Database: MEDLINE <: biomedical, nursing & dental literature, 1966 - Oct 2000.> Search Strategy (You Saved Citations 1-300 From Set 70): ----------------------------------------------------------------------------- 1 exp Decision support techniques/ 19211 2 exp Decision making/ 28700 3 exp Decision making, computer-assisted/ 16758 4 ((decision: or consensus) adj (making or make$1 or support 14407 or theory or trees or technique:)).mp. 5 exp "Sensitivity and specificity"/ 89544 6 Computer simulation/ 19925 7 Computer systems/ 3947 8 Computers/ 40006 9 (computer: adj5 (simulation: or system: or decision: or 23667 predict: or forecast:)).mp. 10 Forecasting/ 28594 11 Models, biological/ 101335 12 Likelihood functions/ 3382 13 exp Risk/ 227197 14 exp "Outcome assessment (health care)"/ 103983 15 or/1-14 649701 16 exp Tooth demineralization/ 22628 17 demineralization.mp. 1620 18 caries.mp. 15295 19 caires.mp. 1 20 craies.mp. 0 21 careis.mp. 4 22 carise.mp. 0 23 (teeth adj3 cavit:).mp. 422 24 (tooth adj3 cavit:).mp. 217 25 (dental adj3 cavit:).mp. 276 26 (dentin adj3 cavit:).mp. 254 27 (enamel adj3 cavit:).mp. 182 28 (teeth adj3 decay:).mp. 374 29 (tooth adj3 decay:).mp. 321 30 (dental adj3 decay:).mp. 250 31 (dentin adj3 decay:).mp. 12 32 (enamel adj3 decay:).mp. 20 33 (active adj decay).mp. 9 34 (rampant adj3 decay:).mp. 14 35 (recurrent adj3 decay:).mp. 30 36 (white adj spot:).mp. 509 37 carious.mp. 2077 38 cariology.ti,ab. 56 39 (non-cavitated adj3 lesion:).mp. 15 40 (noncavitated adj3 lesion:).mp. 2 41 Tooth remineralization/ 478 42 (dental adj3 fissure:).mp. 99 43 (tooth adj3 fissure:).mp. 50 44 (teeth adj3 fissure:).mp. 98 45 caries-free.mp. 603 46 cariesfree.mp. 17 47 Cariogenic agents/ 728 48 precavit:.mp. 8 49 (filled adj3 teeth).mp. 510 50 (filled adj3 tooth).mp. 117 51 (oral adj fissure:).mp. 6 52 (tooth adj3 remineraliz:).mp. 28 53 (teeth adj3 remineraliz:).mp. 24 54 dft.mp. 413 55 dfs.mp. 1258 56 dmf:.mp. 6397 57 cariogeni:.mp. 1787 58 or/16-57 32256 59 15 and 58 2571 60 limit 59 to (human and english language and yr=1980-2000) 2084 61 limit 60 to (infant < 1 to 23 months > or preschool child < 735 2 to 5 years > or child < 6 to 12 years >) 62 limit 60 to (adolescence < 13 to 18 years > or adult < 19 1117 to 44 years > or middle age < 45 to 64 years > or "aged < 65 and over >" or "aged, < 80 and over >") 63 61 and 62 393 64 60 not 61 1349 65 64 or 63 1742 66 (disease adj free adj (survival or patient:)).mp. 6825 67 65 not 66 1490 68 "Root caries"/ 297 69 exp "Tooth root"/ 7047 70 67 not (68 or 69) 1390 71 from 70 keep 1-300 300 72 from 70 keep 301-600 300 *************************** <1> UI - 98134962 AU - Sundqvist G AU - Figdor D AU - Persson S AU - Sjogren U IN - Endodontics Department, Umea University, Sweden. TI - Microbiologic analysis of teeth with failed endodontic treatment and the outcome of conservative re-treatment. SO - Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics 1998 Jan;85(1):86-93 AB - OBJECTIVE: The purposes of this study were to determine what microbial flora were present in teeth after failed root canal therapy and to establish the outcome of conservative re-treatment. STUDY DESIGN: Fifty-four root-filled teeth with persisting periapical lesions were selected for re-treatment. After removal of the root filling, canals were sampled by means of advanced microbiologic techniques. The teeth were then re-treated and followed for up to 5 years. RESULTS: The microbial flora was mainly single species of predominantly gram-positive organisms. The isolates most commonly recovered were bacteria of the species Enterococcus faecalis. The overall success rate of re-treatment was 74%. CONCLUSIONS: The microbial flora in canals after failed endodontic therapy differed markedly from the flora in untreated teeth. Infection at the time of root filling and size of the periapical lesion were factors that had a negative influence on the prognosis. Three of four endodontic failures were successfully managed by re-treatment. <2> UI - 98134966 AU - Tyndall DA AU - Ludlow JB AU - Platin E AU - Nair M IN - Department of Diagnostic Sciences, Unc-Ch School of Dentistry, USA. TI - A comparison of Kodak Ektaspeed Plus film and the Siemens Sidexis digital imaging system for caries detection using receiver operating characteristic analysis. SO - Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics 1998 Jan;85(1):113-8 AB - OBJECTIVE: To evaluate the accuracy of proximal caries detection comparing enhanced and unenhanced Siemens Sidexis CCD-based digital images with Ektaspeed Plus films utilizing receiver operating characteristic analysis. STUDY DESIGN: Sixty extracted teeth (24 posterior and 36 anterior) were imaged under identical standardized geometric and exposure conditions. Six observers, using a 5-point confidence scale, rated 120 proximal surfaces for the presence or absence of carious lesions by means of three image modalities: (1) observer enhanced and (2) unenhanced Sidexis displays, and (3) Ektaspeed Plus films. The ground truth was determined by microscopic analysis of ground sections. Receiver operating characteristic curves were generated with calculated areas (AZ) analyzed with analysis of variance for effect of reader, reading, and modality. RESULTS: Analysis of variance demonstrated significant differences among readers, readings and modalities (mean square values of 0.012, 0.005, 0.004, F ratios of 13.604, 5.329, 5.100; p = values of 0.001, 0.043, and 0.030, respectively). Post-hoc paired comparisons of modalities using Tukey's statistic demonstrated that only film and enhanced Sidexis images were different from each other (p = 0.024). AZ scores were 0.7650, 0.7499, and 0.8008 respectively, for unenhanced Sidexis, enhanced Sidexis, and Ektaspeed Plus film. CONCLUSION: Unenhanced digital Sidexis images were equivalent to film for the detection of proximal caries in this in vitro study. Observer enhanced Sidexis images exhibited a statistically significant lower diagnostic accuracy than the unenhanced digital and film images. <3> UI - 98099411 AU - Dibdin GH AU - Dawes C IN - MRC Dental Group, The Dental School, Bristol, UK. TI - A mathematical model of the influence of salivary urea on the pH of fasted dental plaque and on the changes occurring during a cariogenic challenge. SO - Caries Research 1998;32(1):70-4 AB - Urea diffusing from saliva into dental plaque is converted to ammonia and carbon dioxide by bacterial ureases. The influence of normal salivary urea levels on the pH of fasted plaque and on the depth and duration of a Stephan curve is uncertain. A numerical model which simulates a cariogenic challenge (a 10% sucrose rinse alone or one followed by use of chewing-gum with or without sugar) was modified to include salivary urea levels from 0 to 30 mmol/l. It incorporated: site-dependent exchange between bulk saliva and plaque surfaces via a salivary film; sugar and urea diffusion into plaque; pH-dependent rates of acid formation and urea breakdown; diffusion and dissociation of end-products and other buffers (acetate, lactate, phosphate, ammonia and carbonate); diffusion of protons and other ions; equilibration with fixed and mobile buffers; and charge-coupling between ionic flows. The Km (2.12 mmol/l) and Vmax (0.11 micromol urea/min/mg dry weight) values for urease activity and the pH dependence of Vmax were taken from the literature. From the results, it is predicted that urea concentrations normally present in saliva (3-5 mmol/l) will increase the pH at the base of a 0.5-mm-thick fasted plaque by up to 1 pH unit, and raise the pH minimum after a sucrose rinse or sugar-containing chewing-gum by at least half a pH unit. The results suggest that plaque cariogenicity may be inversely related to salivary urea concentrations, not only when the latter are elevated because of disease, but even when they are in the normal range. <4> UI - 98099407 AU - Ekstrand KR AU - Bruun G AU - Bruun M IN - Department of Cariology and Endodontics, Faculty of Health Sciences, University of Copenhagen, Denmark. KIM.EKSTRAND@ODONT.KU.DK TI - Plaque and gingival status as indicators for caries progression on approximal surfaces. SO - Caries Research 1998;32(1):41-5 AB - This study aimed to (1) record the plaque and gingival status on sound and carious approximal surfaces and (2) investigate whether the two parameters could predict approximal lesion progression. For this purpose two samples were selected among 18- to 25-year-old patients at the Dental Faculty in Copenhagen. Sample 1 consisted of 45 patients, each having an approximal posterior surface requiring operative treatment and a contralateral approximal space, where both surfaces were radiographically sound. Sample 2 consisted of 25 patients, each having a posterior approximal tooth surface with an enamel/initial dentinal lesion recorded on a bitewing. Plaque and gingival status were classified using 4-point ranked scales. The recordings were performed once on each participant in sample 1. The recordings in sample 2 were repeated 5 times during a 15-month period. In order to assess lesion progression in sample 2, two serial intraoral examinations were performed, i.e. at the beginning and end of the study. Less than 10% of the sound and carious surfaces were recorded as plaque-free, while about 40% had a thick or heavy plaque accumulation. No significant difference was observed between plaque scores on sound and carious surfaces (p = 0.5), in contrast to findings representing the gingival status (p < 0.001). Tooth surfaces requiring operative treatment were associated with bleeding of the gingiva after probing. In sample 2, 3 of the 25 participants did not finish the study. On the remaining participants caries progression was observed in 9 cases (41%), while no progression was observed in 13 cases. Analyses showed that there were no significant differences between plaque scores in cases with caries progression, as compared with no caries progression (p > 0.05). Similar analyses concerning gingival status showed that bleeding of the gingiva was related to cases with progressing caries. Analyses also disclosed no direct association between plaque and gingival status (Spearman correlation coefficient 0.39). Thus, the occurrence of plaque does not have the same predictive power as bleeding after probing in decision-making as to whether or not a lesion progresses. <5> UI - 98099405 AU - Nair MK AU - Tyndall DA AU - Ludlow JB AU - May K IN - Department of Diagnostic Sciences, UNC-CH School of Dentistry, Chapel Hill, N.C. 27599-7450, USA. nairm@email.unc.edu TI - Tuned aperture computed tomography and detection of recurrent caries. SO - Caries Research 1998;32(1):23-30 AB - This study compared the diagnostic efficacy of four imaging modalities for the detection of artificially induced recurrent caries: intraoral film, direct digital bitewing images, tuned apertuce computed tomography (TACT) slices and iteratively restored TACT images using an in vitro model. Twenty-four posterior teeth were prepared for MOD inlay restorations. These were then restored with different restorative materials (amalgam, Herculite and Durafill). Lesions were simulated in half the number of surfaces studied. These lesions were created either at the intersection of the facial or lingual walls and the gingival floor or on the gingival floor midway between the facial and lingual walls in the proximal boxes of the MOD restorations. Analysis of observations from 8 observers using ROC curve reveal the superior diagnostic efficacy with TACT iteratively restored images (Az for TACT iteratively restored images = 0.9171, TACT slices = 0.7052, Film = 0.6608, direct digital images = 0.5979). ANOVA revealed significance with respect to the imaging modality used (p < 0.0001). The results suggest that TACT images hold promise as a more effective imaging modality than film or direct digital systems for detection of recurrent caries. <6> UI - 98099404 AU - Wenzel A AU - Hintze H AU - Horsted-Bindslev P IN - Department of Oral Radiology, Royal Dental College, Faculty of Health Sciences, University of Aarhus, Denmark. awenzel@odont.aau.dk TI - Accuracy of radiographic detection of residual caries in connection with tunnel restorations. SO - Caries Research 1998;32(1):17-22 AB - The aim of this study was to evaluate the diagnostic accuracy of radiographic examination for the detection of residual caries after tunnel preparation and filling with glass ionomer cement. Further, two different radiographic modalities were compared. Forty-five extracted human premolars and molars with clinical signs of approximal caries were selected for the study. The teeth were radiographed in order to identify surfaces with dentinal lesions suitable for tunnel preparation. Seventeen of the teeth had lesions that were as a minimum through the enamel and as a maximum into the outer half of the dentin (14 teeth = 1 lesion, 3 teeth = 2 lesions). Seventeen surgically removed third molars were thereafter included. These teeth were sound with respect to caries. The teeth were arranged in blocks with approximal contacts and radiographed using two image receptors: Ektaspeed Plus film (E) and the Digora (D) digital storage phosphor plate system. The 20 carious surfaces and 20 surfaces of the impacted teeth were prepared following the guidelines for the class II tunnel technique and filled with glass ionomer cement. The radiographic examination was repeated with both modalities after filling, and the approximal surfaces scored on the radiographs by 5 observers using the criteria: 0 = no filling, 1 = filling with residual caries, 2 = filling with no adjacent caries. All teeth except the unerupted third molars were sectioned, and the sections examined under the microscope. Residual caries was observed in 8 surfaces. On average, sensitivity was 0.25 for E and 0.32 for D, specificity 0.83 for E and 0.76 for D, positive predictive value 0.38 for E and 0.32 for D, and negative predictive value 0.75 for E and 0.77 for D. The differences between the two modalities were not statistically significant (p > 0.3). Based on the relatively small number of lesions in this study, it is suggested that radiography immediately after tunnel restoration cannot be recommended, as the diagnostic benefit from this examination seems to be minuscule. <7> UI - 98100051 AU - Ghorayeb SR AU - Xue T AU - Lord W