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 *************************** <1> UI - 20209944 AU - Nazarko L TI - Molar maintenance. SO - Nursing Times. Nursing Homes 1999 Sep-Oct;1(3):28 <2> UI - 20265404 AU - Nummikoski PV AU - Steffensen B AU - Hamilton K AU - Dove SB IN - Department of Dental Diagnostic Science, University of Texas Health Science Center at San Antonio, 78284, USA. nummikoski@uthscsa.edu TI - Clinical validation of a new subtraction radiography technique for periodontal bone loss detection. SO - Journal of Periodontology 2000 Apr;71(4):598-605 AB - BACKGROUND: Diagnostic subtraction radiography (DSR) is a new digital radiographic image subtraction method designed to enhance detection of crestal or periapical bone density changes and to help evaluate caries progression in teeth. In this clinical study, the performance of the DSR method was evaluated for its ability to detect periodontal bone loss and was compared with that of conventional evaluation of radiographs and the standardized cephalostat-guided image acquisition and subtraction technique (LRA) which served as the "gold standard." METHODS: In each of 25 subjects with alveolar crestal bone loss created by periodontal surgery, one set of DSR radiographs and one set of LRA radiographs were obtained before and after the surgery. Subtraction images were then generated by both the proprietary DSR and the LRA techniques. Four viewers evaluated the paired film sets and both subtraction image sets using a 5 point confidence scale to determine the presence or absence of crestal bone loss. Receiver operating characteristics (ROC) statistical procedures were applied to analyze the diagnostic accuracy and statistical differences between the three imaging modalities. RESULTS: The DSR subtraction viewing generated an ROC area of 0.882. For 2 of the viewers this represented a statistically significant gain (P <0.05) over the conventional viewing of the radiographs which had an average ROC area of 0.730. In comparison, the LRA method achieved an area of 0.954. The differences between the LRA and the DSR subtraction methods were not statistically significant, but the statistical power for claiming equality was low ranging from 0.2 to 0.6. CONCLUSIONS: The use of the DSR technique in clinical radiographic image acquisition and subsequent subtraction analysis clearly enhanced the accuracy of alveolar crestal bone loss detection when compared to conventional film viewing. Because this methodology is less resource demanding than LRA and the film exposure techniques and computer-based image analysis skills may be acquired with only a few hours of training, the DSR has potential in clinical practice. <3> UI - 20345682 AU - Pakhomov GN IN - Oral Health Program, Division of Non-communicable Diseases, World Health Organization, Geneva, Switzerland. TI - Future trends in oral health and disease. SO - International Dental Journal 1999 Feb;49(1):27-32 AB - The World Health Report, published annually by the World Health Organization, provides a rich source of information from which trends may be distinguished and planning can be initiated. In terms of oral health, trends in caries prevalence are of particular importance, as are developments in health promotion in general, which touch on life style factors and thus oral health decisions. This paper highlights aspects of the Report in relation to oral health and discusses some of WHO's responses to the global problems associated with improving oral health. <4> UI - 20345681 AU - Reich E AU - Lussi A AU - Newbrun E IN - University of Saarland, Department of Periodontology and Conservative Dentistry, Homburg, Germany. zmkerei@med-rz.uni-sb.de TI - Caries-risk assessment. [Review] [157 refs] SO - International Dental Journal 1999 Feb;49(1):15-26 AB - Dental caries has a multifactorial aetiology in which there is an interplay of three principal factors: the host (saliva and teeth), the microflora (plaque), and the substrate (diet), and a fourth factor: time. There is no single test that takes into consideration all these factors and can accurately predict an individual's susceptibility to caries. The risk of dental caries can be evaluated by analysing and integrating several causative factors. These include caries experience (initial caries lesions and established caries defects, secondary caries and present caries activity), fluoride use, extent of plaque present, diet, bacterial and salivary activity and social and behavioural factors. [References: 157] <5> UI - 20269630 AU - Trope C AU - Kaern J AU - Hogberg T AU - Abeler V AU - Hagen B AU - Kristensen G AU - Onsrud M AU - Pettersen E AU - Rosenberg P AU - Sandvei R AU - Sundfor K AU - Vergote I IN - Department of Gynecologic Oncology, The Norwegian Radium Hospital, Oslo. claes.trope@klinmed.uio.no TI - Randomized study on adjuvant chemotherapy in stage I high-risk ovarian cancer with evaluation of DNA-ploidy as prognostic instrument [see comments]. CM - Comment in: Ann Oncol 2000 Mar;11(3):259-61 SO - Annals of Oncology 2000 Mar;11(3):281-8 AB - PURPOSE: Adjuvant chemotherapy versus observation and chemotherapy at progression was evaluated in 162 patients in a prospective randomized multicenter study. We also evaluated DNA-measurements as an additional prognostic factor. PATIENTS AND METHODS: Patients received adjuvant carboplatin AUC 7 every 28 days for six courses (n = 81) or no adjuvant treatment (n = 81). Eligibility included surgically staged and treated patients with FIGO stage I disease, grade 1 aneuploid or grade 2 or 3 non-clear cell carcinomas or clear cell carcinomas. Disease-free (DFS) and disease-specific (DSS) survival were end-points. RESULTS: Median follow-up time was 46 months and progression was observed in 20 patients in the treatment group and 19 in the control group. Estimated five-year DFS and DSS were 70% and 86% in the treatment group and 71% and 85% in the control group. The hazard ratio was 0.98 (95% confidence interval (95% CI): 0.52-1.83) regarding DFS and 0.94 (95% CI: 0.37-2.36) regarding DSS. No significant differences in DFS or DSS could be seen when the log-rank test was stratified for prognostic variables. Therefore, data from both groups were pooled for the analysis of prognostic factors. DNA-ploidy (P = 0.003), extracapsular growth (P = 0.005), tumor rupture (P = 0.04), and WHO histologic grade (P = 0.04) were significant independent prognostic factors for DFS with P < 0.0001 for the model in the multivariate Cox analysis. FIGO substage (P = 0.01), DNA ploidy (P < 0.05), and histologic grade (P = 0.05) were prognostic for DSS with a P-value for the model < 0.0001. CONCLUSIONS: Due to the small number of patients the study was inconclusive as regards the question of adjuvant chemotherapy. The survival curves were superimposable, but with wide confidence intervals. DNA-ploidy adds objective independent prognostic information regarding both DFS and DSS in early ovarian cancer. <6> UI - 20294398 AU - Brik A AU - Haskell E AU - Brik V AU - Scherbina O AU - Atamanenko O IN - Institute of Geochemistry, Mineralogy and Ore Formation, Kiev, Ukraine. TI - Anisotropy effects of EPR signals and mechanisms of mass transfer in tooth enamel and bones. SO - Applied Radiation & Isotopes 2000 May;52(5):1077-83 AB - Peculiarities of the internal construction of tooth enamel and bones that cause anisotropy effects and mass transfer in these objects are described. It is shown that the composition of the mineral component of teeth and bones depends on a mechanical-electrical mechanism, which pumps ions into nanocrystals. Decrease in the efficiency of the mechanical-electrical mechanism results in demineralization of enamel and bones, which progresses most rapidly at a disease of the biomineral or under special conditions, such as in space flights. Effects of signal anisotropy in the practice of retrospective EPR dosimetry are discussed. <7> UI - 20321835 AU - Munshi AK AU - Hegde AM AU - Munshi A IN - Department of Pedodontics and Preventive Dentistry, A.B. Shetty Memorial Institute of Dental Sciences, Karnataka. TI - Relationship between the existing caries status, plaque S. mutans and Cariostat caries activity test in children. SO - Journal of the Indian Society of Pedodontics & Preventive Dentistry 1999 Sep;17(3):73-89 AB - An attempt was made in this study to find out the sensitivity and specificity of a caries activity test, CARIOSTAT and its relationship to the existing caries status and the plaque S. mutans level. The test proved to be highly sensitive and specific with significant relationship to the S.mutans count in the dental plaque. There also was a significant relationship between both the cultured microorganisms on MSB agar and the plaque in the Cariostat medium. <8> UI - 20317662 AU - Milano M IN - University of Texas-Houston Dental Branch, USA. TI - Increased risk for dental caries in asthmatic children. SO - Texas Dental Journal 1999 Sep;116(9):35-42 <9> UI - 20316548 AU - Mjor IA AU - Gordan VV IN - Department of Operative Dentistry, UFCD, Gainesville, FL 32610-0415, USA. TI - A review of atraumatic restorative treatment (ART). SO - International Dental Journal 1999 Jun;49(3):127-31 AB - The purpose of this paper was to critically analyse the results obtained with the Atraumatic Restorative Treatment (ART) technique. The ART approach involves the excavation of cavitated carious lesions with hand instruments and restoration of the cavities and associated pits and fissures with a glass ionomer restorative material. The clinical trial outcomes involving ART include retention rates, cost effectiveness, operative sensitivity, and the effect of personnel with different educational backgrounds involved in this alternative operative treatment. Comparative studies involving permanent and deciduous teeth using amalgam and glass ionomer sealants have also been included in the same projects. Specially defined clinical criteria have been used to evaluate the results. ART offers an opportunity for restorative dental treatment under field conditions where no electricity is available. Three-year data have been published, but long term studies using relevant comparison alternatives are lacking. ART has so far been largely employed on populations with a low DMFT. The technique should also be applied to high risk patients with rampant caries before the maximal benefit of the treatment can be ascertained. <10> UI - 20323648 AU - Cederberg RA AU - Frederiksen NL AU - Benson BW AU - Shulman JD IN - Baylor College of Dentistry/Texas A&M University System, Dallas 75266-0677, USA. TI - Influence of the digital image display monitor on observer performance. SO - Dento-Maxillo-Facial Radiology 1999 Jul;28(4):203-7 AB - OBJECTIVE: To assess the influence of the display monitor on observer performance. MATERIAL AND METHODS: Artificial enamel lesions were created in 40 extracted teeth at random using 1/4 and 1/2 round burs. Teeth were mounted in dental stone blocks to simulate a hemidentition. Approximate exposures were recorded at 70 kVp using a Digota (Soredex, Orion Corp, Helsinki, Finland) digital imaging system, calibrated to achieve optimum density. Six dentists rated each image on a five-point scale for the presence or absence of a lesion. Radiographic images were viewed on the following monitors: (1) AlphaScan 711 (Sampo Corp.); (2) Multiscan 17 Se II (Sony Electronics Inc.); (3) DS 2000 (Clinton Electronics Corp.) and (4) Latitude CP Laptop (Dell Computer Corp.). Raters were allowed to magnify and to adjust density and contrast of each image at will. Receiver Operating Characteristic (ROC) analysis was performed and curves were plotted for each image. Data was subjected to repeated measures analysis of variance and ordinal logistic regression to test for significance between variables and to determine odds ratios. RESULTS: Mean ROC curve areas ranged from 0.8728 for the Sampo monitor to 0.8395 for the Sony. Repeated measures analysis of variance showed significant differences between observers (P < 0.0001), lesion size (P < 0.0001), examiner/monitor interaction (P < 0.033) and examiner/block interaction (P < 0.013). However, no significant difference was found between monitors. CONCLUSION: This study suggests that observer performance is independent of the visual characteristics of the display monitor. <11> UI - 20305622 AU - Martin-Iverson N AU - Pacza T AU - Phatouros A AU - Tennant M IN - School of Oral Health Sciences, University of Western Australia. TI - Indigenous Australian dental health: a brief review of caries experience. [Review] [17 refs] SO - Australian Dental Journal 2000 Mar;45(1):17-20 AB - The indigenous community in Australia is an at risk population for oral diseases such as dental caries. The majority of communities are isolated and dental services in these areas are limited. Oral hygiene standards are poor and this combined with a diet rich in refined carbohydrates has led to high incidences of dental caries. In addition, diabetes, which is related to obesity (and a diet high in sugar and fat) has been linked to increases in oral disease. Caries prevalence was found to be low in areas where fluoridation levels in the water were high. The fact that the fluoride supplementation appears to improve oral health to a significant degree suggests that implementation of fluoride treatment programmes for school children and, where viable, fluoridation of water sources would be appropriate. In addition, dental education programmes should receive high priority. As with the rest of the community, these preventive measures will result in less need for emergency dental treatment in the future, better oral health for the community and reduced financial burden on the State. It is under these circumstances that oral health planners and providers must, in consultation with the relevant community representatives, develop appropriate mechanisms to address the needs of this group. The development of strategies that integrate with the plethora of general health strategies currently being implemented is just one means of achieving improved oral health outcomes for indigenous Australians. [References: 17] <12> UI - 20305621 AU - Messer LB IN - School of Dental Science, University of Melbourne. TI - Assessing caries risk in children. [Review] [31 refs] SO - Australian Dental Journal 2000 Mar;45(1):10-6 AB - With the dramatic improvements in the oral health of children in Australia that have occurred over the past two decades, the option of, and the need for, targeted prevention of dental caries for those at high risk has become apparent. Since caries is of multifactorial aetiology, the clinical outcome varies depending on which factor, or combination of factors, is prominent in a particular individual; this may be related to both age and stage of life. Tests for caries risk can assist in prediction, but clinical signs and history are as important in assessing the main cause(s) of caries in an individual. In studies involving several factors, past caries experience (especially of the first permanent molar) continues to be the best predictor of future caries in children. Despite their ready availability, tests in the form of commercial kits are still expensive; no one test is an adequate predictor of caries risk, and the specificity and sensitivity of the tests are not reliably diagnostic for an individual. There is a need for regional longitudinal risk assessment studies in which potential risk factors are identified before the onset of caries in order to maximize predictive power and then validated against subsequent caries. Caries activity may not be able to be predicted in a population with low disease prevalence. Any risk assessment strategy must be followed by appropriate preventive interventions. [References: 31] <13> UI - 20242949 AU - Perez MD AU - Abrams SA AU - Loddeke L AU - Shypailo R AU - Ellis KJ IN - US Department of Agriculture/Agriculture Research Service Children's Nutrition Research Center, Houston, Texas. TI - Effects of rheumatic disease and corticosteroid treatment on calcium metabolism and bone density in children assessed one year after diagnosis, using stable isotopes and dual energy x-ray absorptiometry. [Review] [30 refs] SO - Journal of Rheumatology 2000 Apr;27 Suppl 58:38-43 AB - OBJECTIVE: To evaluate calcium (Ca) metabolism and bone mineral density (BMD) in children with rheumatic disease (RD) at diagnosis and one year later, and effects of different therapies. METHODS: We used dual tracer isotope studies and dual energy x-ray absorptiometry (DEXA) to measure Ca metabolism and BMD in 13 children with RD at diagnosis and one year later. Seven subjects were treated with steroids (RD-ST), 6 with antiinflammatory agents (RD-NS), excluding steroids. RESULTS: Ca balance data for RD subjects were not significantly different from data reported previously for healthy sex and age matched controls. True Ca absorption (Va) was slightly but not significantly greater at study entry in RD-NS subjects (313+/-67 vs 239+/-112 mg/day in RD-ST subjects; p = 0.13). Calculated Ca balance retention (Vbal) was higher at entry in RD-NS (200+/-51 vs RD-ST 60+/-125 mg/day; p = 0.08). One year later, Vbal remained higher in RD-NS (202+/-77 mg/day vs RD-ST 101+/-157 mg/day; p = 0.02). BMD was similar in both groups at entry (RD-NS 0.81+/-0.06 g/cm2 vs RD-ST 0.89+/-0.1 g/cm2; p = 0.07). One year later, BMD was 0.86+/-0.6 g/cm2 in RD-NS versus 0.89+/-0.08 g/cm2 in RD-ST; p = 0.07. Ca kinetic and DEXA studies did not reveal significant alteration of Ca kinetics or significantly lower BMD in steroid treated subjects versus non-steroid treated subjects. However, slightly lower Va and Vbal indicated a possible risk of bone demineralization in steroid treated subjects. CONCLUSION: Children with RD who are treated with steroids may be at greater risk of bone demineralization at diagnosis that persists through the first year. However, bone loss may take years to manifest when measured by quantitative methods such as DEXA. [References: 30] <14> UI - 20237506 AU - Lussi A AU - Schaffner M IN - Department of Operative, Preventive and Paediatric Dentistry, University of Bern, School of Dental Medicine, Bern, Switzerland. TI - Progression of and risk factors for dental erosion and wedge-shaped defects over a 6-year period. SO - Caries Research 2000 Mar-Apr;34(2):182-7 AB - It has been shown that dental erosion is not a very rare condition. Careful observation and clinical experience led us to hypothesize a progression of these lesions with time despite dietary counselling and oral hygiene instruction. The purpose of this study was to determine the progression rate and risk factors of dental erosion and wedge-shaped defects over a 6-year period. In the year 1987, 204 randomly selected persons living in Bern from two age groups (26-30 and 46-50 years) were examined for frequency and severity of dental erosion and wedge-shaped defects. In the year 1993, 55 persons could be re-examined by the same dentist using the same indices. Further, detailed case histories of the patients were recorded and the flow rate and buffering capacity of the saliva were determined. The results indicated a distinct progression of erosion on facial and occlusal surfaces and wedge-shaped defects over the 6-year period. The increase in the defects was more marked in the older age group. Surprisingly, nutritional habits did not change despite thorough informative discussion about erosive foodstuff with every patient during the first session. Multiple linear regression analysis revealed consumption of nutritional acids and age as significant risk factors explaining 28% of the variability of the progression of erosions. The significant factors for the progression of wedge-shaped defects were identified to be frequency of tooth brushing and age, explaining 21% of the variability of the progression of wedge-shaped defects. In summary, there was a definite statistically significant progression of non-carious dental hard tissue defects in our sample. This progression was correlated with age (erosion and wedge-shaped defects), consumption of dietary acids (erosion) and frequency of toothbrushing (wedge-shaped defects). <15> UI - 20237497 AU - Williams SA AU - Kwan SY AU - Parsons S IN - Dental Public Health, Leeds Dental Institute, Leeds, UK. den6saw@leeds.ac.uk TI - Parental smoking practices and caries experience in pre-school children. SO - Caries Research 2000 Mar-Apr;34(2):117-22 AB - Voluntary and involuntary smoking influence general health. Links between voluntary smoking and oral health are confirmed for periodontal diseases and oral cancer/precancer. Since recent reports have suggested an association between parental smoking and caries experience in young children, this study aimed to explore varying patterns of parental smoking, adjusted for social class, with caries prevalence, using data derived from the UK National Diet and Nutrition Survey (1995). Data analysis was confined to 749 children aged 3.0-4.5 years, to avoid confounding effects of unerupted teeth. Bivariate analysis indicated that the prevalence of maternal rather than paternal smoking was significantly related to caries and substantially attenuated social class differences. The reported number of cigarettes smoked was not important. To compensate for the association between social class and maternal smoking, data were dichotomised by social class (manual/non-manual). With caries prevalence as the dependent variable, logistic regression analysis recorded maternal smoking as a significant independent variable in each case, with odds ratios of 1.55/1.96, respectively. The process was repeated for the combined dataset, using the more extensive (six) social class categories. This further analysis yielded an odds ratio for maternal smoking of 1.54 compared with 1.46 for social class. Nutrition status (as growth parameters) and dietary intake (as household spending on confectionery) were not significant independent variables in these equations. The rationale for these findings is discussed. Further research is required to determine mechanisms underlying these observations. It is concluded that maternal smoking is a significant factor to be considered as an additional risk indicator beyond social class when predicting caries risk in young children. <16> UI - 20261449 AU - Lattimore PJ AU - Thompson GM AU - Halford JC IN - Department of Psychology, University of Central Lancashire, Preston, England. p.j.lattimore@uclan.ac.uk TI - Developmental onset of eating-related color-naming interference: the role of restraint and eating psychopathology. SO - International Journal of Eating Disorders 2000 Jul;28(1):27-32 AB - OBJECTIVE: This study investigated the developmental onset of the Stroop interference effect for food and body shape words in 12- and 14-year-old females to determine whether dietary restraint and eating psychopathology influenced Stroop performance times. METHOD: A Stroop task containing neutral, food, and body shape-related words was administered to 152 schoolgirls. Participants completed the restraint scale of the Dutch Eating Behavior Questionnaire and the Drive for Thinness (DFT) subscale of the Eating Disorders Inventory. RESULTS: Significant color-naming impairments were observed for food-related words in 12- and 14-year-olds, in 14-year-old restrained eaters, and in 12-year-old unrestrained eaters. There were no significant differences between restrained and unrestrained eaters in either age group. Participants scoring high on the DFT subscale showed significant impairments for food-related words, but did not differ significantly from those scoring low on the DFT. There were no significant impairments in color-naming body shape-related words in any subgroups. DISCUSSION: This study did not confirm a different developmental onset for the food and body shape Stroop interference effect. Consideration of dietary restraint did add clarity to previously observed food-related interference effects in both age groups. The results for high- and low-DFT participants do not support the use of the eating-related Stroop tests as an early objective indicator of eating psychopathology. Copyright 2000 John Wiley & Sons, Inc. <17> UI - 20308784 AU - Fontana M AU - Gonzalez-Cabezas C AU - Wilson ME AU - Appert C IN - Indiana University, School of Dentistry, Indianapolis 46202, USA. mfontana@iusd.iupui.edu TI - In vitro evaluation of a "smart" dental material for its efficacy in preventing secondary caries using a microbial artificial mouth model. SO - American Journal of Dentistry 1999 Nov;12 Spec No:S8-9 <18> UI - 20285774 AU - Boonyasai NJ IN - Columbia University School of Dental and Oral Surgery, USA. TI - Considering a new paradigm in caries diagnosis. Towards a more conservative approach to treatment. SO - New York State Dental Journal 1999 Nov;65(9):30-3 AB - Advances in the understanding of caries and the introduction of new treatment techniques have led to the development of a new approach, or new paradigm. This paper contrasts the new paradigm with its predecessor, discusses the implications of both for the diagnosis and treatment of caries, and describes impediments to the adoption of the new paradigm. <19> UI - 20268723 AU - Choktanasiri W AU - Rojanasakul A AU - Rajatanavin R IN - Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. TI - Bone mineral density in primary and secondary amenorrhea. SO - Journal of the Medical Association of Thailand 2000 Mar;83(3):243-8 AB - Amenorrhea in young women is one of the best clinical indicators for estrogen deficiency, except in the presence of gynecological structural pathology. This study aimed at investigating bone mineral density (BMD) in patients with primary and secondary amenorrhea. Thirty-six patients were enrolled in the study, seven with primary amenorrhea (mean age 24.3 +/- 4.5 yrs.) and twenty-nine with secondary amenorrhea (mean age 31.1 +/- 6.9 yrs.). Eighteen regularly menstruating women (mean age 31.8 +/- 3.7 yrs.) served as controls. BMD was measured at lumbar spine, femoral neck, Ward's triangle and trochanter. RESULTS: BMD was significantly decreased in both primary and secondary hypoestrogen amenorrheic patients. Primary amenorrheic patients were more severely affected with a BMD mean Z score below 80 per cent (osteopenia) at all sites measured. The age of primary amenorrheic women also strongly correlated with degree of demineralization. This should emphasize the importance of early diagnosis and treatment of young amenorrheic patients. <20> UI - 20285616 AU - Wilder AD Jr AU - May KN Jr AU - Bayne SC AU - Taylor DF AU - Leinfelder KF IN - Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, USA. TI - Seventeen-year clinical study of ultraviolet-cured posterior composite Class I and II restorations. SO - Journal of Esthetic Dentistry 1999;11(3):135-42 AB - OBJECTIVES: To compare the clinical performance of four commercial ultraviolet light-cured composite materials, and to evaluate curing-system effects on long-term wear resistance of Class I and II restorations. MATERIALS AND METHODS: Approximately 32 samples of each of four different ultraviolet light-cured composites (n = 130) were inserted into conventional Class I and II cavity preparations by two clinicians. Cavosurface margins of the preparations were not beveled. Enamel walls of the preparation were etched, and the respective bonding agent was applied. Each restoration was evaluated by two clinicians at 5, 10, and 17 years. Direct evaluations were performed using modified United States Public Health Service (USPHS) criteria. Indirect evaluations were performed using the Leinfelder cast evaluation method. RESULTS: After 17 years, 65% of the restorations were recalled and pooled direct evaluations were conducted for color matching (94% alfa), marginal discoloration (100% alfa), marginal integrity (100% alfa), secondary caries (92% alfa), surface texture (72% alfa), and anatomic form (22% alfa). Mean occlusal wear from indirect evaluations at 5, 10, and 17 years was 197 +/- 85 microns, 235 +/- 72 microns, and 264 +/- 80 microns, respectively. For direct and indirect evaluations there were significant differences (p < or = .05) between the baseline and 5-year recall evaluations. CLINICAL SIGNIFICANCE: This study demonstrated that the mean pooled occlusal wear of