used preventive fluoride less frequently and their standard of oral hygiene was much poorer than that of the normal children. In the registered children with mentally handicapping conditions, caries occurrence was less than that in the normal children. In the unregistered children with mentally handicapping conditions, caries occurrence was greater than in the normal children. Irrespective of administrative status or severity of mentally handicapping conditions, these children received less dental treatment than the normal children with regard to treatment need. The need to further educate dental care personnel in the dental treatment of these children seems evident, especially as long as the dental care system is not able to meet the restorative dental treatment needs of the children with mentally handicapping conditions. The necessity of preventive regimens for these children should be emphasized even at low levels of caries occurrence.
Dental considerations in the treatment of patients with oculoauriculovertebral dysplasia (Goldenhar's syndrome)
Authors: BORAZ ROBERT A.
Published: March 2008

The medical and dental problems of patients with oculoauriculovertebral dysplasia (Goldenhar's syndrome) are presented. The particular dental problems of diminished or absent parotid gland secretion and hemifacial microsomia are detailed. A case is presented to demonstrate problems common to the management of these patients as well as appropriate treatment recommendations. A suggestion for an experimental, nonsurgical approach to treatment of the hemifacial microsomia is also discussed.
Dental health knowledge in a group of inner‐city older adults
Authors: ODRICH JOHANNA , LEVINE JOANNE
Published: March 2008

We studied a group of inner‐city older volunteers to evaluate their dental health knowledge. The respondent group, though small (n = 23), presented data that suggest that there is a need for specific information on fluoride use and benefits as well as on the utility of home and professional dental care. The findings also suggest that communicating in the older adults' native language might be advisable for ensuring comprehension of vital health information.
Oral manifestations of drug therapy
Authors: FELDER ROBERT S. , MILLAR SUZANNE B. , HENRY ROBERT H.
Published: March 2008

Increasingly, patients with complicated medical problems are coming to dental offices for treatment. These patients report using a variety of medications to control one or more chronic conditions. Many of these medications produce changes in the mouth because of toxic overdoses, side effects, allergic reactions, or as a consequence of the primary action of the drug. These effects include: xerostomia, gingival hyperplasia, candidiasis, mucositis, stomatopyrosis, gingival bleeding, petechia, salivary gland problems, intrinsic stain, cheilitis, erythema multiforme, lichen planus, ulcerations, taste changes, tardive dyskinesias, and soft tissue pigmentation. This article discusses presentations and causes of oral changes secondary to systemic drug use.
Fevers of unknown origin in patients requiring mechanical ventilation: an odontogenic problem?
Authors: CORDON MARCIA A. , GOLDBERG NORMA BOONE , GOLDBERG ALLEN FRED
Published: March 2008

Patients who are on continuous monitors and mechanical ventilators, and who are receiving medical care in an intensive care setting, do not meet the usual expectations for dental care. Two examples of odontogenic contribution to fevers of unknown origin are presented in the context of treatment of continuously monitored patients with mechanically supported respiration. It is intended that these cases show the need for active dental consultation and participation by dentists in the care of the patient who is chronically ill and who cannot be brought to the traditional dental care setting.
Oral complications of cancer chemotherapy: prevention and management
Authors: NAYLOR GREGORY D. , TEREZHALMY GEZA T.
Published: March 2008

Cancer chemotherapy is used to destroy rapidly proliferating cells. However, normal cells with high mitotic indexes are also affected by chemotherapy, particularly those in the oral and gastrointestinal mucosa and the hemopoietic system. Ultimately, this may lead to certain oral complications of cancer chemotherapy such as mucositis, infection, hemorrhage, xerostomia, and neurologic and nutritional disorders.

The prevention and management of these oral complications that may result from the chemotherapeutic management of cancer are discussed here.
Feeding disorders research and teams: a new challenge for dentistry
Authors: JUDD PETER L. , KENNY DAVID J.
Published: March 2008

Feeding disorders, which include masticatory and cerebral disabilities, present a major problem for disabled persons, but only in the last decade have health professionals shown an increased interest in the diagnosis and management of patients with such problems. Dentists are experts in the diagnosis and treatment of disorders of the oral‐facial region, yet they have either worked in intradisciplinary isolation or have not demonstrated their interest in patients with feeding disorders. Consequently, those involved in the assessment and treatment of persons with feeding disorders are not aware of the contributions dentists have made to the basic and clinical data base of feeding assessment and therapy. Dentistry is simply not mentioned in rehabilitation. The opportunity now exists for dentistry to inform others of our expertise in the field from both a research and a clinical perspective. The basic and clinical base of dental therapeutics and its role in the diagnosis and treatment of disorders of the masticatory apparatus and of swallowing are reviewed here. It is hoped that this review will stimulate interest among dentists to take part in the rehabilitation of patients with feeding disorders through the use of the extensive data base within the profession.
Interim dentures for the older patient who is medically compromised
Authors: HONDRUM STEVEN O.
Published: March 2008