IN - Department of Engineering, Hofstra University, Hempstead, New York 11549, USA. TI - A finite element study of ultrasonic wave propagation in a tooth phantom. SO - Journal of Dental Research 1998 Jan;77(1):39-49 AB - Ultrasound is used extensively in industry for the detection and characterization of defects in critical engineering structures. Similar techniques could be used in dentistry if a thorough understanding of ultrasonic wave propagation in teeth were available. This paper presents a hypothesis that finite element analysis can be used to solve the hyperbolic partial differential equation which governs ultrasonic wave propagation in teeth. A three-layer tooth phantom based on the geometry of a human second molar is used to illustrate the validity of this hypothesis. Simulated wave propagation studies are described for the tooth phantom with a gold crown layer, with an amalgam restoration insertion, and containing a cavity. Results clearly show the finite element code's ability to predict and visualize ultrasonic wave propagation in complex dental structures. <8> UI - 99457877 AU - Kumar JV AU - Siegal MD IN - Bureau of Dental Health, New York State Department of Health, Albany 12237-0619, USA. TI - A contemporary perspective on dental sealants. [Review] [29 refs] SO - Journal of the California Dental Association 1998 May;26(5):378-85 AB - In spite of significant improvements in the oral health of Americans, dental caries still affects a majority of school-aged children. Its distribution is uneven, with a small proportion of the children experiencing a greater burden of the disease. In addition, caries in children's permanent teeth is predominantly a disease of the pits and fissures. The use of dental sealants has the potential to significantly reduce the disease burden. Although sealants are safe and effective, their use continues to be low. Efforts are needed to make sealants a covered benefit under all insurance plans and to encourage their appropriate use. This paper provides a review of the changes in the prevalence and distribution of dental caries, the effectiveness of sealants, and guidelines for the appropriate use of sealants in public health programs and private practice. [References: 29] <9> UI - 99143524 AU - Chakraborty M AU - Saha JB AU - Bhattacharya RN AU - Roy A AU - Ram R IN - Deptt. of Community Medicine, North Bengal Medical College, Dist. Darjeeling. TI - Epidemiological correlates of dental caries in an urban slum of West Bengal. SO - Indian Journal of Public Health 1997 Apr-Jun;41(2):56-60, 67 AB - The overall prevalence of dental caries was found to be 57.47 percent in an urban slum irrespective of sex, with a maximum of 75.88 percent in the age group of 5-9 years. Habit of taking hard and sticky food, bad oral hygiene were some of the important epidemiological correlates. Fluoride content of drinking water did not show any significant role. <10> UI - 99007511 AU - Velasco E AU - Machuca G AU - Martinez-Sahuquillo A AU - Rios V AU - Lacalle J AU - Bullon P IN - University of Seville, School of Dentistry, Spain. TI - Dental health among institutionalized psychiatric patients in Spain. SO - Special Care in Dentistry 1997 Nov-Dec;17(6):203-6 AB - This study assessed the dental health of an institutionalized psychiatric population in Spain. The study population was composed of 347 males and 218 females with a mean age of 58.0. The mean length of hospitalization was 26.1 years. The largest proportion of the patients (62%) was diagnosed as having schizophrenia. All subjects were taking psychotropic drugs, with a mean number of 2.1 medications. The sample was examined according to the WHO dental criteria. The DMFT index demonstrated the mean number of carious teeth to be 7.9; missing teeth, 17.0; and filled teeth, 0.0. The DMFT index increased significantly with the patient's age and length of hospitalization. Female and demented patients had significantly higher DMFT scores. These findings suggest that institutionalized patients with mental illness in Spain have extensive untreated dental disease. <11> UI - 98273218 AU - Mojon P AU - Budtz-Jorgensen E AU - Michel JP AU - Limeback H IN - Division of Gerodontology and Removable Prosthodontics, University of Geneva, Switzerland. mojon@cmu.unige.ch TI - Oral health and history of respiratory tract infection in frail institutionalised elders. SO - Gerodontology 1997 Jul;14(1):9-16 AB - OBJECTIVES: The purpose of this study was to look for a relationship between history of respiratory tract infection (RTI) and oral health in very old subjects. SETTING AND SUBJECTS: 302 frail elders (mean age: 85 years) living in a medical care facility were examined by one dentist. OUTCOME MEASURES: The incidence of RTI over 1 year had been recorded along with markers of nutritional status and degree of dependency. The oral examination comprised an evaluation of hygiene, quality of prostheses and the prevalence of caries, periodontal disease and mucosal disorders. RESULTS: One third (33%) of the subjects had experienced at least one episode of RTI, and a fifth (19%) had visited the dentist in emergency. The incidence of RTI had been greater among dentate subjects and those who came to the dentist in emergency. The dentate subjects with a history of RTI had higher plaque score (P = 0.02). Half (49%) of the subjects had oral disorders that could develop in a dental emergency and these subjects had had a higher risk of RTI (relative risk: 1.9, 95% confidence interval: 1.1-3.9). The presence of selected oral disorders associated with low serum albumin increased the relative risk of having had RTI to 3.2 (1.5-6.7). The association between presence of actual oral health problems and previous experience of RTI was more noticeable in those who had poor general health or were more debilitated. CONCLUSIONS: The present study suggests that poor oral hygiene and the presence of potential emergency could be major risk factors for RTI among the frail elderly. <12> UI - 98157021 AU - Lehane RJ AU - Murray PA AU - Deasy MJ IN - Department of Periodontics, University of Medicine & Dentistry of New Jersey, New Jersey Dental School, Newark 07103-2425, USA. TI - Effect of an enzymatic rinse on salivary levels of Streptococcus mutans and lactobacilli in periodontally treated patients. SO - Periodontal Clinical Investigations 1997 Fall;19(2):17-21 AB - Root surface caries is prevalent in patients with both treated and untreated periodontal disease. The major etiologic factor has been identified as microbial plaque. In periodontally treated patients, significantly higher root caries prevalence and incidence have been found in patients with high levels of Streptococcus mutans and Lactobacilli in saliva. Reducing the levels of S. mutans and Lactobacilli in saliva may lower the risk of root caries development. The purpose of this investigation was to determine the effect of an oral enzymatic rinse on the salivary counts of S. mutans and Lactobacilli in periodontally treated patients. Fifteen adult subjects participated in a double-blind, cross-over designed clinical trial. Each subject had previously undergone comprehensive periodontal therapy and had been maintained on a regular program of supportive periodontal therapy. Paraffin-stimulated whole saliva was collected from each participant. Each subject was then randomly given either the enzymatic rinse product or a control rinse and instructed to rinse with one tablespoonful twice a day for 2 weeks, after which saliva samples were taken. After a washout period, salivary samples were again taken, and the subjects received the alternate rinse product. Two weeks later, final salivary samples were taken. The salivary samples were serially diluted and incubated aerobically on selective culture media. S. mutans and Lactobacilli were counted on the basis of colonial morphology. Pretreatment and posttreatment salivary counts of S. mutans and Lactobacilli were analyzed using the Wilcoxon matched-pairs signed-rank test at the 5% level of significance. Analysis of data revealed that neither the test nor the control rinse significantly lowered salivary counts of either species in the sample population. <13> UI - 98221391 AU - Lewis AM IN - LewisDDS@aol.com TI - Sealing caries out ... or in?. [Review] [27 refs] SO - Dentistry Today 1997 Sep;16(9):104-7 <14> UI - 98257090 AU - Gray GB AU - Paterson RC IN - Department of Rest. Dent., Bristol Dental School, UK. TI - Fissure caries diagnosis and resulting treatment decisions by clinical community dental officers and general dental practitioners. SO - European Journal of Prosthodontics & Restorative Dentistry 1997 Mar;5(1):23-9 AB - In this in vitro study, 12 General Dental Practitioners and 13 Clinical Community Dental Officers examined the occlusal, buccal and palatal pits and fissures of 35 extracted molar teeth. They were asked to make a management/treatment decision, on the basis of their diagnosis of caries, whether each tooth should be left untreated, fissure sealed or investigated. After all the management/treatment decisions had been made, the teeth were serially sectioned perpendicular to the occlusal surface and examined for the presence of caries in dentine. It was impossible to demonstrate differences in the management/treatment decisions and the diagnosis of caries made by the two groups. No significant difference in sensitivity or specificity could be detected between operators diagnosing by visual inspection alone and those using visual inspection in combination with a tactile method. The use of radiographs did not significantly improve the validity of the diagnosis or management of fissure caries. <15> UI - 98165212 AU - Nugent ZJ IN - Dental Health Services Research Unit, Dental School, Dundee, UK. z.j.nugent@dundee.ac.uk TI - BASCD surveys and computer communication. British Association for the Study of Community Dentistry. SO - International Journal of Medical Informatics 1997 Nov;47(1-2):35-7 AB - The British Association for the Study of Community Dentistry (BASCD) has coordinated National Health Service surveys of the dental health of school children since 1985, when Wales and parts of England were included. Scotland joined in 1987 and Northern Ireland in 1994. This series spans an interesting time in the growth of accessible technology in both statistics and medical research. The purpose of this paper is to chart the development of this data base from pen and paper via microcomputers to the Internet. The annual work now involves calibration of examiners, data collection with portable computers or by manual transcription and subsequent 'punching', paper reports passed to regional coordinators who fill in spread sheets that are passed by e-mail or through posted discs to the data coordinating centre at the Dental Health Services Research Unit at the University of Dundee. The data is checked; statistical analyses are undertaken; a paper is prepared for print and the data is deposited on the BASCD Web Site. Four operating systems and at least eight software packages are used to produce and distribute the survey results. <16> UI - 98138305 AU - Sjogren U AU - Figdor D AU - Persson S AU - Sundqvist G IN - Faculty of Odontology, Umea University, Sweden. TI - Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis [published erratum appears in Int Endod J 1998 Mar;31(2):148]. SO - International Endodontic Journal 1997 Sep;30(5):297-306 AB - This study investigated the role of infection on the prognosis of endodontic therapy by following-up teeth that had had their canals cleaned and obturated during a single appointment. The root canals of 55 single-rooted teeth with apical periodontitis were thoroughly instrumented and irrigated with sodium hypochlorite solution. Using advanced anaerobic bacteriological techniques, post-instrumentation samples were taken and the teeth were then root-filled during the same appointment. All teeth were initially infected; after instrumentation low numbers of bacteria were detected in 22 of 55 root canals. Periapical healing was followed-up for 5 years. Complete periapical healing occurred in 94% of cases that yielded a negative culture. Where the samples were positive prior to root filling, the success rate of treatment was just 68%--a statistically significant difference. Further investigation of three failures revealed the presence of Actinomyces species in each case; no other specific bacteria were implicated in failure cases. These findings emphasize the importance of completely eliminating bacteria from the root canal system before obturation. This objective cannot be reliably achieved in a one-visit treatment because it is not possible to eradicate all infection from the root canal without the support of an inter-appointment antimicrobial dressing. <17> UI - 98159183 AU - Solheim T IN - Department of Oral Pathology, Faculty of Dentistry, University of Oslo, Norway. TI - A hierarchical system for the coding of dental information in reports and computer-assisted identifications. SO - Journal of Forensic Odonto-Stomatology 1997 Jun;15(1):5-8 AB - Dental coding systems have hitherto been developed mainly to record treatment. The present hierarchical system was specially designed for computer aided dental identification and has been tested for 15 years in the Norwegian register of missing persons. It is in addition well suited for rapid and exact reporting of dental findings in identification cases. The system has also been proposed for adoption by Interpol. <18> UI - 98211155 AU - Andersen RM AU - Davidson PL IN - Department of Health Service, University of California, Los Angeles 90095, USA. TI - Ethnicity, aging, and oral health outcomes: a conceptual framework. [Review] [68 refs] SO - Advances in Dental Research 1997 May;11(2):203-9 AB - An expanded version of Andersen's Behavioral Model of Health Services Utilization is used as the theoretical and analytical framework for the International Collaborative Study of Oral Health Outcomes (ICS-II). The conceptual framework for understanding determinants of oral health is based on a "systems" perspective. The framework posits that characteristics of the external environment, the dental care delivery system, and the personal characteristics of the population influence oral health behaviors. The expanded behavioral model conceptualizes health behaviors (oral