four ultraviolet light-cured posterior composites at 17 years was 264 microns (approximately 0.25 mm), and that most wear (75%) occurred in the first 5 years. Of all recalled restorations, 76% were judged clinically acceptable at 17 years, and 22% of those exhibited no clinically detectable wear. <21> UI - 20282487 AU - Forner L AU - Llena MC AU - Almerich JM AU - Garcia-Godoy F IN - University of Valencia, Faculty of Medicine and Dentistry, Spain. TI - Digital radiology and image analysis for approximal caries diagnosis. SO - Operative Dentistry 1999 Sep-Oct;24(5):312-5 AB - The aim of this study was to determine if radiology combined with digital reception and image analysis, radiovisiography (RVG), is effective in the early diagnosis of simulated approximal carious lesions. An experimental lesion similar to the one produced by caries was made in 39 permanent molars and premolars. Radiographic images of these lesions were obtained under standardized conditions using RVG. The image obtained was magnified 700 times and the densities of the lesion, the enamel, the dentin, and the pulp were measured using an image analysis program (Visualdent). The results showed statistically significant differences between the density of the produced lesions and that of healthy enamel. This measurement was independent of the differing thickness of the approximal enamel surface in molars and premolars. These results indicated the potential usefulness of the system tested in the diagnosis of incipient approximal caries. <22> UI - 20274758 AU - Brunton PA AU - Cowan AJ AU - Wilson MA AU - Wilson NH IN - Unit of Operative Dentistry and Endodontology, University Dental Hospital of Manchester, UK. paul.brunton@man.ac.uk TI - A three-year evaluation of restorations placed with a smear-layer-mediated dentin bonding agent in non-carious cervical lesions. SO - Journal of Adhesive Dentistry 1999;1(4):333-41 AB - PURPOSE: To evaluate the handling characteristics, clinical behavior, and effectiveness of Coltene ART Bond/Brilliant restorations in mixed Class V preparations in maxillary premolar and canine teeth of adult patients over a three-year period. MATERIALS AND METHODS: Single-center, uncontrolled, clinical evaluation of 50 restorations in 26 patients extending over 36 months. RESULTS: At three years, 34 restorations, or 68% of those originally placed, in 20 patients were available for review. One of the 34 restorations had been lost 15 months after placement. In terms of marginal integrity and staining, anatomic form, surface texture and staining, and postoperative sensitivity, over 90% of the restorations reviewed at three years were rated alpha. Following difficulties in obtaining excellent color match in relation to 14 (28%) of the restorations at the time of placement, only 44% of the restorations were rated alpha at three years. CONCLUSION: It was concluded that with the possible exception of excellent color match, ART Bond/Brilliant restorations may be found to perform favorably in mixed Class V lesions in selected adult patients over a period of at least three years. The findings indicate that resin composite restorations placed with a smear-layer mediated dentin bonding agent may be found to have a favorable clinical outcome in non-carious cervical lesions. <23> UI - 20274757 AU - Setcos JC AU - Staninec M AU - Wilson NH IN - Dental School, University of Manchester, UK. TI - A two-year randomized, controlled clinical evaluation of bonded amalgam restorations. SO - Journal of Adhesive Dentistry 1999;1(4):323-31 AB - PURPOSE: The clinical performance of adhesively bonded dental amalgam restorations was compared with that of traditionally placed non-bonded control amalgams in a randomized prospective study. MATERIALS AND METHODS: One-hundred thirteen Class II Dispersalloy amalgams were placed in permanent molars and premolars of 31 (21 males, 10 females) human subjects with their informed consent. By random assignment, 60 amalgam restorations were adhesively bonded using ED Primer and Panavia 21 TC (both Kuraray Co, Japan), and 53 traditional non-bonded restorations were placed. Most preparations involved replacement of defective amalgam restorations. Clinical recalls were conducted by experienced evaluators using modified USPHS criteria for occlusal and proximal anatomic form, occlusal and proximal marginal adaptation, and occlusal and proximal surface roughness. RESULTS: For the categories of anatomic form, marginal adaptation, surface quality, and temperature sensitivity, there were no significant differences between bonded and non-bonded amalgam restorations (chi-square analysis, p > 0.05). Three non-bonded restorations were lost at 4, 7, and 24 months from preparations with no deliberate retention. CONCLUSION: After two years' clinical service, there were no failures among the amalgam restorations adhesively bonded using ED Primer and Panavia 21 TC, but three non-bonded restorations failed due to lack of retention. For traditional preparations, adhesively bonded amalgams of the type investigated perform as well as non-bonded amalgams over two years' clinical service. <24> UI - 20274749 AU - Walton TR IN - University of Sydney, Faculty of Dentistry, Australia. twalton@mail.usyd.edu.au TI - A 10-year longitudinal study of fixed prosthodontics: clinical characteristics and outcome of single-unit metal-ceramic crowns. SO - International Journal of Prosthodontics 1999 Nov-Dec;12(6):519-26 AB - PURPOSE: The purpose of this study was to report on the clinical characteristics and outcome of 688 single-unit metal-ceramic crowns placed in a specialist prosthodontic practice between January 1984 and December 1992. MATERIALS AND METHODS: Clinical and laboratory techniques were standardized and patients were recalled by the author between June and December of 1993. The outcome of all crowns was allocated to one of 6 fields in this assessment period. RESULTS: Clinical review examination by the author covered 87% of the crowns. Of these, 52% had been in service for 5 to 10 years and 48% for less than 5 years but more than 1 year; 67% of the crowns were placed on vital teeth and 94% were given a "good prognosis" rating at examination. The repair and failure rates of crowns in the 5 to 10 years in clinical service group were both 3%. Crowns on nonvital teeth in the same grouping had a significantly greater failure rate (5%) than crowns on vital teeth (1%), and anterior teeth had a significantly greater retreatment rate than posterior teeth. Retreatment for all 25 crowns occurred within 66 months after cementation. Tooth fracture accounted for 56% of retreatments, while caries and loss of retention accounted for only 24% of retreatments; 2% of initially vital teeth were endodontically treated during the survey period. CONCLUSION: Single-unit metal-ceramic crowns have a high expectancy of exceeding 10 years of clinical service when the described clinical and laboratory protocol is applied. <25> UI - 99313124 AU - Moss ME AU - Lanphear BP AU - Auinger P IN - Eastman Department of Dentistry, The University of Rochester School of Medicine and Dentistry and Children's Hospital Medical Center, NY 14642, USA. moss@prevmed.rochester.edu TI - Association of dental caries and blood lead levels [see comments]. CM - Comment in: JAMA 1999 Jun 23-30;281(24):2340-2, Comment in: JAMA 2000 Jan 25;283(4):476-7; discussion 477 SO - JAMA 1999 Jun 23-30;281(24):2294-8 AB - CONTEXT: Experiments show that dental caries rates are higher among lead-exposed animals, but this association has not been established in humans. OBJECTIVE: To examine the relationship between blood lead levels and dental caries. DESIGN: Cross-sectional survey conducted from 1988 to 1994 that included a dental examination and venipuncture blood lead assay. SETTING AND PARTICIPANTS: A total of 24901 persons aged 2 years and older who participated in the Third National Health and Nutrition Examination Survey, which assessed the health and nutritional status of children and adults in the United States. MAIN OUTCOME MEASURES: For children aged 2 to 11 years, the sum of decayed and filled deciduous or primary surfaces; for persons aged 6 years and older, the sum of decayed and filled permanent surfaces; for those 12 years and older, the sum of decayed, missing, and filled surfaces. RESULTS: The log of blood lead level was significantly associated with the number of affected surfaces for both deciduous and permanent teeth in all age groups, even after adjusting for sociodemographic characteristics, diet, and dental care. Among children aged 5 to 17 years, a 0.24-micromol/L (5-microg/dL) change in blood lead level was associated with an elevated risk of dental caries (odds ratio, 1.8; 95% confidence interval, 1.3-2.5). Differences in blood lead level explained some of the differences in caries prevalence in different income levels and regions of the United States. We estimated the population attributable risk of lead exposure to be 13.5% and 9.6% of dental caries occurring in 5- to 17-year-olds exposed to the high and moderate levels, respectively. CONCLUSIONS: Environmental lead exposure is associated with an increased prevalence of dental caries in the US population. Findings may help explain the distribution of caries by income and region of the United States. <26> UI - 99139138 AU - Gelbier S IN - King's College London, UK. TI - The present and future role of the community dental services [see comments]. CM - Comment in: Community Dent Health 1999 Jun;16(2):67 SO - Community Dental Health 1998 Dec;15 Suppl 1:306-11 <27> UI - 99139131 AU - Morgan MV AU - Campain AC AU - Adams GG AU - Crowley SJ AU - Wright FA IN - School of Dental Science, University of Melbourne, Victoria, Australia. TI - The efficacy and effectiveness of a primary preventive dental programme in non-fluoridated areas of Victoria, Australia [see comments]. CM - Comment in: Community Dent Health 1999 Jun;16(2):123 SO - Community Dental Health 1998 Dec;15(4):263-71 AB - OBJECTIVE: To determine the efficacy and effectiveness of a primary preventive dental programme. DESIGN: A field trial comparing an intervention and control group over three years. The intervention group received a preventive programme which consisted of a weekly fluoride mouthrinse (0.2% neutral NaF), an annual application, replacement or repair of pit and fissure sealants, and an annual oral hygiene education programme. The control group received the oral hygiene education programme only. Examinations to record dental caries status were conducted annually for both study groups. SETTING: Five secondary colleges in two non-fluoridated regions of Victoria, Australia. SUBJECTS: 522 subjects aged 12-13 years and considered at high risk of developing dental caries were recruited for the study; 256 received the preventive programme and 266 acted as controls. OUTCOME MEASURES: Dental caries was diagnosed according to World Health Organization criteria. RESULTS: Subjects in the intervention group who completed the three-year preventive programme (efficacy) incurred an average of 1.49 fewer decayed, missing or filled tooth surfaces than the control group. The difference was highly statistically significant. The programme also had a statistically significant impact when analysed by intention-to-treat (effectiveness), even when it was assumed that subjects lost to follow-up received minimal future benefit. Approximately 70% of the improvement in oral health was in the pit and fissure surfaces, with the remainder in the smooth surfaces. CONCLUSION: A comprehensive preventive dental programme introduced into adolescent populations at high risk of developing dental caries can result in significant improvements in their dental health. Further research is required to clarify the public health impact of school-based fluoride mouth rinsing. <28> UI - 20180952 AU - Tyrer GL IN - Birch Hill Hospital, Rochdale. TI - Referrals for dental general anaesthetics--how many really need GA? [see comments]. CM - Comment in: Br Dent J 2000 Jan 8;188(1):3; discussion 3-4 SO - British Dental Journal 1999 Oct 23;187(8):440-3 AB - AIM: To find out how many patients for whom dental general anaesthesia was requested actually needed it in order to complete treatment. DESIGN: Analysis of clinical outcomes supported by telephone canvassing of parents. METHOD: In summer 1998, eighty two child patients were seen in the Community Dental Service in Rochdale with a request for the provision of dental general anaesthesia (DGA) for the extraction of teeth. Their ages ranged from 3 to 14 years and all were required to attend for a pre-anaesthetic visit. Unless objective indicators of a need for DGA applied, the parents and children were actively discouraged from having DGA, and the alternative of local anaesthetic (LA) was offered. Clinical outcomes and parent satisfaction were recorded after treatment was finished. RESULTS: In 75% of cases it proved possible to complete the extractions without need for DGA; in the 10% of cases where DGA was necessary, it was to deal with the sequelae of dental caries. Fifteen percent of subjects failed to complete treatment. Subjects found to have a need for DGA tended to be younger and with treatment required in more than one sextant. Pain as a presenting symptom, young age and multiple treatment needs were found to be poor predictors of need for DGA and did not automatically preclude successful treatment without DGA. The satisfaction ascertained from users of the service was high and explanation of proposed treatments, especially the comparative risks and benefits of DGA versus LA, was well received. CONCLUSION: There is scope for significant reduction in provision of dental general anaesthesia if current professional guidelines are followed. <29> UI - 20123263 AU - Green J TI - Blood lead level and dental caries [letter; comment]. CM - Comment on: JAMA 1999 Jun 23-30;281(24):2294-8 SO - JAMA 2000 Jan 26;283(4):476-7; discussion 477 <30> UI - 20198790 AU - Warren JJ AU - Hand JS AU - Levy SM AU - Kirchner HL IN - University of Iowa, College of Dentistry, Iowa City 52242, USA. john-warren@uiowa.edu TI - Factors related to decisions to extract or retain at-risk teeth. SO - Journal of Public Health Dentistry 2000 Winter;60(1):39-42 AB - OBJECTIVES: Decisions to extract a tooth may be among the most critical in dentistry. The aim of this study was to prospectively investigate both clinical and nonclinical factors related to decisions to extract or retain teeth in private general dental practice. METHODS: A convenience sample of 196 Iowa dentists in private general dental practice reported on 549 cases where decisions were made to extract or retain teeth as they occurred in their practices during a one-month period in May 1997. Bivariate and multivariate analyses were used to identify factors that differentiated between cases where a tooth (or teeth) was extracted and cases where an at-risk tooth was retained. RESULTS: Of the 549 cases, 67 percent involved extraction, while the remainder involved alternatives to extraction. In comparing extraction cases to alternative treatment cases, we excluded 150 extraction cases because dentists reported that no alternative to extraction was available. Using Generalized Estimating Equations (GEE), we identified cost of treatment, presence of tooth mobility, poor prognosis of alternative treatment, and presence of gross caries as significant factors associated with extraction, while previous treatment of the tooth and concerns with patients' health were significantly associated with alternatives to extraction. CONCLUSIONS: For teeth at risk for extraction, cost, substantial periodontal disease, and several clinical factors were predictive of extraction. <31> UI - 20198789 AU - Eklund SA AU - Pittman JL AU - Heller KE IN - University of Michigan, School of Public Health, Department of Epidemiology, Ann Arbor 48109-2029, USA. saeklund@umich.edu TI - Professionally applied topical fluoride and restorative care in insured children. SO - Journal of Public Health Dentistry 2000 Winter;60(1):33-8 AB - OBJECTIVES: This study evaluates the association between use of professionally applied topical fluoride and use of interproximal restorations in primary and permanent teeth of children. METHODS: Insurance claims from 15,190 children, for treatment provided by 1,556 different dentists, were analyzed to look for associations between frequency of use of professionally applied topical fluoride and use of interproximal restorations. The average follow-up period for the children included in the analysis was 5.3 years, with the range from 3.0 to 7.9 years. RESULTS: Both tabular and regression results failed to demonstrate an association between frequency of use of professionally applied topical fluoride and use of interproximal restorations in either the primary or permanent dentition. The most powerful predictor of restorative care for these children was the overall propensity of the dentist to place restorations in children. CONCLUSIONS: In this group of insured children, we were unable to find an association between the frequency of use of professionally applied topical fluoride and restorative care. Further, despite numerous recommendations that professionally applied topical fluorides should be used only in moderate- and high-caries children, approximately two-thirds of these children received topical fluoride at every recall visit, nearly two times per year. <32> UI - 20200896 AU - Llena-Puy MC AU - Montanana-Llorens C AU - Forner-Navarro L IN - Dental Pathology and Therapeutics Unit, Faculty of Medicine and Dentistry, University of Valencia, Spain. TI - Cariogenic oral flora and its relation to dental caries. SO - ASDC Journal of Dentistry for Children 2000 Jan-Feb;67(1):42-6, 9 AB - Many attempts have been made to establish the risk profile of dental caries; however, no diagnostic procedures are yet available to reliably predict such risk particularly among the pediatric and adolescent population. Age of subject, a history of caries affecting the primary dentition, the prevalence of Streptococcus mutans, pH values, salivary flow, and the frequency and amount of sugar consumption have been the factors most studied. A cross-sectional study is made of schoolchildren in the 12-13-year age-range to evaluate the relationship between dental caries and CFU/ml of S. mutans and Lactobacillus, salivary buffer capacity, and salivary flow. Likewise, an evaluation is made of the predictive value of the variables, bacterial count and salivary pH with respect to caries. A total of 167 children were subjected to oral examination to establish the DMFT and DMFS indices, followed by the collection of saliva for quantitating S. mutans, Lactobacillus, pH and salivary flow, by the Dentocult (SM)(LB) and Dentobuff systems (Vivadent). The data obtained were subjected to descriptive analysis, comparisons among variables were made by nonparametric testing with a confidence level of 95 percent. Test predictive value was studied in terms of sensitivity, specificity, positive and negative predictive values, and probability ratio. Statistically significant (p < 0.001) correlations were observed between the caries indices and bacterial counts. No significant association was recorded with the rest of the variables studied. Bacterial counts as well as salivary buffer capacities exhibited greater negative than positive predictive values, i.e., they were more effective in identifying healthy individuals than patients who required treatment. <33> UI - 20205735 AU - Kneckt MC AU - Syrjala AM AU - Knuuttila ML IN - Institute of Dentistry, University of Oulu, Finland. mkneckt@hotmail.com TI - Attributions to dental and diabetes health outcomes. SO - Journal of Clinical Periodontology 2000 Mar;27(3):205-11 AB - Previous studies have proposed common psychological factors between oral health behavior and diabetes self-care. The aim here was to describe and analyse more comprehensively the relationships between dental and diabetes health behavior on the basis of attribution theory. The likeness between subjects' own assessments, similarities of the causes given to success and failure, and the predictive power of own dental assessments concerning the metabolic balance of diabetes were studied. The research population was composed of 149 IDDM patients. Data were collected by means of a quantitative questionnaire, a clinical oral examination and from patient records. It was found that from the patients reporting success with avoiding gingivitis 82% also reported success with metabolic status and they also had lower mean HbA1c levels than patients assessing failure with gingivitis. There were some correlations between causes of failure: not bothering to clean approximal surfaces correlated with non-adherence to diabetes treatment instructions, and laziness as the cause of caries correlated with non-adherence to diabetes treatment instructions and with poor motivation for diabetes care. It can be concluded that there are some common determinants for both dental health behavior and diabetes self-care. This connection should be taken into account in health education by health care professionals. <34> UI - 20262475 AU - Meyer U AU - Weingart D AU - Deng MC AU - Scheld HH AU - Joos U IN - Maxillofacial and Plastic Reconstructive Surgery, University of Munster, Germany. TI - Heart transplants--assessment of dental procedures. SO - Clinical Oral Investigations 1999 Jun;99(2):79-83 AB - The object of this study was to evaluate the effects of dental foci on survival rates and rejection episodes in heart transplant recipients. Therefore, in a retrospective longitudinal study we studied 74 heart transplant recipients at the Department of Maxillofacial Surgery and Department of Thoracic and Cardiovascular Surgery, University of Munster. Study patients were divided into groups: those in which dental foci had been verified (n = 31) and those without dental foci (n = 43). Statistical analysis was performed using the chi-square test, Kaplan-Meier life table analysis, and the log-rank test. Before heart transplantation, patients were screened clinically and radiographically to determine the extent of dental foci. Postoperatively, patients were evaluated dentally and medically to identify the impact of dental foci on the incidence of systemic and oral infections, frequency and severity of rejection episodes, mortality, and complications arising during dental treatment. By comparing the mortality, infection and rejection rates in the various groups no statistically significant differences (P > 0.05) were found between patients. Despite immunosuppression, extended inflammatory processes such as abscess formation or viral stomatitis were not found in the oral cavity. We therefore suggest that patients suffering from the symptoms of severe heart failure need not be subjected to rigorous preoperative dental treatment. <35> UI - 20262473 AU - Reusens B AU - D'hoore W AU - Vreven J IN - University of Louvain, School of Dental Medicine and Stomatology, Department of Operative Dentistry, Brussels, Belgium. TI - In vivo comparison of a microfilled and a hybrid minifilled composite resin in Class III restorations: 2-year follow-up. SO - Clinical Oral Investigations 1999 Jun;99(2):62-9 AB - An in vivo comparison was made of two different types of restorative resins over a 2-year period: a microfilled resin (-1158262462Silux Plus, 3M-1158262462, USA) and a hybrid minifilled composite resin (-1158262461Herculite XRV, Kerr-1158262461, USA); 56 restorations were placed in 28 patients by one experienced dentist and examined by two independent evaluators using the United States Public Health Service (UPSHS) rating system for marginal adaptation, marginal discoloration, surface roughness, anatomic form and modified criteria for color match (direct and indirect evaluation). Modified criteria divided the classic A score into A1 for "not detectable" filling and A2 for "slightly discernible filling". Restorations were evaluated at baseline, 1 week, 6 months, 1 year and 2 years later. After 2 years, all materials were considered satisfactory for marginal adaptation, anatomic form and surface roughness (no "Charlie", or "Delta" ratings). No recurrent caries was observed. Clinical evaluation showed a significantly higher rate of marginal discoloration for the microfilled composite resin than the other resin. Hybrid composite resin materials may be expected to perform well as an anterior restorative material. Photographic ratings confirmed the clinical evaluation. The modified evaluation for color match demonstrated differences, which are not discernible with the USPHS system and showed, more rapidly, differences that appear later with the USPHS system. <36> UI - 20194473 AU - Uprichard KK AU - Potter BJ AU - Russell CM AU - Schafer TE AU - Adair S AU - Weller RN IN - Department of Oral Diagnosis and Patient Services, School of Dentistry, Medical College of Georgia, Augusta, USA. TI - Comparison of direct digital and conventional radiography for the detection of proximal surface caries in the mixed dentition. SO - Pediatric Dentistry 2000 Jan-Feb;22(1):9-15 AB - PURPOSE: The aim of this study was to compare the performance of direct digital radiography and traditional dental radiography for the detection of proximal surface dental caries in the mixed dentition. METHODS: 15 quadrants of extracted teeth, arranged from the primary canine to permanent first molar, were imaged using direct digital (Schick Technologies, Long Island City, NY, USA) and conventional films (D-speed and E-speed Plus; Eastman Kodak Co., Rochester, NY, USA). Five pediatric dentists viewed the images and scored the 270 proximal surfaces for presence of caries on a 5 point scale and extent of caries on a 4 point scale. The teeth were sectioned and viewed microscopically to determine the gold standard. Receiver operating characteristic (ROC) analysis and analysis of variance (ANOVA) were used to evaluate the viewer's performance for detecting proximal caries using the 3 different image receptor types. RESULTS: Experienced examiners were significantly more accurate in diagnosis of proximal surface caries using either D-speed or E-speed Plus films than they were using the direct digital receptor. The mean areas under the ROC curve (Az) for the viewers were 0.7595 for D-speed film, 0.7557 for E-speed Plus film, and 0.5928 for the direct digital receptor. The results also indicated that selected viewers' accuracy increased when viewing the direct digital images a second time. CONCLUSION: CCD based direct digital radiography was not as accurate as conventional film images for the purpose of diagnosing proximal surface caries in the mixed dentition. However, the results imply that with increased experience, direct digital images may be as accurate as conventional film based images for diagnosis. <37> UI - 20221513 AU - Haselton DR AU - Diaz-Arnold AM AU - Hillis SL IN - University of Iowa, College of Dentistry, Iowa City, Iowa 52242, USA. debra-haselton@uiowa.edu TI - Clinical assessment of high-strength all-ceramic crowns. SO - Journal of Prosthetic Dentistry 2000 Apr;83(4):396-401 AB - STATEMENT OF PROBLEM: All-ceramic crowns are being used extensively. Little data are available on their clinical performance. PURPOSE: This study evaluated the clinical performance of In-Ceram (Vita Zahnfabrik) crowns. MATERIAL AND METHODS: Forty-one patients (16 men, 25 women; mean age 47.3 years, range 18 to 77 years) were examined with a total of 80 In-Ceram all-ceramic crowns fabricated at the University of Iowa College of Dentistry from 1994 to 1997. The percentage distribution for crowns included: 67% anterior single crowns, 26% posterior single crowns, 6% anterior implant crowns, and 1% posterior implant crowns. This study documented the integrity of the junction between crown and tooth, color match to adjacent teeth, secondary dental caries, wear of crown and opposing dentition, and visible cracks in the crown. Alpha, Bravo, and Charlie ratings were assigned with a modified USPHS criteria. The patients were also surveyed with respect to oral hygiene and satisfaction of treatment. Estimations of 4-year success rates and corresponding confidence intervals were calculated by fitting a constant hazard function model with the SAS procedure GENMOD. RESULTS: Marginal integrity for 88% of artificial crowns was rated Alpha or Bravo. Shade match for 99% was Bravo or better. Only 1% of the crowns were carious, and 1 crown exhibited occlusal wear. One premolar crown had a small fracture of veneering porcelain. One molar crown was remade after core fracture. All patients (100%) expressed satisfaction with their crowns. The estimated 4-year success rates (Alpha or Bravo), with 95% confidence intervals in parentheses were calculated as: 83.5% (65.7%-94.6%) for marginal integrity, 95.8% (82.9%-99.8%) for shade match, and 95.5% (81.6%-99.7%) for secondary caries, 100% (88%-100%) for wear, and 100% (88%-100%) for cracks. <38> UI - 20235761 AU - Venugopal T AU - Kulkarni VS AU - Nerurker RA AU - Damle SG AU - Patnekar PN IN - Department of Pediatrics, Dr. R.N. Cooper Municipal General Hospital, Mumbai. TI - Epidemiological study of dental caries. SO - Indian Journal of Pediatrics 1998 Nov-Dec;65(6):883-9 AB - A total of 2000 children (1-14 year age group) attending pediatric OPD, school clinic & well body clinic of Dr. R.N. Cooper Municipal Hospital & K.E.M Hospital, Mumbai were examined for caries prevalence and 35.6% had dental caries. Parental income was not shown to have any bearing on caries prevalence. Parental literacy, particularly maternal literacy was shown to influence caries prevalence in children. The prevalence was low in well-nourished children and in those taking vegetarian type of diet. Frequency of sweet consumption was shown to be associated with prevalence of dental caries. In 1-4 year age group it was noted that bottle fed children were more affected by dental caries. Tooth brush with paste was the commonest method used for cleaning their teeth in all age groups in our study. Caries prevalence was low in those children using tooth brush than in those using tooth powder. Those children who were using neem datun were found to be less affected with dental caries. Dental caries was also found to be low in those who rinsed their mouth with water after food. <39> UI - 20236898 AU - Stephen KW IN - Dental Public Health Unit, University of Glasgow Dental School, Scotland. TI - Fluoride prospects for the new millennium--community and individual patient aspects. [Review] [47 refs] SO - Acta Odontologica Scandinavica 1999 Dec;57(6):352-5 AB - Over the past 2 decades, it has been suggested that with the generalized availability of fluoridated dentifrices, and coupled with a possible increased likelihood of fluorosis, the benefits of community-based fluoridation have receded. However, while this may be so for dentally motivated populations, there are convincing data to suggest that the least fortunate amongst us could still benefit from communally delivered fluoride. Furthermore, the deleterious effects of such program withdrawals have been demonstrated and, with respect to fluorosis fears, client assessment of their own fluorosis status has indicated few concerns. Alternative, centrally delivered means of fluoride dispensing, e.g. via schools, etc., although effective in the short-term, are impractical over longer time-spans. Nonetheless, at the individual level, fluoride supplements and dentifrices, in particular, are successful caries inhibitors. This is especially so if these vehicles are employed in their most effective, proven manners. Finally, fears relating to disfiguring fluorosis should be allayed, but where fluoride abuses result in mild mottling, a simple remineralizing technique obviates the need for traumatic restorative procedures. [References: 47] <40> UI - 20236890 AU - Honkala S AU - Honkala E AU - Tynjala J AU - Kannas L IN - Department of Health Sciences, University of Jyvaskyla, Finland. TI - Use of xylitol chewing gum among Finnish schoolchildren. SO - Acta Odontologica Scandinavica 1999 Dec;57(6):306-9 AB - The preventive, and partly the remineralizing, effect of xylitol was shown in Finland in the Turku Sugar Studies in 1971-73. Since then, several clinical trials in many countries have confirmed these results. In Finland, oral health personnel have recommended daily use of xylitol chewing gum in their dental health education. Moreover, commercial companies have advertised xylitol, emphasizing in particular its caries preventive effects. All Nordic dental associations have given their recommendations for xylitol use. The aim of this study was to describe how this health habit has been adopted by Finnish schoolchildren. The study was part of the comprehensive cross-national survey on Health Behavior in School-aged Children (HBSC Study)--a WHO Collaborative Study. The data were collected using standardized questionnaires to which pupils in grades 5 (11 years), 7 (13 years) and 9 (15 years) responded anonymously in school classrooms during the spring term 1998. The response rate varied between 87% (15-year-old boys) and 94% (11- and 13-year-old girls). Among boys, the percentages of daily users of xylitol chewing gum were 47% (11 years), 46% (13 years), and 44% (15 years), and among girls, 57% (11 years), 65% (13 years), and 69% (15 years), respectively. Use of sugar-sweetened chewing gum was very rare (1%), as also was use of chewing gum with other artificial sweeteners (1%). It may be concluded that since 1991 the use of xylitol chewing gum has further increased in Finland and currently more than a half of all schoolchildren benefit from it. <41> UI - 20200498 AU - Jeremic B AU - Shibamoto Y AU - Milicic B AU - Nikolic N AU - Dagovic A AU - Aleksandrovic J AU - Vaskovic Z AU - Tadic L IN - Departments of Oncology and Otorhynolaryngology, University Hospital, Kragujevac, Yugoslavia. bjeremic@med.uni-tuebingen.de TI - Hyperfractionated radiation therapy with or without concurrent low-dose daily cisplatin in locally advanced squamous cell carcinoma of the head and neck: a prospective randomized trial. SO - Journal of Clinical Oncology 2000 Apr;18(7):1458-64 AB - PURPOSE: To investigate whether the addition of cisplatin (CDDP) to hyperfractionation (Hfx) radiation therapy (RT) offers an advantage over the same Hfx RT given alone in locally advanced (stages III and IV) squamous cell carcinoma of the head and neck. PATIENTS AND METHODS: One hundred thirty patients were randomized to receive either Hfx RT alone to a tumor dose of 77 Gy in 70 fractions in 35 treatment days over 7 weeks (group I, n = 65) or the same Hfx RT and concurrent low-dose (6 mg/m(2)) daily CDDP (group II, n = 65). RESULTS: Hfx RT/chemotherapy offered significantly higher survival rates than Hfx RT alone (68% v 49% at 2 years and 46% v 25% at 5 years; P =.0075). It also offered higher progression-free survival (46% v 25% at 5 years; P =.0068), higher locoregional progression-free survival (LRPFS) (50% v 36% at 5 years; P =.041), and higher distant metastasis-free survival (DMFS) (86% v 57% at 5 years; P =.0013). However, there was no difference between the two treatment groups in the incidence of either acute or late high-grade RT-induced toxicity. Hematologic high-grade toxicity was more frequent in group II patients. CONCLUSION: As compared with Hfx RT alone, Hfx RT and concurrent low-dose daily CDDP offered a survival advantage, as well as improved LRPFS and DMFS. <42> UI - 98429388 AU - Beck JD IN - Department of Dental Ecology, University of North Carolina, Chapel Hill 27599, USA. JamesvBeck@dentistry.unc.edu TI - Risk revisited [see comments]. CM - Comment in: Community Dent Oral Epidemiol 1999 Dec;27(6):394-7 SO - Community Dentistry & Oral Epidemiology 1998 Aug;26(4):220-5 AB - As our knowledge of dental caries and periodontal diseases has increased, our perspective has changed from viewing these diseases as ubiquitous to one which sees a variety of risk profiles in a population. Now, from a perspective of assigning risk, caries and periodontitis can be thought to be more like some of our common medical conditions, i.e., certain people or subgroups of the population are at higher risk than others and that prevention and intervention involve a combination of personal behaviors and professional practices. Research into risk assessment, however, is often hampered by confusing and ambiguous use of terminology. This commentary proposes some specific definitions for terms used in risk assessment in dentistry. These terms include risk factor, risk indicator, demographic risk factor, risk predictor (risk marker), prognostic factor, risk model, and prediction model. <43> UI - 20067054 AU - Alanen P IN - Institute of Dentistry, University of Turku, Finland. pentti.alanen@utu.fi TI - Risks in risk definitions [comment]. CM - Comment on: Community Dent Oral Epidemiol 1998 Aug;26(4):220-5 SO - Community Dentistry & Oral Epidemiology 1999 Dec;27(6):394-7 AB - Exact definitions of epidemiological concepts are necessary tools for exact studies. The present paper, stimulated by Beck's article in this journal (Community Dent Oral Epidemiol 1998; 26: 220-5), includes some further comments on this topic. For detailed risk analyses, one has to know a) whether the subjects are disease free or not at baseline in the groups to be compared, and b) whether the follow-up period is fair for all the study groups in prevention studies. An epistemological aspect is presented in a discussion of the roles of empirical evidence and theory in identifying evidence for or against some suspected risk factors. <44> UI - 20228705 AU - Calabrese JM AU - Friedman PK AU - Rose LM AU - Jones JA IN - Boston University Goldman School of Dental Medicine, MA, USA. TI - Using the GOHAI to assess oral health status of frail homebound elders: reliability, sensitivity, and specificity. SO - Special Care in Dentistry 1999 Sep-Oct;19(5):214-9 AB - A pilot study assessed the clinically determined and self-reported oral health status of 50 randomly selected homebound patients served by Boston's Home Medical Service. The sample was largely female, low-income, and edentulous. The median age of the patients was 81 years (range, 64-101). While 76% deemed themselves to be in good to excellent oral health, 80% of the patients had not seen a dentist within the last two years, and 80% were found to be in need of routine dental care. To assess whether the Geriatric Oral Health Assessment Index (Atchison and Dolan, 1990) could be used by non-dental health professionals to determine the need for requesting dental consultation, the study physician repeated the administration of the GOHAI for 23 of the 50 subjects within eight weeks of the initial examination. For the 23 subjects having both dentist- and physician-administered GOHAI scores, the intraclass correlation coefficient was r = 0.61 (p = 0.002), indicating good agreement between the dentist's and physician's administrations of the GOHAI. However, given the high prevalence of need for care, the GOHAI appears to be of less value than an examination for identifying persons who need dental care in this population. Future research is needed to examine the GOHAI's sensitivity and specificity in populations with low to moderate prevalence of treatment need. <45> UI - 20228698 AU - Hawkins RJ IN - Department of Community Dentistry, Faculty of Dentistry, University of Toronto, Canada. TI - Functional status and untreated dental caries among nursing home residents aged 65 and over. SO - Special Care in Dentistry 1999 Jul-Aug;19(4):158-63 AB - This descriptive study examined the relationship between untreated dental caries and functional status among 958 dentate nursing home residents aged 65 and over. Functional status was measured by the Physical Self-Maintenance Scale (PSMS). The PSMS assessment revealed that 32% of subjects were unable to perform all activities, and only 10% could perform all activities. Overall, 59% of subjects had untreated coronal decay and 46% had untreated root decay. In bivariate analysis, untreated coronal and root caries experiences were significantly associated with PSMS limitations, lack of dental care utilization, sex, and number of remaining teeth. Stratified analysis suggested an interaction between functional status and dental care utilization. Among subjects who had received dental care in the preceding year, PSMS status was not significantly related to untreated caries experience; but among subjects who had not received care, PSMS status was significantly related to untreated caries experience. In logistic regression analysis of untreated root decay, a significant interaction was found between PSMS status and dental care utilization. However, in logistic regression analysis of untreated coronal caries, no significant interaction was found; significant independent effects were found for dental care utilization and number of remaining teeth, but not for PSMS status. <46> UI - 20227017 AU - Alanen P TI - Are all clinical caries prevention studies biased? [editorial]. SO - Journal of Dental Research 2000 Mar;79(3):796-7 <47> UI - 20203553 AU - Kafferlein HU AU - Goen T AU - Muller J AU - Wrbitzky R AU - Angerer J IN - Institut und Poliklinik fur Arbeits-, Sozial- und Umweltmedizin, Friedrich-Alexander Universitat, Erlangen-Nurnberg, Erlangen, Germany. TI - Biological monitoring of workers exposed to N,N-dimethylformamide in the synthetic fibre industry. SO - International Archives of Occupational & Environmental Health 2000 Mar;73(2):113-20 AB - OBJECTIVES: Monitoring of workplace air and biological monitoring of 23 workers exposed to N,N-dimethylformamide (DMF) in the polyacrylic fibre industry was carried out on 4 consecutive days. The main focus of the investigation was to study the relationship between external and internal exposure, the suitability of the metabolites of DMF for biological monitoring and their toxicokinetic behaviour in humans. METHODS: Air samples were collected using personal air samplers. The limit of detection (LOD) for DMF using an analytical method recommended by the Deutsche Forschungsgemeinschaft (DFG) was 0.1 ppm. The urinary metabolites, N-hydroxymethyl-N-methylformamide (HMMF), N-methylformamide (NMF), and N-acetyl-S-(N-methylcarbamoyl)-cysteine (AMCC), were determined in one analytical run by gas chromatography with thermionic sensitive detection (GC/TSD). The total sum of HMMF and NMF was determined in the form of NMF. The LOD was 1.0 mg/l for NMF and 0.5 mg/l for AMCC. RESULTS AND CONCLUSIONS: The external exposure to DMF vapour varied greatly depending on the workplace (median 1.74 ppm, range < 0.1-159.77 ppm). Urinary NMF concentrations were highest in post-shift samples. They also covered a wide range (< 1.0-108.7 mg/l). This variation was probably the result of different concentrations of DMF in the air at different workplaces, dermal absorption and differences in the protective measures implemented by each individual (gloves, gas masks etc.). The urinary NMF concentrations had decreased almost to zero by the beginning of the next shift. The median half-time for NMF was determined to be 5.1 h. The concentrations of AMCC in urine were determined to be in the range from < 0.5 to 204.9 mg/l. Unlike the concentrations of NMF, the AMCC concentrations did not decrease during the intervals between the shifts. For the exposure situation investigated in our study, a steady state was found between the external exposure to DMF and the levels of AMCC excreted in urine about 2 days after the beginning of exposure. AMCC is therefore excreted more slowly than NMF. The half-time for AMCC is more than 16 h. Linear regression analysis for external exposure and urinary excretion of metabolites was carried out for a sub-group of 12 workers. External exposure to 10 ppm DMF in air (the current German MAK value) corresponds to an average NMF concentration of about 27.9 mg/l in post-shift urine from the same day and an average AMCC concentration of 69.2 mg/l in pre-shift urine from the following day. NMF in urine samples therefore represents an index of daily exposure to DMF, while AMCC represents an index of the average exposure over the preceding working days. AMCC is considered to be better suited for biomonitoring purposes because (1) it has a longer half-time than NMF and (2) its formation in humans is more closely related to DMF toxicity. <48> UI - 20215925 AU - Duncan TB AU - Duncan WK AU - De Ball S TI - Fluoride: a review--Part II: Topical fluorides. [Review] [29 refs] SO - Mississippi Dental Association Journal 1999 1st Quarter;55(1):34-6 AB - Fluoride therapy continues to be the best defense in the battle against dental caries. The decision to utilize topical fluorides is no longer age dependent. Changing disease patterns require dentists to critically evaluate the caries risk of each patient and develop a fluoride treatment plan based upon the needs of the individual patient. A variety of professional and self-applied fluoride products are available and new fluoride delivery systems have recently entered the market. A critical review of literature, combined with an understanding of the advantages and disadvantages of each topical fluoride system will assist the dentist in selecting the product best suited for each patient. [References: 29] <49> UI - 20191321 AU - Mattila KJ AU - Asikainen S AU - Wolf J AU - Jousimies-Somer H AU - Valtonen V AU - Nieminen M IN - Dept of Medicine, Helsinki University Central Hospital, Finland. kimmo.mattila.km@bayer.fi TI - Age, dental infections, and coronary heart disease. SO - Journal of Dental Research 2000 Feb;79(2):756-60 AB - Epidemiological and intervention studies have suggested that infections are risk factors for coronary heart disease (CHD). Dental infections have appeared as cardiovascular risk factors in cross-sectional and in follow-up studies, and the association has been independent of the "classic" coronary risk factors. This case-control study aimed at detailed assessment of the dental pathology found in various CHD categories (including elderly patients). Altogether, 85 patients with proven coronary heart disease and 53 random controls, matched for sex, age, geographic area, and socio-economic status, were compared with regard to dental status, assessed blindly with four separate scores, and to the "classic" coronary risk factors (seven of the controls had CHD, and they were not included in the analyses). The dental indices were higher among CHD patients than in the controls, but, contrary to previous studies, the differences were not significant (between the CHD patients and their matched controls or among the different CHD categories). This result could not be explained by potential confounding factors. The participants in the present study were older and had more often undergone recent dental treatment in comparison with subjects in our earlier studies. Age correlated with the severity of dental infections only in the random controls but not in the coronary patients who, although young, already had high dental scores. We believe that the higher age of the participants in the present study is the most likely reason for the results. Other possible explanations include an age-related selection bias among older CHD patients, and the fact that those participating in studies like this may have better general health and thus also less severe dental infections. Thus, the role of dental infections as a coronary risk factor varies according to the characteristics of the population studied. <50> UI - 20204647 AU - Wenzel A AU - Hintze H IN - Department of Oral Radiology, Royal Dental College, Faculty of Health Sciences, University of Aarhus, Denmark. TI - Comparison of microscopy and radiography as gold standards in radiographic caries diagnosis. SO - Dento-Maxillo-Facial Radiology 1999 May;28(3):182-5 AB - OBJECTIVES: To compare the effect of the choice of gold standard on the diagnostic outcome of approximal caries detection in original and compressed digital radiographs. METHODS: 116 extracted teeth radiographed with a storage phosphor system constituted the original images. These images were compressed at 1:20 and 1:33 with the JPEG irreversible compression standard. Five radiologists scored the three sets of images for the presence of approximal caries on a five-rank confidence scale. The radiographic scores were validated by stereomicroscopy (the true gold standard). The individual ROC areas for the five observers were used to select the worst (obsworst) and the best (obsbest) performer: Their scores in the original images were used as the second and third 'gold standards' for the remaining observers. Mean ROC areas for the three observers with the three types of images were calculated using these two new 'gold standards'. Differences between the ROC areas when using microscopy, obsworst, and obsbest as the 'gold standard' were compared. RESULTS: The mean ROC areas in the original images were 0.66, 0.74 and 0.91 using the true gold standard and obsbest and obsworst as the 'gold standards' respectively. The difference between the true gold standard and obsworst was statistically significant (P < 0.001). The mean ROC areas using the true gold standard decreased with increasing compression whereas they were constant or increased using obsworst and obsbest as 'gold standards', respectively. CONCLUSIONS: Accuracy in approximal caries diagnosis was significantly higher when an observer was the 'gold standard' than when the true gold standard was obtained by microscopy. Paradoxically, the compressed, degraded images were more accurate than the originals when an observer was the 'gold standard' while they were less accurate with the true gold standard. Thus, results obtained using observers' scores from the radiographs which are being evaluated, as validation for the presence of caries may mislead the clinician. <51> UI - 20204642 AU - Abreu Junior M AU - Tyndall DA AU - Platin E AU - Ludlow JB AU - Phillips C IN - Division of Maxillofacial Radiology, Federal Unversity of Santa Catarina School of Dentistry, Florianopolis, Brasil. TI - Two- and three-dimensional imaging modalities for the detection of caries. A comparison between film, digital radiography and tuned aperture computed tomography (TACT). SO - Dento-Maxillo-Facial Radiology 1999 May;28(3):152-7 AB - OBJECTIVES: To compare the diagnostic performance provided by two- (film and digital radiography) and three-dimensional imaging modalities (TACT slices and TACT pseudoholograms) in the detection of primary caries. METHODS: Forty-two extracted human posterior teeth were mounted and imaged with conventional film and direct digital radiography. Free-hand positioning of a dental X-ray source was used for all exposures. From the digital images, iteratively restored TACT slices and TACT pseudoholograms were generated. Film images were viewed on a viewbox. Digital format images were viewed on a high-resolution monitor. Eight observers used a five-point scale to score the presence or absence of occlusal and proximal caries using the four image modalities. Observers' assessments were compared with the histological examination of tooth sections. Possible differences in ROC curve areas among image modalities, observers, and surfaces were assessed by ANOVA. Intra- and interobserver reliability as indicated by intraclass correlation was also calculated. RESULTS: There were no statistically significant differences between the diagnostic performances of film, digital radiography, TACT slices and TACT pseudoholograms in the detection of caries (P = 0.310). Intraclass correlation indicated the highest concordance both within and between observers when film was used for the evaluation. CONCLUSIONS: Under the experimental conditions of this study, three-dimensional TACT images did not improve caries detection over film or digital radiography. Further research should investigate the effects of imaging variables on TACT's diagnostic efficacy. <52> UI - 20204638 AU - Wenzel A AU - Hintze H TI - The choice of gold standard for evaluating tests for caries diagnosis [editorial]. [Review] [85 refs] SO - Dento-Maxillo-Facial Radiology 1999 May;28(3):132-6 <53> UI - 20190765 AU - White SC AU - Yoon DC AU - Tetradis S IN - Section of Oral Radiology, University of California at Los Angeles School of Dentistry, USA. TI - Digital radiography in dentistry: what it should do for you. [Review] [84 refs] SO - Journal of the California Dental Association 1999 Dec;27(12):942-52 AB - Digital radiology will become an important part of dental practice. Manufacturers should develop more sophisticated tools, including software for digital subtraction; image processing routines for the diagnosis of caries, periodontitis and periapical disease; tools for three-dimensional viewing of the teeth and supporting structures; and analysis of bone trabecular pattern for early detection of systemic disease. Hardware improvements should include increased dynamic range and sensitivity to radiation, and improved resolution. Sensors should be made the size of film, and components should be interchangeable across manufacturers. The true opportunity offered by digital imaging, computer-aided diagnosis, should continue to develop with particular attention to development of tools that add value for solving diagnostic problems and ease of use for the dentist and patient. [References: 84] <54> UI - 20190756 AU - Murdoch-Kinch CA IN - University of Detroit Mercy School of Dentistry, USA. TI - Oral medicine: advances in diagnostic procedures. [Review] [46 refs] SO - Journal of the California Dental Association 1999 Oct;27(10):773-80, 782-4 AB - In the latter part of the 20th century, the computer and molecular biology have facilitated great scientific progress in medicine and dentistry. In dentistry, emerging clinical methods based in molecular biology and digital technology have the potential to improve the early diagnosis of dental caries, periodontal disease, and oral cancer. In addition, saliva shows potential as a convenient substitute for blood in diagnostic testing for systemic and oral diseases. DNA chip technology, a new system that combines these two technologies, has potential diagnostic value in dentistry as well as medicine. For each of the three common oral disease processes, emerging diagnostic procedures are discussed, with an emphasis on their potential utility for the practicing dentist of the 21st century. [References: 46] <55> UI - 20155132 AU - Lah TT AU - Cercek M AU - Blejec A AU - Kos J AU - Gorodetsky E AU - Somers R AU - Daskal I IN - Department of Genetic Toxicology and Cancer Biology, National Institute of Biology, Ljubljana, Slovenia. tamara.lah@uni.lj.si TI - Cathepsin B, a prognostic indicator in lymph node-negative breast carcinoma patients: comparison with cathepsin D, cathepsin L, and other clinical indicators. SO - Clinical Cancer Research 2000 Feb;6(2):578-84 AB - New prognosticators are needed for breast cancer patients after the initial surgical treatment to make therapeutic decisions that ultimately will affect their DFS. These consist of specific proteolytic enzymes including lysosomal endopeptidases. In this study, the activity and protein concentrations of cathepsins (Cats) D, B, and L were measured in 282 invasive breast tumor cytosols. These potential biological prognostic indicators were compared with other histopathological parameters, such as tumor size, lymph node involvement, tumor-node-metastasis stage, histological grade, DNA analysis, and steroid receptors. CatD protein concentration correlated with lymph node involvement. CatB and CatL levels correlated significantly with Scarf-Bloom-Richardson histological grade and were also higher in estrogen-negative tumors, and CatB was higher in larger tumors. As prognostic markers, CatB concentration was significant for increased risk for recurrence in the entire patient population and specifically also in lymph node-negative patients as follows: high CatB concentration (above 371 micrograms/g) in tumor cytosols was significant (P < 0.00) for high risk of recurrence but was of only borderline prognostic significance (P < 0.06) for overall survival of all patients. In lymph node-negative patients, CatB (above 240 micrograms/g, P < 0.003) was highly significant for recurrence-free survival, followed by CatL (above 20 micrograms/g, P < 0.049) and CatD (above 45 nmol/g, P < 0.044) concentrations. For overall survival of node-negative patients, only CatB was a significant (P < 0.014) prognosticator. We conclude that CatB is useful as a prognostic indicator in lymph