The concept of interim or transitional dentures is appropriate to the treatment of older patients who are hospitalized or medically compromised. This paper briefly reviews the emotional and physiological needs of these patients, and illustrates a case in which an interim denture technique was beneficial.
An educational consultative model for general practice training programs
Authors: MEYEROWITZ CYRIL , GLADSTEIN GERALD A. , HANDELMAN STANLEY L.
Published: March 2008

A behavioral science consultant has been retained by two hospital‐based general practice residency (GPR) programs and one advanced program in general dentistry at the University of Rochester, and Eastman Dental Center, NY. This consultant is available throughout the year and serves as an external consultant who knows the programs well, and can be used as a source of information on various existing and potential issues and problems. The model used by the consultant has been inductive and is based on the expressed needs of faculty members, trainees, and directors. A number of issues or problems were identified, including faculty member morale, evaluation of residents' growth, resident and supporting staff relations, curriculum development, cooperation with other departments and institutions, and dealing with patients' anxiety to dental treatment. For each, a specific plan was developed. Various types of experiential techniques were used, including brainstorming, role playing, and taping and feedback. Didactic activities included minicourses and workshops in which standard teaching methods were used, such as lectures, seminar discussions, literature study, and demonstration. The model has evolved, and as each activity has succeeded, more faculty members have sought help from the consultant.
Oral health care attitudes of nursing assistants in long‐term care facilities
Authors: KAZ MARY ELIZABETH , SCHUCHMAN LYNN
Published: March 2008

This study compares the oral health attitudes of nursing assistants employed in facilities served by mobile dental units, with attitudes of nursing assistants employed in facilities that are not served by mobile dental units.

Seventy‐seven nursing assistants were selected from seven long‐term care facilities. Mobile dental service was available in four of the seven facilities. Certified nursing assistants completed a three part questionnaire that included demographics, personal oral health care habits, and an attitudinal section based on Kegeles' health belief model, measured by a Likert‐type scale.

Demographically, a majority of assistants in each group were female, worked the first shift, and had worked at their respective facilities from 6–12 months. On the average, assistants who worked at facilities that were not served by a mobile dental unit had more years of postsecondary education. Both groups had similar in‐service dental histories for the previous year.

A greater number of nursing assistants at facilities that were not served by a mobile dental unit reported having dental checkups within the past year. The majority of assistants in each group brushed their teeth twice per day, used a medium or hard toothbrush, and did not floss.

Attitudinal mean scores were similar in all the areas of the health belief model, with the exception that assistants who were not served by a dental unit showed a greater mean score for the area of susceptibility. Through use of the t‐test, the area of susceptibility was found to be statistically significant (P= .05) between the two groups.

Results suggest nursing assistants' exposure to mobile dental services may not strongly influence oral health attitudes.
Oral hygiene for the severely handicapped: clinical evaluation of the University of Mississippi dental care system
Authors: Fitchie James G. , Reeves Gary W. , Comer Robert W. , Gatewood R. Scott , Campbell E. Ann , Rommerdale Eric H.
Published: March 2008

The study reported here was a clinical evaluation of an automatic toothbrushing device for persons with severe handicapping conditions. This device, the University of Mississippi dental care system, is designed for patients who are unable to control their arms and hands. The effectiveness of this device was compared to routine (ordinary, manual) regimens of oral hygiene through use of gingival (Loe‐Silness) and plaque (Turesky) indexes (GIs, PIs). Plaque indexes for patients under routine care averaged 2.11; PIs for patients under the dental care system averaged 1.47. Based on Ebbutt's extra period changeover design model, the t‐test for difference in plaque scores is significant (P < .001). The results indicate that the University of Mississippi dental care system improves the patients' ability to independently control plaque.
Special patient care in the undergraduate curriculum
Authors: Reed Michael J.
Published: March 2008

I have related a series of human experiences. which when linked with environmental factors, have led to a set of beliefs and commitments that are integral to our responsibilities as educators and dental care providers.

The struggle to implement a very ambitious and challenging program in special patient care is essential if we are to fulfill our responsibilities as educators.
Profile and expectations of students entering gener practice residency programs
Authors: Gogan Catherine M. , Davis Elaine L.
Published: March 2008

Although various studies have attempted to evaluate the success of general practice residency (GPR) programs in providing postdoctoral training, little work has investigated the motivation for senior dental students opting for such training compared with entering directly into private practice. Questionnaires were administered to 58 seniors at the State University of New York at Buffalo School of Dental Medicine 1 month before graduation to determine possible differences between those entering GPR programs and those planning to enter private practice. The survey also examined the goals of dentists about to enter GPR programs and compared them with the training goals determined by the Commission on Dental Accreditation.