hygiene practices and dental services utilization) as intermediate dependent variables, which in turn influence oral health outcomes (evaluated, perceived, patient satisfaction). The framework is presented with an increased focus on the effects of race-ethnicity and age cohort, the major exogenous variables used in this study for systematic assessment of the differences in the multitude of factors influencing oral health. The framework can be applied by policy analysis and health services managers to help describe, predict, and explain population-based health behaviors and health outcomes. [References: 68] <19> UI - 98194559 AU - Nevins ML AU - Gartner-Sekler JL IN - Harvard School of Dental Medicine, Boston, Massachusetts, USA. TI - Periodontal, implant, and prosthetic treatment for advanced periodontal disease. SO - Compendium of Continuing Education in Dentistry (Jamesburg, NJ) 1997 May;18(5):469-74, 476, 478-9; quiz 480 AB - This article reports a case that involved a challenge in multidisciplinary decision making. A patient presented with severe periodontal disease and the need for prosthetic rehabilitation for purposes of tooth replacement and the stabilization of periodontally compromised teeth. The initial diagnosis revealed that the treatment regimen would require periodontic, endodontic, and orthodontic treatment, as well as dental implants. This case report demonstrates teamwork and a sequential approach to a complex case in a postgraduate clinical setting. <20> UI - 98135900 AU - Johansson AK AU - Johansson A AU - Birkhed D AU - Omar R AU - Baghdadi S AU - Khan N AU - Carlsson GE IN - Department of Cariology, Faculty of Odontology, Goteborg University, Sweden. TI - Dental erosion associated with soft-drink consumption in young Saudi men. SO - Acta Odontologica Scandinavica 1997 Dec;55(6):390-7 AB - This study reports on the causative factors of dental erosion in selected high- (n = 19) and low-erosion (n = 19) subgroups of a larger random sample (n = 95) of young male Saudi military inductees. By means of a questionnaire, the role of various possible factors related to oral health in general, and to dental erosion in particular, was assessed for each participant. Clinical examination included recordings of severity of dental erosion and fluorosis, presence of buccal cervical defects and first permanent molar 'cuppings', DMFT and DMFS, visible plaque index, and gingival bleeding index. In addition, bitewing radiographs, study casts, and intraoral color transparencies were obtained for each individual. Logistic regression analysis showed a strong correlation between the presence of dental erosion and a high level of consumption of cola-type soft drinks. Other statistically significant associated factors, although of less predictive strength, were type of cleaning aid and gingival bleeding index. In subgroup comparisons, dental problems (primarily pain), number of buccal cervical defects, and number of missing teeth were significantly greater in the high- than in the low-erosion subgroup. <21> UI - 98155694 AU - Dittadi R AU - Brazzale A AU - Mione R AU - Di Fresco S AU - Gatti C AU - Vinante O AU - Bassan F AU - Nascimben O AU - Gion M IN - Center for the Study of Biological Markers of Malignancy, P.F. Calvi Hospital, Noale, Italy. TI - Quantitative chemiluminescent immunoassay of p53: prognostic significance in 220 node-negative breast cancer tissue. SO - Anticancer Research 1997 Nov-Dec;17(6D):4691-6 AB - The prognostic and predictive role of p53 overexpression in breast cancer samples is usually investigated by using molecular biology or immunohistochemical methods. However, the results are to date controversial, and this is in part due to the methodological pitfalls of both the methods. To study the possibility of overcoming, at least in part, these problems we evaluated a commercially available chemiluminescent immunoassay with which the p53 concentrations of 220 specimens from node negative breast cancer were determined. The assay showed good analytical performance and found detectable levels in 84.7% of cases (median 0.22 ng/mg of proteins, range 0-50 ng/mg of proteins). p53 has been found inversely correlated with estrogen receptors and directly correlated with cathepsin D. The prognostic role of p53 was evaluated in two different ways: a) two previous studies (Borg et al 1995, DeWitte et al. 1996) using the same method found almost 30% of samples had significantly shorter DFS and OS. We subdivided our cases in order to identify the same positivity rate and to verify if the previous cathegorizations were effective also in our patient series. We confirmed the independent association with DFS (p = 0.006) and OS (p = 0.0005); b) considering that any categorization of quantitative parameters could cause a loss of clinical information, we also evaluated p53 as a continuous variable. Multivariate analysis showed a significant quantitative relationship between p53 and both disease free (p = 0.026) and overall survival (p = 0.02). <22> UI - 98176324 AU - Kidd EA IN - UMDS, Guy's Hospital, London. TI - A caries control programme for adult patients. SO - Dental Update 1997 Sep;24(7):296-301 AB - This paper concerns the management of an adult patient with a caries problem. Once a dentist has decided the patient is at high risk to dental decay, involvement of the patient in the management of the problem is essential because it is the patient who will control caries, not the dentist. It is essential to determine why the patient is at risk so that risk factors may be modified appropriately. All members of the dental team have a role to play. <23> UI - 98129505 AU - Wiktorsson AM AU - Zimmerman M AU - Angmar-Mansson B IN - Department of Cariology, Faculty of Odontology, Karolinska Institutet, Huddinge, Sweden. TI - Erosive tooth wear: prevalence and severity in Swedish winetasters. SO - European Journal of Oral Sciences 1997 Dec;105(6):544-50 AB - Full-time Swedish winetasters test on average 20-50 different wines, nearly 5 days a week. As the pH of wines ranges from 3.0 to 3.6, there is a potential risk for tooth erosion. The aims of this study were to document the prevalence and severity of tooth erosion in qualified winetasters in relation to number of years of winetasting, salivary flow rate, and buffer capacity. The subjects comprised all 19 qualified winetasters (7 women and 12 men, aged 29-64 years employed in Stockholm by Vin & Sprit AB, the state-owned company marketing wines and spirits. At intraoral examination, tooth surface loss was registered and documented by photography. Salivary flow rate and buffer capacity of unstimulated and stimulated saliva were measured. Data on occupational background and dental and medical histories were collected. Fourteen subjects had tooth erosion, the severity varying from mild to extreme, mainly on the labio-cervical surfaces of maxillary incisors and canines. The severity of the erosion tended to increase with years of occupational exposure. Caries activity in all subjects was low. 14 subjects had low unstimulated salivary flow rates. It was concluded that full-time winetasting is an occupation associated with increased risk for tooth erosion. <24> UI - 98131294 AU - Wu W AU - Nancollas GH IN - Department of Chemistry, State University of New York at Buffalo 14260-3000, USA. TI - The relationship between surface free-energy and kinetics in the mineralization and demineralization of dental hard tissue. SO - Advances in Dental Research 1997 Nov;11(4):566-75 AB - The interfacial free-energy is an important factor in the regulation of mineralization and dissolution at the surfaces of dental hard tissues. However, few thermodynamic studies have been aimed at the elucidation of the interfacial terms. Contact angle measurements (sessile drop and thin layer wicking) and kinetic dissolution and growth techniques have been used to study the interfacial properties of root dentin (D), human enamel (E), and hydroxyapatite (HAP). The interfacial tensions between water (w) and each of these phases were calculated from contact angle data according to surface tension components theory. The values gamma wD = 4.5 x 10(-3) J m-2, gamma wE = 8.8 x 10(-3) J m-2, and gamma w,HAP = 10.4 x 10(-3) J m-2 were of the same order of magnitude as those obtained from dissolution kinetic data (pH = 4.5): gamma wD = 1.4 x 10(-3) J m-2, gamma wE = 3.2 x 10(-3) J m-2, and gamma wHAP = 9.3 x 10(-3) J m-2. Kinetics studies of the crystallization of HAP on HAP, dentin, and enamel yielded the interfacial free-energy values, gamma wHAP = 17.1 x 10(-3) J m-2, 17.7 x 10(-3) J m-2, and 9.4 x 10(-3) J m-2, respectively, probably reflecting the interfacial energies of the deposited phases rather than those of the dental hard-tissue substrata. The lower interfacial tension values are consistent with the higher solubilities of these solid phases: logKSO = -52.0, -55 approximately 57, and -58 approximately 59, for root dentin, enamel, and HAP, respectively, expressed as an equivalent HAP ionic product. The higher interfacial free-energy is also consistent with the slower mineralization of HAP on dentin and enamel surfaces. <25> UI - 98111928 AU - Dokur Z AU - Olmez T AU - Yazgan E AU - Ersoy OK IN - Istanbul Technical University, Electrical & Electronics Engineering Department, Turkey. TI - Detection of ECG waveforms by neural networks. SO - Medical Engineering & Physics 1997 Dec;19(8):738-41 AB - In this study, ECG waveform detection was performed by using artificial neural networks (ANNs). Initially, the R peak of the QRS complex is detected, and then feature vectors are formed by using the amplitudes of the significant frequency components of the DFT spectrum. Grow and Learn (GAL) and Kohonen networks are comparatively investigated to detect four different ECG waveforms. The comparative performance results of GAL and Kohonen networks are reported. <26> UI - 98145127 AU - Peretz B AU - Yakir O AU - Fuks AB IN - Department of Pediatric Dentistry, Hadassah Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel. Benny@cc.huji.ac.il TI - Follow up after root canal treatment of young permanent molars. SO - Journal of Clinical Pediatric Dentistry 1997 Spring;21(3):237-40 AB - The purpose of the present study was to assess the success of root canal treatment in permanent molars of children and adolescents. Twenty-eight endodontically treated first permanent molars of 18 patients aged 8 to 16 years at the time of treatment were examined. The age of the patient at the time of treatment ranged from 8 to 16 years (mean age 12.4 +/- 2.3). The majority of the treatments were done on the mandibular teeth (67%). Nine patients had one treated molar, eight patients had two treated molars and one patient had three treated teeth. None of the patients had all four molars treated. The time elapsed from the root canal treatment until our examination ranged from 24 months to 77 months (mean time 45.1 +/- 19.1). The examination included clinical and radiological parameters as follows: sensitivity to percussion, mobility, quality of restoration (contact point reproduced, overhang, secondary caries), periapical lesions before and after treatment, external root resorption, furcation involvement and interproximal bone resorption. Treatment was considered completely successful if no pathology was found. Only 10 teeth (36%) demonstrated complete treatment success, less than previously reported. No significant differences between mandibular and maxillary teeth were found with respect to any of the variables. The results suggest that considering a number of multidisciplinary criteria for assessing success of root canal treatments in first permanent molars of children and young adolescents is essential, and provides a realistic success rate. <27> UI - 98145142 AU - Briley JB AU - Dove SB AU - Mertz-Fairhurst EJ AU - Hermesch CB IN - Dental Professional Services, Fairchild AFB, WA 99011-8701, USA. TI - Computer-assisted densitometric image analysis (CADIA) of previously sealed carious teeth: a pilot study. SO - Operative Dentistry 1997 May-Jun;22(3):105-14 AB - Previous studies have shown that occlusal dental caries can be arrested with sealants. Radiographic monitoring must be performed to ensure success. Standardized sequential bitewing radiographs over a 10-year interval of four patients who had sealed composite restorations placed without caries removal were digitized and analyzed using the CADIA algorithm. CADIA values for the 10-year period were analyzed using Analysis of Variance (ANOVA), and showed no significant change in radiographic density for this interval (P > 0.05), which is suggestive of arrested dental caries. <28> UI - 98081577 AU - Tosti A AU - Piraccini BM AU - Peluso AM IN - Department of Dermatology, University of Bologna, Italy. TI - Contact and irritant stomatitis. [Review] [31 refs] SO - Seminars in Cutaneous Medicine & Surgery 1997 Dec;16(4):314-9 AB - Contact stomatitis is rather uncommon because of the relative resistance of the oral mucosa to irritant agents and allergens. The clinical manifestations of contact stomatitis are extremely variable and include erythema, erosions, ulcerations, leukoplakia-like lesions, and lichenoid reactions. Clinical signs are frequently less pronounced than subjective symptoms, and patients commonly experience severe functional problems despite only mild mucosal alterations. Allergic stomatitis is rare and almost always attributable to metallic mercury and gold salts. A careful history and an accurate examination of the oral cavity, teeth, and dental restorations are essential for a correct diagnosis. Patch testing is indicated in all lesions that are not clearly related to trauma or physical injuries. Patch testing is not useful in the burning mouth syndrome. Evaluation of clinical relevance of patch test results is always very difficult and requires an interdisciplinary approach to the patient. Successful treatment requires the identification and elimination of the causative factor, when possible. It is important to bear in mind that replacement of dental restorations and prostheses may be very expensive and stressful for the patient and thus should not be recommended when their causative role is doubtful. [References: 31] <29> UI - 98073443 AU - Chang HS AU - Walsh LJ AU - Freer TJ IN - Department of Dentistry, University of Queensland