node-negative patients. This suggests that selective adjuvant therapy should be applied in this lower risk group of patients when high levels of CatB are determined. <56> UI - 20138562 AU - Bacci G AU - Briccoli A AU - Ferrari S AU - Saeter G AU - Donati D AU - Longhi A AU - Manfrini M AU - Bertoni F AU - Rimondini S AU - Monti C AU - Forni C IN - Sezione di Chemioterapia, Istituto Ortopedico Rizzoli, I-40136 Bologna, Italy. TI - Neoadjuvant chemotherapy for osteosarcoma of the extremities with synchronous lung metastases: treatment with cisplatin, adriamycin and high dose of methotrexate and ifosfamide. SO - Oncology Reports 2000 Mar-Apr;7(2):339-46 AB - We report on the clinical course and outcome of 28 patients, treated at The Istituti Ortopedici Rizzoli between 1995 and 1997 for osteosarcoma of the extremities metastatic to the lung at presentation. The treatment for these patients was the following: primary chemotherapy with cisplatin, adriamycin and high dose of methotrexate and ifosfamide followed by simultaneous resection of primary and metastatic lesions (when feasible), and further chemotherapy. After primary chemotherapy, lung metastases disappeared in 6 patients, whereas metastases in 3 remained surgically unresectable. These 9 patients received surgical treatment of the primary tumor only. In the remaining 19 patients, after chemotherapy, a simultaneous resection of the primary and metastatic tumor was performed. The resection of metastatic lesions was complete in 18 cases and incomplete in one. Three of the 4 patients who did not achieve a tumor-free status died in a few months and one is still alive with uncontrolled disease. With a median follow-up of 32 months (19-43) of the 24 patients who achieved remission, 12 (55%) remained continuously free of disease, 11 relapsed with new metastases and 1 died of chemotherapy-related toxicity. The 2-year DFS and OS were 36% and 53% respectively. These results are much worse than those achieved in 114 contemporary patients with localised disease (2-year DFS: 81%) treated in the same period and they are superimposible to the results achieved in 23 patients previously treated with the same protocol, but with standard dose of ifosfamide (2-year DFS: 32%). However, it must be underlined that, as regards prognosis, patients with metastatic disease at presentation are a hetero-geneous group. The DFS was significantly higher for patients with only one or two metastatic lesions than for patients with 3 or more lesions (2 year DFS: 78% vs. 28%). In 12 of the 19 patients who had a complete simultaneous resection of the primary and metastatic tumor, a strong correlation between the degree of necrosis of the primary and metastatic lesions was found. We conclude that in patients with osteosarcoma of the extremity with lung metastases at presentation: a) the combination of aggressive chemotherapy with simultaneous resection of primary and metastatic tumors works very well only for those patients who present with one or two metastatic nodules whereas for patients with 3 or more pulmonary metastases the prognosis is very poor; b) within the 4-drug regimen used in this study, the increment of ifosfamide dose from 10 g/m2 to 15 g/m2 for cycle does not improve prognosis; c) the strong correlation found between the histologic response of the primary tumor and metastases supports the strategy, largely used nowadays in the neoadjuvant treatment of osteosarcoma, of tailoring postoperative chemo-therapy on the basis of the primary tumor histologic response to preoperative chemotherapy. <57> UI - 20174791 AU - Cumella S AU - Ransford N AU - Lyons J AU - Burnham H IN - University of Birmingham School of Medicine, Division of Neuroscience, Queen Elizabeth Psychiatric Hospital, UK. S.Cumella@bham.ac.uk TI - Needs for oral care among people with intellectual disability not in contact with Community Dental Services. SO - Journal of Intellectual Disability Research 2000 Feb;44 ( Pt 1):45-52 AB - Previous research has found an unmet need for oral care among people with intellectual disability. The key factors which have been indicated are low expectations, fear of treatment, lack of awareness among carers and problems in accessing dental services. The withdrawal of many general dental practitioners (GDPs) from the National Health Service (NHS) may have exacerbated the latter problem in the UK. The aims of the present study were: (1) to assess the extent of unmet clinical needs in a group of adults with intellectual disability living in the community who were not in contact with the Community Dental Service (CDS); and (2) to explore their perceptions of teeth and contact with dentists to identify how oral care can be improved. Interviews were completed with subjects and/or carers and a dental examination was completed. There were higher levels of untreated caries (decay), and gingival or periodontal (gum) problems among the sample than in either the general population, or in a previous survey of CDS users at day centres and residential facilities. The subjects were largely unaware of dental problems, and used the appearance and absence of pain to judge the condition of their teeth. They depended greatly on their carers for decision-making and support with regard to visiting the dentist and tooth-brushing. Carers requested training in oral care and the use of dental services, and support in dealing with clients who have problems tolerating tooth-brushing. The subjects had experienced a wide variation in the treatment provided by dentists, but had not found it difficult to access a dentist despite recent reductions in the availability of NHS dental care. They expressed a particular need for a good relationship with their dentist and for their dentist to have personal skills in relating to people with an intellectual disability. Dental screening checks and oral care training for carers should be made easily available. Care plans should include tooth-brushing and dietary issues for all clients who have their own natural teeth. There are significant training issues for dentists in developing personal skills in total communication, disability awareness and attitudes which value people with intellectual disability. <58> UI - 20151852 AU - Gryst ME AU - Mount GJ IN - Specialist Services, Adelaide Dental Hospital. TI - The use of glass ionomer in special needs patients. SO - Australian Dental Journal 1999 Dec;44(4):268-74 AB - Placement of restorations for patients who are physically or intellectually disabled or mentally ill can pose considerable difficulties for the general practitioner. Access to the oral environment is often limited and patient tolerance and concentration may be reduced to rather brief periods of time. Oral hygiene routines may be less than ideal leading to a high caries rate. Enamel surfaces which do not normally become carious can develop broad but shallow lesions with a poorly defined outline. Selection of the most suitable restorative material will be important, with longevity of the restoration as the prime consideration. Other factors such as access, isolation of the lesion and patient co-operation must also be taken into account. Also, forces acting on restorative materials may be less than usual due to poor occlusion, teeth opposing dentures or being completely unopposed. Restoration by indirect techniques will often not be possible so the choice will be limited to the three plastic restorative materials normally used in restorative dentistry: amalgam, resin composite and glass ionomer. As a result of clinical experience it is suggested that glass ionomer will often be the material of choice. This paper describes five years experience with the resin-modified glass ionomers in an institutional practice which is limited to patients with special needs. Clinical significance Placement of restorations, with a reasonable expectation of longevity, can pose considerable problems for the patient with special needs. Resin-modified glass ionomer is a useful alternative material and has been placed with a high degree of success over a period of five years. <59> UI - 20138329 AU - Rees JS AU - Jacobsen PH IN - Department of Adult Dental Health, Dental School, University of Wales College of Medicine, Cardiff, U.K. TI - The effect of interfacial failure around a class V composite restoration analysed by the finite element method. SO - Journal of Oral Rehabilitation 2000 Feb;27(2):111-6 AB - Partial failure around the tooth-composite interface of a class V restoration is common due to the effects of polymerization shrinkage. The effect that this has on the force distribution of the remaining intact interfaces has not been investigated. The aim of this study was to quantify the effect that partial failure of an isolated cavity wall interface had on the force distribution around the remaining intact interfaces of a class V composite restoration in a lower first premolar using a two-dimensional plane strain finite element model. Partial failure resulted in a 4-6-fold increase in peak tensile and shear forces compared to a tooth with a fully intact cavity wall interface. In some instances, the peak stresses were greater than the known bond strengths of composite to dentine. <60> UI - 20174295 AU - Cederlund A AU - Lindskog S AU - Blomlof J IN - Department of Basic Oral Sciences, School of Dentistry, Karolinska Institutet, Huddinge, Sweden. andreas.cederlund@ofa.ki.se TI - Efficacy of Carisolv-assisted caries excavation. SO - International Journal of Periodontics & Restorative Dentistry 1999 Oct;19(5):464-9 AB - As a possible alternative to conventional techniques for excavating caries chemomechanical methods have been developed. Caridex has so far been the dominating product. However, a new system, Carisolv, was recently introduced. The purpose of the present study was to evaluate the caries-dissolving efficacy of Carisolv in vitro. After excavation with Carisolv all dentin surfaces were caries free. However, 6 of the 10 cavities showed residual caries in the dentinoenamel junction. The dentin and enamel surfaces were covered by smear and debris. Since there may be a risk of leaving caries in the dentinoenamel junction proper case selection appears to be of importance to ensure a successful result. <61> UI - 20162073 AU - Frame PS AU - Sawai R AU - Bowen WH AU - Meyerowitz C IN - Tri-County Family Medicine, Cohocton, New York 14826, USA. TI - Preventive dentistry: practitioners' recommendations for low-risk patients compared with scientific evidence and practice guidelines. [Review] [16 refs] SO - American Journal of Preventive Medicine 2000 Feb;18(2):159-62 AB - INTRODUCTION: The purpose of this article is to compare published evidence supporting procedures to prevent dental caries and periodontal disease, in low-risk patients, with the actual preventive recommendations of practicing dentists. METHODS: Methods included (1) a survey questionnaire of general dentists practicing in western New York State concerning the preventive procedures they would recommend and at what intervals for low-risk children, young adults, and older adults; and (2) review of the published, English-language literature for evidence supporting preventive dental interventions. RESULTS: The majority of dentists surveyed recommended semiannual visits for visual examination and probing to detect caries (73% to 79%), and scaling and polishing to prevent periodontal disease (83% to 86%) for low-risk patients of all ages. Bite-wing radiographs were recommended for all age groups at annual or semiannual intervals. In-office fluoride applications were recommended for low-risk children at intervals of 6 to 12 months by 73% of dentists but were recommended for low-risk older persons by only 22% of dentists. Application of sealants to prevent pit and fissure caries was recommended for low-risk children by 22% of dentists. Literature review found no studies comparing different frequencies of dental examinations and bite-wing radiographs to determine the optimal screening interval in low-risk patients. Two studies of the effect of scaling and polishing on the prevention of periodontal disease found no benefit from more frequent than annual treatments. Although fluoride is clearly a major reason for the decline in the prevalence of dental caries, there are no studies of the incremental benefit of in-office fluoride treatments for low-risk patients exposed to fluoridated water and using fluoridated toothpaste. CONCLUSIONS: Comparative studies using outcome end points are needed to determine the optimal frequency of dental examinations and bite-wing radiographs for the early detection of caries, and of scaling and polishing to prevent periodontal disease in low-risk persons. There is no scientific evidence that dental examinations, including scaling and polishing, at 6 month intervals, as recommended by the dentists surveyed in this study, is superior to annual or less frequent examinations for low-risk populations. There is also no evidence that in-office fluoride applications offer incremental benefit over less costly methods of delivering fluoride for low-risk populations. [References: 16] <62> UI - 20166392 AU - Soikkonen K AU - Wolf J AU - Salo T AU - Tilvis R IN - Department of Diagnostics and Oral Medicine, Institute of Dentistry, University of Oulu, Finland. TI - Radiographic periodontal attachment loss as an indicator of death risk in the elderly. SO - Journal of Clinical Periodontology 2000 Feb;27(2):87-92 AB - OBJECTIVES: Oral infections have been associated with serious systemic diseases and an increased risk of death. Our aims were to investigate whether radiographically-observed apical periodontitis lesions, carious teeth, periodontal attachment loss (horizontal bone loss, furcation lesions, number of teeth with infrabony periodontal pockets, the extent of infrabony periodontal pockets) and the sum of all these findings have any relationships with all-cause mortality within 4-year follow-up. MATERIAL AND METHODS: 292 community-dwelling elderly persons aged 76, 81 and 86 years. The number of deaths within 4 years was 54 (18.5%). In the dentate 169 subjects, of whom 32 (18.9%) deceased within 4 years, the mean number of teeth was 15.5 in men and 13.2 in women. The imaging method used was panoramic radiography supplemented by intraoral radiographs. RESULTS: 51% of the dentate subjects had infrabony pockets (mean 1.5, s.d. 2.2), and 40% had periapical periodontitis lesions (mean 1.0, s.d. 1.6). After controlling for age and gender, vertical bone loss judged as advanced infrabony pockets was associated with 4-year all-cause mortality (Odds ratio 2.2,1.0-4.7). Other associations were statistically insignificant. CONCLUSION: Periodontal attachment loss may indicate an increased risk of death in the elderly. <63> UI - 20172928 AU - Paulus D AU - Wolf M AU - Meller S AU - Niemann H IN - Lehrstuhl fur Mustererkennung (Informatik 5), Universitat Erlangen-Nurnberg, Erlangen, Germany. paulus@informatik.uni-erlangen.de TI - Three-dimensional computer vision for tooth restoration. [Review] [50 refs] SO - Medical Image Analysis 1999 Mar;3(1):1-19 AB - If a person with carious lesions needs or requests crowns or inlays, these dental fillings have to be manufactured for each tooth and each person individually. We survey computer vision techniques which can be used to automate this process. We introduce three particular applications which are concerned with the reconstruction of surface information. The first one aims at building up a database of normalized depth images of posterior teeth and at extracting characteristic features from these images. In the second application, a given occlusal surface of a posterior tooth with a prepared cavity is digitally reconstructed using an intact model tooth from a given database. The calculated surface data can then be used for automatic milling of a dental prosthesis, e.g. from a preshaped ceramic block. In the third application a hand-made provisoric wax inlay or crown can be digitally scanned by a laser sensor and copied three dimensionally into a different material such as ceramic. The results are converted to a format required by the computer-integrated manufacturing (CIM) system for automatic milling. [References: 50] <64> UI - 20106113 AU - Wilson N AU - Quigley R AU - Mansoor O IN - Ministry of Health, Wellington, New Zealand. nwilson@actrix.gen.nz TI - Food ads on TV: a health hazard for children?. SO - Australian & New Zealand Journal of Public Health 1999 Dec;23(6):647-50 AB - OBJECTIVE: To examine the nutritional quality of food in television food advertisements that are targeted at children. METHOD: We videotaped 42 hours of children's programs and analysed the food advertisements' content and nutrient composition using the New Zealand Food Composition Database. RESULTS: Of 269 food advertisements, 63% were for foods 'high in fat and/or sugar'. Children who ate only the advertised foods would eat a diet too high in fat, saturated fat, protein, free sugars and sodium. Furthermore, their diets would have suboptimal levels of fibre and suboptimal intakes of a number of important micronutrients (depending on age), including magnesium, selenium and vitamin E. The food products advertised on this channel rarely included nutritious low-cost foods that are necessary for food security in low-income groups. There were also no food advertisements that included any of the healthy foods consumed by Maori and Pacific peoples. CONCLUSIONS: Food advertisements targeted at children generally reflect the dietary pattern associated with an increased risk of obesity and dental caries in childhood; and cardiovascular disease, diabetes and cancers in adulthood. <65> UI - 20106111 AU - Brennan DS AU - Spencer AJ IN - AIHW Dental Statistics and Research Unit, University of Adelaide, South Australia. TI - Variation in dental service provision among adult migrant public-funded patients. SO - Australian & New Zealand Journal of Public Health 1999 Dec;23(6):639-42 AB - OBJECTIVE: To examine type of care, oral health status and service patterns by country of birth and language. METHODS: A random sample of public-funded patients (n = 6, 109) was surveyed in 1995-96. RESULTS: Emergency care was highest among overseas-born patients who spoke a non-English language at home; edentulism was highest among Australian-born/English only patients; while a higher percentage of Australian-born persons were in the periodontal health category (chi 2; p < 0.05). Differences in caries experience were generally small (ANOVA; p < 0.05). Service provision varied by country of birth/language after controlling for socio-demographic characteristics, type of care, and oral health status in six service areas (logistic regression; p < 0.05). CONCLUSIONS: Service patterns may reflect behavioural and cultural factors of patients or providers operating independently of socio-demographic and oral health status variables. IMPLICATIONS: Variation and potential inequality in service patterns related to cultural factors existed within a group of disadvantaged patients. <66> UI - 20146914 AU - Moss SJ IN - Health Education Enterprises, New York, NY 10017, USA. healthee@ix.netcom.com TI - The case for retaining the current supplementation schedule. SO - Journal of Public Health Dentistry 1999 Fall;59(4):259-62 AB - Following ingestion of dietary fluoride, microquantities of fluoride return to the mouth in saliva, but in quantities large enough to facilitate the maintenance and reparative functions of enamel. Dietary fluoride supplements alone are unlikely to be the cause of the reported increase in fluorosis. Compliance continues to be extremely poor and few children use supplements for more than a year and a half. The amount of background fluoride resulting from dietary fluoride supplements appears to be very small. Considering the almost ubiquitous presence of fluoride dentifrice and the strong possibility of additional unintentional fluoride ingestion from many sources, the present fluorosis data is too amorphous to use as a basis for making reasonable risk/benefit evaluations. Very mild and mild fluorosis is not a serious problem for either the clinician or the patient. By altering the present recommended dosage we may deprive children from receiving a proven effective dose. One cannot make a risk/benefit decision concerning an esthetic problem without involving the patient's perception as well as the caries score. The apparent severity of the milder forms of fluorosis lessens with age and a community fluorosis index should be used only on populations who are older than 15 years. <67> UI - 20144636 AU - McDaniel RJ AU - Davis RD AU - Murchison DF AU - Cohen RB IN - Department of TMJ and Orofacial Pain, University of Minnesota Dental School, USA. TI - Causes of failure among cuspal-coverage amalgam restorations: a clinical survey. SO - Journal of the American Dental Association 2000 Feb;131(2):173-7 AB - BACKGROUND: Investigations of cuspal-coverage amalgam restorations suggest that tooth fracture is the leading cause of failure, while for Class I and II restorations, the leading cause is caries. In this study, the authors evaluated the causes of failure for a large number of cuspal-coverage restorations. METHODS: The causes of failure for 706 cuspal-coverage amalgam restorations were determined through the use of a questionnaire. Dentists from a variety of dental schools; Army, Navy, Air Force, Public Health and Veterans Affairs dental clinics; and private practice were asked to record pertinent information regarding patients and restoration failures from choices provided on a survey form. RESULTS: The survey documented 706 failed restorations. Mandibular first molars accounted for 36.25 percent of all failures. The majority of failures were caused by fractured teeth (24.3 percent), caries (20 percent) and fractured restorations (17.1 percent). Among all of the failed restorations, 82.15 percent were restorable, 9.35 percent were repairable and 8.50 percent were nonrestorable. Among the fractured teeth, 80 percent were restorable, 14.5 percent were nonrestorable and 5.5 percent were repairable. Among the carious teeth, 84 percent were restorable, 8 percent were nonrestorable and 8 percent were repairable. A chi 2 analysis revealed that tooth fracture was more likely to be associated with nonrestorability than either caries (chi 2 = 5.013, P < .05) or restoration fracture (chi 2 = 6.202, P < .05). CONCLUSIONS: The leading cause of failure among the 706 restorations was tooth fracture, which resulted in significantly greater numbers of nonrestorable teeth than either caries or fractured restorations. CLINICAL IMPLICATIONS: Tooth fracture creates a greater risk of nonrestorability than any other cause of failure. Replacement or coverage of fracture-prone cusps is likely to improve the life expectancy of complex amalgam restorations. <68> UI - 20128565 AU - Helminen SE AU - Vehkalahti M AU - Lammi R AU - Ketomaki TM AU - Murtomaa H IN - Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Finland. TI - Dentists' decisions as to mode of preventive treatment in adolescents and young adults in Finland. SO - Community Dental Health 1999 Dec;16(4):250-5 AB - OBJECTIVE: To evaluate dentists' real-life decisions as to mode of preventive treatment in adolescents and young adults, in relation to these patients' oral-health status, and to the dentists' characteristics. DESIGN: A random sample of 206 adolescents and 239 young adults (mean ages 13 and 27 years) produced 411 (92%) individual oral health records providing data on actual clinical examinations and treatment courses carried out by 56 dentists in one administrative unit of the Finnish public oral health service during 1994-1996. OUTCOME MEASURES: Preventive measures were defined as active and passive, active including any kind of motivation or instructions given to a patient concerning home self-care, and passive prevention being topical application of fluoride. RESULTS: More adolescents had received both active and passive prevention than had young adults (active: 27% vs. 20%; passive: 85% vs. 70%). Of adolescents, 7% and of young adults 25% were given no preventive treatment. The mean number of active preventive measures per adolescent during the treatment course was 0.3 and of passive measures 1.0; for young adults 0.2 and 0.8, respectively. A subject's oral health status made no significant difference in active prevention given. Active measures were more frequently given to all patients by male dentists, 35% vs. 22% (P < 0.02), and passive measures by females, 82% vs. 52% (P < 0.001). The odds of active prevention for adolescents were 7.4 comparing male dentists to female; of passive 13.8 comparing female to male. CONCLUSIONS: Dentists should be motivated to make considered treatment decisions on preventive treatment. <69> UI - 20146493 AU - Hobdell MH AU - Lalloo R AU - Myburgh NG IN - University of Texas-Houston, Dental Branch 77030, USA. mhobdell@mail.db.uth.tmc.edu TI - The Human Development Index and Per Capita Gross National Product as predictors of dental caries prevalence in industrialized and industrializing countries. SO - Annals of the New York Academy of Sciences 1999;896:329-31 <70> UI - 20146491 AU - Drury TF AU - Garcia I AU - Adesanya M IN - National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland 20892, USA. TI - Socioeconomic disparities in adult oral health in the United States. SO - Annals of the New York Academy of Sciences 1999;896:322-4 <71> UI - 20131410 AU - Manolis AS AU - Maounis T AU - Vassilikos V AU - Chiladakis J AU - Cokkinos DV IN - Patras University, Rio, Greece. TI - Electrophysiologist-implanted transvenous cardioverter defibrillators using local versus general anesthesia. SO - Pacing & Clinical Electrophysiology 2000 Jan;23(1):96-105 AB - With the advent of smaller biphasic transvenous implantable cardioverter defibrillators (ICDs) and the experience gained over the years, it is now feasible for electrophysiologists to implant them safely in the abdominal or pectoral area without surgical assistance. Throughout the years, general anesthesia has been used as the standard technique of anesthesia for these procedures. However, use of local anesthesia combined with deep sedation only for defibrillation threshold (DFT) testing might further facilitate and simplify these procedures. The purpose of this study was to test the feasibility of using local anesthesia and compare it with the standard technique of general anesthesia, during implantation of transvenous ICDs performed by an electrophysiologist in the electrophysiology laboratory. For over 4 years in the electrophysiology laboratory, we have implanted transvenous ICDs in 90 consecutive patients (84 men and 6 women, aged 58 +/- 15 years). Early on, general anesthesia was used (n = 40, group I), but in recent series (n = 50, group II) local anesthesia was combined with deep sedation for DFT testing. Patients had coronary (n = 58) or valvular (n = 4) disease, cardiomyopathy (n = 25) or no organic disease (n = 3), a mean left ventricular ejection fraction of 35%, and presented with ventricular tachycardia (n = 72) or fibrillation (n = 16), or syncope (n = 2). One-lead ICD systems were used in 74 patients, two-lead systems in 10 patients, and an AVICD in 6 patients. ICDs were implanted in abdominal (n = 17, all in group I) or more recently in pectoral (n = 73) pockets. The DFT averaged 9.7 +/- 3.6 J and 10.2 +/- 3.6 J in the two groups, respectively (P = NS) and there were no differences in pace-sense thresholds. The total procedural duration was shorter (2.1 +/- 0.5 hours) in group II (all pectoral implants) compared with 23 pectoral implants of group I (2.9 +/- 0.5 hours) (P < 0.0001). Biphasic devices were used in all patients and active shell devices in 67 patients; no patient needed a subcutaneous patch. There were six complications (7%), four in group I and two in group II: one pulmonary edema and one respiratory insufficiency that delayed extubation for 3 hours in a patient with prior lung resection, both probably related to general anesthesia, one lead insulation break that required reoperation on day 3, two pocket hematomas, and one pneumothorax. There was one postoperative arrhythmic death at 48 hours in group I. No infections occurred. Patients