Although 75% of those entering GPR programs cited additional clinical experience as the reason for choosing this step in their careers, the most frequent response from those entering directly into private practice concerned the financial benefits. Also, of the respondents about to enter GPR programs, only one student indicated a desire for training in hospital dentistry.

Although this survey was relatively limited in size, it appears that advanced instruction in the management of patients with complex health care problems is not one of the primary motivating factors for students considering residencies. This may indicate a need at the pre doctoral level for greater instruction in changing health care demographics and in the training goals of general practice residencies, to continue to attract qualified dental graduates with goals compatible with those of GPR programs.
Treatment of self‐induced trauma in a patient with cerebral palsy
Authors: Sonnenberg Edward M.
Published: March 2008

Factitious illness can be a problem for disabled patients who experience recurrent trauma or irritation to a particular part of the body. In this case, the patient's recurring lip trauma combined with his overlying physical disability presented a problem not easily solved with prior methods of treating lip trauma. Modifying the standard orthodontic appliance solved the problem; after a short period of use, the patient dropped the harmful habit that caused the lip trauma. The appliance was no longer needed.
Referral of the handicapped, disabled, or infected patient
Authors: Wakeen Linda M.
Published: March 2008

Author's Note: This paper was presented in April, 1990 at the 2nd National Conference on Special Care Issues in Dentistry. Since that time, Congress has adopted the Americans With Disabilities Act (the Act), Although the paper has been edited to include a brief discussion of the Act, it does not fully explore the legal ramifications of the Act and the significant effect the Act will have in replacing state and local laws that regulate discrimination in the dental office.
Aplastic anemia: current concepts and dental management
Authors: Valdez Ingrid H. , Patton Lauren L.
Published: March 2008

Aplastic anemia (AA) is a rare blood dyscrasia in which the peripheral blood cells are decreased because of bone marrow failure. The clinical course reflects the severity of pancytopenia and is unpredictable for the individual. Hemorrhage and infection remain the major threats to these patients. Recent advances in transfusion medicine, infection management, bone marrow transplantation, and immunosuppressive therapy have improved survival of patients with AA. Oral manifestations of AA are common and may have serious sequelae. Two cases of acute periodontal infection associated with AA are presented. Dental management guidelines are presented in the context of interdisciplinary care.
A scoring system for the quantitative evaluation of oral mucositis during bone marrow transplantation
Authors: Walsh Laurence J. , Hill Graham , Seymour Gregory , Roberts Andrew
Published: March 2008

A system for assessing the severity of mucositis in patients undergoing bone marrow transplantation (BMT) is presented. Ten criteria were graded to give component scores together with a total score. The overall severity score ranged from 0 through 21. Scores were assigned three times daily by nursing staff members and verified daily by the attending dental and medical practitioners. Total scores were highly reproducible and were related to the severity of neutropenia. Variation between sequential total scores was not related to interexaminer variation but rather to changes in the severity of oral mucositis. Component scores provided a useful means for transmitting oral health information between health care personnel. Total scores were used to regulate the nature and frequency of oral hygiene procedures for patients undergoing BMT as well as other hematology/oncology patients. Application of this oral assessment system to other institutional settings may be beneficial.
A national survey of dental protocols for the patient with a cardiac transplant
Authors: Boraz Robert A. , Myers Ronnie
Published: March 2008

To assess current practice of dental protocols for the patient with a cardiac transplant, a 19‐question survey was designed and distributed to all general practice and oral surgery residency programs accredited by the American Dental Association. Analysis of the survey demonstrates a great amount of variability in the protocols used in this field.

With the discovery of cyclosporine in 1976 by Borel, organ transplantation surgery has become increasingly common. This is especially true of heart transplantation. Success rates have increased dramatically in recent years; they are now documented at 81% at 1 year, 74% at 2 years, and 50% at 5 years. The two primary causes of death after cardiac transplantation are organ rejection and infection.

Cyclosporine and azathioprine have improved the delicate balance between preventing organ rejection and encouraging infections. However, numerous bacterial infections, viral infections, and fungal infections may originate in the mouth and become life‐threatening problems. For this reason, dentists must be members of the cardiac transplant teams and a nationally accepted dental protocol should be devised to ensure proper patient care.
Objective evaluation of an airway management appliance in infants with craniofacial anomalies
Authors: Wood A. Jeffrey , Farrington Frank H.
Published: March 2008

This study describes an intraoral appliance designed to reposition the tongue to facilitate a patent airway for infants experiencing respiratory distress. Transcutaneous pulse oximetry is used to objectively evaluate this method of airway management in 15 neonates with craniofacial anomalies. The appliance can significantly improve the blood oxygen saturation level in the infants in whom it is used (P<.0001).
An undergraduate dental education program providing care for children with disabilities
Authors: Marinelli Rosalie D. , Ferguson Fred S. , Berentsen Barbara J. , Richardson Peggy S.
Published: March 2008