Dental School. TI - Enamel demineralization during orthodontic treatment. Aetiology and prevention. [Review] [30 refs] SO - Australian Dental Journal 1997 Oct;42(5):322-7 AB - The aetiology of enamel demineralization during fixed orthodontic treatment and its sequelae are discussed. A summary is given of the various methods available to assess the risk of demineralization prior to active treatment. The best preventive strategy would appear to be an assessment of risk factors prior to banding, coupled with fluoride rinses, regular reinforcement of oral hygiene, and dietary advice throughout the course of treatment. [References: 30] <30> UI - 98087749 AU - Halbach S AU - Kremers L AU - Willruth H AU - Mehl A AU - Welzl G AU - Wack FX AU - Hickel R AU - Greim H IN - Institute of Toxicology, GSF-National Research Center for the Environment and Health, Neuherberg, Germany. TI - Compartmental transfer of mercury released from amalgam. SO - Human & Experimental Toxicology 1997 Nov;16(11):667-72 AB - The number of amalgam-covered surfaces and the occlusal area of the fillings, the concentrations of total mercury in plasma, erythrocytes and urine, the urinary excretion rate, and the absorbed daily doses estimated by two separate methods from intra-oral Hg emission were determined in 29 volunteers with a low amalgam load. The transfer of Hg from the fillings via the oral cavity and blood to urinary excretion was evaluated by multiple correlations between these variables. In addition, the combination of variables most representative of the entire compartmental transfer of amalgam Hg was determined. Urinary excretion (1), Hg concentration in plasma (2) and absorbed dose (3) were most closely correlated to each other, followed by correlations with the variables of the fillings (4). Correlation coefficients were 0.75 for variables 1 vs 2 and 2 vs 3, and 0.49 for variables 3 vs 4. It was concluded that variables 1-3 best reflected the transfer of mercury from amalgam fillings throughout the organism and that they were relatively insensitive to dietary mercury. The determination of total mercury in plasma and of its urinary excretion rate appears, under practical aspects, most suitable for the investigation of Hg uptake from amalgam. <31> UI - 98091647 AU - Lawrence HP AU - Sheiham A IN - Department of Epidemiology and Public Health, University College London, UK. herenia:lawrence@dentistry.unc.edu TI - Caries progression in 12- to 16-year-old schoolchildren in fluoridated and fluoride-deficient areas in Brazil. SO - Community Dentistry & Oral Epidemiology 1997 Dec;25(6):402-11 AB - Water fluoridation may reduce the rate of caries initiation, but relatively little is known of its effect on rates of caries progression through the enamel and the dentin. OBJECTIVE: This longitudinal study was designed to compare rates of caries progression in fluoridated and fluoride-deficient areas. METHODS: Approximal caries progression was evaluated on two standardized sets of bitewing radiographs taken at a 12-month interval of 290 12- to 16-year-old Brazilian schoolchildren. Pitts' scoring system was used to measure caries progression on conventional bitewing images. Caries progression data on the occlusal, free-smooth, and approximal surfaces of the anterior teeth were collected via clinical visual examinations. RESULTS: The mean rate of approximal caries progression in school-children living in fluoridated areas (0.54) was found to be 62% lower than that in children from fluoride-deficient areas (1.41). When progression rates were adjusted for the initial number of decayed surfaces per subject, differences were statistically significant for lesions located at the inner half of the enamel at baseline (11% in the fluoridated areas vs. 16.5% in the fluoride-deficient areas). Multivariate logistic regression analysis revealed that residence in a fluoride-deficient area remained a significant risk factor for caries progression after controlling for caries prevalence (D1FS), number of cavitated carious lesions, whether tooth type was molar or premolar, and toothbrushing frequency. CONCLUSIONS: These results suggest that water fluoridation reduces the rates of caries progression through the enamel and dentin, but the effect was more pronounced for lesions in the inner enamel than for those in the dentin. <32> UI - 98091653 AU - Tobi H AU - Kuik J TI - Predictors of tooth loss over 10 years in adult and elderly Chinese [letter; comment]. CM - Comment on: Community Dent Oral Epidemiol 1997 Jun;25(3):204-10 SO - Community Dentistry & Oral Epidemiology 1997 Dec;25(6):444-5 <33> UI - 98114782 AU - Mount GJ AU - Hume WR IN - University of Adelaide, Australia. TI - A revised classification of carious lesions by site and size. SO - Quintessence International 1997 May;28(5):301-3 AB - The present classification used by the profession for the identification of carious lesions was devised by Black about 100 years ago. It was based, in part, on the location of the lesion but was modified to take into account the materials that were available for restoration. Over the last 20 years, there has been considerable modification of these materials; adhesion between the restoration and tooth structure is now possible, and the understanding of the relevance of fluoride and other ions in the prevention and repair of caries has improved. It would be logical at this time to adopt a new classification based on the site of the carious lesion and the extent to which it has progressed. More relevant detail could be recorded for each restoration, and this would be of value both for personal records and epidemiologic studies. The proposal is a simple digital system that is compatible with the use of computers for record keeping. <34> UI - 98120161 AU - Locker D AU - Jokovic A AU - Payne B IN - Community Dental Health Services Research Unit, Faculty of Dentistry, University of Toronto, Ontario, Canada. TI - Life circumstances, lifestyles and oral health among older Canadians. SO - Community Dental Health 1997 Dec;14(4):214-20 AB - OBJECTIVE: To examine the contribution of life circumstances and lifestyles, and the interaction between them, to the oral health status of older Canadians. DESIGN: Subjects were recruited using a telephone interview survey, based on random digit dialling and subsequently interviewed and clinically examined. PARTICIPANTS: Four hundred and ninety-eight dentate subjects aged 53 years and over living independently in Ontario, Canada. MEASURES: Subjects were classified as living in deprived, middle or privileged life circumstances based on their social and personal attributes. They were also classified as having relatively poor or relatively favourable lifestyles based on their health behaviours. The oral health status indicators used were: the number of missing teeth, the number of decayed and filled root surfaces, mean periodontal attachment loss, the number of oral symptoms in the previous four weeks, self-rated oral health, and a psycho social impact score. RESULTS: In bivariate analyses, life circumstances were significantly associated with three of these six indicators and lifestyles with five. Healthy lifestyles had an effect on the oral health status of those living in deprived and middle circumstances but not on the privileged, although no overall interaction effect was observed in multivariate analyses controlling for gender and age. CONCLUSIONS: These data suggest that, among this population, life circumstances and lifestyles are both related to oral health. They also indicate that the role of these factors varies according to the condition and health indicator in question. <35> UI - 98120166 AU - Mills DC AU - Hollis S IN - St Helens and Knowsley Community (NHS) Trust, Merseyside, UK. TI - Training for dental screening using clinical photographs. SO - Community Dental Health 1997 Dec;14(4):245-7 AB - OBJECTIVE: To determine how the referral pattern from school screening of a group of dentists changed following a training programme. DESIGN: Eighty clinical photographs of teeth were shown to a group of dentists both before and after a training programme. The photographs were of teeth in various stages of the carious process from children aged between three and 15 years. The dentists were shown each of the 80 photographs and were asked to categorise each slide according to the decision they were most likely to make during school screening. CLINICAL SETTING: An NHS Community Trust in Merseyside, UK. PARTICIPANTS: A group of 12 community dental officers. OUTCOME MEASURES: Evaluation was carried out in relation to consensus refer/not refer decisions. Consensus was defined as the majority decision provided that no more than two dentists disagreed with the majority. RESULTS: As a consequence of training there was a change from no consensus to consensus in 21.5 per cent of the slides, whereas only 2.5 per cent changed from consensus to no consensus. However, after training there was still no consensus on 30 per cent of the slides. CONCLUSIONS: This study demonstrates a means by which referral decisions from school screening can be audited. <36> UI - 98120178 AU - Jost-Brinkmann PG AU - Radlanski RJ AU - Artun J AU - Loidl H IN - Department of Orthodontics and Dentofacial Orthopaedics, Humboldt University, Berlin, Germany. TI - Risk of pulp damage due to temperature increase during thermodebonding of ceramic brackets. SO - European Journal of Orthodontics 1997 Dec;19(6):623-8 AB - The purpose of this study was to perform in vitro measurements of the temperature increase at the enamel-dentine interface during electrothermal removal of ceramic brackets, and to analyse, in vivo, whether signs of pulp damage can be observed 4 weeks after the procedure. In vitro study: a total of 29 caries-free human teeth were cut into buccal and lingual halves. The buccal halves were bonded with ceramic brackets, and miniature thermocouples were placed from the pulpal side into holes drilled to the enamel-dentine interface under the centre of the bracket slot. From the onset of thermodebonding, the temperature increase relative to room temperature was recorded for a period of 43 seconds. The maximum temperature increase at the enamel-dentine interface was 6.9 degrees C. In vivo study: a total of 12 human premolars scheduled for extraction for orthodontic reasons were bonded with ceramic brackets. Electrothermal debonding was performed the following day. After 4 weeks, the teeth were extracted and prepared for histological examination. Following demineralization, sections were prepared for light microscopic examination. No signs of pulpal inflammation were observed. <37> UI - 98108230 AU - Price C AU - Ergul N IN - Faculty of Dentistry, University of BC, Vancouver, Canada. TI - A comparison of a film-based and a direct digital dental radiographic system using a proximal caries model. SO - Dento-Maxillo-Facial Radiology 1997 Jan;26(1):45-52 AB - OBJECTIVES: To compare the diagnostic accuracy of a dental radiographic film (Ektaspeed Plus) with the Sens-A-Ray direct digital imaging system using a proximal caries model. To study the effects of a scattering medium and compare the interpretations of dentists with dental students. METHODS: We used 20 extracted premolar and molar teeth with 10 sound and 15 naturally carious surfaces, and prepared artificial cavities in the remaining 15 surfaces. Seven dentists and seven senior dental students reported the presence of lesions using a five point confidence scale. We analysed our data by Receiver Operating Characteristic (ROC) analysis and by obtaining sensitivities and specificities. RESULTS: ROC areas showed no significant differences in the diagnostic accuracy achieved by dentists and dental students or by the addition of 20 mm of water as a scattering medium. A paler set of exposures produced significantly poorer diagnostic accuracy, but a darker set gave insignificant differences. Highly significant differences were found between the ROC areas for film and Sens-A-Ray and natural caries and artificial cavities, but the magnitudes of the differences were small. Sensitivities and specificities showed greater differences between methods and identified inferior interpretation of sound surfaces by students. CONCLUSIONS: Film was superior to Sens-A-Ray in the interpretation of proximal caries. The effects of a scattering medium were insignificant or trivial. Students were less reliable than dentists in the interpretation of sound surfaces but performed equally well with respect to natural caries and artificial cavities. <38> UI - 98108228 AU - White SC AU - Yoon DC IN - UCLA School of Dentistry 90095, USA. TI - Comparative performance of digital and conventional images for detecting proximal surface caries. SO - Dento-Maxillo-Facial Radiology 1997 Jan;26(1):32-8 AB - OBJECTIVE: To evaluate the performance of a digital CCD system for detecting proximal surface caries compared with film. METHOD: Three hundred and twenty extracted human teeth were imaged by making direct digital (Schick Technologies, Inc) and conventional film images (E-speed) of each. A total of 16 experienced dentists scored the proximal surfaces of these teeth for the extent of enamel and dentin lesions. The teeth were subsequently sectioned to determine the actual caries depth. RESULTS: The sensitivity of the CCD system was consistently lower than film while the specificity of the CCD system was consistently higher. The accuracy of CCD and film images was not significantly different, neither when sensitivity and specificity were averaged nor when accuracy was weighted to reflect caries prevalence of 2, 5 or 10%. The predictive values of both positive/negative outcomes were virtually identical for the CCD and film images. The interrater variability in lesion confidence scores with digital images was comparative with film. CONCLUSIONS: Dentists using a direct digital CCD system performed as well in interpreting proximal surface caries as with E-speed film. This work suggests that for this task these two competing systems are diagnostically comparable. <39> UI - 98104744 AU - Svenson B AU - Welander U AU - Shi XQ AU - Stamatakis H AU - Tronje G IN - Department of Oral Radiology, Postgraduate Dental Education Center, Orebro, Sweden. TI - A sensitometric comparison of four dental X-ray films and their diagnostic accuracy. SO - Dento-Maxillo-Facial Radiology 1997 Jul;26(4):230-5 AB - OBJECTIVES: To compare the sensitometric properties and accuracy in the diagnosis of approximal caries of two E-speed (Ektaspeed Plus and EV 57) and two D-speed (Ultra-speed and DV 57) films. METHODS: Speed and contrast for the four films were determined following 30 exposures for each film. Base plus fog density was measured on unexposed films and the increase was studied over a 18-month period. Seventy-five extracted premolars with known pathology were radiographed under standardized conditions and the radiographs assessed by nine observers for approximal caries. Receiver Operating Characteristic (ROC) curve technique was used to analyse the diagnostic accuracy. RESULTS: The sensitometric analysis showed that the Ektaspeed Plus film had the highest speed of the four films. At a density of 1.0 it was 2.28 times faster than Ultra-speed. The contrast of Ektaspeed Plus was comparable with that of the other films and base plus fog density plateaued at 0.4 ten months before expiry date. There were no statistically significant differences in diagnostic accuracy for white spot lesions between the four films. For cavitations there was a significant difference between EV 57 and DV 57 and Ektaspeed Plus (P = 0.005) but not between Ultra-speed and Ektaspeed Plus nor between Ultra-speed and EV 57 and DV 57. CONCLUSION: Ektaspeed Plus film is comparable with D-speed and a conventional E-speed film. Since it is at present the fastest available dental film it should be recommended for general dental practice. <40> UI - 98104756 AU - Maupome G AU - Sheiham A IN - Department of Clinical Dental Sciences, Faculty of Dentistry, University Clinical Dental of British Columbia, Vancouver B.C., Canada. TI - Decisions on diagnosis and management of approximal caries by final-year dental students. SO - Dento-Maxillo-Facial Radiology 1997 Mar;26(2):107-11 AB - OBJECTIVES: To investigate the decision-making processes for dental caries from bitewing radiographs of final-year dental students in Mexico City. METHODS: Five sets of radiographs were converted to slides and projected on a screen under standardized conditions. 143 students were asked to determine separately the presence of all proximal caries, of proximal lesions to be restored in the present course of treatment, and of unreadable surfaces due to technical deficiencies. A gold standard was obtained from two expert clinicians who examined the radiographs under similar conditions. RESULTS: Misdiagnoses were common. Overdiagnoses became evident at the treatment planning stage where many surfaces were incorrectly planned for restoration. Subjective appraisals of presence of lesions, unreadable surfaces, and surfaces planned for restoration showed substantial variation. CONCLUSIONS: Students' overall assessment of lesions detected did not differ between restored and unrestored surfaces. However, when compared with the gold standard, their decision-making was found to be better on surfaces which had not been restored previously as opposed to those already restored, both in terms of identification of lesions and in terms of treatment planned for deeper lesions. <41> UI - 98082133 AU - Tanzer JM IN - Department of Oral Diagnosis, School of Dental Medicine, University of Connecticut Health Center, Farmington 06030-1605, USA. tanzer@nso.ucho.edu TI - Salivary and plaque microbiological tests and the management of dental caries. [Review] [59 refs] SO - Journal of Dental Education 1997 Nov;61(11):866-75 <42> UI - 98082134 AU - Suddick RP AU - Dodds MW IN - Department of Community Dentistry, University of Texas Health Science Center at San Antonio 78284-7917, USA. TI - Caries activity estimates and implications: insights into risk versus activity. SO - Journal of Dental Education 1997 Nov;61(11):876-84 <43> UI - 98082135 AU - Benn DK AU - Dankel DD 2nd AU - Clark D AU - Lesser RB AU - Bridgwater AB IN - Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, University of Florida College of Dentistry, Gainesville 32610-0414, USA. TI - Standardizing data collection and decision making with an expert system. SO - Journal of Dental Education 1997 Nov;61(11):885-94 AB - The software for the pilot system has been completed. The appropriateness of the risk factor weights needs to be evaluated by clinical testing. However, this does not prevent the system from being used to teach the philosophy of risk group identification and selection of different management strategies according to disease activity. The current system does demonstrate a dynamic relationship between caries risk assessment/activity and different management strategies. A formal scientific evaluation of the effectiveness of the system as a teaching tool is being developed. <44> UI - 98053197 AU - Kopel HM IN - Section of Pediatric Dentistry, School of Dentistry, Center for the Health Sciences, University of California, Los Angeles 90095-1668, USA. TI - The pulp capping procedure in primary teeth "revisited" [see comments]. [Review] [59 refs] CM - Comment in: ASDC J Dent Child 1998 Mar-Apr;65(2):84-5 SO - ASDC Journal of Dentistry for Children 1997 Sep-Oct;64(5):327-33 AB - The purpose of this review is to "revisit" an earlier paper (1992) on the subject of direct pulp capping in primary teeth and bring some new considerations for the procedure by the use of dentin bonding adhesives. It has come to be recognized that the customary employment of calcium hydroxide for this therapy has some shortcomings that reduce the prognosis for a favorable outcome. For at least a decade, many investigations have found that postoperative sensitivity, thermal stimuli, pulp inflammation and pathosis can be attributed not to the composition of various dental materials and their insertion techniques, but to microleakage with subsequent bacterial invasion at the enamel/restoration and the dentin/pulp interfaces. It is imperative, as pointed out, that there be an impervious resinous bond between the dentin and the dentinopulpal complex which can be achieved by the use of dentinal adhesive agents to eliminate microleakage outward movement of pulpal fluids. Various steps in the bonding technique for the treatment of deep dentin caries and/or a pulp exposure has raised some concerns for their effect on the pulp. This review discusses these concerns, which can lead to the conclusion that the use of dentinal bonding adhesives is a safe and biologically feasible procedure, whether it be in permanent or primary teeth. [References: 59] <45> UI - 98092063 AU - Anonymous TI - Fluoridation debate [news]. SO - Environmental Health Perspectives 1997 Nov;105(11):1176 <46> UI - 98061556 AU - Besimo C AU - Gachter M AU - Jahn M AU - Hassell T IN - Department of Prosthodontics, School of Dentistry, University of Basel, Switzerland. TI - Clinical performance of resin-bonded fixed partial dentures and extracoronal attachments for removable prostheses. SO - Journal of Prosthetic Dentistry 1997 Nov;78(5):465-71 AB - STATEMENT OF PROBLEM: It is important to evaluate the long-term clinical performance of resin-bonded fixed partial dentures and extracoronal attachments for removable prostheses. PURPOSE: A prospective, long-term clinical study was conducted to evaluate the success of resin-bonded fixed partial dentures since 1985 and of resin-bonded extracoronal attachments from 1987. METHODS: Until 1993, a total of 130 resin-bonded fixed partial dentures had been seated in 101 patients, as well as 12 removable partial dentures (RPDs) with 24 extracoronal retainers in 10 patients. The clinical treatment protocol and the laboratory procedures were standardized. By the end of 1993, it was possible to reexamine 98 patients with a total of 127 resin-bonded fixed partial dentures and all 10 patients with removable partial dentures. The average time in function for the resin-bonded fixed partial dentures at the time of examination was 3.4 years and 2.3 years for the removable restorations. RESULTS: During the period of observation, one retainer failed on six of the resin-bonded fixed partial dentures, which represents a failure rate of 4.7%. Debonding of extracoronal attachments was recorded for 8.3% of the total number of retainers. CONCLUSION: The resin-bonded fixed partial denture technique can be considered to be a clinically reliable method of treatment, and permits the expansion of indications beyond a classical three-unit resin-bonded fixed partial denture. Long-term clinical success of removable partial dentures with resin-bonded extracoronal retainers warrants additional clinical studies. <47> UI - 97463611 AU - Elderton RJ IN - University of Bristol, UK. TI - Changing the course of dental education to meet future requirements. SO - Journal / Canadian Dental Association. Journal de l Association Dentaire Canadienne 1997 Sep;63(8):633-4, 637-9 AB - Dental education is burdened by outdated curricula, which are based on yesteryear's concepts. As a result, caries and restored teeth are still largely "managed" by traditional operative dentistry. This leads into a repeat restoration cycle, which fails to address the fundamental bacterial nature of caries, the primary raison d'etre for this form of therapy. At the same time, many fundamental changes have taken place in the parameters that affect, or should affect, dental care. These range from an improved scientific understanding of the caries process, to a realization by society that maintaining oral health through regular preventive dental care, as opposed to ongoing restorative dental procedures, is a worthwhile and achievable goal. Dental education needs to rise proactively to the challenges presented by the new parameters of modern dental care, or it will be forced to make changes from a defensive position. The ultimate change, which most readers would not consider trivial, would be the closure of one or more of Canada's 10 dental schools. <48> UI - 98034482 AU - Keem S AU - Elbaum M IN - Department of Electrical Engineering, Columbia University, Irvington-on-Hudson, NY, USA. keem@ctr.columbia.edu TI - Wavelet representations for monitoring changes in teeth imaged with digital imaging fiber-optic transillumination. SO - IEEE Transactions on Medical Imaging 1997 Oct;16(5):653-63 AB - Digital imaging fiber-optic transillumination (DI-FOTI) is a novel method to detect and monitor dental caries, using light, a charge-coupled device (CCD) camera, and computer-controlled image acquisition. The advantages of DIFOTI over radiography include: no ionizing radiation, no film, real-time diagnosis, and higher sensitivity in detection of early lesions not apparent to X-ray, as demonstrated in vitro. Here, we present a method of processing DIFOTI images, acquired at different times, for monitoring changes. Of central importance to this application is pattern matching of image frames that is invariant to translation and rotation of a tooth, relative to the field of view of the imaging camera, and that is robust to changes in illumination source intensity. Our method employs: 1) wavelet modulus maxima representations for segmentation of teeth images; 2) first and second moments of gray level representations of DIFOTI images in the spatial domain, to estimate tooth location and orientation; and 3) multiresolution wavelet magnitude representations for quantitative monitoring. Even with illumination source intensity variation, it is demonstrated in vitro that such wavelet representations can facilitate detection of simulated clinical changes in light transmission that cannot be detected in the spatial domain. <49> UI - 98014995 AU - Hawkins RJ AU - Jutai DK AU - Brothwell DJ AU - Locker D IN - Community Dental Health Services Research Unit, Faculty of Dentistry, University of Toronto, Ontario, Canada. TI - Three-year coronal caries incidence in older Canadian adults. SO - Caries Research 1997;31(6):405-10 AB - This paper describes the incidence of coronal caries in a sample of older adults. A 3-year follow-up study was conducted of 493 community-dwelling adults aged 50 years and over in Ontario, Canada. The incidence of coronal caries was 57.0%, and the mean net DFS increment was 1.9 surfaces. In bivariate analysis, several variables were significantly associated with incidence and/or mean DFS increment. These included: age, marital status, baseline coronal DFS, number of teeth at baseline, mean periodontal attachment loss of 4 mm or more, and wearing partial dentures. In logistic regression analysis only four factors had significant independent effects. These were level of education, marital status, mean periodontal attachment loss and number of teeth at baseline. The predictive ability of this model was fair: accuracy 65.7%, sensitivity 80.2%, and specificity 46.2%. When logistic analysis was repeated separately for two age groups, different predictors had significant independent effects, and sensitivity and specificity values differed substantially. These findings indicate predictive models for caries incidence should include both clinical and non-clinical variables because both types of variables may help to explain different aspects of coronal caries experience. Further research is required to identify other factors associated with coronal caries in older adults. <50> UI - 98045910 AU - Swerdlow CD AU - Brewer JE AU - Kass RM AU - Kroll MW IN - Department of Medicine, Cedars-Sinai Medical Center, and University of California Los Angeles School of Medicine, 90048, USA. swerdlow@ucla.edu TI - Application of models of defibrillation to human defibrillation data: implications for optimizing implantable defibrillator capacitance. SO - Circulation 1997 Nov 4;96(9):2813-22 AB - BACKGROUND: Theoretical models predict that optimal capacitance for implantable cardioverter-defibrillators (ICDs) is proportional to the time-dependent parameter of the strength-duration relationship. The hyperbolic model gives this relationship for average current in terms of the chronaxie (t(c)). The exponential model gives the relationship for leading-edge current in terms of the membrane time constant (tau(m)). We hypothesized that these models predict results of clinical studies of ICD capacitance if human time constants are used. METHODS AND RESULTS: We studied 12 patients with epicardial ICDs and 15 patients with transvenous ICDs. Defibrillation threshold (DFT) was determined