were discharged at a mean time of 3 days. All devices functioned well at predischarge testing. Thus, it is feasible to use local anesthesia for current ICD implants to expedite the procedure and avoid general anesthesia related cost and possible complications. <72> UI - 99447528 AU - Hale GA AU - Heslop HE AU - Bowman LC AU - Rochester RA AU - Pui CH AU - Brenner MK AU - Krance RA IN - Division of Bone Marrow Transplantation, St Jude Children's Research Hospital, Memphis, TN, USA. TI - Bone marrow transplantation for therapy-induced acute myeloid leukemia in children with previous lymphoid malignancies. SO - Bone Marrow Transplantation 1999 Oct;24(7):735-9 AB - Twenty-one children who developed therapy-related acute myeloid leukemia after treatment for acute lymphoblastic leukemia received allogeneic bone marrow transplants between January 1990 and June 1997. All had previously received epipodophyllotoxin-containing regimens and 11 had cytogenetic abnormalities involving 11q23. Induction chemotherapy was given to 13 patients and eight patients went directly to BMT. Eleven received marrow from matched siblings, eight from matched unrelated donors and two from haploidentical family members. Conditioning regimens included cyclophosphamide (CY), cytarabine, and total body irradiation. Four patients are alive disease-free between 1118 and 1825 days post-BMT resulting in a 3-year DFS of 19%. Ten patients relapsed at a median of 150 days (range 30-664 days) post-BMT and all eventually died of disease. Seven patients died of regimen-related toxicity. The outlook for patients with therapy-related AML/MDS remains poor and more effective therapy is needed. <73> UI - 20024640 AU - Roddick A TI - Epidemiology in practice [letter; comment]. CM - Comment on: N Z Dent J 1999 Jun;95(420):66-7 SO - New Zealand Dental Journal 1999 Sep;95(421):101; discussion 101-2 <74> UI - 20113838 AU - Leake JL AU - Main PA AU - Sabbah W IN - Department of Biological and Diagnostic Science, Faculty of Dentistry, University of Toronto, Ontario, Canada. jleake@dental.utoronto.ca TI - A system of diagnostic codes for dental health care. SO - Journal of Public Health Dentistry 1999 Summer;59(3):162-70 AB - OBJECTIVES: We set out to develop and implement a system of diagnostic codes for use in the computerized management information system of the Community Dental Services of the North York Public Health Department. METHODS: We received staff input on common diagnoses, reviewed other diagnostic systems and established criteria for an ideal coding system. The codes are consistent with the format of other classification systems used in dental management information in Canada. They were implemented in 1997-98. RESULTS: We developed a system of four-digit, numeric codes for dental diagnoses. The diagnostic codes are specific at the level of the patient, consistent with current evidence on the natural history and classification of diseases, consistent with conventional measures of oral conditions, and fit the paradigm of the Canadian system of treatment codes. In the first year, 91 percent of 6,740 patients had at least one diagnosis, with a mean of 2.5 per patient. The five most common diagnoses were smooth surface caries, pit and fissure caries, calculus, teeth with deep fissures, and gingivitis. CONCLUSIONS: We have developed a coding system for dental diagnoses that has achieved high use and provided more accessible information on the conditions seen by staff dentists. <75> UI - 20113837 AU - Bader JD AU - White BA AU - Olsen O AU - Shugars DA IN - Sheps Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7590, USA. jim:bader@unc.edu TI - Dentist reliability in classifying disease risk and reason for treatment. SO - Journal of Public Health Dentistry 1999 Summer;59(3):158-61 AB - OBJECTIVES: The reliability of practicing dentists' classifications of patients' caries risk and periodontal disease risk and reason for treatment for individual teeth were determined. The risk classification protocols had been in use in a group practice for more than a year, and the reason-for-treatment protocol had been introduced six months previously. METHODS: Eight dentists' classifications for caries (n = 66) and periodontal disease risk (n = 66), and six dentists' classifications for reason for treatment (n = 73) were compared to those of a nominal standard examiner. Reliability was expressed as percent agreement and kappa values. RESULTS: Percent agreement was 76 percent, 83 percent, and 74 percent for caries, periodontal disease, and reason for treatment, respectively, with kappa values of 0.56, 0.70, and 0.69. CONCLUSIONS: Dentists can attain reasonable levels of reliability using simple classification protocols with little formal training, although misclassification may be problematic for specific administrative or research-related purposes. <76> UI - 20113836 AU - Bader JD AU - Shugars DA AU - White BA AU - Rindal DB IN - Sheps Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7590, USA. jim:bader@unc.edu TI - Evaluation of audit-based performance measures for dental care plans. SO - Journal of Public Health Dentistry 1999 Summer;59(3):150-7 AB - OBJECTIVES: Although a set of clinical performance measures, i.e., a report card for dental plans, has been designed for use with administrative data, most plans do not have administrative data systems containing the data needed to calculate the measures. Therefore, we evaluated the use of a set of proxy clinical performance measures calculated from data obtained through chart audits. METHODS: Chart audits were conducted in seven dental programs--three public health clinics, two dental health maintenance organizations (DHMO), and two preferred provider organizations (PPO). In all instances audits were completed by clinical staff who had been trained using telephone consultation and a self-instructional audit manual. The performance measures were calculated for the seven programs, audit reliability was assessed in four programs, and for one program the audit-based proxy measures were compared to the measures calculated using administrative data. RESULTS: The audit-based measures were sensitive to known differences in program performance. The chart audit procedures yielded reasonably reliable data. However, missing data in patient charts rendered the calculation of some measures problematic--namely, caries and periodontal disease assessment and experience. Agreement between administrative and audit-based measures was good for most, but not all, measures in one program. CONCLUSIONS: The audit-based proxy measures represent a complex but feasible approach to the calculation of performance measures for those programs lacking robust administrative data systems. However, until charts contain more complete diagnostic information (i.e., periodontal charting and diagnostic codes or reason-for-treatment codes), accurate determination of these aspects of clinical performance will be difficult. <77> UI - 20113835 AU - Bader JD AU - Shugars DA AU - White BA AU - Rindal DB IN - Sheps Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7590, USA. jim:bader@unc.edu TI - Development of effectiveness of care and use of services measures for dental care plans. SO - Journal of Public Health Dentistry 1999 Summer;59(3):142-9 AB - OBJECTIVES: Standardized measures to assess clinical aspects of the performance of managed dental care plans are not available. This project sought to develop and evaluate measures for effectiveness of care and use of services that could be calculated using a plan's administrative data. METHODS: Two panels of stake holders representing dental plans, purchasers, and dental providers participated in a modified Delphi process to refine initial sets of effectiveness of care and use of services measures modeled after HEDIS measures for medical care. The refined measures were then pilot tested in two dental health maintenance organizations. RESULTS: The development process resulted in specification of seven effectiveness of care measures assessing disease activity classification, and prevention and outcomes for caries, periodontal disease, and tooth loss. Six use of services measures focusing on prophylaxes, third molar surgery, preventive, restorative, prosthetic, surgical, and endodontic care also were specified. Pilot testing of the measures indicated reasonable reliability and sensitivity, but also demonstrated the need for supervision or auditing of the process. CONCLUSIONS: These standardized measures for dental care plan performance are available for immediate use. However, because the measures depend on diagnostic information (periodontal probing data and diagnoses associated with restorative treatments) in the administrative data set, their adoption will require changes in most plans' data systems and data collection policies. <78> UI - 20113834 AU - Crall JJ AU - Szlyk CI AU - Schneider DA IN - Department of Pediatric Dentistry, University of Connecticut Health Center, Farmington 06030-1610, USA. crall@nso.uchc.edu TI - Pediatric oral health performance measurement: current capabilities and future directions. SO - Journal of Public Health Dentistry 1999 Summer;59(3):136-41 AB - This paper offers an overview of performance measurement in health care, provides a synopsis of the findings and recommendations of an Oral Health Expert Panel organized by the National Committee for Quality Assurance (NCQA) under contract with the Health Care Financing Administration (HCFA), and discusses challenges and possible future directions for pediatric oral health care performance measures development. Existing performance measures for pediatric oral health care are extremely limited; however, several new measures have been proposed and are in various stages of development and testing. Measures capable of being implemented in the short-term focus on access and use of services, rely on administrative data sources, and represent refinements and enhancements of current measures. Measures proposed for future implementation focus more on the effectiveness of care, consumer assessments of care and plan performance, and the value of services provided to enrolled children. Recommendations are targeted toward high-risk children who, for the most part, are covered by public programs (e.g., Medicaid and the Children's Health Insurance Program). Nevertheless, the entire set of recommended measures is considered to be relevant to all pediatric populations and applicable to all forms of dental care coverage, including state-administered programs and commercial third party arrangements. <79> UI - 20137424 AU - Cugini MA AU - Haffajee AD AU - Smith C AU - Kent RL Jr AU - Socransky SS IN - Department of Periodontology, The Forsyth Institute, Boston, MA, USA. TI - The effect of scaling and root planing on the clinical and microbiological parameters of periodontal diseases: 12-month results. SO - Journal of Clinical Periodontology 2000 Jan;27(1):30-6 AB - BACKGROUND/AIMS: Previously, we reported that SRP resulted in a decrease in mean pocket depth and attachment level and reduced prevalence and levels of Bacteroidesforsythus, Porphyromonas gingivalis, and Treponema denticola at 3 and 6 months post-SRP in 57 subjects with adult periodontitis. 32 of the 57 subjects were monitored at 9 and 12 months. Thus, the purpose of the present investigation was to evaluate the microbial and clinical effects of SRP in 32 (mean age 48+/-11) subjects over a 12-month period. METHOD: Clinical assessments of plaque, gingival redness, suppuration, bleeding on probing, pocket depth and attachment level were made prior to SRP and at 3, 6, 9, and 12 months post-therapy. Subgingival plaque samples were taken at each visit and analyzed using the checkerboard DNA-DNA hybridization technique for the presence and levels of 40 subgingival species. Each subject also received maintenance scaling at each of the subsequent monitoring visits. Differences in clinical parameters and prevalence and levels of bacterial species were analyzed pre- and post-therapy using the Wilcoxon signed ranks test. The Quade test for related samples was used for analysis of multiple visits. RESULTS: Mean pocket depth (mm+/-SEM) decreased from 3.2+/-0.3 at baseline to 2.9+/-0.3 at 12 months (p<0.01). Mean attachment level showed significant reduction at 6 months, but did not diminish further. Bleeding on probing and plaque were significantly reduced at 12 months (p<0.001, p<0.05, respectively). P. gingivalis, B. forsythus and T. denticola decreased in prevalence and levels up to the 6-month visit and remained at these lower levels at 9 and 12 months. Significant increases in levels and prevalence were noted at 12 months for Actinomyces naeslundii genospecies 2, Actinomyces odontolyticus, Fusobacterium nucleatum ss polymorphum, Streptococcus mitis, Capnocytophaga sp, and Veillonella parvula. CONCLUSIONS: The data suggest that the maintenance phase of therapy may be essential in consolidating clinical and microbiological improvements achieved as a result of initial therapy. <80> UI - 20137423 AU - Unell L AU - Soderfeldt B AU - Halling A AU - Birkhed D IN - Community Dental Health Unit, Orebro County Council, Sweden. lennart.unell@orebroll.se TI - Explanatory models for clinical and subjective indicators of periodontal disease in an adult population. SO - Journal of Clinical Periodontology 2000 Jan;27(1):22-9 AB - BACKGROUND: The aim of this study was to analyze indicators of periodontal disease using: (1) community periodontal index of treatment needs (CPITN), (2) subjectively reported change of front teeth position, and 3) subjectively reported gingival bleeding. METHOD: These 3 indicators were used in models with explanatory variables from 4 domains: (A) socio-economic attributes, (B) general health and health-related lifestyle, (C) dental attitudes and behaviors, and (D) dental status expressed as (number of teeth and DFT) for the clinically-determined dependent variables. In 1992, the study was carried out cross-sectionally in all 50-year olds in 2 Swedish counties using a questionnaire (n=6343) and clinical investigation of a 20 % sub-sample (n= 1040). RESULTS: Multiple and logistic regression analysis showed that explanatory patterns varied for the clinical and subjective indicators. Use of tobacco had strong effects in all models as did high care utilization. There were few associations with socio-economic attributes. The 2 subjective indicators "changed front position" and "gingival bleeding" associated with attitudes, behaviors and subjective health. Number of teeth and DFT covaried with clinical indicators. CONCLUSIONS: The main conclusions from this study are: (1) that it is possible to find multivariate models with acceptable goodness of fit for prediction of occurrence of periodontal indicators, and (2) that the lack of relation between social attributes and the disease gives arguments for a biological provenance of periodontitis. <81> UI - 20110283 AU - Kinirons MJ AU - Stewart C IN - Division of Paediatric and Preventive Dentistry, School of Clinical Dentistry, Belfast, UK. TI - Adolescents' knowledge of common foods and drinks and the importance of the pattern of consumption: a study undertaken in an area of high dental needs. SO - Community Dental Health 1998 Sep;15(3):175-8 AB - OBJECTIVE: To assess the knowledge of adolescents concerning the cariogenic status of a range of foods and drinks. To determine the associations between this knowledge and their awareness of the importance of the ways sugars may be consumed in order to reduce tooth decay. DESIGN: Self-complete questionnaires assessing the above factors in a cross sectional study. PARTICIPANTS: Four hundred and fifteen 14-15-year-old young people attending second level schools. SETTING: North and West Belfast area, Northern Ireland. OUTCOME MEASURES: Students rated the dental safety of common foods and drinks, and their views on the necessity of reducing all sugars, and avoiding them between meals were recorded. RESULTS: Correct assessment of harmful items ranged from 96.9% for chocolate and 92.8% for cola to 39.0% for orange squash and 17.8% for plain biscuits. For non-harmful products there were high levels for most items and somewhat lower levels for crisps (57.6%). Significant links were established between this knowledge and children's awareness of the role of eating patterns, although the items involved varied. A majority recognised the importance of eating patterns in relation to dental caries. CONCLUSION: Health educators should be aware that many adolescents have poor knowledge of the cariogenic status of some of the foods and drinks they consume and some are unsure of the importance of eating patterns. <82> UI - 20123264 AU - Neiburger EJ TI - Blood lead level and dental caries [letter]. SO - JAMA 2000 Jan 26;283(4):477 <83> UI - 20114170 AU - Konishi N AU - Fried D AU - Staninec M AU - Featherstone JD IN - Department of Operative Dentistry, Dental School, Okayama University, Japan. TI - Artificial caries removal and inhibition of artificial secondary caries by pulsed CO2 laser irradiation. SO - American Journal of Dentistry 1999 Oct;12(5):213-6 AB - PURPOSE: To investigate the inhibition of artifical secondary caries around restorations placed after removal of artificial caries by pulsed CO2 laser irradiation and by mechanical means. MATERIALS & METHODS: Beveled cavities were prepared mechanically on the facial surfaces of extracted human molars. Each cavity was subsequently exposed to an artificial caries (demineralizing) solution (pH 5.0) for 7 d to generate a demineralized zone approximately 100-200 microns thick on the cavity surface. The artificial carious/demineralized zones of the cavities were removed by a pulsed CO2 laser operating at a wavelength of 9.3 microns with pulse duration of 100 microseconds and an irradiation intensity of 5 J/cm2. Artificial control caries were removed mechanically with a carbide bur in a slow speed handpiece. The cavities were slightly undercut and restored with a resin-based composite without etching and bonding and the restored teeth were subjected to pH cycling solutions for 10 d as follows: Demineralization solution, pH 4.5 for 6 hrs, followed by remineralization solution, pH 7.0 for 18 hrs. Cycled teeth were sectioned through the restorations and the resulting lesions were analyzed in thin section using polarized light and Knoop microhardness. RESULTS: Mean microhardness delta Z values, indicating mineral loss were: 549 (SD 191) for control, and 140 (SD 127) N = 11. This difference is significant with t = 5.543 and P = 0.000 (Paired t-test). Caries penetration: Control side--231 microns (SD 71), Laser treated side: 123 microns (SD 79) N = 6. This difference is significant with t = 5.198 and P = 0.003 (Paired t-test). The results show that the laser treatment not only removed artificial caries, but also inhibited decalcification of the cavity wall in a subsequent artificial caries challenge by as much as 81% compared to control samples. No etching and bonding was used in this pilot study, which might have influenced the results. Future studies should address the inhibition effect of the laser treatment as compared to adhesive techniques, fluoride treatments and fluoride release restorative materials. CONCLUSION: Caries removal by a pulsed lambda = 9.3 microns CO2 laser produces a cavity surface morphology with marked resistance to artificial secondary caries as compared to mechanical removal. <84> UI - 20069267 AU - O'Sullivan EA AU - Curzon ME IN - Department of Paediatric Dentistry, Leeds Dental Institute, Leeds, UK. DENEAO@leeds.ac.uk TI - Salivary factors affecting dental erosion in children. SO - Caries Research 2000 Jan-Feb;34(1):82-7 AB - Dental erosion is becoming a major dental problem in both children and adults. The aim of this study was to measure the salivary flow rates, buffering capacity and mutans streptococci counts in children with erosion, and compare them to age- and sex-matched caries-free and caries-active individuals to establish which factors may be important in erosion. The study was conducted as a case-control study with standard methods of salivary and mutans streptococci measurement. The results showed significant differences for mutans streptococci counts (p = 0.05), unstimulated and stimulated salivary pH and buffering capacity (p = 0.001). These results suggest that although individuals with erosion have caries experience similar to a caries-free individual, their salivary characteristics more closely match those of a caries-active subject. The tests described are simple to carry out and may be useful in explaining individual patient susceptibility. <85> UI - 20101194 AU - Cardoso M AU - Baratieri LN AU - Ritter AV IN - Department of Operative Dentistry, Federal University of Santa Catarina, Florianopolis, Brazil. TI - The effect of finishing and polishing on the decision to replace existing amalgam restorations. SO - Quintessence International 1999 Jun;30(6):413-8 AB - OBJECTIVE: The purpose of this investigation was to evaluate the influence of finishing and polishing procedures on the decision to replace existing amalgam restorations. METHOD AND MATERIALS: Twenty Class I and Class II amalgam restorations, free from obvious defects, were selected in 6 patients. The restorations were photographed before and after being submitted to a standard finishing and polishing procedure. In the first phase, the preoperative slides were examined by 27 clinicians and senior dental students, who were instructed to inspect each restoration and answer a questionnaire indicating if and why the restoration needed to be replaced. Two weeks later, the postoperative slides were presented to the same examiners, who were asked to answer the same questionnaire as before. RESULTS: At the first phase, there were 236 decisions (44%) to replace existing amalgam restorations. Following the finishing and polishing procedures, 114 decisions (21%) were made to replace existing amalgam restorations. This difference was statistically significant. Secondary caries was the most common reason for replacement. CONCLUSION: The finishing and polishing procedure reversed the decision to replace old amalgam restorations. <86> UI - 20007837 AU - Thompson PD AU - Hsieh JC AU - Whitfield GK AU - Haussler CA AU - Jurutka PW AU - Galligan MA AU - Tillman JB AU - Spindler SR AU - Haussler MR IN - Department of Biochemistry, College of Medicine, The University of Arizona, Tucson, Arizona 85724, USA. TI - Vitamin D receptor displays DNA binding and transactivation as a heterodimer with the retinoid X receptor, but not with the thyroid hormone receptor. SO - Journal of Cellular Biochemistry 1999 Dec 1;75(3):462-80 AB - The vitamin D receptor (VDR) is a transcription factor believed to function as a heterodimer with the retinoid X receptor (RXR). However, it was reported [Schrader et al., 1994] that, on putative vitamin D response elements (VDREs) within the rat 9k and mouse 28k calcium binding protein genes (rCaBP 9k and mCaBP 28k), VDR and thyroid hormone receptor (TR) form heterodimers that transactivate in response to both 1,25-dihydroxyvitamin D(3) (1,25(OH)(2)D(3)) and triiodothyronine (T(3)). We, therefore, examined associations of these receptors on the putative rCaBP 9k and mCaBP 28k VDREs, as well as on established VDREs from the rat osteocalcin (rOC) and mouse osteopontin (mOP) genes, plus the thyroid hormone response element (TRE) from the rat myosin heavy chain (rMHC) gene. In gel mobility shift assays, we found no evidence for VDR-TR heterodimer interaction with any tested element. Further, employing these hormone response elements linked to reporter genes in transfected cells, VDR and TR mediated responses to their cognate ligands only from the rOC/mOP and rMHC elements, respectively, while the CaBP elements were unresponsive to any combination of ligand(s). Utilizing the rOC and mOP VDREs, two distinct repressive actions of TR on VDR-mediated signaling were demonstrated: a T(3)-independent action, presumably via direct TR-RXR competition for DNA binding, and a T(3)-dependent repression, likely by diversion of limiting RXR from VDR-RXR toward the formation of TR-RXR heterodimers. The relative importance of these two mechanisms differed in a response element-specific manner. These results may provide a partial explanation for the observed association between hyperthyroidism and bone demineralization/osteoporosis. Copyright 1999 Wiley-Liss, Inc. <87> UI - 20084553 AU - Litt MD AU - Kalinowski L AU - Shafer D IN - Department of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington 06030, USA. litt@nso.uchc.edu TI - A dental fears typology of oral surgery patients: matching patients to anxiety interventions. SO - Health Psychology 1999 Nov;18(6):614-24 AB - Two studies are described in which dental patients were administered the Dental Fear Survey (DFS) and then received 1 of 5 anxiety reduction interventions to prepare them for extraction of 3rd-molar teeth. Interventions included standard clinic treatment, oral premedication, and several relaxation-based procedures. Dependent variables were self-reported and observer-rated distress. In the 1st study (N = 231), cluster analyses of the DFS subscales revealed that patients could be subtyped as low-fear, high-fear, or cue-anxious patients who admitted fear only in response to specific stimuli. Dental fear subtypes were distinguishable by situational cognitions reported, and fear subtype interacted with anxiety intervention to predict distress. These results were replicated in the 2nd study (N = 150). The results are seen as supportive of a multidimensional view of dental anxiety. <88> UI - 20091704 AU - Heidemann W AU - Gerlach KL IN - Department of Maxillofacial Surgery, Otto-von-Guericke University Magdeburg, Germany. TI - Clinical applications of drill free screws in maxillofacial surgery. SO - Journal of Cranio-Maxillo-Facial Surgery 1999 Aug;27(4):252-5 AB - Drill free screws are newly designed osteosynthesis screws with specially formed tips and cutting flutes, which act like a cork-screw and can be inserted into bone without predrilling. A prospective study on 82 patients was performed in order to investigate the efficiency of mini- and micro-drill free screws (DFS) in clinical use and to find out areas in maxillofacial traumatology and orthognathic surgery, where the application of this new type of screw may be recommended. Thirty-eight Le-Fort-osteotomies, 23 central and lateral midfacial fractures and 21 fractures of the mandible were fixed using the Champy titanium micro/miniplate system and in total 518 center-drive titanium micro-DFS (1.5 mm) and 392 center-drive titanium mini-DFS (2 mm) with lengths between 4 and 7 mm. The results showed that the grip of micro- and mini-DFS was sufficient for the fixation of bone fragments in the central and lateral midface and in the mandibular area. The insertion of DFS was simple and is recommended in the area of the central midface; the insertion of the screws was difficult, but possible in the anterior mandible and in the lateral midface. The application of DFS in the mandibular angle region is not recommended. <89> UI - 20088438 AU - Skaret E AU - Raadal M AU - Berg E AU - Kvale G IN - Center for Odontophobia, Faculty of Odontology, University of Bergen, Norway. erik.skaret@odont.uib.no TI - Dental anxiety and dental avoidance among 12 to 18 year olds in Norway. SO - European Journal of Oral Sciences 1999 Dec;107(6):422-8 AB - The aim of this study was to explore the prevalence and possible explanatory factors of dental avoidance due to dental anxiety among 12 to 18 year olds treated within the Norwegian Public Dental Service. A total of 754 20-yr-olds completed a questionnaire and three psychometric scales, the Dental Fear Scale (DFS), the Dental Beliefs Survey (DBS) and the Geer Fear Scale (GFS), and gave their consent to collect data from their dental records. A total of 169 subjects (22.4%) had high dental anxiety (DFS>59 or DBS>47 at age 20 yr), and 124 subjects (16.4%) had high frequency of missed/cancelled appointments (20% or more) during the period 12-18 yr. Forty-seven subjects (6.2%) fulfilling both of the above criteria constituted the dental avoidance group. An analysis using a stepwise regression model indicated that having had more than one painful or unpleasant treatment experience increased the risk of being included in the avoidance group by a factor of 10.9. Equally, adolescents who were not attending school (working or without specified occupation) increased the risk by a factor of 6.9, having a high caries experience by a factor of 5.0, and not having their dental treatment completed at the age of 18 yr by a factor of 4.4. <90> UI - 20036483 AU - Buglioni S AU - D'Agnano I AU - Cosimelli M AU - Vasselli S AU - D'Angelo C AU - Tedesco M AU - Zupi G AU - Mottolese M IN - Pathology Department, Regina Elena Cancer Institute, Rome, Italy. TI - Evaluation of multiple bio-pathological factors in colorectal adenocarcinomas: independent prognostic role of p53 and bcl-2. SO - International Journal of Cancer 1999 Dec 22;84(6):545-52 AB - About 40% of patients with colorectal carcinoma will develop local or distant tumour recurrences. Integrated analyses of bio-pathological markers, predictive of tumour aggressiveness, may offer a more rational approach to planning adjuvant therapy. To this end, we analysed the correlation between p53 accumulation, Bcl-2 expression, DNA ploidy, cell proliferation and conventional clinico-pathological parameters by testing the prognostic significance of these variables in a series of 171 colorectal carcinoma patients with long-term follow-up. The relationships among the various bio-pathological parameters, analysed by multiple correspondence analysis, showed 2 different clinico-biological profiles. The first, characterised by p53 negativity, Bcl-2 positivity, diploidy, low percentage of cells in S-phase (%S-phase), a low Ki-67 score, is associated with Dukes' A-B stage, well differentiated tumours and lack of relapse. The second, defined by p53 positivity, Bcl-2 negativity, aneuploidy, high %S-phase and elevated Ki-67 score, correlates with Dukes' C-D stage, poorly differentiated tumours and presence of relapse. When these parameters were examined according to Kaplan-Meier's method, significantly shorter disease-free (DFS) and overall survival (OS) were also observed in patients bearing p53 positive and Bcl-2 negative tumours, in Dukes' B stage. In multivariate analysis, p53 accumulation and Bcl-2 expression emerged as independent predictors of a worse and better clinical outcome, respectively. Our results indicate that, in colorectal adenocarcinomas, a biological profile, based on the combined evaluation of p53 and Bcl-2, may be useful for identifying high risk patients to be enrolled in an adjuvant setting, mainly in an early stage of the disease. Int. J. Cancer (Pred. Oncol.) 