In 1981, the School of Dental Medicine at Stony Brook provided treatment for disabled children as part of the regular clinical rotation in the Department of Children's Dentistry. In 1988, 64% of the graduates of this program responded to a questionnaire survey (157 questionnaires sent, 97 returned). Forty‐eight percent stated that they regularly treat this population in their current practices. Of those not regularly treating this population, 40% attributed this to specialty practice limitation. The majority of those responding (62%) reported that the experience this training provided was relevant to their current practice of dentistry
Polycythemia Vera: dental management considerations
Authors: Badner Victor M. , Lawrence Christine , Mehler Shalom
Published: March 2008

This article presents a case of dental treatment in a patient with polycythemia Vera. Polycythemia Vera is an uncommon myeloproliferative disease that can have hematologic and surgical implications. The concerns and consequences of dental care in these patients are discussed and recommendations for dental treatment are given.
Mucous membrane pemphigoid: a disease of the elderly
Authors: Antonelli John R. , Bachiman Rima , Scherer Warren
Published: March 2008

Mucous membrane pemphigoid (MMP) is a vesiculo‐bullous, mucocu‐taneous disease that generally affects elderly people. The diagnosis of mucous membrane pemphigoid may be overlooked since the disease is often confined to the mouth and desquamative gingivitis may be the only symptom. Gerodontic patients with this condition are often diagnosed as having “desquamative gingivitis” without obtaining the proper therapy to control chronic pain and effect disease remission. The discomfort associated with eating may prevent many elderly patients from obtaining adequate nutrition. Topical and/or systemic corticosteroid therapy are the only available methods of managing this condition. Immu‐nologic studies support the autoimmune nature of MMP and infer that it may be a variant of bullous pemphigoid.
Social work in a dental program for the developmentally disabled
Authors: Wile Karin E. , Ferguson Fred S.
Published: March 2008

This article discusses the role of a social worker in a dental school based program for the developmentally disabled. Developmentally disabled people constitute a heterogeneous population with problems that often prevent them from receiving appropriate dental services. A social worker In the dental care setting can help this population access dental services. Data gathered during a 2‐year period support the hypothesis that patients living at home present more obstacles to dental care and require more social work intervention in obtaining dental care than patients living in residential settings.
Attitudes of older versus younger adults toward dentistry and dentists
Authors: Abrams Richard A. , Ayers Curt S. , Lloyd Patrick M.
Published: March 2008

A total of 416 adults were interviewed by telephone to gauge their attitudes toward dentistry and dentists. Attitudes of those age 55 and older were compared with those younger than age 55. It was found that 72% of those 55 and older had not visited a dentist In the previous 2 years because they felt it was not necessary; 38.5% of respondents younger than 55 gave this reason. Only 15% of those 55 and older reported that high costs kept them away from the dentist
Erythema multiforme: a literature review and case report
Authors: Krippaehne James A. , Montgomery Michael T.
Published: March 2008

Erythema multiforme is a florid mucocutaneous disease characterized by oral, cutaneous, and ocular manifestations. The cutaneous lesions are pathognomonic because of their unique “target‐like” appearance. A severe form of EM has been termed “Stevens‐Johnson Syndrome”. Although the etiology of EM is unknown, much of the research suggests an immunological association with HSV. The diagnosis of EM is based on signs and symptoms, and a differential diagnosis should include other ulcerative, mucocutaneous diseases, such as erosive lichen planus, pemphigus, varicella zoster, ANUG, TEN, aphthous stomatitis, and primary HSV. Therapeutic measures are palliative, including a soft bland diet, topical anesthetics, and corticosteroids. A case of EM is described which underscores the appearance of the disease and its clinical course.
The role of salivary function on oropharyngeal colonization*
Authors: Gibson Gretchen , Barrett Elizabeth
Published: March 2008

Aspiration of oropharyngeal flora is the most common route of acquiring Gram‐negative pneumonia, a major nosocomial infection. Epidemiologic studies indicate that the elderly are at increased risk for developing these life‐threatening pneumonias. The primary objective of this study was to determine the effects of salivary oral defenses against Gram‐negative colonization. The study population consisted of 41 male outpatients, age 70 and older, seen at the Denver VAMC. The group included subjects with both diminished and normal salivary flow. Each subject answered a questionnaire regarding overall health, medication use, and symptoms of salivary dysfunction. We then collected whole saliva, unstimulated and stimulated parotid saliva, and performed a throat swab on each patient. For each throat culture, analysis was done to identify Gram‐negative bacteria. Flow rates between colonized (n = 6) and noncolonized subjects (n = 34) were compared. While there were no significant differences in the flow rates between the two groups, a trend was noticed in that flow rates were lower for all three flow measures in the colonized group (whole, 22% decrease; unstimulated, 22% decrease; and stimulated, 28% decrease). These preliminary findings suggest that subjects with diminished salivary flow may possibly be at Increased risk for oropharyngeal Gram‐negative colonization. Research on the role that saliva plays in oropharyngeal bacterial colonization is continuing
A national survey of medical risk assessment instruction in general practice residency programs (Part I)
Authors: Napholz Linda , Kelly William H.
Published: March 2008