for 120-microF monophasic capacitive-discharge pulses at pulse widths of 1.5, 3.0, 7.5, and 15 ms. To compare the predictions of the average-current versus leading-edge-current methods, we derived a new exponential average-current model. We then calculated individual patient time parameters for each model. Model predictions were validated by retrospective comparison with clinical crossover studies of small-capacitor and standard-capacitor waveforms. All three models provided a good fit to the data (r2=.88 to .97, P<.001). Time constants were lower for transvenous pathways (53+/-7 omega) than epicardial pathways (36+/-6 omega) (t(c), P<.001; average-current tau(m), P=.002; leading-edge-current tau(m), P<.06). For epicardial pathways, optimal capacitance was greater for either average-current model than for the leading-edge-current model (P<.001). For transvenous pathways, optimal capacitance differed for all three models (P<.001). All models provided a good correlation with the effect of capacitance on DFT in previous clinical studies: r2=.75 to .84, P<.003. For 90-microF, 120-microF, and 150-microF capacitors, predicted stored-energy DFTs were 3% to 8%, 8% to 16%, and 14% to 26% above that for the optimal capacitance. CONCLUSIONS: Model predictions based on measured human cardiac-muscle time parameter have a good correlation with clinical studies of ICD capacitance. Most of the predicted reduction in DFT can be achieved with approximately 90-microF capacitors. <51> UI - 98009073 AU - Elias AC AU - Jutkowitz AS IN - Mount Sinai Hospital, New York, New York, USA. TI - Cosmetic options for the aging dentition. [Review] [29 refs] SO - Dermatologic Clinics 1997 Oct;15(4):673-8 <52> UI - 98002955 AU - Ettinger RL IN - Department of Prosthodontics and Dows Institute for Dental Research, University of Iowa, Iowa City 52242, USA. TI - The unique oral health needs of an aging population. [Review] [110 refs] SO - Dental Clinics of North America 1997 Oct;41(4):633-49 AB - Over the last century, the number and percentage of older adults has increased dramatically. In the last 30 years, the percentage of older edentulous adults has declined significantly but the total number is expected to remain constant at 9 million until the year 2020. The increasing number of and percentage of dentate adults will have more teeth at risk for caries and periodontal disease. Many of these adults will have multiple medical problems and be taking various pharmacotherapies which will complicate oral disease and its treatment. New concepts in prevention of oral disease will be required, as will more accurate diagnostic procedures, especially to identify the at-risk older adults. [References: 110] <53> UI - 98002960 AU - Erickson L IN - Department of Veterans Affairs Medical Center, Salt Lake City, Utah 84148, USA. TI - Oral health promotion and prevention for older adults. [Review] [143 refs] SO - Dental Clinics of North America 1997 Oct;41(4):727-50 AB - An oral health promotion and prevention program customized to individual needs begins with a thorough assessment of function and risk profile for dental diseases. Toothbrushes and interproximal cleaners can be selected or adapted to meet special needs of older adults. Fluoride use based on caries risk is an important adjunct to any prevention program. Other preventive agents such as chlorhexidine rinses and xylitol gum supplement the program as risk factors increase or when health and disability limit the ability to effectively perform oral hygiene procedures. Oral cancer screening examination is advocated on a regular basis for all older persons. [References: 143] <54> UI - 98050846 AU - Robison VA AU - Rozier RG AU - Weintraub JA AU - Koch GG IN - Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland 21205, USA. TI - The relationship between clinical tooth status and receipt of sealants among child Medicaid recipients. SO - Journal of Dental Research 1997 Dec;76(12):1862-8 AB - This study investigated the association between caries status and sealant need at a prior survey and subsequent sealant use in a Medicaid program. Clinical data from a 1986-87 statewide epidemiological survey (N = 8026) representative of North Carolina (NC) schoolchildren (grades K-12) were linked with all NC Medicaid dental claims submitted during 1987-92, yielding 570 children in the survey who had at least one dental visit during 1987-1992. From the 570, 390 children were included: 71 who received sealants (S) and 319 who received non-sealant care (NS). Children were excluded based on age, having preexisting sealants, or having no sealant-eligible molars or premolars. S and NS were compared on baseline dfs, DMFS, and sealant need, controlling for the patient's age, number of visits, and the provider's propensity to seal. At all ages, NS was twice as likely to have had prior dfs or DMFS (OR = 2.04, 95% CI = 1.15, 3.70). The association between sealant receipt and prior sealant need varied by age. At 6 to 11 years, S and NS had equal likelihood of sealant need (OR = 1.41, 95% CI = 0.62, 3.18). At 12 to 15 years, NS had a greater likelihood of sealant need (OR = 6.82, 95% CI = 1.60, 29.08). Caries-free status was associated with subsequent sealant receipt. Prior sealant need caused variability in dentists' decisions, depending on the child's age and past caries experience. Sealants were used infrequently by most providers and for a minority of patients. These findings are important for the Medicaid program and for future non-randomized studies of sealant effectiveness. <55> UI - 98045009 AU - Heller KE AU - Eklund SA AU - Burt BA IN - School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA. kheller@umich.edu TI - Dental caries and dental fluorosis at varying water fluoride concentrations [see comments]. CM - Comment in: J Public Health Dent 1998 Summer;58(3):199 SO - Journal of Public Health Dentistry 1997 Summer;57(3):136-43 AB - OBJECTIVES: The purpose of this study was to investigate the relationships between caries experience and dental fluorosis at different fluoride concentrations in drinking water. The impact of other fluoride products also was assessed. METHODS: This study used data from the 1986-87 National Survey of US School-children. Fluoride levels of school water were used as an indicator of the children's water fluoride exposure. The use of fluoride drops, tablets, professional fluoride treatments, and school fluoride rinses were ascertained from caregiver questionnaires. Only children with a single continuous residence (n = 18,755) were included in this analysis. RESULTS: The sharpest declines in dfs and DMFS were associated with increases in water fluoride levels between 0 and 0.7 ppm F, with little additional decline between 0.7 and 1.2 ppm F. Fluorosis prevalence was 13.5 percent, 21.7 percent, 29.9 percent, and 41.4 percent for children who consumed < 0.3, 0.3 to < 0.7, 0.7 to 1.2, and > 1.2 ppm F water. In addition to fluoridated water, the use of fluoride supplements was associated with both lower caries and increased fluorosis. CONCLUSIONS: A suitable trade-off between caries and fluorosis appears to occur around 0.7 ppm F. Data from this study suggest that a reconsideration of the policies concerning the most appropriate concentrations for water fluoridation might be appropriate for the United States. <56> UI - 98045014 AU - Clark DC AU - Berkowitz J IN - Department of Clinical Dental Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada. dcc@unixg.ubc.ca TI - The relationship between the number of sound, decayed, and filled permanent tooth surfaces and the number of sealed surfaces in children and adolescents. SO - Journal of Public Health Dentistry 1997 Summer;57(3):171-5 AB - OBJECTIVES: The purpose of this investigation was to determine the prevalence of sound, decayed, filled, and sealed permanent tooth surfaces for children and adolescents from three fluoridated communities in British Columbia and to develop a predictive model of sealant use that included the dental caries status of tooth surfaces. METHODS: Children in grades 2 and 3 (n = 2,715) and adolescents in grades 8 and 9 (3,317) were surveyed to determine the prevalence of sound, decayed, filled, and sealed permanent tooth surfaces. The DMFS index, modified to include incipient (D1) and cavitated (D2) lesions, was used to measure the status of all tooth surfaces. The prevalence of D1D2MF and sealed tooth surfaces was estimated by age group and tooth type. Logistic regression models were developed to analyze the association between a number of independent variables and sealant use. RESULTS: About 60 percent of surveyed students had one or more sealants present, with a mean of 3.2 sealants per subject. Of all pit and fissure surfaces on permanent first molars, 23.4 percent and 20.1 percent were sealed for the 11 years and younger and 12 years and older age groups, respectively. For these same two age groups, the percentages of pit and fissure surfaces that were decayed and filled were 6.7 percent and 19.7 percent, respectively. For both age groups combined, 10.8 percent and 23.7 percent of all pit and fissure surfaces on second molars and premolars, respectively, were sealed. The prevalence of decayed and filled pit and fissure surfaces was 5.6 percent and 1.8 percent, respectively, for second molars and premolars. Premolars were being sealed at a rate of 13 to 1 compared to the number of decayed and filled surfaces. Logistic regression failed to identify meaningful predictors of sealant use. CONCLUSIONS: Results from this study found an increase in the prevalence of sealants in the three communities surveyed, yet failed to identify criteria used by dentists or auxiliaries when making decisions about sealant placement. Professional education in the appropriate use of sealants may be necessary. <57> UI - 98043098 AU - Ciancio SG IN - Department of Periodontology, University at Buffalo School of Dental Medicine, USA. TI - Medications as a risk factor for caries and periodontal disease. [Review] [35 refs] SO - New York State Dental Journal 1997 Oct;63(8):32-6 AB - Since our population is aging, patients will present to our offices with more medications than in the past. Although these medications may benefit their general health, they may adversely affect their dental health. Although most medications discussed increase the risk for caries and periodontal disease, a few may actually decrease the risk. [References: 35] <58> UI - 98036981 AU - Wallengren ML AU - Johnson U AU - Ericson D IN - Department of Cariology, Lund University, Malmo, Sweden. TI - HLA-DR4 and number of mutans streptococci in saliva among dental students and staff. SO - Acta Odontologica Scandinavica 1997 Oct;55(5):296-8 AB - Our aim was to corroborate previous findings that HLA-DR4 carriers are characterized by higher levels of mutans streptococci in saliva than are individuals expressing other HLA-DR types. Of 68 subjects (dental students, staff, and faculty) who were sampled for salivary counts of mutants streptococci, 13 subjects with the lowest counts of mutans streptococci and 15 subjects with the highest counts were selected for HLA-typing. Of the 13 who expressed HLA-DR4, 8 were heavily colonized by mutants streptococci. Although a trend towards a relationship was found between HLA-DR4 carriage and high levels of mutans streptococci, it was not statistically significant. In this selected population, knowledge of how to minimize the risk of caries and mutans streptococci level may have influenced the results. <59> UI - 97473278 AU - Ludlow JB AU - Platin E AU - Delano EO AU - Clifton L IN - Diagnostic Services Department, University of North Carolina School of Dentistry, Chapel Hill 27599-7450, USA. TI - The efficacy of caries detection using three intraoral films under different processing conditions. SO - Journal of the American Dental Association 1997 Oct;128(10):1401-8 AB - This study compares the diagnostic accuracy of caries detection using Ultra-speed (Eastman Kodak), Ektaspeed (Eastman Kodak) and Ektaspeed Plus (Eastman Kodak) films after they were developed in both new and used processing solutions. Ektaspeed Plus film provided significantly better diagnostic accuracy for small proximal-surface caries limited to the outer third of the dentin than did Ektaspeed film. Ektaspeed Plus film did not differ significantly from Ultra-speed film in aiding in the diagnosis of small carious lesions, and it maintained diagnostic accuracy in used processing solutions. Dentists can offer the X-ray dose-reducing technology of Ektaspeed Plus film to their patients and maintain consistently high diagnostic quality. <60> UI - 97467688 AU - Krall EA AU - Dawson-Hughes B AU - Garvey AJ AU - Garcia RI IN - Boston University, Goldman School of Dental Medicine, MA 02118, USA. TI - Smoking, smoking cessation, and tooth loss. SO - Journal of Dental Research 1997 Oct;76(10):1653-9 AB - Smoking is associated with an increased risk of tooth loss, but it is not known if this risk decreases significantly when individuals quit smoking. The objectives of this study were to describe the rates of tooth loss by smoking status in two populations of medically healthy men and women. Among the men, rates of tooth loss and edentulism in relation to smoking cessation were also evaluated. The subjects were drawn from a group of 584 women (aged 40 to 70) recruited from the Boston, MA, area and a separate population of 1231 male veterans (aged 21 to 75) who participated in the VA Dental Longitudinal Study in Boston. In cross-sectional baseline analyses, current cigarette smokers of either sex had significantly more missing teeth than never-smokers or former smokers. Former smokers and pipe or cigar smokers tended to have an intermediate number of missing teeth. Current male smokers had more teeth with calculus, but the differences in plaque, tooth mobility, probing depth > 2 mm, filled and decayed teeth, and bleeding on probing by smoking history were not significant. Prospective observations of 248 women (mean follow-up time = 6 +/- 2 years) and 977 men (mean = 18 +/- 7 years) indicated that individuals who continued to smoke cigarettes had 2.4-fold (men) to 3.5-fold risk (women) of tooth loss compared with non-smokers. The rates of tooth loss in men were significantly reduced after they quit smoking cigarettes but remained higher than