84:545-552, 1999. Copyright 1999 Wiley-Liss, Inc. <91> UI - 20061175 AU - Kafferlein HU AU - Angerer J IN - Institut und Poliklinik fur Arbeits, Sozial- und Umweltmedizin der Friedrich-Alexander Universitat Erlangen-Nurnberg, Erlangen, Germany. TI - Simultaneous determination of two human urinary metabolites of N,N-dimethylformamide using gas chromatography-thermionic sensitive detection with mass spectrometric confirmation. SO - Journal of Chromatography. B, Biomedical Sciences & Applications 1999 Nov 12;734(2):285-98 AB - Two human urinary metabolites of the industrial solvent N,N-dimethylformamide (DMF), N-hydroxymethyl-N-methylformamide (HMMF) and N-acetyl-S-(N-methylcarbamoyl)cysteine (AMCC), were assayed using a new analytical method (gas chromatography and thermionic sensitive detection). Clean-up of urine samples includes a liquid-liquid extraction step followed by a solid-phase extraction step to separate HMMF and AMCC from other urine components. During clean-up, AMCC is converted into ethyl-N-methylcarbamate (EMC), and during gas chromatography, HMMF is degraded in the injector to N-methylformamide (NMF). All the validation data necessary for a quantitative procedure are given. The method was applied to urine samples from workers exposed to DMF and from the general population. The results were confirmed by mass spectrometric determination. For this purpose a further liquid-liquid extraction step was introduced in the clean-up procedure. Background levels of AMCC in the general population were identified. <92> UI - 99371359 AU - Anttila SS AU - Knuuttila ML AU - Sakki TK IN - Department of Periodontology and Geriatric Dentistry, Institute of Dentistry, University of Oulu, Finland. TI - Depressive symptoms favor abundant growth of salivary lactobacilli. SO - Psychosomatic Medicine 1999 Jul-Aug;61(4):508-12 AB - OBJECTIVE: The purpose was to study the growth of lactobacilli in subjects with depressive symptoms in the total 55-year-old population of Oulu (a medium-sized town in Finland); 780 people participated. METHODS: The dental examination included measurements of salivary lactobacillus growth with the Dentocult-LB method; measurements of salivary flow rate, pH, and buffering capacity; and assessment of oral health status. Depressive symptoms were determined with the Zung Self-Rating Depression Scale (ZSDS). Participants were also asked about their health, medication, smoking, and dietary habits. RESULTS: The prevalence of high lactobacillus counts (> or =100,000 CFU/ml) was 22% among women and 31% among men (p = .02). Thirty-seven percent of the subjects with a high rate of depressive symptoms (ZSDS score of > or = 40) and 23% of those with an ZSDS score of < or = 39 had high counts of lactobacilli (p = .003). A logistic regression analysis with improvement of goodness of fit was made to confirm the relation between abundant lactobacilli and a high rate of depressive symptoms. After the confounding factors had been added stepwise into the logistic regression model, depressive symptoms were still significantly associated with abundant lactobacillus growth. CONCLUSIONS: The association between high lactobacillus counts and depressive symptoms suggests that depressed subjects are at risk of having caries and possibly other dental diseases that should be recognized in the treatment of these patients. <93> UI - 20079968 AU - Taybos GM IN - Department of Diagnostic Sciences, University of Mississippi School of Dentistry, USA. TI - Xerostomia. Common patient complaint and challenging dental management problem. [Review] [14 refs] SO - Mississippi Dental Association Journal 1998 3rd Quarter;54(3):24-5 <94> UI - 20038247 AU - Mauri FA AU - Maisonneuve P AU - Caffo O AU - Veronese S AU - Aldovini D AU - Ferrero S AU - Cozzaglio F AU - Dalla Palma P AU - Galligioni E AU - Barbareschi M IN - Department of Histopathology, SS. Trinita Hospital, Borgomanero, Italy. TI - Prognostic value of estrogen receptor status can be improved by combined evaluation of p53, Bcl2 and PgR expression: an immunohistochemical study on breast carcinoma with long-term follow-up. SO - International Journal of Oncology 1999 Dec;15(6):1137-47 AB - Steroid receptor analysis is the only widely accepted prognostic/predictive marker in breast cancer (BC) treatment. In the present study we evaluated the prognostic role of ER/PgR with p53 and Bcl2, in a series of 277 BC (153 pN1/2, 122 pNO, 2 pNx) with a long-term follow-up (67 months for DFS, 75 months for OS). Our results, besides confirming the usefulness of ER immunohistochemical expression as a prognostic marker, showed that PgR expression alone had a borderline/not significant prognostic value in the whole series (p=0.08 for DFS and p=0.09 for OS), while showed to be prognostic in N+ cases (p=0.02 for DFS and p=0.03 for OS). PgR prognostic value, however, was not independent at the multivariate analysis. By combining ER with PgR, p53 and Bcl2, we showed that ER/p53 and ER/Bcl2 phenotypes had a better discriminant role than ER/PgR phenotype. The ER+/p53+ phenotype was at higher risk of relapse/death as compared with ER+/p53- phenotype. Conversely ER-/p53+ phenotype showed the most unfavourable prognosis. Similar results could be observed concerning ER/Bcl2 phenotypes. Our study showed that the combined evaluation of ER/PgR weakly enhanced the prognostic/predictive power of ER status alone. On the contrary, the combined evaluation of ER/p53 and ER/Bcl2, improved this prognostic/predictive capability and allowed the separation of ER positive and ER negative cases into subgroups with different prognosis. <95> UI - 20006947 AU - Helminen SE AU - Vehkalahti M AU - Ketomaki TM AU - Murtomaa H IN - Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Finland. sari.helminen@helsinki.fi TI - Dentists' selection of measures for assessment of oral health risk factors for Finnish young adults. SO - Acta Odontologica Scandinavica 1999 Aug;57(4):225-30 AB - Dentists' selection of measures for assessing oral health risk factors for young adults, in relation to their oral health status and to those dentists' characteristics, was studied in one administrative unit of the Finnish public oral health service. A random selection (n = 239) was made of all young adults born in the period 1966-71 and clinically examined during 1994. On the original oral health records of those selected, all notes were scrutinized concerning the most recent clinical examination and treatment course; in total 208 (87%) records. We found that assessment of risk factors to oral health was rare. The patient's diet had been recorded as assessed in 7% of all cases, use of fluoride in 8%, and oral hygiene habits in 14%. No salivary tests were performed; nor was patients' use of tobacco assessed. No correlation was detected between measures used by these dentists and their patients' oral health status (DMFT and DT scores, number of approximal incipient lesions, and number of healthy sextants by CPITN). The oral health status impelled only slightly assessments by bite-wing radiographs. Fewer than half (44%) of the dentists performed and recorded any kind of assessment measure; 4% assessed diet, hygiene, and use of fluoride for all their patients in our sample. A dentist's gender showed no correlation with number of measures used; younger dentists tended to perform and record assessments slightly more often than did older dentists, but in all age groups there were those who had not done this. The practice of risk-factor assessment should be more widespread and standardized, contributing to needs-based treatment and allocation of resources. <96> UI - 20006942 AU - Pyk N AU - Mejare I IN - Ektorp Public Dental Health Clinic and Eastman Dental Institute, Stockholm County Council, Sweden. TI - Tunnel restorations in general practice. Influence of some clinical variables on the success rate. SO - Acta Odontologica Scandinavica 1999 Aug;57(4):195-200 AB - Using bitewing radiographs and clinical inspection, the success rate for tunnel restorations was assessed in a population with low caries activity. The material consisted of 242 tunnel restorations in permanent premolars and molars in 142 individuals (mean age = 18.8 years). The median DFSappr value (decayed and filled approximal surfaces) at the time of restoration was 4.0. The mean follow-up time was 25 months. Bivariate associations between the outcome variable (success/failure of the tunnel restoration) and conceivable explanatory variables were investigated. In a multivariate logistic regression analysis, the independent variables tooth type (premolars vs molars), surface site (mesial vs distal), radiographic stage of approximal carious progression and age of patient at the time of restoration (9-15 years vs > 15 years) were used to estimate the effect on the dependent variable success/failure. Using the life table method, the estimated cumulative proportion of successful restorations was 81% after 2 years and 64% after 3.5 years. The success rate was not related to caries activity and did not differ between the two types of tunnel preparation techniques nor between different follow-up periods. In the multivariate regression analysis, tooth type (molars vs premolars) was the only factor significantly associated with failure. Thus, a failure occurred about 5 times as often in molars as in premolars. Of the failures, half were due to caries; either radiographically observed adjacent to the restoration or progressing enamel caries on the outer proximal surface. Marginal ridge fractures constituted 26% of the failures. From the present results it can be concluded that in a population with low caries activity, the tunnel restoration technique can be recommended for premolars. <97> UI - 20038835 AU - Yorty JS AU - Brown KB IN - West Virginia University, School of Dentistry, Restorative Department, Morgantown 26506-9460, USA. jyorty@hsc.wvu.edu TI - Caries risk assessment/treatment programs in U.S. dental schools. SO - Journal of Dental Education 1999 Oct;63(10):745-7 <98> UI - 99420451 AU - Fan K AU - Lee K AU - Lau CP IN - University Cardiac Medical Unit, Grantham Hospital, Hong Kong, China. fankatherine@hotmail.com. TI - Dual chamber implantable cardioverter defibrillator benefits and limitations. SO - Journal of Interventional Cardiac Electrophysiology 1999 Oct;3(3):239-45 AB - Dual chamber ICD capable of providing dual chamber pacing (DDD) and ventricular arrhythmia therapy is now available. We report our experience of clinical performance of dual chamber ICDs amongst Chinese population.METHODS: 9 patients (6 men and 3 women) received dual chamber ICDs, mean age 50 +/- 18.8 years. The indications were ventricular fibrillation (VF) [5], hemodynamic intolerant ventricular tachycardia (VT) [3] and unexplained syncope plus positive induction of VF [1]. The underlying cardiac pathology were congenital LQT syndrome(1), hypertrophic cardiomyopathy [2], coronary artery disease [2], rheumatic valvular disease [1], Brugada syndrome [1], arrhythmogenic right ventricular dysplasia [1] and idiopathic VF [1]. Four patients have documented paroxysmal atrial fibrillation (AF). All patients have defibrillation thresholds (DFT) determined with a binary search protocol starting at 12 joules (J) at implantation.RESULTS: A total of 34 episodes of VF were induced at implantation with mean DFT 13.8 +/- 7 J. The average shocking impedance was 40 +/- 3.6 Omega. The mean acute P wave measured 3.3 +/- 1.3 mV and R wave measured 13.2 +/- 3.2 mV. Atrial and ventricular thresholds, at pulse width 0.5 ms, averaged 0.8 +/- 0.4 V and 0.4 +/- 0.2 V. During follow-up period, 16 episodes of VF were documented and were successfully treated with the first programmed shock. In the patient with LQT syndrome, DDD was initiated to prevent pause-dependant VF. Three episodes of inappropriate therapy (15.8%) were delivered. One patient experienced 2 shocks after exercise. Stored electrograms showed sinus tachycardia with first degree heart block which was misdiagnosed as VT with retrograde 1:1 conduction. Another inappropriate therapy occurred with AF with fast ventricular response within the VF zone and VT therapy inhibitor was disabled.CONCLUSION: Dual chamber ICD allows combined benefits of DDD and VT/VF therapy. Storage of both atrial and ventricular electrograms provide more information in elucidation of nature of dysarrhythmias. Inappropriate shocks, though reduced, are still possible and the rigid algorithms of SVT discrimination from VT will need further published. <99> UI - 20042080 AU - Scinto AF AU - Ferraresi V AU - Milella M AU - Tucci E AU - Santomaggio C AU - Pasquali-Lasagni R AU - Del Vecchio MR AU - Campioni N AU - Nardi M AU - Cognetti F IN - Division of Medical Oncology, Regina Elena Cancer Institute, Rome, Italy. TI - Ifosfamide, cisplatin and etoposide combination in locally advanced inoperable non-small-cell lung cancer: a phase II study. SO - British Journal of Cancer 1999 Nov;81(6):1031-6 AB - From March 1993 to February 1997, 43 eligible patients with inoperable stage IIIA (ten patients) and stage IIIB (33 patients), histologically confirmed NSCLC received 3 courses of the ICE combination (ifosfamide 1.5 g m(-2) and mesna 750 mg m(-2) two times a day, cisplatin 25 mg m(-2) and etoposide 100 mg m(-2), all administered intravenously (i.v.) on days 1-3 every 3 weeks) with G-CSF support. After three cycles, patients were submitted to radical surgery or received two additional courses of the ICE regimen and/or curative radiotherapy. Grade 3-4 neutropenia occurred in 21% of 114 evaluable courses, but was of short duration, leading to neutropenic fever in 5% of the courses. Severe thrombocytopenia and anaemia were observed in 13% and 3% of the courses respectively. Non-haematological toxicity was generally mild with only two episodes of reversible renal impairment. The overall response rate after three chemotherapy courses was 69% (28 partial responses, one complete response). Ten patients (8/10 patients in stage IIIA, 2/33 patients in stage IIIB) underwent radical surgery. Median TTP for patients not undergoing surgery (n = 33) was 8 months (range 3-34+); median DFS for patients rendered NED by surgery (n = 10) was 26 months (range 1-54+). Median OS for the entire group was 12.5 months (range 2-57+). The ICE regimen is active in locally advanced NSCLC with acceptable toxicity and warrants further exploration as induction chemotherapy in larger series. <100> UI - 20048516 AU - Edwards MJ AU - Brickley MR AU - Goodey RD AU - Shepherd JP IN - Department of Oral Surgery, Medicine and Pathology, University of Wales College of Medicine Dental School, Heath Park, Cardiff. TI - The cost, effectiveness and cost effectiveness of removal and retention of asymptomatic, disease free third molars. SO - British Dental Journal 1999 Oct 9;187(7):380-4 AB - PURPOSE OF INVESTIGATION: The study was undertaken to identify the least costly, most effective and most cost-effective management strategy for asymptomatic, disease free mandibular third molars. METHODS AND PATIENTS: A decision tree model of the outcomes of mandibular third molar retention and removal was constructed. Probability data for possible outcomes were obtained from a comprehensive literature review and entered into the decision tree. The cost to the NHS in treating each outcome was calculated. 100 patients attending the oral surgery clinics, University of Wales Dental Hospital rated the effect of each outcome on their own life. The cost and effectiveness data for each outcome were entered into the decision tree and the analyses were conducted by 'folding back' the decision tree based on the probabilities. MAIN FINDINGS: Mandibular third molar retention was less costly (170 Pounds), more effective (69.5 effectiveness units on a 100 point scale) and more cost-effective (2.43 Pounds per unit of effectiveness) than removal (226 Pounds, 63.3 and 3.57 Pounds respectively). These findings were sensitive to changes in the probability of pericoronitis, periodontal disease and caries. PRINCIPAL CONCLUSIONS: Mandibular third molar retention is less costly to the NHS, more effective for the patient and more cost-effective to both parties than removal. However, should the likelihood of developing pericoronitis, periodontal disease and caries increase substantially then removal becomes the more cost-effective strategy. <101> UI - 99396573 AU - Abreu M Jr AU - Tyndall DA AU - Ludlow JB IN - Department of Stomatology, Federal University of Santa Catarina School of Dentistry, Florianopolis, Brazil. TI - Detection of caries with conventional digital imaging and tuned aperture computed tomography using CRT monitor and laptop displays. SO - Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics 1999 Aug;88(2):234-8 AB - OBJECTIVE: The purpose of this study was to compare the diagnostic performance of conventional digital images and tuned aperture computed tomography (TACT) slices in caries detection through use of cathode-ray tube monitor and laptop displays. STUDY DESIGN: Forty-two extracted posterior teeth were mounted and imaged with a direct digital radiography system. Conventional digital bitewing projections and TACT slices were acquired. Images were viewed on a high-resolution cathode-ray tube monitor and on an active-matrix laptop display. Eight observers assessed caries status of occlusal and proximal surfaces of the teeth using all combinations of image and display modality. Observers' assessments were compared with the results of histologic examination of tooth sections. Possible differences in receiver operating characteristic curve areas among displays, image modalities, observers, and surfaces were analyzed by means of analysis of variance. RESULTS: There was no statistically significant difference between the diagnostic performances provided by the cathode-ray tube monitor and laptop displays in caries detection (P = .588). In addition, the performances of digital images and TACT slices were not significantly different (P = .843). CONCLUSIONS: Modern active-matrix laptop displays provide diagnostic quality for caries detection comparable to that obtainable with cathode-ray tube monitors. <102> UI - 99408158 AU - Mejare I AU - Sundberg H AU - Espelid I AU - Tveit B IN - Eastman Dental Institute, Stockholm County Council, Sweden. ingegerd.mejare@ftv.sll.se TI - Caries assessment and restorative treatment thresholds reported by Swedish dentists. SO - Acta Odontologica Scandinavica 1999 Jun;57(3):149-54 AB - The aim was to study any variability in approximal and occlusal caries diagnoses and restorative treatment decisions among Swedish dentists. The material consisted of a pre-coded questionnaire sent to a random sample of 923 dentists with 4 items concerning approximal and occlusal caries diagnosis and restorative treatment decisions. Responses were received from 651 (70.5%) dentists. In an adolescent with low caries activity and good oral hygiene, more than 90% of the dentists stated that they would not automatically restore a primary approximal caries lesion if its radiographic appearance did not show obvious progression in the outer 1/3 to 1/2 of the dentin. Moreover, 67% of the dentists would only consider immediate restorative treatment of an occlusal surface if obvious cavitation and/or radiographic signs of dentin caries could be observed. When diagnosing questionable occlusal caries, the dentists largely relied on the radiographic appearance. Concerning both approximal and occlusal caries, the threshold for restorative treatment differed between the metropolitan regions in Sweden, and younger more often than older dentists would postpone restorative treatment of approximal caries until the lesion had reached a relatively advanced stage of progression. The responses also showed that dentists in private practice would restore approximal caries at an earlier stage of progression than the dentists in the Public Dental Health Service. <103> UI - 99408155 AU - Unell L AU - Soderfeldt B AU - Halling A AU - Birkhed D IN - Community Dental Health Unit, Orebro County Council, Sweden. lennart.unell@orebroll.se TI - Explanatory models for clinically determined and symptom-reported caries indicators in an adult population. SO - Acta Odontologica Scandinavica 1999 Jun;57(3):132-8 AB - The aim of the present study was to analyze possible indicators of: (i) relative number of decayed and filled teeth, (ii) relative number of decayed teeth, (iii) subjectively reported toothache, and (iv) sensitive teeth, and to find explanatory models for these phenomena. Independent variables from three domains were used: (i) socio-economic factors, (ii) general health and health-related lifestyle, and (iii) dental attitudes and behaviors. The study basis was validated questionnaires from all 50-year-olds in 2 Swedish counties (n = 8888), response rate 71% (n = 6343). For a 20% subsample (58% participation) the DFT and DT were determined by calibrated dentists. Analyses were done with logistic and multiple regression. The variables born outside Sweden, gender, education, shift work, satisfaction with dental care, fear and care utilization were associated with DFT/number of teeth. For DT/number of teeth, the direction of association was reversed for the variables born outside Sweden and gender. Social class, education, general health, and use of tobacco were further covariates. Good oral hygiene gave a lower ratio of DT. For the logistic regression model of toothache, residence in cities and satisfaction with dental care had lower probability for toothache reports, while born outside Sweden, mouth dryness, use of pharmaceuticals, tobacco, fear, and high utilization increased this probability. In general, the association pattern was as could be expected: immigrants, working class, low education, smoking, dissatisfaction with dental treatment and low utilization all appeared as risk factors for both the clinically determined caries indicators, but not necessarily for subjective symptom reports. Only fear of dental treatment showed a consistent positive association with all the indicators. <104> UI - 99365535 AU - Warren JJ AU - Levy SM IN - Department of Preventive & Community Dentistry, College of Dentistry, University of Iowa, USA. TI - A review of fluoride dentifrice related to dental fluorosis. [Review] [53 refs] SO - Pediatric Dentistry 1999 Jul-Aug;21(4):265-71 AB - Introduced to the commercial market 40 years ago, fluoride dentifrice now accounts for nearly all dentifrice purchased in the United States. During this same time, the prevalence and severity of dental caries has declined while dental fluorosis prevalence has increased. While the caries decline can be largely attributed to widespread fluoride dentifrice use, as well as many other sources of fluoride, several recent studies have attributed much of the increase in fluorosis prevalence to early use of fluoride dentifrice. This paper reviews these studies, as well as the efficacy of fluoride dentifrices with lower fluoride concentrations. Finally, recommendations regarding fluoride dentifrice to maintain caries prevention and reduce the risk of dental fluorosis are presented. [References: 53] <105> UI - 99390389 AU - Favale S AU - Dicandia CD AU - Tunzi P AU - Rizzon P IN - Department of Metodologia Clinica e Tecnologie Medico-Chirurgiche, University of Bari, Italy. SFAVALE@TIN.IT TI - A prospective, randomized, comparison in patients between a pectoral unipolar defibrillation system and that using an additional inferior vena cava electrode. SO - Pacing & Clinical Electrophysiology 1999 Aug;22(8):1140-5 AB - The decrease of defibrillation energy requirement would render the currently available transvenous defibrillator more effective and favor the device miniaturization process and the increase of longevity. The unipolar defibrillation systems using a single RV electrode and the pectoral pulse generator titanium shell (CAN) proved to be very efficient. The addition of a third defibrillating electrode in the coronary sinus did not prove to offer advantages and in the superior vena cava showed only a slight reduction of the defibrillation threshold (DFT). The purpose of this study was to determine whether the defibrillation efficacy of the single lead unipolar transvenous system could be improved by adding an electrode in the inferior vena cava (IVC). In 17 patients, we prospectively and randomly compared the DFT obtained with a single lead unipolar system with the DFT obtained using an additional of an IVC lead. The RV electrode, Medtronic 6936, was used as anode (first phase of biphasic) in both configurations. A 108 cm2 surface CAN, Medtronic 7219/7220 C, was inserted in a left submuscular infraclavicular pocket and used as cathode, alone or in combination with IVC, Medtronic 6933. The superior edge of the IVC coil was positioned 2-3 cm below the right atrium-IVC junction. Thus, using biphasic 65% tilt pulses generated by a 120 microF external defibrillator, Medtronic D.I.S.D. 5358 CL, the RV-CAN DFT was compared with that obtained with the RV-CAN plus IVC configuration. Mean energy DFTs were 7.8 +/- 3.6 and 4.8 +/- 1.7 J (P < 0.0001) and mean impedance 65.8 +/- 13 O and 43.1 +/- 5.5 O (P < 0.0001) with the RV-CAN and the IVC configuration, respectively. The addition of IVC significantly reduces the DFT of a single lead active CAN pectoral pulse generator. The clinical use of this biphasic and dual pathway configuration may be considered in patients not meeting implant criteria with the single lead or the dual lead RV-superior vena cava systems. This configuration may also prove helpful in the use of very small, low output ICDs, where the clinical impact of ICD generator size, longevity, and related cost may