Formal and structured training in medical risk assessment (MRA) has been a requirement in general practice residency (GPR) programs since their Inception in 1972. Institutions offering GPR programs frequently differ in the levels and types of available resources necessary to implement this training. Program directors have expressed significant concerns that this training is difficult to provide, especially in the area of physical examination. The literature has not yet established how or if programs have organized their curricula to conform to accreditation standards in MRA established by the American Dental Association's Commission on Dental Accreditation. The purpose of this study was to conduct a nationwide survey of all GPR programs to Identify program characteristics and resources, didactic and clinical educational methods, and perceived achievement of ADA Standard Fourteen for MRA training. Recommendations for further research are also given. Results will be reported in this paper, the paper following in this issue, and an additional paper to be published in a forthcoming issue.
A national survey of medical risk assessment instruction in general practice residency programs (Part II)
Authors: Kelly William H. , Napholz Linda
Published: March 2008

This is the second part of a three‐part series reporting a national survey of general practice residency directors and their evaluation of the medical risk assessment (MRA) instruction curriculum in their programs. The purpose of Part II is to evaluate the degree of success of the Implementation of the ADA Commission on Accreditation's standard for MRA programs. Acceptable levels of achievement were attained in most areas of basic and intermediate‐level skills. However, approximately one‐third to one‐half of general practice residency directors report that they are not achieving the standard for some intermediate or advanced assessment skills. When various instructor categories were compared, physicians scored significantly higher than oral and maxillofacial surgeons or other dentists in their ability to achieve acceptable outcomes in MRA instruction. The results of this survey, coupled with available literature concerning medical risk assessment instruction, support that changes in the undergraduate curriculum, a mandatory additional year of training, or modification of defined goals and outcomes should be considered.
Detecting cardiac valvular pathology in patients with systemic lupus erythematosus
Authors: Luce Ernest B. , Presti Charles F. , Montemayor Irma , Crawford Michael H.
Published: March 2008

Systemic lupus erythematosus (SUE) is associated with multiple cardiac complications, including valvular damage and an increased risk of bacterial endocarditis. The purpose of this study was to evaluate prospectively a group of patients with SLE for the presence of valvular abnormalities in order to assess their candidacy for antibiotic prophylaxis prior to invasive dental procedures. Of the 43 participants, 19 (44%) had echocardiographic evidence of valvular pathology; however, only seven (16%) had a physical exam consistent with pathologic valve anatomy or function. Because of the high percentage of SLE patients with valvular abnormalities, and the poor sensitivity of the physical exam, referral to a cardiologist for echocardiography is suggested prior to invasive dental care for patients with SLE. If cardiac valvular pathology is detected, antibiotic prophylaxis should be considered.
Treatment outcomes for specific subtypes of dental fear: Preliminary clinical findings
Authors: Enneking Deborah , Milgrom Peter , Weinstein Philip , Getz Tracy
Published: March 2008

In order to examine the clinical treatment outcome for dental fears, we examined 111 active patient records retrospectively using an 80‐item structured format. Subjects were from three fear subtypes: needle phobic (N = 15), gagger (N = 11), and non‐specific dental fear (N = 85). Mean subtype Dental Fear Survey scores ranged from 72.3 to 81.0. Patients received either behavioral therapy alone (N = 85) or behavioral therapy with a nitrous oxide or IV sedation adjunct (N = 26). Mean psychological treatment time was 3.9 hours (SD = 2.8 h) and did not differ by fear subtype (p > 0.05). All patients successfully completed initial dental treatment. Relapse of fear requiring additional psychological treatment occurred only in the nonspecific fear subtype (rate = 11.2%). Patients receiving pharmacological adjuncts to behavior therapy (nitrous oxide) experienced less relapse.
Are dental practices less productive with older patients? Comparison of alternative output measures
Authors: Shuman Stephen K. , Loupe Michael J. , Davidson Gestur B. , Martens Leslie V.
Published: March 2008

This study assessed the effects of increased visits by older dental patients on alternative measures of time‐ and dollar‐based practice productivity. The Minnesota Dental Practice Analysis System was used for analysis of data from 31 practices (12,818 patient visits) reporting increased visits by older adults between June, 1980, and December, 1984. Results suggested that the productivity effects associated with older patient visits were highly dependent on the practice output measure selected. While increased visits by patients age 70 and over were associated with increased monetary productivity per patient visit, time and monetary productivity per practice day were found to decline. An association between increased proportions of older patient visits and increased dentist minutes per visit appeared to account for this. This econometric analysis tends to support the notion that dental practices are less productive with older patients
An evaluation of the effectiveness of four mechanical plaque‐removal devices when used by a trained care‐provider
Authors: Kambhu Peter P. , Levy Steven M.
Published: March 2008