those in non-smokers. Men who smoked cigarettes had a 4.5-fold increase in risk of edentulism, and this risk also decreased upon smoking cessation. These findings indicate that the risk of tooth loss is greater among cigarette smokers than among non-smokers. Smoking cessation significantly benefits an individual's likelihood of tooth retention, but it may take decades for the individual to return to the rate of tooth loss observed in non-smokers. <61> UI - 97473972 AU - Petti S AU - Tarsitani G AU - Panfili P AU - Simonetti D'Arca A IN - Hygiene Institute of La Sapienza University, Rome, Italy. TI - Oral hygiene, sucrose consumption and dental caries prevalence in adolescent systemic fluoride non-users. SO - Community Dentistry & Oral Epidemiology 1997 Aug;25(4):334-6 <62> UI - 97473965 AU - van Palenstein Helderman WH AU - Munck L AU - Mushendwa S AU - van't Hof MA AU - Mrema FG IN - WHO Collaborating Centre, Dentistry, University of Nijmegen, The Netherlands. TI - Effect evaluation of an oral health education programme in primary schools in Tanzania. SO - Community Dentistry & Oral Epidemiology 1997 Aug;25(4):296-300 AB - This study aimed to assess the clinical oral health outcome effects among schoolchildren participating in a school-based oral health education (OHE) programme. Local social, cultural and environmental conditions were determinants of the school-based OHE programme, which was compiled on the basis of prevailing beliefs and on what teachers and educational authorities considered to be important for the oral health of schoolchildren. Consequently, the practical aspects of oral hygiene and information on the cause and prevention of caries and gingivitis were the components of oral health education. The teachers were prepared to carry out weekly supervised toothbrushing sessions and monthly lessons on aspects of oral health for the school year in grade 4. Eight participating schools were selected for the clinical effect evaluation and four non-participating schools served as the control. In total, 309 children from the participating schools and 122 children from the non-participating schools were available for the evaluation. Their ages varied between 9 and 14 years. The mean plaque score, calculus score and gingival bleeding score at baseline and at follow-up examinations 3, 8, 15 and 36 months later were not significantly different for participating schools and controls. The mean DMFT value at baseline was 0.4 and 3 years later 0.9 in both the participating and control schools. In conclusion, the present study shows that the implemented school-based OHE programme did not result in significant reductions of the clinical parameters measured. <63> UI - 97473961 AU - Worthington H AU - Holloway P AU - Clarkson J AU - Davies R IN - Dental Health Unit, Turner Dental School, Manchester, UK. TI - Predicting which adult patients will need treatment over the next year. SO - Community Dentistry & Oral Epidemiology 1997 Aug;25(4):273-7 AB - This prospective study was conducted to determine factors important in predicting which regularly attending adult patients would receive first, restorations or extractions for any reason (receiving treatment) and, second, restorations or extractions undertaken specifically for caries (receiving treatment related to caries). Baseline and incremental clinical data were obtained from 24 general dental practitioners on a group of their regularly attending, dentate adult patients over a 12-month period. The patients completed a postal questionnaire with questions relating to dental health behaviour, attitudes, knowledge, and social factors. Complete data were obtained from 2553 patients. Thirty-one variables were identified as potential predictors for the two dependent variables receiving treatment and receiving treatment related to caries, and logistic regression models were fitted. Receiving treatment was associated with having fewer sound teeth and more anterior fillings, posterior fillings and crowns (P < 0.001). The dentist's prediction of the need for treatment related to caries and the patient's own prediction of the need for a filling were also important in the model (P < 0.001). Some of these variables, together with having received recent medical treatment and taking sugar in tea or coffee were also found to predict treatment related to caries. The model for receiving treatment related to caries was more successful at predicting the patient's individual risk but the model for receiving treatment was slightly better at classifying patients into whether or not they received treatment. It is reassuring that the common assumptions made by the dental practitioners of their patient's risk have received statistical validation. <64> UI - 97473960 AU - Baelum V AU - Luan WM AU - Chen X AU - Fejerskov O IN - Department of Periodontology and Oral Gerontology, Royal Dental College, Faculty of Health Sciences, Aarhus University, Denmark. TI - Predictors of destructive periodontal disease incidence and progression in adult and elderly Chinese. SO - Community Dentistry & Oral Epidemiology 1997 Aug;25(4):265-72 AB - This study describes some predictors of new and progressing destructive periodontal disease over a 10-year period in rural Chinese. A total of 398 persons aged 20-80 years, who had participated in a baseline survey of tooth mortality, dental caries and periodontal conditions and were still dentate 10 years later, were reexamined for the same parameters as assessed at baseline. Three different threshold values were used to define new and progressing destructive periodontal disease. Irrespective of the threshold used, most persons experienced new disease. Progressing disease was very prevalent when a 2+ mm disease definition was used, but occurred less frequently at the higher threshold levels. The logistic regression models for 2+ and 3+ mm disease were essentially similar, and showed that women, persons with 104 sites or more, and persons with 0-5% sites with 4+ mm attachment levels had a lower risk of disease progression as well as of new disease than did men, persons with few sites and persons with 6% sites or more with attachment levels 4+ mm. The variables sex, number of sites present, percentage of sites with 4+ mm attachment levels, and presence of mobile teeth were predictive for new disease using a 4+ mm definition. Age, percentage of sites with 4+ mm attachment levels and percentage of sites with 4+ mm pockets were predictive for progressing disease using the 4+ mm disease definition. <65> UI - 97473179 AU - Varsio S AU - Vehkalahti M IN - Department of Oral Public Health, University of Helsinki, Finland. TI - Dentists' decisions on caries risk and preventive treatment by dental state among 15-year-old adolescents. SO - Community Dental Health 1997 Sep;14(3):166-70 AB - OBJECTIVE: To evaluate dentists' decisions on caries risk and preventive treatment in relation to their clinical findings among 15-year-old children. DESIGN: Two groups of children were selected on the basis of subjects' number of decayed teeth. Data were also used from personal oral health records. PARTICIPANTS: 15-year-old children (n = 132) clinically checked and treated in public dental clinics in Helsinki. The high-risk group (n = 100) had the greatest numbers of decayed teeth (DT + dt), the low-risk group (n = 32) was cavity-free. OUTCOME MEASURES: Dental state, treatment decision, preventive and operative treatment recorded by visit, were used for assessment of caries risk and individual needs for caries prevention, and for evaluation of diversity and intensity of preventive treatment given to each patient. RESULTS: Dentists had judged only 17 per cent of the high-risk patients (mean DT + dt 6.5; range 4-16) as being at high risk of caries. Preventive measures were given only on one out of three visits. One out of two preventive measures was application of fluoride varnish and only one out of ten was dietary counselling. Patients with more decayed surfaces had been given more diversified (P < 0.01) and more intensive (P < 0.005) preventive treatment than had those with none or only a few caries lesions. Despite this, only 4 per cent of the patients with DS = 8-27 had been given four different preventive measures, and one patient out of seven had been left without any caries-preventive intervention. CONCLUSION: To meet individual needs of high caries-risk patients, the variety and intensity of preventive measures directed towards them need to be further improved. <66> UI - 97448690 AU - Grau AJ AU - Buggle F AU - Ziegler C AU - Schwarz W AU - Meuser J AU - Tasman AJ AU - Buhler A AU - Benesch C AU - Becher H AU - Hacke W IN - Department of Neurology, University of Heidelberg, Germany. ArminvGrau@krzmail.krz.uni-heidelberg.de TI - Association between acute cerebrovascular ischemia and chronic and recurrent infection [see comments]. CM - Comment in: Stroke 1998 Jan;29(1):257-8 SO - Stroke 1997 Sep;28(9):1724-9 AB - BACKGROUND AND PURPOSE: We performed a case-control study to investigate whether chronic or recurrent respiratory, ear-nose-throat (ENT), and dental infections are risk factors for cerebrovascular ischemia. METHODS: Using a standardized questionnaire we investigated past infectious diseases in 166 consecutive patients with acute cerebrovascular ischemia and in 166 age- and sex-matched nonstroke neurological patient controls. In subgroups, we performed standardized ENT (69 patients, 66 control subjects) and dental examinations including orthopantomography (66 patients, 60 control subjects). Dental status was determined by a total dental index (TDI) that reflects caries, periapical lesions, periodontitis, and other dental lesions and by an orthopantomography index (OPGI) that was assessed blinded. RESULTS: Frequent (> or = 2 episodes in each of the 2 preceding years) or chronic bronchitis was associated with cerebrovascular ischemia in age-adjusted multiple logistic regression analysis (odds ratio, OR, 2.2; 95% confidence interval, CI, 1.04 to 4.6). Groups were not different in ENT examination. Patients tended to have a worse dental status (TDI: P = .070; OPGI: P = .062) and had more severe periodontitis (P = .047) and periapical lesions (P = .027) than control subjects. In age-adjusted multiple logistic regression analysis with social status and established vascular risk factors, poor dental status (TDI) was independently associated with cerebrovascular ischemia (OR, 2.6; 95% CI, 1.18 to 5.7). CONCLUSION: Recurrent or chronic bronchial infection and poor dental status, mainly resulting from chronic dental infection, may be associated with an increased risk for cerebrovascular ischemia. <67> UI - 97411368 AU - Scheutz F AU - Matee MI AU - Andsager L AU - Holm AM AU - Moshi J AU - Kagoma C AU - Mpemba N IN - Department of Oral Epidemiology and Public Health, Royal Dental College, Faculty of Health Sciences, University of Aarhus, Denmark. TI - Is there an association between periodontal condition and HIV infection?. SO - Journal of Clinical Periodontology 1997 Aug;24(8):580-7 AB - Individuals in Tanzania who have limited access to medical and dental treatment provide an opportunity to study the natural association between periodontal condition and HIV infection and the stage of infection. 119 HIV-infected adult individuals and 73 individuals with AIDS from the AIDS Clinical Trial Clinic at Muhimbili Medical Centre (MMC) in Dar-es-Salaam participated as cases. Mean age was 35.3 and 35.1 years, respectively. 156 individuals with a mean age of 28.3 years, confirmed as HIV-seronegative, served as controls. There were no significant differences in bleeding on probing, pocket formation or attachment loss among the HIV-seronegative individuals, HIV-seropositive and AIDS patients. We applied multiple logistic regression to calculate odds ratios for presence of periodontal conditions adjusting for age, gender and DMFT. Our odds ratios did not reveal any significant associations between bleeding on probing, pocket formation or attachment loss with regard to lymphocyte and CD4+ T-cell counts among the HIV-infected individuals and AIDS patients. When associations were investigated with regard to HIV-serostatus (HIV-seronegative, HIV-seropositive or AIDS), our adjusted odds ratios were insignificant, too. In fact, most odds ratios were close to 1. Thus, our study supports recent views that the presence, extent and severity of periodontal disease among HIV-infected individuals, may be less that hitherto thought. <68> UI - 97435616 AU - Chisick MC AU - Poindexter FR AU - York AK IN - U.S. Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, MD 21010, USA. TI - Factors influencing perceived need for dental care by active duty U.S. military personnel. SO - Military Medicine 1997 Sep;162(9):586-9 AB - This study explores factors that influence perceived need for dental care among active duty U.S. military personnel. The data were collected on a prestratified random sample of 12,950 (76% response rate) service members between April 1994 and January 1995. Participants received a comprehensive oral examination from a dentist and answered queries concerning perceived need on self-administered questionnaires. Using bivariate and logistic regression analyses, we examined the association between demographic and clinical measures and perceived need for dental care. Bivariate results show that half of all U.S. military personnel perceive a need for dental care, with statistically significant differences across race, rank, education, branch of service, dental health class, and dental utilization. Logistic regression results show that the likelihood of perceived need is influenced by age, race, rank, branch of service, dental disease, dental health class, and dental utilization. Extensive dental decay is the strongest predictor of perceived need in this population. <69> UI - 97432635 AU - Gray GB AU - Paterson RC IN - Division of Restorative Dentistry (Conservation), Bristol Dental Hospital, UK. TI - Prediction of the extent of caries in pit and fissure lesions in a field trial in the west of Scotland. SO - Caries Research 1997;31(5):329-35 AB - A field trial is in progress in which 14 community clinical dental officers and 19 general dental practitioners were asked to record the actual extent of fissure lesions and how this compared with the cavity size they expected. Participating operators worked under their normal conditions of daily practice. Forty-eight to fifty-seven percent of 644 prepared cavities were of the expected size upon investigation, depending on the diagnostic technique used. Greater accuracy was achieved among the smaller cavities (58-75% as expected) than with the larger (52-69% larger than expected). More difficulty with cavity size prediction occurred with the lower right first molar than with the other first molar teeth and with both mandibular second molars compared to the maxillary molars. Comparisons between the accuracy of cavity size prediction achieved using a visual inspection in combination with the probe and a visual inspection alone showed no significant difference. Under the conditions of this field trial, considerable difficulties were experienced in predicting cavity size accurately. <70> UI - 97453588 AU - Banks PA AU - Burn A AU - O'Brien K IN - Department of Orthodontics, Fairfield General Hospital, Bury, UK. TI - A clinical evaluation of the effectiveness of including fluoride into an orthodontic bonding adhesive. SO - European Journal of Orthodontics 1997 Aug;19(4):391-5 AB - A clinical trial was undertaken to assess the value of incorporating fluoride released from a commercially available bonding adhesive (Rely-a-Bond) to determine the extent of any protection provided against enamel decalcification. Fifty patients undergoing fixed appliance therapy were included in the trial. Contralateral quadrants were used as controls where no fluoride was present in the adhesive. Enamel decalcification after treatment and bond failure rates during treatment were investigated. A total of 366 experimental and 371 control teeth were included in the study. The results showed that 50 per cent of patients and 13.5 per cent of teeth exhibited post-treatment decalcification. The addition of fluoride to the adhesive did not significantly reduce the incidence of enamel decalcification. Bond failure rates were satisfactory for both experimental and control teeth (all under 5 per cent). <71> UI - 97407117 AU - Cozean C AU - Arcoria CJ AU - Pelagalli J AU - Powell GL IN - Premier Laser Systems, Inc., Irvine, USA. TI - Dentistry for the 21st century? Erbium:YAG laser for teeth. SO - Journal of the American Dental Association 1997 Aug;128(8):1080-7 AB - The first dental laser for use in cutting human teeth in vivo was cleared by the Food and Drug Administration for marketing in the United States. The authors explored, in summary form, the data provided to the FDA for the clinical use of the erbium:yttrium-aluminum-garnet, or Er:YAG, laser. The authors concluded that using the Er:YAG laser to treat dental hard tissue is both safe and effective for caries removal, cavity preparation and enamel etching. <72> UI - 97450284 AU - Stineman MG AU - Goin JE AU - Granger CV AU - Fiedler R AU - Williams SV IN - University of Pennsylvania Health System, Philadelphia, USA. TI - Discharge motor FIM-function related groups. SO - Archives of Physical Medicine & Rehabilitation 1997 Sep;78(9):980-5 AB - OBJECTIVE: To develop a patient classification system that groups patients achieving similar functional outcome scores by discharge from medical rehabilitation. DESIGN: Patient groups were developed using a recursive partitioning algorithm and clinical input. Results were validated in a separate set of patient records. SETTING: Two hundred fifty-two free-standing rehabilitation hospitals and distinct part units that participate in the Uniform Data System for Medical Rehabilitation. PATIENTS: The 84,492 rehabilitation inpatients discharged in 1992 were grouped into 20 impairment categories. MAIN OUTCOME MEASURE: Discharge score on the motor subscale of the Functional Independence Measure (FIM). RESULTS: In the Discharge Motor FIM-Function Related Groups (DMF-FRGs) system, patients are first classified into one of 20 impairment categories and then into FRGs by their admission motor FIM scores. Some FRGs are also subdivided on the basis of admission cognitive FIM scores and age. The entire system consists of 139 patient groups that explain 63% of the variation in motor FIM discharge scores in the validation data set. Nontraumatic brain injury and joint replacement DMF-FRGs are provided as examples. CONCLUSION: Clinicians can use the DMF-FRGs to identify groups of patients whose motor FIM scores at discharge are below, within, or above nationally established ranges of values for the purpose of outcomes management, guideline development, and quality improvement. The DMF-FRGs can also be considered in the design of an outcome-based payment system for medical rehabilitation. <73> UI - 97414149 AU - Tyndall DA AU - Clifton TL AU - Webber RL AU - Ludlow JB AU - Horton RA IN - Department of Diagnostic Sciences, University of North Carolina, School of Dentistry, Chapel Hill, USA. TI - TACT imaging of primary caries. SO - Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics 1997 Aug;84(2):214-25 AB - OBJECTIVE: Tuned-aperture computed tomography, a new method for creating 3-D radiographic information based on optical aperture theory, was evaluated for diagnostic efficacy in primary caries detection. STUDY DESIGN: Sixty-four extracted teeth with 89 carious lesions were imaged with D-speed film, direct digital, and TACT modalities. A commercially available, 8-bit, charge-coupled device was used in the later two modalities. Six trained observers were asked to identify the presence or absence and depth of interproximal and occlusal lesions for all three modalities. The teeth were sectioned and examined microscopically to determine ground truth. Logistic regression analysis was performed for all three imaging systems for the detection task. Analysis of variance was used for depth determination. Detection of lesion, depth of lesion accuracy, and time for diagnosis were also examined. RESULTS: For caries detection TACT and film were not different (p = 0.2216) with the Wald statistic. Film and TACT were significantly more accurate than the digital system (p = 0.0001). Scheffe's post hoc test revealed that TACT and film were more accurate than the direct digital system for determining lesion depth (p = 0.05) but not statistically different when compared with each other. The detection data were substantiated further by receiver operating characteristic analysis that demonstrated similar statistical relationships. Time required per diagnosis was not shown to be statistically different among the three imaging modalities. CONCLUSIONS: We conclude for caries detection and depth determination that TACT could not be distinguished from film despite the significant relative loss of information capacity in the charge-coupled device receptor. The relatively poorer performance yielded by the digital control images suggests that increased information capacity associated with more modern charge-coupled device detectors may improve diagnostic performance for both direct digital and TACT displays over that demonstrated in this investigation. <74> UI - 97414148 AU - Versteeg KH AU - Sanderink GC AU - Velders XL AU - van Ginkel FC AU - van der Stelt PF IN - Department of Oral Radiology, ACTA, Academic Center for Dentistry Amsterdam, The Netherlands. C.Versteeg@acta.nl TI - In vivo study of approximal caries depth on storage phosphor plate images compared with dental x-ray film. SO - Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics 1997 Aug;84(2):210-3 AB - The aim of this in vivo study was to compare approximal caries depth on storage phosphor plate images to conventional film. A Soredex Digora imaging plate was placed in a film bite-wing positioner behind a Kodak Ektaspeed Plus film package without lead foil. The effect of scattered radiation on film without lead foil with a storage phosphor plate at the back was studied in a separate in vitro experiment. Compared with film protected by lead foil, the film showed higher density, but comparable contrast. For the in vivo study, clinical bite-wing exposures were made with the setup described above, with exposure settings for Ektaspeed Plus film. A four-point scale was chosen for approximal caries depth: 0 = no caries; 1 = caries in enamel; 2 = caries reaching dentino-enamel junction; 3 = caries into dentin. The bite-wing film images were shown to a panel of four experts. Sixty surfaces were selected for observer performance, based on identical scorings of the experts consensus classification. Next, six dentists evaluated both film and storage phosphor plate images with the same four point scale. Analysis of variance revealed a significant observer and image modality effect without an interaction effect. In conclusion, caries depth on storage phosphor plate images was underestimated compared with film-based images. <75> UI - 97406745 AU - Libby G AU - Arcuri MR AU - LaVelle WE AU - Hebl L IN - College of Dentistry, University of Iowa, Iowa City, USA. TI - Longevity of fixed partial dentures. SO - Journal of Prosthetic Dentistry 1997 Aug;78(2):127-31 AB - STATEMENT OF PROBLEM: The anticipated length of service and reasons for replacement of fixed partial dentures (FPDs) are a frequent inquiry by patients. Previous reports have provided limited information on material and techniques used in restoration or standards in evaluations of restorations at delivery. PURPOSE: This study determined the reasons for failure and length of service for FPDs delivered with specific clinical, radiographic, and laboratory procedures. METHODS: A clinical and retrospective chart review was conducted on all patients with FPDs who were treated in the prosthodontic clinic at the University of Iowa Hospital for routine dental hygiene recalls during a 6-month period. Fifty patients were examined with a total of 89 FPDs. Of the 89 FPDs, 13, or 15%, were identified as failures or had been replaced because of failure. Dental caries was the most frequent cause of failure (38%), followed by periapical involvements (15%), perforated occlusal surfaces (15%), fractured post and cores (8%), defective margins (8%), fractured teeth (7%), and porcelain failures (8%). The mean length of service for failed FPDs ranged from 16.0 years, because of failure from dental caries, to 4.1 years, because of a fractured post and core. RESULTS: A linear regression model of years in service against number of failed FPDs indicated that the number of years in service provided no information on predictability of failure for FPDs. CONCLUSIONS: This study supported previous reports of dental caries as the primary cause for failure of FPDs, but specific radiographic, clinical, and laboratory procedures can increase the length of service of these restorations. <76> UI - 97406845 AU - Saemundsson SR AU - Slade GD AU - Spencer AJ AU - Davies MJ IN - Department of Dental Ecology, School of Dentistry, University of North Carolina-Chapel Hill, USA. TI - The basis for clinicians' caries risk grouping in children. SO - Pediatric Dentistry 1997 Jul-Aug;19(5):331-8 AB - Despite the growing emphasis on targeting care to high-risk groups, little is known about the factors used by clinicians to designate risk. This study investigates the degree to which factors measured in a typical dental health survey are used by clinicians in assigning children to dental disease risk groups. A random sample of 9690 children aged 5-15 years was selected from the South Australian School Dental Service. Dentists or dental therapists judged each child as low-, medium-, or high-risk for dental disease. Clinicians recorded caries experience (DMFS/dmfs), and children's parents completed a questionnaire on dental behaviors and socioeconomic status (SES). Two binary logistic models were fitted using the risk grouping as the outcome variable, one comparing low- with moderate-risk and the other comparing moderate- with high-risk. Sixty percent of children were judged as moderate-risk, 27% as low-risk, and only 13% as high-risk. In the logistic models, proximal DMFS/dmfs were stronger predictors of assignment to the higher-risk groups than were factors indicating past occlusal caries, while factors describing caries on buccal or lingual surfaces appeared unimportant. Untreated lesions on permanent and primary teeth were among the strongest predictors of assignment to the higher-risk groups. Other significant factors (P < 0.05) were: exposure to professionally applied fluoride and sealants, country of birth, frequency of toothbrushing, and exposure to fluoridated water. No SES factors reached significance. The models explained nearly one-half the variation in the risk predictions. Clinical markers of past caries experience explained the greatest variation in the judgments, showing that clinicians base their risk predictions largely on children's past disease. The three types of surfaces contribute unevenly to the judgments and unrestored caries was the largest contributor to the decision. <77> UI - 97439293 AU - Thomson WM IN - Department of Community Dental Health, School of Dentistry, University of Otago, Dunedin. TI - Predicted distribution of treatment needs for caries across three indicator age groups by the year 2031 [see comments]. CM - Comment in: N Z Dent J 1997 Jun;93(412):35 SO - New Zealand Dental Journal 1997 Jun;93(412):39-43 AB - New Zealand is undergoing a demographic transition which is resulting in fewer young people and greater numbers of elderly people. A dental transition is also occurring by which more elderly people are retaining more teeth. Projections of the caries experience of three indicator adult age groups show that the bulk of future restorative demands on the dental-care system will come from those in the middle-aged and elderly groups. Such a trend requires an increase in gerodontological input at all levels of dental education and training. <78> UI - 97366108 AU - Leupin P AU - Weil J AU - Buchler U IN - Division of Hand Surgery, Inselspital, University of Berne, Switzerland. TI - The dorsal middle phalangeal finger flap. Mid-term results of 43 cases. SO - Journal of Hand Surgery - British Volume 1997 Jun;22(3):362-71 AB - The dorsal middle phalangeal finger (DMF) flap is a (neuro)vascular island flap based on one palmar proper digital artery, its venae comitantes (and/or a separate dorsal vein) and the dorsal branch(es) of the palmar digital nerve. The main nerve supply of the do