offset the problems of dual lead systems. <106> UI - 99399180 AU - Molina R AU - Farrus B AU - Filella X AU - Jo J AU - Zanon G AU - Pahisa J AU - Latre M AU - Munoz M AU - Ballesta AM IN - Laboratory of Clinical Biochemistry (Unit for Cancer Research), Hospital Clinic, Medical School, Barcelona, Spain. TI - Carcinoembryonic antigen in tissue and serum from breast cancer patients relationship with steroid receptors and clinical applications in the prognosis and early diagnosis of relapse. SO - Anticancer Research 1999 Jul-Aug;19(4A):2557-62 AB - From July 1982 to August 1994, CEA levels were determined in 298 mammary tissue samples (30 benign, 242 primary breast cancer and 26 metastatic breast cancer). CEA serum levels were also evaluated in 30 patients with benign diseases, 153 patients with primary breast cancer and 26 patients with metastases. CEA tissue levels in both pellet and cytosol were significantly higher in samples from cancerous than from non malignant tissues (p < 0.0001), and higher in the pellet than in the cytosol (p < 0.0001). CEA in the pellet and cytosol were related to steroid receptors, with the highest levels being observed in ER+/PR+ tumors (p < 0.001). They were, however, not related to other pathological parameters such as tumor size or nodes. There was a correlation between CEA pellet and CEA serum in both patients with primary or metastatic tumors, with significantly higher CEA serum levels in patients with CEA pellet positivity than in those with CEA pellet negativity. CEA serum levels were a prognostic factor (DFS and OS) in the whole group as well as in node-positive and node-negative breast cancer patients. This prognostic value was only found in patients with CEA pellet positivity. In the follow-up of 143 NED patients, abnormal CEA serum levels rose prior to the diagnosis of relapse in 73% (29/40) of CEA pellet+ patients with distant recurrences but in only 9% (2/22) of CEA pellet- cases (p < 0.0001). In summary, CEA evaluation in tissue improves the CEA clinical application, selecting those patients whose serum CEA will be useful in the prognosis and early diagnosis of recurrence. <107> UI - 99390396 AU - Friedman PA AU - Rasmussen MJ AU - Grice S AU - Trusty J AU - Glikson M AU - Stanton MS IN - Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA. pfriedman@mayo.edu TI - Defibrillation thresholds are increased by right-sided implantation of totally transvenous implantable cardioverter defibrillators. SO - Pacing & Clinical Electrophysiology 1999 Aug;22(8):1186-92 AB - Whether an ICD is placed via a left- or right-sided approach depends on venous access, the presence of a preexisting pacemaker, and other factors. Since the DFT is affected by lead position, which in turn is determined in part by the side of access, right-sided venous access could adversely affect DFTs. Furthermore, right-sided active can placement directs electric current toward the right hemithorax, which could further increase DFTs. This study sought to determine whether DFTs were increased by right-sided vascular access, and whether active can technology was beneficial or detrimental with right-sided ICD placement. Stepdown to failure DFTs were found in 290 patients receiving transvenous systems at the time of initial ICD implantation. Of these, 271 (93%) received left-sided systems and 19 (7%) received right-sided systems. The mean DFT in systems placed via left-sided vascular access was 11.3 +/- 5.3 J versus 17.0 +/- 4.9 J for right-sided implantation (P < 0.0001); right-sided DFTs were elevated for both active can and cold can systems. Right-sided active can devices had a lower DFT than right-sided cold can systems (15 +/- 4.1 J vs 19 +/- 4.8 J, P = 0.05). The right-sided implantation of implantable defibrillators results in significantly higher DFTs than the left-sided approach. This may be due to the less favorable distribution of the defibrillating field relative to the myocardium with the devices on the right. When right-sided implantation is clinically mandated, active can devices result in lower thresholds and should be used. <108> UI - 99390402 AU - Welch PJ AU - Joglar JA AU - Hamdan MH AU - Nelson L AU - Page RL IN - Department of Internal Medicine (Cardiology, Clinical Cardiac Electrophysiology), University of Texas Southwestern Medical Center, Dallas 75235-9047, USA. TI - The effect of biphasic defibrillation on the immediate pacing threshold of a dedicated bipolar, steroid-eluting lead. SO - Pacing & Clinical Electrophysiology 1999 Aug;22(8):1229-33 AB - It is apparent that pacing threshold increases following an ICD shock, although the degree of change observed is dependent on the method used to assess pacing and the lead design used. We previously demonstrated a rise in postshock pacing threshold using a lead with integrated bipolar pacing in which the distal shocking coil also serves as the pacing anode. In this study, we sought to investigate whether the postshock pacing threshold increased significantly in an endocardial, steroid-eluting lead with dedicated bipolar pacing electrodes. Twenty patients (16 men, 4 women; median age 73, ejection fraction [EF] 0.17-0.58) were studied during pectoral ICD implantation (Medtronic active can model 7221Cx or 7223Cx with model 6932-65 lead). The diastolic pulse width pacing threshold at 1 or 2 V was determined. Pacing rate was set > or = 100/min at twice diastolic threshold output to assess pacing immediately following the first DFT test shock. For subsequent shocks, the output was adjusted to establish postshock thresholds as 1, 2, 3, or 4 times the diastolic threshold. The postshock threshold was defined as the output yielding 100% capture > or = 2.5 seconds following a shock. In 8 of 20 patients (ratio 0.40 +/- 0.11), a rise in the post-shock threshold was shown by failure of consistent capture when pacing at 2 times diastolic threshold > or = 2.5 seconds after a DFT test shock. Two of these patients failed at 3 times threshold, but none failed at 4 x threshold. Five of 12 patients with successful capture of 2 times threshold failed to capture at threshold. The postshock threshold increased by a mean factor of 2.83 +/- 0.83 in the group of patients with a threshold rise. Following ICD shock in an active can, steroid-eluting lead system with dedicated bipolar pacing, the post-shock threshold increases significantly. Our studies suggest a need for postshock pacing to be set at least 4 x threshold regardless of the lead design. <109> UI - 99409667 AU - Tetu B AU - Brisson J AU - Lapointe H AU - Wang CS AU - Bernard P AU - Blanchette C IN - Department of Pathology, Universite Laval, Quebec, Canada. Bernard.Tetu@crhdq.ulaval.ca TI - Cathepsin D expression by cancer and stromal cells in breast cancer: an immunohistochemical study of 1348 cases. SO - Breast Cancer Research & Treatment 1999 May;55(2):137-47 AB - This study was aimed at investigating the influence of cathepsin D (CD) expression by cancer cells and stromal cells on breast cancer prognosis. This is a study of 1348 node-positive (NPBC) and node-negative (NNBC) breast cancers diagnosed between 1980 and 1986 and with a minimum follow-up of 5.2 years. CD expression was assessed by immunohistochemistry on archival material using a polyclonal antibody. The expression by cancer and stromal cells was assessed separately and correlated with distant metastasis free (DMFS) and overall survival (OS). Cancer cells expressed CD (more than 10% cells expressing CD) in 38.9% of cases and reactive stromal cells in 43.6%. CD expression by reactive stromal cells, and not cancer cells, correlated with several factors of poor prognosis by cancer cells. A strong association was also found with expression of other proteases (stromelysin-3, gelatinase A, and urokinase Plasminogen Activator) by these same reactive stromal cells. CD expression by cancer cells did not predict DMFS or OS but, by univariate analysis, CD expression by reactive stromal cells was associated with earlier recurrence and shorter survival in NNBC (p = 0.0425) and NPBC patients submitted to adjuvant chemotherapy (p = 0.0234). However, CD expression by reactive stromal cells remained a significant predictor of recurrence by multivariate analyses only in a subgroup of NPBC submitted to adjuvant chemotherapy. Overall, those data support the concept that proteases produced by reactive stromal cells are under cancer cell stimulation and that CD by stromal cells, and not cancer cells, influences the prognosis, but only in a subgroup of patients with breast cancer. <110> UI - 99276434 AU - Lussi A AU - Imwinkelried S AU - Pitts N AU - Longbottom C AU - Reich E IN - Department of Operative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland. TI - Performance and reproducibility of a laser fluorescence system for detection of occlusal caries in vitro. SO - Caries Research 1999 Jul-Aug;33(4):261-6 AB - The diagnosis of occlusal caries at non-cavitated sites remains problematic, especially since clinical visual detection has limited sensitivity. Electrical methods of detection show considerable promise, but specificity is reduced. The aims of this in vitro study were: (1) to assess the validity of a new laser fluorescence device--the DIAGNOdent--(and compare the values with those of a fixed-frequency electrical device); (2) to determine the optimum cut-off points of the new device for different stages of the caries process, and (3) to assess the reproducibility of the new laser device. For validity and determination of optimum cut-off points, 105 extracted teeth with macroscopically intact occlusal surfaces were measured by a single examiner, using both the laser fluorescence device (on both moist and dried teeth) and an Electronic Caries Monitor. The teeth were subsequently examined histologically to determine the specificity, sensitivity and likelihood ratio at the D2 (caries extending through more than half of the enamel thickness) and D3 (caries involving dentin) levels. The values obtained for the laser device ranged from 0.72 to 0.87 (specificity), 0.76 to 0.87 (sensitivity) and 3.0 to 5.6 (likelihood ratio). Those for the ECM ranged from 0.64 to 0.78 (specificity), 0. 87 to 0.92 (sensitivity) and 2.4 to 4.1 (likelihood ratio). To determine intra- and interexaminer reproducibility of the DIAGNOdent, 11 dentists recorded two different measurements at the same site on a separate set of 83 extracted molar teeth, and these were compared using Cohen's kappa (at D2 and D3 levels) and Spearman's correlation coefficient. The average intra-examiner kappa scores were 0.88 (D2) and 0.90 (D3), with a Spearman correlation of 0.97. For interexaminer reproducibility, the average kappa values were 0.65 (D2) and 0.73 (D3), with a Spearman correlation of 0.84. It is concluded that for occlusal caries (1) the new laser device has a higher diagnostic validity than the ECM, and (2) in vitro, measurements using the device are highly reproducible. Thus, the laser device could be a valuable tool for the longitudinal monitoring of caries and for assessing the outcome of preventive interventions. <111> UI - 99381469 AU - Martin-Iverson N AU - Phatouros A AU - Tennant M IN - School of Oral Health Sciences, University of Western Australia. TI - A brief review of indigenous Australian health as it impacts on oral health. [Review] [53 refs] SO - Australian Dental Journal 1999 Jun;44(2):88-92 AB - The indigenous population of Australia constitutes approximately 2 per cent of the total population. This group has faced significant cultural, economic and health changes since European settlement some 200 years ago. In this brief review some of the health changes that have influenced the oral health status of this community have been examined. Of major importance is the dietary change that the once nomadic indigenous community has undergone. Today's Western diet, high in sugar, low in proteins and vitamins, has resulted in a significant increase in the risk (and prevalence) of caries and periodontal disease. In addition, the high prevalence of diabetes also exacerbates the periodontal problem. The remoteness of a significant proportion of Australian indigenous communities from modern health care services and limited access to fluoridation increases the incidence of oral disease. It is also noted that the incidence of rheumatic heart disease is one of the highest in the world, thereby increasing the risk of bacterial endocarditis. It is clear that indigenous communities have unique oral health needs but the extent of these needs is not well documented. It is important that more research be undertaken to assess these needs so that appropriate oral health programmes can be developed. [References: 53] <112> UI - 99388557 AU - Sgan-Cohen HD AU - Horev T AU - Zusman SP AU - Katz J AU - Eldad A IN - Department of Community Dentistry, School of Dental Medicine, Hebrew University-Hadassah, Jerusalem, Israel. TI - The prevalence and treatment of dental caries among Israeli permanent force military personnel. SO - Military Medicine 1999 Aug;164(8):562-5 AB - A survey was conducted to determine dental caries prevalence and treatment among 1,095 25- to 44-year-old permanent force Israeli military personnel. Caries experience, by decayed, missing, and filled permanent teeth (DMFT), was 11.66, with an average of 1.37 untreated caries, 2.40 extracted teeth, and 7.90 treated teeth. Caries was positively associated with age (p < 0.001). Females demonstrated statistically higher DMFT levels than males (p = 0.009). Negative associations were detected for education levels and untreated and extracted components (p < 0.001), and a positive association was detected for the treated caries component (p < 0.001). Permanent military personnel treated by private dentists exhibited 17.6% untreated caries, compared with 9.4% among personnel treated in the army. Officers had lower levels of untreated caries (8.6%) than others (13.3%). Among the present population, 77% had attended a dental clinic in the preceding 2 years. Permanent force personnel are offered free, comprehensive, and accessible dental treatment. The data emphasize a need for further dental health education. <113> UI - 99388556 AU - Cook LJ IN - Agency for Health Care Policy and Research, Department of Health and Human Services, Rockville, MD 20852, USA. TI - The implications of protocol-based care on dental services in the military. SO - Military Medicine 1999 Aug;164(8):556-61 AB - Downsizing, limited resources, and increasing costs provide challenges to the military health system. Variations in the diagnosis and treatment of dental disease add to the demands on the delivery system to provide access and ensure quality for uniformed personnel. Evidence-based dentistry is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. An evidence-based practice combines individual clinical expertise with the best external evidence available from systematic review of research findings. It provides a scientific basis for patient care, planning and implementation of health services, and development of health policy. Practice guidelines formulated on scientific evidence can reduce variations in the diagnosis and treatment of various dental conditions. A risk assessment protocol for treating dental caries can reduce operative dental treatment recommended at the initial examination and decrease the need for restorative care during a military career. <114> UI - 99407385 AU - el-Kalla IH IN - Department of Pediatric Dentistry, Faculty of Dentistry, Mansoura University, Egypt. Kallaih@mum.mans.eun.eg TI - Marginal adaptation of compomers in Class I and V cavities in primary molars. SO - American Journal of Dentistry 1999 Feb;12(1):37-43 AB - PURPOSES: To evaluate in primary molars (1) the adaptation of three compomers in Class I and V cavities at the cavosurface margins and inside the cavity, and (2) the effect of cavity etching on such adaptation. MATERIALS AND METHODS: The three compomers used were Compoglass, Dyract and Hytac. Sixty exfoliated primary molars were divided for the three compomers, which were subdivided into Class I and V (10 each) and subdivided again into etched and non-etched (5 each). Standard Class I and Class V cavities with the gingival margins at cementum were prepared. The cavities were restored with the three compomers used with or without etching the cavity. The restored cavities were finished and polished. The cavosurface margins were inspected under the light microscope. Then the restored teeth were sectioned into two halves. The cut halves were fixed in glutaraldehyde and the cut surfaces smoothed, polished and inspected under the light microscope for adaptation of the restorative material inside the cavities. One halve of each molar was prepared for SEM. RESULTS: The three compomers showed good adaptation at the cavosurface margin except the non-etched Class V cavities restored with Dyract. Compoglass and Dyract were well adapted inside the cavity better than Hytac. Cavity angles were common sites for adhesive pooling for all materials. SEM examination showed good adaptation of the restorative at enamel and cementum interface especially in etched cavities. The dentin-restorative interface showed consistent hybrid layer with resin tags in the etched cavities. However this layer was inconsistent in the non-etched cavities. <115> UI - 99407384 AU - Grossman ES AU - Matejka JM IN - Dental Research Institute, South Africa. 078esg@cosmos.wits.ac.za TI - Reliability of outer lesion secondary caries as a predictor of wall lesions. SO - American Journal of Dentistry 1999 Feb;12(1):31-6 AB - PURPOSE: To assess the reliability of in vitro developed secondary caries outer lesions as an indicator of presence and extent of wall lesions. MATERIALS AND METHODS: Class I occlusal cavities were cut in 132 extracted premolars: 12 teeth were not restored, 120 restored with one of 20 different restoration combinations of silver amalgam, base and varnish. Specimens were aged in 1% NaCl for up to 1 year where after 80 restored and 12 unrestored teeth were subjected to an in vitro bacterial challenge for 36 days, the other 40 specimens were similarly incubated in an acidified broth (pH = 4.0). Sections were prepared for polarized light microscopy and outer and wall lesion areas, outer lesion width, wall lesion length and enamel thickness measured. Data were subjected to Fisher's exact test and Pearson Correlation. RESULTS: There was a significant association (P < 0.05) between outer and wall lesions in all cariously challenged specimen groups. Sensitivity was high 95-96% but specificity was 26% for acid broth, 68% for restored bacterial and 100% for unrestored specimens. Restoration variables impacted widely on specificity. Correlation values were too low to show clinically relevant associations between wall and outer lesion size. Frequency distribution showed that wall lesions extending beyond the dentin-enamel junction were generally associated with potentially remineralizable outer lesions. <116> UI - 99372532 AU - Ahlberg J AU - Murtomaa H AU - Meurman JH IN - Institute of Dentistry, University of Helsinki, Finland. jari.ahlberg@yle.fi TI - Subsidized dental care associated with lower mutans streptococci count in male industrial workers. SO - Acta Odontologica Scandinavica 1999 Apr;57(2):83-6 AB - Salivary mutans streptococci count, dental status, and related factors were studied in male industrial workers (age 38-65 years) with or without access to subsidized dental care. Altogether 315 subsidized workers and 168 controls without subsidy were compared. A prior questionnaire survey had shown that the two study groups were similar in age, oral self-care habits, and socio-environmental factors. In the present study, the mean number of carious teeth was significantly lower in the subsidized group (0.4, SD 1.2) than in the control group (1.7, SD 3.2) (P< 0.001). Otherwise the study groups had similar dental status. A total of 92% subsidized employees had visited a dentist within the past 2 years, while 82% in the control group had done so (P< 0.01). According to the trend test, men in the subsidized group tended to have a lower mutans streptococci count than the control employees (P< 0.01). The logistic regression showed that the probability of having one or more carious tooth was significantly negatively associated with subsidized care and positively associated with high mutans streptococci count. It is concluded that subsidized dental care leading to a smaller number of untreated carious teeth might result in decreased levels of mutans streptococci. <117> UI - 99372539 AU - Gisselsson H AU - Birkhed D AU - Emilson CG IN - Department of Cariology, Faculty of Odontology, Goteborg University, Sweden. TI - Effect of professional flossing with NaF or SnF2 gel on approximal caries in 13-16-year-old schoolchildren. SO - Acta Odontologica Scandinavica 1999 Apr;57(2):121-5 AB - The aim of this study was to evaluate the effect of professional flossing with NaF and SnF2 gels on caries development on approximal tooth surfaces. Two-hundred-and-eighty 13-year-old schoolchildren were divided into 3 groups: (1) NaF (n = 97), (2) SnF2 (n = 85), and (3) placebo gel group (n = 98). The investigation was carried out double-blind. The children were treated 4 times a year for 3 years with 1% NaF gel, 1% SnF2 gel, or placebo gel. The treatment was carried out by dental nurses and the time required per visit was approximately 10 min. After 3 years, the mean approximal caries increment, including initial caries lesions, was 2.8 in the NaF, 2.4 in the SnF2, and 4.0 in the placebo gel group (P< 0.05 for SnF2 vs placebo); a reduction compared to the placebo of 30% and 39% in the NaF and SnF2 groups, respectively. Thus, professional flossing with NaF or SnF2 gel carried out 4 times a year may be considered as an interesting caries-preventing method for large-scale application in schoolchildren. <118> UI - 99367883 AU - Almstahl A AU - Wikstrom M IN - Department of Oral Microbiology, Faculty of Odontology, Goteborg, Sweden. TI - Oral microflora in subjects with reduced salivary secretion. SO - Journal of Dental Research 1999 Aug;78(8):1410-6 AB - It is generally assumed that a decreased salivary secretion rate will promote plaque accumulation and increase the risk for caries, gingival inflammation, and mucosal infections. In this study, the effect of hyposalivation on the oral microflora was examined. The following micro-organisms were analyzed in rinsing samples from 14 subjects with hyposalivation: the total number of anaerobically growing micro-organisms, alpha-hemolytic streptococci, mutans streptococci, lactobacilli, Fusobacterium nucleatum, Prevotella intermedia/Prevotella nigrescens, Staphylococcus aureus, Candida albicans, and enterics. The study group, age 53 +/- 7 years, had no history of radiation therapy and showed no signs of inflammation in their salivary glands on biopsy. All were dentate with a mean of 24 +/- 3 teeth. Their salivary secretion rates were 0.03 +/- 0.02 mL/min (unstimulated) and 0.84 +/- 0.65 mL/min (stimulated). The control group was matched to the hyposalivation group according to age, sex, and number of teeth. There was a significantly increased number of lactobacilli, and a tendency, not statistically significant and with large variations within the groups, toward a higher proportion of mutans streptococci and a lower proportion of alpha-hemolytic streptococci in the hyposalivation group. The presence of micro-organisms associated with gingival inflammation and mucosal infections was comparable with that in the healthy controls. The results indicated that a low salivary secretion rate mainly promotes a flora associated with the development of caries. <119> UI - 99317465 AU - Swedberg Y IN - Department of Health and Environment, Faculty of Health Sciences, Linkoping, Sweden. TI - On the reporting of dental health, time for dental care, and the treatment panorama. SO - Swedish Dental Journal - Supplement 1999;133:1-65 AB - The thesis included five methodological studies and one caries epidemiological investigation, the general aim being to study how to measure and report dental health, time for dental care, treatment panorama, and dental care outcomes, within a Public Dental Service organization. The specific aims were to monitor dental clinic activities using a time study method, to apply time study results of a dental health-related patient group system for the 3-19 year age groups, and to compare time study results with corresponding results from computerized systems used for reporting dental care. Other specific aims were to compare longitudinal caries index data results between cohort and cross-sectional samples, to analyse caries index for extreme caries groups among adolescents leaving organized dental care, and--using time series methods--to analyse dental health development of the 15-19 year age groups. Results from the time studies portrayed the dental clinic as a working unit, showed that reported values can represent dental care only for intervention procedures, and indicated that clinic patterns were not adapted to the health situation of the patient groups. Longitudinal cohort attempts gave different values from those of the cross-sectional year classes, which should be the primary focus when presenting caries index mean values in dental health reviews. Caries-free groups from 15 to 19 years of age seem to be stable in their caries development in about 60%-80% of cases; while the 20% groups with the highest index values accounted for about 80% of all approximal lesions. In times of major economic adjustment, dental health for adolescents in Goteborg was an example of sustainable dental health development. A model system for monitoring, analysing, and reporting dental health and dental care outcomes within a dental care-giving organization calls for several conditions, for example, a dental health-related patient group system, and a rationale for the choice of dental team models. These areas could be gathered into a system where contemporary socio-economic factors and dental research results interact with performed dental care, and also with different methods for reporting and evaluating dental health, dental care costs, and the demand for dental care competence. <120> UI - 99331515 AU - Slade GD AU - Caplan DJ IN - Department of Dental Ecology, University of North Carolina, Chapel Hill 27599-7450, USA. gary:slade@dentistry.unc.edu TI - Methodological issues in longitudinal epidemiologic studies of dental caries. [Review] [47 refs] SO - Community Dentistry & Oral Epidemiology 1999 Aug;27(4):236-48 AB - As longitudinal epidemiologic studies of dental caries address increasingly complex research questions, approaches to analysis of data from those studies have become more sophisticated. This review examines methods available for analyzing and reporting data from such studies. Traditional analytic methods utilize the DMFS increment as the outcome measure in longitudinal studies of caries. However, two other outcome measures may be needed to address some research issues: cumulative incidence, which quantifies caries risk; and incidence density, which quantifies caries rate. Four major analytic decisions have to be addressed when computing DMFS increment: examiner misclassification ("reversals"), teeth lost due to caries, findings from more than two examinations, and multiple events such as caries initiation and progression. We present a uniform approach for enumerating caries events that permits the same analytic decisions made in calculating DMFS increment to be applied to cumulative incidence and incidence density calculations. In view of the variety of analytic decisions that must be made when enumerating events in longitudinal studies of caries, authors should specify how all potential changes in caries status were handled. Furthermore, if a study uses more than one outcome measure, the same decisions for enumerating events should be used when computing those measures. [References: 47] <121> UI - 99331518 AU - Astrom AN AU - Awadia AK AU - Bjorvatn K IN - Department of Odontology-Community Dentistry, University of Bergen, Norway. anne.nordrehaug@cih.uib.no TI - Perceptions of susceptibility to oral health hazards: a study of women in different cultures. SO - Community Dentistry & Oral Epidemiology 