Many care‐dependent elderly individuals live in nursing homes and must depend on nursing home aides for oral hygiene care. It is generally agreed that the level of oral hygiene care among care‐dependent nursing home residents is less than optimal. Two reasons are time constraints and the difficulty involved in brushing other individuals' teeth. The identification of effective and efficient plaque‐removal devices for use by care‐providers should make it easier for nursing home aides to incorporate effective oral hygiene care into their daily routines. This pilot study was undertaken to determine the relative effectiveness of four plaque removal devices with different basic designs when used by a non‐professional careprovider on 10 healthy volunteers. A brush with curved bristles on the lateral aspect of the brush head and short straight bristles in the center (Collis‐curver̀) and an electric toothbrush with tuffs that rotate reciprocally (Interplakr̀) were the most effective, a conventional brush (Oral‐Br̀) was somewhat less effective, and a disposable foam brush (Abcor̀) was least effective and similar to the prebrushing plaque score (baseline). All the volunteers reported that the Collis‐curver̀ as the most comfortable brush, and the care‐provider reported that it was the easiest to use.
A suggested curriculum for teaching conscious sedation in advanced general practice programs: GPR and AEGD
Authors: Glassman Paul , Garrison Raymond
Published: March 2008

Previously published national guidelines related to the teaching and performance of conscious sedation in dentistry have not included guidance in this area for program directors of General Practice Residency and Advanced Education in General Dentistry Programs. A suggested curriculum is presented here for use by program directors of such programs who wish to design training experiences in their own programs or as a reference for program directors who wish to compare their programs with experiences provided in other locations. Guidelines are provided for facilities, equipment, personnel, records and preparation necessary to perform conscious sedation procedures, as well as goals, objectives, and evaluation methodology for training residents in conscious sedation.
Dental fear treatment outcomes for substances use disorder patients
Authors: Milgrom Peter , Weinstein Philip , Roy‐Byrne Peter , Tay Khoon‐Mei
Published: March 2008

In order to examine the clinical treatment outcome for dental fears, we compared the records of 18 phobics who had co‐morbid substance use disorder (SUD) with those of 27 subjects who were phobic without concomitant SUD. Outcomes were determined by calculation of changes in the Dental Fear Survey (DFS score. Subjects were classified by the Structured Clinical Interview for DSM‐III‐R. All subjects received exposure based behavioral therapy with or without pharmacological adjuncts. All 27 subjects in the non‐SUD group and 15 of 18 (83.3%) of subjects in the SUD group improved. Non‐SUD subjects improved more than SUD's on the avoidance and specific fear, but not on the physioiogical upset, dimensions of the DFS.
Preanesthesia transfusion and sickle cell anemia patients: Case report and controversies.
Authors: John B , Thornton, DMD, MA  , Deirdre R , Sams, DDS, MS
Published: March 2008

Preoperative transfusion of sickle cell anemia (SCA) patients prior to general anesthesia is considered a routine procedure to ensure adequate levels of normal adult hemoglobin A to prevent a sickle cell crisis. Blood transfusion risks have led some clinicians to question this procedure. A case report is presented in which a SCA patient developed a delayed hemolytic reaction from a transfusion given prior to dental treatment under general anesthesia. The controversy of transfusion in this patient group is presented
A national survey of medical risk assessment instruction in general practice residency programs: Part III
Authors: Kelly William h. , Napholz Linda
Published: March 2008

This is the third of a three‐part series reporting a national survey of general practice residency directors and their evaluation of the medical risk assessment (MRA) instruction curriculum in their programs. The purpose of Part III was to report the program directors' narrative comments in response to six essay‐style questions regarding problems, suggestions, and innovations encountered in their efforts.

Availability of physician faculty was the most frequently mentioned problem in providing MRA instruction for general practice residents. Defining and communicating goals and objectives were also of major concern. Proposed solutions included attempts to recruit additional physician faculty and improved supervision and management of program activities, especially off‐service rotations.

There was no consensus as to what future modifications the Commission on Dental Accreditation should make in its approach to teaching MRA as defined in Standard 14. The majority of responses indicated a desire to decrease total experience, especially in physical examination requirements other than head and neck
Management of spontaneous osteoradionecrosis: A case report
Authors: Southerland Janet H. , Patton Lauren L.
Published: March 2008

Spontaneous osteoradionecrosis of the mandible is an oral complication of radiation therapy. Bone necrosis, unrelated to trauma or infection, is more common when high doses of radiation, including interstitiai implants, are delivered to a large bone volume. Management provides a challenge for the dentist and patient. When conservative, nonsurgical treatment is unsuccessful, surgical debridement with adjunctive hyperbaric oxygen therapy and eventual mandibular resection may result. A case of spontaneous osteoradionecrosis is described which underscores the clinical course of the disease and treatment outcomes.
Dietary intake, food preferences, stimulated salivary flow rate, and masticatory ability in older adults with complete dentitions
Authors: Ernest Sheryl L.
Published: March 2008

This study was conducted to determine whether significant relationships exist among the masticatory ability, chewing‐stimulated salivary flow rate, food preferences, and dietary intake of older adults with complete natural dentitions. Pearson r correlations revealed that significant relationships existed between: (1) salivary flow rate and eighteen out of the twenty‐two nutrients comprising dietary intake; (2) masticatory ability and six out of the twenty‐two nutrients comprising dietary intake; and (3) the perceived frequency of ingestion of the thirteen test foods and the dietary intake of thirteen of the nutrients comprising dietary intake. No significant relationships were found among salivary flow rate, masticatory ability, and food preferences. The amount of saliva accumulated in the mouth during the consumption of food may play an important role in food choices and subsequent intake of nutrients by older adults. Masticatory ability may not play as large a role as salivary flow rate in determining the selection and consumption of nutrient‐rich foods.
Israeli dentists: A survey of infection control office practices and care of medically compromised patients
Authors: Trieger Norman , Schlesinger Nitzan , Kaufman Eliezer , Mann Jonathan
Published: March 2008

A survey was conducted by interviewing a randomly selected sample of practicing dentists in Israel in 1991. The aim of this study was to evaluate methods of infection control in current use and to learn about the access to care for medically compremised patients.

One hundred seventeen dentists were interviewed. This group represented a majority of graduates from Israeli schools (66).

With respect to infection control, only 28% of the population surveyed routinely uses gloves, but 43% use steam autoclave, and 70% use dry‐heat sterilization.

A very high percentage (87%) took a verbal medical history, while a small minority (27%) had their patients fill out a written questionnaire. Only occasionally was the name of the patient's physician requested or recorded, implying a flaw in interprofessional communications. Only 26% of the dentists said they would treat patients with hepatitis and/or AIDS. Only about half the dentists accepted patients on chemotherapy or radiotherapy or those who were taking anticoagulant drugs.

Physical access for dental patients in wheelchair or stretcher was markedly limited, with referral to regional hospitals the routine for these patients.
Fragile X (Martin‐Bell) syndrome
Authors: Kulkarni Gajanan V. , Levine Norman
Published: March 2008

Fragile X syndrome is a common condition resulting from a cytogenetic abnormality in the X chromosome. Mental retardation, characteristic facies, and large testes are some of the most important characteristics of the condition. The relatively high incidence of the syndrome—approximately one per thousand—the high incidence of cardiac anomalies in these individuals, the oral and facial features associated with the condition, and the paucity of reported cases in the dental literature make it particularly interesting to dentistry. Here we report the case of a 12‐year‐old male, including the cytogenetic and cephalometric analyses, presenting with some of the classic features and some features not commonly reported
Neuropathological chewing: A dental management protocol and treatment appliances for pediatric patients
Authors: Hallett Kerrod B.
Published: March 2008

Neuropathological chewing in hospitalized, comatose patients can occur from severe brain damage following a closed head injury, hypoxia, and septic shock. The dental management protocol developed by the Department of Dentistry at the Royal Children's Hospital, Melbourne, Australia, is presented. Treatment appliances utilizing a mandibular cast‐silver cap splint with acrylic bite blocks and a maxillary mouthguard with acrylic bite blocks are discussed.
Prevalence of oral methicillin‐resistant Staphy/ococcus aureus in an institutionalized veterans population
Authors: Owen Mary K.
Published: March 2008

Methicillin‐resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen now of great concern in nursing homes and other institutional settings. MRSA has been well‐documented to inhabit the nares, skin wounds, and respiratory tract, but little is known about its presence in the oral cavity. In this study, all patients admitted to an 80‐bed VA extended care facility were cultured weekly for 12 weeks to detect the presence of MRSA in the nares, wounds, in‐dwelling devices, and the oral cavity. Of a total of 107 participating subjects, 20 cultured positive for oral MRSA, yielding a prevalence of 18.7%, compared with 19.6% prevalence in the nares—the traditionally accepted screening site for MRSA. There was a 91.6% agreement between oral and nasal carriage in subjects, but four of 107 subjects (3.7%) cultured positive for oral MRSA without evidence of nasal carriage. These results suggest that oral MRSA may be more common than previously thought in high‐risk settings, with a prevalence comparable with that of nasal infection. Further investigation is necessary to characterize the factors associated with the presence of MRSA in the oral cavity
Assessment of the oral health status of the medically compromised homebound geriatric patient: A descriptive pilot study
Authors: Paunovich Eleonore
Published: March 2008

This pilot study was designed to assess the oral health status of homebound elderly and determine their dental care needs. Fifty‐one subjects enrolled in a hospital‐based home care program were recruited for this study. Subjects were visited in their homes by both a dentist and a physician. Care plans and medications were reviewed for each subject. Initial assessments to receive informed written consent were conducted by the physician. Oral health assessments by the dentist included comprehensive examinations for sot? tissue pathology, periodontal health, caries, restoration, and tooth condition, as well as existing prosthesis assessment, plaque index, and grip strength. A Physical Self‐Maintenance Scale was administered in order to determine the level of dependence of this population for their oral hygiene self‐care.

The oral health status of these homebound elderly was found to be poor, with 84% of the subjects requiring dental care.
Oral‐surgeon‐reported incidence of complications related to simple extractions in adults
Authors: Vogler James C. , Karuza Jurgis , Miller William A.
Published: March 2008

This study examined the incidence of complications related to simple forceps extractions in male and female adults. A total of 413 patients (156 young adults, 150 middle‐aged, and 107 older adults) presenting for extraction in the practices of 20 privately practicing oral surgeons was followed prospectively for a 30‐day period. A total of 74 patients had complications. No age differences were found in the incidence of operative or postoperative complications. Reasons for extraction, number of teeth extracted, or the time required for extraction did not vary among the age groups. Oral surgeons were more likely to prescribe postoperative analgesic medications to patients already on medications. Tendency to prescribe analgesic medications was unrelated to patient age. Results indicate that among community‐dwelling adults, age is not a risk factor for complications resulting from simple extractions.
Testing tooth brushing ability of elderly patients
Authors: Felder Robert , Reveal Marge , Lemon Sherry , Brown Claudia
Published: March 2008

An individual's ability to perform adequate oral care may become jeopardized by medical and physical insults associated with the aging process. Declines in oral care abilities may be difficult to identify, and usually go unnoticed and unaddressed. This study examined a tool developed to assess tooth brushing ability in elderly patients. The Tooth brushing Ability Test (TAT) was examined for its ability to predict brushing effectiveness (measured by plaque levels) and to determine its interrater and intrarater reliability. Fifty‐eight dentate subjects, age 65 and older, from the Portland Veterans Affairs Medical Center and a community nursing home participated. Results showed highly significant Spearman correlations between TAT scores and plaque levels (r = 0.719; p < 0.000). Correlations also revealed high interrater (r = 0.87) and intrarater reliability (r = 0.82). The results suggest that the TAT is a practical and effective screening tool for assessing oral self‐care ability in the elderly.
Hypoxemia due to inserting a bite block in severely handicapped patients
Authors: Ogasawara Tadashi , Watanabe Tatsuo , Hosaka Kazuo , Kasahara Hiroshi
Published: March 2008

In severely handicapped patients with severe cerebral palsy, stridor can be caused by a bite block in the mouth. So that dental treatment can be performed safely for these patients, the effect of a bite block on the respiratory function of 30 severely handicapped patients was investigated with two pulse oximeters.

Of the 30 subjects examined, 96.7% showed SpO2 values above 95% in the resting state, and 26.7% showed SpO2 values under 94% after insertion of a small or middle‐sized bite block. Patients who did not show SpO2 decrease while using a small bite block did have deterioration of SpO2 values when a middle‐sized bite block was used. According to analysis by AIC, patients whose weight was less than 20 kg, who were shorter than 130 cm, and who were more severely handicapped tended to have a deterioration of breathing function when using a bite block.
Tartar‐control toothpaste as a possible contributory factor in the onset of superficial mucocele: A case report
Authors: Navazesh Mahvash
Published: March 2008

Superficial mucoceles are small, clear vesicles that occur on clinically non‐inflamed mucosa and are often misdiagnosed as vesiculobullous disorders. Soft palate, retromolar pads, and posterior buccal mucosa are common sites of involvement. The lesions are more common in women than in men and need no treatment. This paper describes a 71‐year‐old female who demonstrated some of the pitfalls in diagnosis and a possible contributory role of a tartar‐control toothpaste in the onset of the lesions.
Oral epidermolysis bullosa in adults
Authors: Harel‐Raviv Mili , Bernier Steve , Raviv Eli , Gornitsky Mervyn
Published: March 2008

A rare case of epidermolysis bullosa in an adult is reported and the English‐language dental literature of the last 20 years is reviewed. Special dental management is suggested. Early detection because of potential malignant transformation is discussed.
What is currently available in terms of medically necessary oral care?
Authors: Conway Thomas E.
Published: March 2008

This is the text of a presentation to the Consensus Conference on Medically Necessary Oral Health Care, Chicago, IL, April 29–30, 1995, sponsored by the National Alliance for Oral Health.