1999 Aug;27(4):268-74 AB - People typically attribute lower health risks to themselves than to others, a phenomenon called unrealistic optimism. OBJECTIVES: The purpose of this study was to investigate how women's perceived susceptibility to tooth decay is related to information from various sources, trust in these sources and personal experience with risk factors. Comparative risk judgments for oral health hazards were also investigated. METHODS: Two samples of women were included. In 1997, a random sample of adults (n = 1190) aged 25 years, from three counties of western Norway, were invited to complete postal questionnaires at home. A total of 735 adults (62%) responded, of whom 374 (51%) were women. During July 1997, a convenient sample of 140 women, aged 15-40 years, participated in a structured interview at a Maternal Child Health clinic in Arusha town, Tanzania. RESULTS: Among the Tanzanian women, information from health workers and media, trust in these sources, symptoms of tooth decay and intake of sugared foods were significantly related to perceived risk for tooth decay. Pearson's correlation coefficients varied from r = 0.47, P < 0.001 (trust in health workers) to r = 0.20, P < 0.05 (intake of sugared foods). In both groups of women all mean ratings of comparative risk differed significantly (P < 0.001) from the midpoint of the scales (marked same risk as others), as tested by one sample t-test (test value = 0). The range of t-values was from t = -12.7 (dental fluorosis) to t = -18.2 (tooth decay) and from t = -4.9 (gum disease) to t = -8.3 (loss of teeth) among the Tanzanian and Norwegian women, respectively. CONCLUSIONS: When judging their susceptibility for tooth decay, Tanzanian women seem to consider both information from health workers and their personal risk experience. Optimism in comparative risk judgments for oral health hazards was evident among both the Tanzanian and the Norwegian women investigated. These findings are discussed in the context of implications for oral health education. <122> UI - 99333025 AU - Stephen KW TI - Use of fluoride [letter; comment]. CM - Comment on: Lancet 1999 May 1;353(9163):1462 SO - Lancet 1999 Jul 3;354(9172):74-5 <123> UI - 99312080 AU - Kumar JV AU - Swango PA IN - Bureau of Dental Health, New York State Department of Health, Albany 12237-0619, USA. jvk01@health.state.ny.us TI - Fluoride exposure and dental fluorosis in Newburgh and Kingston, New York: policy implications. SO - Community Dentistry & Oral Epidemiology 1999 Jun;27(3):171-80 AB - OBJECTIVES: This analysis was conducted to determine the changes in the effect of exposure to fluoridation and other sources of fluoride on dental fluorosis in children attending Newburgh and Kingston school districts in New York State. METHODS: Data for this analysis were obtained from two surveys conducted in the 1986 and 1995 school years. Analyses were limited to 3500, 7-14-year-old lifelong residents of a fluoridated or a nonfluoridated community. Dean's classification and DMFS index were used for recording dental fluorosis and caries, respectively. A questionnaire was used to collect fluoride exposure data. Regression procedures were used to estimate the effect of fluoridation, fluoride supplements, and brushing before the age of 2 years on dental fluorosis. RESULTS: Children examined in 1996 were at higher risk for both questionable and very mild to severe dental fluorosis if they received fluoride from water or daily tablet use, or started brushing before the age of 2 years. The increase in risk from 1986 to 1995 was greater for African-American children. CONCLUSION: This analysis showed that the risk of developing dental fluorosis did not decline over time in these communities. Continuous exposure to water fluoridation had an observable effect on dental fluorosis. However, implementation of fluoridation in Newburgh Town did not result in an increase in dental fluorosis prevalence. <124> UI - 99312082 AU - Worthington H AU - Clarkson J AU - Davies R IN - Dental Health Unit, Turner Dental School, Manchester, UK. helen.worthington@man.ac.uk TI - Extraction of teeth over 5 years in regularly attending adults. SO - Community Dentistry & Oral Epidemiology 1999 Jun;27(3):187-94 AB - OBJECTIVES: This prospective study was conducted to describe the incidence of tooth extraction in a group of regularly attending adults and to assess factors that are predictive of tooth loss. METHODS: Baseline and annual incremental clinical data were obtained from 23 general dental practitioners on a group of their regularly attending, dentate adult patients over a 5-year period. The patients completed a postal questionnaire with questions relating to dental health behaviours, attitudes and knowledge, and social factors. RESULTS: Complete clinical data were obtained from 2799 patients. Four hundred and seventy (17%) patients underwent extractions, 72% of which were posterior teeth. The majority of extractions were for reasons other than caries (79%). Bivariate analyses revealed many significant differences between patients who underwent extractions and those who did not, with respect to the clinical, social, behavioural and attitudinal variables. The logistic regression model for tooth loss included three clinical variables, number of teeth, crowns and sites with recession. Other variables in the final model included the dentist's and patient's prediction of treatment need, having sensitive teeth, having a sweet tooth, living alone and smoking. The sensitivity for the model was 0.57 with specificity 0.72. CONCLUSIONS: This study is unique in its examination of patients and has highlighted that both clinical and other factors are important in predicting who will undergo extractions. Future investigations should assess the consequence of having extractions in terms of health benefit or detriment. <125> UI - 99244522 AU - Dorn PA AU - Piskorski P AU - Gorga MP AU - Neely ST AU - Keefe DH IN - Boys Town National Research Hospital, Omaha, Nebraska 68131, USA. TI - Predicting audiometric status from distortion product otoacoustic emissions using multivariate analyses. SO - Ear & Hearing 1999 Apr;20(2):149-63 AB - OBJECTIVES: 1) To determine whether multivariate statistical approaches improve the classification of normal and impaired ears based on distortion product otoacoustic emission (DPOAE) measurements, in comparison with the results obtained with more traditional single-variable applications of clinical decision theory. 2) To determine how well the multivariate predictors, derived from analysis on a training group, generalized to a validation group. 3) To provide a way to apply the multivariate approaches clinically. DESIGN: Areas under the relative operating characteristic (ROC) curve and cumulative distributions derived from DPOAE, DPOAE/Noise, discriminant function (DF) scores and logit function (LF) scores were used to compare univariate and multivariate predictors of audiometric status. DPOAE and Noise amplitudes for 8 f2 frequencies were input to a discriminant analysis and to a logistic regression. These analyses generated a DF and LF, respectively, composed of a linear combination of selected variables. The DF and LF scores were the input variables to the decision theory analyses. For comparison purposes, DPOAE test performance was also evaluated using only one variable (DPOAE or DPOAE/Noise when f2 = audiometric frequency). Analyses were based on data from over 1200 ears of 806 subjects, ranging in age from 1.3 to 96 yr, with thresholds ranging from -5 to >120 dB HL. For statistical purposes, normal hearing was defined as thresholds of 20 dB HL or better. For the multivariate analyses, the database was randomly divided into two groups of equal size. One group served as the "training" set, which was used to generate the DFs and LFs. The other group served as a "validation" set to determine the robustness of the DF and LF solutions. RESULTS: For all test frequencies, multivariate analyses yielded greater areas under the ROC curve than univariate analyses, and greater specificities at fixed sensitivities. Within the multivariate techniques, discriminant analysis and logistic regression yielded similar results and both yielded robust solutions that generalized well to the validation groups. The improvement in test performance with multivariate analyses was greatest for conditions in which the single predictor variable resulted in the poorest performance. CONCLUSIONS: A more accurate determination of auditory status at a specific frequency can be obtained by combining multiple predictor variables. Although the DF and LF multivariate approaches resulted in the greatest separation between normal and impaired distributions, overlap still exists, which suggests that there would be value in continued efforts to improve DPOAE test performance. <126> UI - 99215482 AU - Nathoo N AU - Nadvi SS AU - van Dellen JR IN - Department of Neurosurgery, University of Natal Medical School and Wentworth Hospital, Durban, South Africa. TI - Cranial extradural empyema in the era of computed tomography: a review of 82 cases. SO - Neurosurgery 1999 Apr;44(4):748-53; discussion 753-4 AB - OBJECTIVE: Intracranial suppurative disorders (abscesses and empyemas) continue to be common neurosurgical emergencies in South Africa. Cranial extradural empyema (EDE) occurs less frequently than its subdural counterpart but remains a potentially devastating disease process. We present our 15-year experience with this condition in the era of computed tomography. METHODS: Of the 4623 patients with intracranial sepsis who were admitted to the neurosurgical unit at Wentworth Hospital (Durban, South Africa) during a 15-year period (1983-1997), 76 patients with EDEs were identified. An additional six patients who were identified from our outpatient records were treated nonsurgically. Analyses were performed with respect to clinical, radiological, bacteriological, surgical, and outcome data. All information for this study was obtained from the computerized databank for the unit. Statistical analyses of the related pre- and postoperative clinical data were performed. RESULTS: The 76 patients with EDEs accounted for 1.6% of the total number of patients admitted for treatment of intracranial sepsis during the study period. Thirteen patients (15.8%) had infratentorial pus collections. Male patients predominated by a ratio of 2:1, and 66 patients were between the ages of 6 and 20 years (mean age, 16.56+/-9.87 yr). The origins of the sepsis were paranasal sinusitis for 53 patients (64.6%), mastoiditis for 16 patients, trauma for 5 patients, dental caries for 1 patient, and miscellaneous causes for 7 patients. The most common clinical presenting features were fever, neck stiffness, and periorbital edema. Surgery was performed in the form of burrholes for 21 patients, small craniectomies for 39 patients, and craniotomies for 5 patients. The additional five patients, while having drainage of their infected paranasal sinuses, had simultaneous drainage of their extradural pus collections by the ear, nose, and throat surgeon. The majority of patients (81 patients) experienced good outcomes (Glasgow Outcome Scale scores of 4 or 5). A single patient died after surgery (mortality rate, 1.22%). CONCLUSION: EDEs occur less frequently than subdural empyemas and are associated with better prognoses. Surgical drainage (burrholes), simultaneous eradication of the source of sepsis, and high-dose intravenous antibiotic therapy remain the mainstays of treatment. Selective nonsurgical management of small EDEs is possible, provided the source of sepsis is surgically eradicated. It is our opinion that EDE is a disease that should be managed without morbidity or death. <127> UI - 99275870 AU - Russell JL AU - Block JE IN - Osteotech Inc, Eatontown, NJ 07724, USA. TI - Clinical utility of demineralized bone matrix for osseous defects, arthrodesis, and reconstruction: impact of processing techniques and study methodology. [Review] [79 refs] SO - Orthopedics (Thorofare, NJ) 1999 May;22(5):524-31; quiz 532-3 AB - The findings of studies on DBM in the surgical management of osseous defects, arthrodeses, and reconstructive procedures have been promising. In general, DBM grafts have supported healing in a timely fashion without complication and with a diminished need to harvest bone from a secondary operative site. Nonetheless, controlled prospective trials are needed to confirm the comparative effectiveness of DBM and to quantitate the benefits of avoiding secondary site autologous bone harvesting. Notwithstanding the known deleterious effects of certain processing steps, current commercial demineralization processes vary widely and use ancillary procedures aimed at attenuating potential residual antigens and pathogens. While some of these procedures may improve or facilitate graft performance (eg, lipid and lipoprotein removal with detergents), others may be deleterious (eg, sterilization with radiation or ethylene oxide) (Table 1). Therefore, it is important that DBM be processed using methods that consistently establish conditions known to preserve DBM's documented osteoinductive potential and that authors appropriately identify processing methods known to have effects on graft performance. [References: 79] <128> UI - 99314767 AU - Harbeck N AU - Dettmar P AU - Thomssen C AU - Berger U AU - Ulm K AU - Kates R AU - Hofler H AU - Janicke F AU - Graeff H AU - Schmitt M IN - Frauenklinik, Klinikum rechts der Isar, Technische Universitat Munchen, Munich, Germany. TI - Risk-group discrimination in node-negative breast cancer using invasion and proliferation markers: 6-year median follow-up. SO - British Journal of Cancer 1999 May;80(3-4):419-26 AB - Factors reflecting two major aspects of tumour biology, invasion (urokinase-type plasminogen activator (uPA), plasminogen activator inhibiter (PAI-1), cathepsin D) and proliferation (S-phase fraction (SPF), Ki-67, p53, HER-2/neu), were assessed in 125 node-negative breast cancer patients without adjuvant systemic therapy. Median follow-up time was 76 months. Antigen levels of uPA, PAI-1 and cathepsin D were immunoenzymatically determined in tumour tissue extracts. SPF and ploidy were determined flow-cytometrically, Ki"'-67, p53, and HER-2/neu immunohistochemically in adjacent paraffin sections. Their prognostic impact on disease-free (DFS) and overall survival (OS) was compared to that of traditional factors (tumour size, grading, hormone receptor status). Univariate analysis determined PAI-1 (P < 0.001), uPA (P = 0.008), cathepsin D (P = 0.004) and SPF (P = 0.023) as significant for DFS. All other factors failed to be of significant prognostic value. In a Cox model, only PAI-1 was significant for DFS (P < 0.001, relative risk (RR) 6.2). In CART analysis for DFS, the combination of PAI-1 and uPA gave the best risk group discrimination. For OS, PAI-1, cathepsin D, tumour size and ploidy were statistically significant in univariate, but PAI-1 was the only independently significant factor in Cox analysis (P < 0.001, RR 8.9). In particular, this analysis shows that PAI-1 is still a strong and independent prognostic factor in node-negative breast cancer after extended 6-year median follow-up. <129> UI - 99225390 AU - Eggertsson H AU - Analoui M AU - van der Veen M AU - Gonzalez-Cabezas C AU - Eckert G AU - Stookey G IN - Department of Oral Biology, Medicine and Pathology, School of Dentistry, Indianapolis, Ind., USA. heggerts@iusd.iupui.edu TI - Detection of early interproximal caries in vitro using laser fluorescence, dye-enhanced laser fluorescence and direct visual examination. SO - Caries Research 1999 May-Jun;33(3):227-33 AB - This in vitro study evaluated the use of laser fluorescence (LF) for the detection of early interproximal carious lesions and whether the detection could be enhanced using a fluorescent dye (DELF). Direct visual examination (DV) was used for comparison. Eighty extracted teeth were used, arranged in 20 blocks, each block having 2 premolars and 2 molars, lined up in a simulated sextant situation. After cleaning with a microabrasion kit, a subcontact window on half of the surfaces (60) was exposed to Carbopol white-spot solution for 5 days. The teeth were remounted in stone and examined by three independent examiners. For LF and DELF an argon laser was used (mixed wavelength of 488 and 514 nm) viewed through glasses (excluding wavelength <520 nm). For DELF a sodium fluorescein dye (0. 075%) was applied before examination. A clinical examination light was used for DV. The approximal surfaces were scored for lesion presence or absence. To verify lesion presence, the subcontact area was cut perpendicularly to the surface, stained with rhodamine B, and images were taken using a confocal microscope. The images were analyzed using a histogram program for lesion depth and image area. Lesions were present in 62 out of 120 approximal surfaces, with an average depth of 60 microm (range 17-190 microm). Sensitivity ranges for LF, DELF and DV were 56-74, 61-79 and 58-74%, and specificity ranges 67-78, 86-98 and 83-97%, respectively. With this model DELF compared favorably with DV and LF in sensitivity, but specificity was better for DELF and DV than for LF. <130> UI - 99225391 AU - Eickholz P AU - Kolb I AU - Lenhard M AU - Hassfeld S AU - Staehle H IN - Department of Operative Dentistry and Periodontology, Dental Clinic, Ruprecht Karls University, Heidelberg, Germany. peter:eickholz@ukl.uni-heidelberg.de TI - Digital radiography of interproximal caries: effect of different filters. SO - Caries Research 1999 May-Jun;33(3):234-41 AB - The aim of this study was to compare the effect of different image processing modes (filters) on reproducibility and validity of the assessment of interproximal carious lesions on digitized radiographic images. Standardized radiographs of 34 extracted teeth exhibiting interproximal caries were obtained. All radiographs were digitized and using the FRIACOM-software the central depth (CD) of each carious lesion was measured on the unchanged radiographic image and after use of five different filters with 7fold and 18fold magnification. All measurements were repeated after 1 week to estimate reproducibility. Histometric CD assessments provided a gold standard for comparison with the radiographic measurements (validity). Neither reproducibility nor validity of CD measurements were improved by one of the filters. Measurements of dentinal lesions showed a statistically higher variability than those of enamel lesions (p<0.001). 18fold magnification provided more valid CD measurements than 7fold magnification (p<0.001). In this study digital manipulations of radiographic images failed to result in statistically significantly improved reproducibility or validity of CD measurements. <131> UI - 99225393 AU - Soetiarto F IN - Non-Communicable Diseases Research Centre, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia. TI - The relationship between habitual clove cigarette smoking and a specific pattern of dental decay in male bus drivers in Jakarta, Indonesia. SO - Caries Research 1999 May-Jun;33(3):248-50 AB - This study has been conducted to establish the relationship between habitual smoking of clove cigarettes and a specific type of dental decay. A retrospective cohort study of 1,160 bus drivers in Jakarta who smoked clove cigarettes and non-smokers showed that a specific type of decay occurs in terms of form, location and pathology. The prevalence was 55.8%. The type of decay is affected by the number of years of smoking and the number of cigarettes smoked each day. Thirty-two percent of the lesions were on the buccal surfaces of the upper teeth, 39.3% on the buccal surfaces of the lower teeth, and 18% of palatal surfaces were affected. The prevalence of clove cigarette caries was related to years of smoking and numbers of cigarettes smoked per day. Of the men who smoked 10 years or less, 27% had caries. The prevalence increased to 79.6% for those smoking for 11-15 years. For those smoking for more than 15 years the prevalence was 89.3%. The relative risk of those smoking 7-12 cigarettes a day was 2.66 (p<0.0001) compared to those smoking 0-6 cigarettes a day. The relative risk increased to 3.19 in those smoking 13-18 cigarettes and 2.96 (p<0.0001) in men smoking more than 18 cigarettes per day. <132> UI - 99322518 AU - Zimmer B TI - Systematic decalcification prophylaxis during treatment with fixed appliances. SO - Journal of Orofacial Orthopedics 1999;60(3):205-14 AB - In a practical setting, 4 different prophylactic methods were compared with regard to their effects on the incidence of decalcification during orthodontic fixed appliance therapy and on the frequency of premature debonding resulting from imminent or already manifest decalcification. This study showed that the use of a system in which selection and care were oriented solely along the clinical impression was associated with the highest rate of decalcification and premature debonding. The findings were significantly better (p < 0.05), when a prophylactic regimen of oral hygiene was implemented which was based on patient selection (API < 30%) and regular oral hygiene check-ups during the treatment. When the DMFT index was considered in addition to the API value, and the number of the initial lesions at the beginning of treatment were included for selecting patients, the incidence of decalcification was significantly reduced even further (p < 0.05). A more comprehensive or "optimized prophylaxis" utilizing saliva test parameters and active prophylactic interventions implemented by a dental hygienist during the treatment phase also had a favorable impact on the main outcome parameters. The present findings indicate that decalcification can be markedly reduced by using a treatment regimen that targets the decalcification risk and a systematic, individualized prophylaxis during active treatment with fixed appliances. <133> UI - 99330253 AU - van Dijken JW AU - Kieri C AU - Carlen M IN - Institution of Oral Biology, Dental School, Umea University, Sweden. TI - Longevity of extensive class II open-sandwich restorations with a resin-modified glass-ionomer cement. SO - Journal of Dental Research 1999 Jul;78(7):1319-25 AB - Several new techniques have been introduced for use in the esthetic restoration of posterior cavities to substitute for the presumed toxicity of amalgam. Composite-laminated glass-ionomer cement restorations, the sandwich technique, have been recommended for caries-risk patients. Clinical evaluation of the use of conventional glass-ionomer cements in the open-sandwich restoration has shown a high failure rate. The aim of this study was to evaluate the durability and cariostatic effect of a modified open-sandwich restoration utilizing a resin-modified glass-ionomer cement (RMGIC) in large cavities. The materials consisted of 274 mostly extensive Class II Vitremer/Z100 restorations performed by four dentists in 168 adults. Six experimental groups were investigated. In four groups a thick and in two groups a thin layer of cement was placed. Cavity conditioning before application of the RMGIC self-etching primer was done in 3 groups with polyacrylic acid and in one group with maleic acid; in two groups, only water rinsing was performed. The restorations were evaluated at baseline and after 6, 12, 24, and 36 months according to modified USPHS criteria (van Dijken, 1986). After 3 years, 239 restorations were evaluated. Twelve (5%) were estimated as non-acceptable. Two were replaced, and seven were repaired with resin composite. Tooth fractures were observed in 2.5%. Slight erosion of the RMGIC part was seen in 4%, and in one case operative treatment was indicated. Post-operative sensitivity was reported for 9 teeth. Forty-three percent of the patients were considered as caries-risk patients. Only one restoration showed secondary caries. The three-year results indicated that the modified open-sandwich restoration is an appropriate alternative to amalgam including extensive restorations. <134> UI - 99309380 AU - Unell L IN - Department of Cariology, Faculty of Odontology, Goteborg University. TI - On oral disease, illness and impairment among 50-year-olds in two Swedish counties. [Review] [105 refs] SO - Swedish Dental Journal - Supplement 1999;135:1-45 AB - There were three general aims of the thesis. To investigate 1) the fulfillment of the judiciary Swedish goal of good dental care on equal conditions in an adult population born 1942 in two Swedish counties in 1992. Both selfrated oral health and clinical observations indicated good oral health in the study population. Full social equality of dental care was not attained, but the social gradient was modest. 2) To find models for risk prediction on population level for oral health, expressed as number of remaining teeth, as caries and as periodontitis. Relatively efficient such models were constructed, with the lowest efficiency for periodontitis indicators. Oral health and disease were found to be qualitatively different. Still, use of tobacco was a consistent risk factor for both poor health and presence of disease. 3) To investigate if questionnaires can be used to monitor oral health, disease and illness. It was found that this is the case on population level, but also that questionnaire surveys cannot wholly replace clinical studies, especially regarding periodontal disease. For number of remaining teeth and frequency of removable dentures, the questionnaire methodology is appropriate for monitoring in this type of population, which has been utilized by setting the present study as a baseline for ongoing longitudinal studies relying on survey methodology. [References: 105] <135> UI - 99247416 AU - Kneckt MC AU - Syrjala AM AU - Laukkanen P AU - Knuuttila ML IN - Institute of Dentistry, University of Oulu, Finland. mkneckt@hotmail.com TI - Self-efficacy as a common variable in oral health behavior and diabetes adherence. SO - European Journal of Oral Sciences 1999 Apr;107(2):89-96 AB - Successful treatment of dental caries, periodontal diseases and diabetes requires persistent daily self-care. The aim of this study was to evaluate the perception of self-efficacy as a common behavioral factor determining oral health behavior, diabetes self-care, and actual health status. Cross-sectional data relating to 149 insulin-dependent diabetes mellitus (IDDM) patients were collected from patient records, and by clinical oral examination and a quantitative questionnaire. The study population was recruited from different locations, and the participation percentage was 80%. Self-efficacy scales associated with corresponding behaviors, and a dental self-efficacy scale also correlated with dental caries. Dental self-efficacy correlated with diabetes self-efficacy, diabetes adherence, and with HbA1c. Also, logistic regression analysis revealed that dental self-efficacy was related to diabetes adherence. Further, those diabetics reporting a high frequency of dental visiting had higher diabetes self-efficacy. As a conclusion, good dental self-efficacy has a positive influence on diabetes adherence. The results suggest that the perception of self-efficacy may be a common behavioral factor determining diabetes self-care and oral health behavior. <136> UI - 99189376 AU - Harbeck N AU - Ross JS AU - Yurdseven S AU - Dettmar P AU - Polcher M AU - Kuhn W AU - Ulm K AU - Graeff H AU - Schmitt M IN - Frauenklinik und Poliklinik, Klinikum rechts der Isar, Technische Universitat Munchen, D-81675 Munich, Germany. TI - HER-2/neu gene amplification by fluorescence in situ hybridization allows risk-group assessment in node-negative breast cancer. SO - International Journal of Oncology 1999 Apr;14(4):663-71 AB - In a collective of 112 node-negative breast cancer patients, we compared the prognostic impact of HER-2/neu gene amplification (AMP) determined by fluorescence in situ hybridization (FISH) and HER-2/neu protein overexpression (EXP) measured by immunohistochemistry (IHC) with traditional prognostic factors (tumor size, grade, steroid hormone receptor status, menopausal status) and tumor invasion markers uPA (urokinase-type plasminogen activator) and its inhibitor PAI-1 determined by enzyme immunoassay (ELISA). Median follow-up in patients still alive at time of analysis was 7 years. Automated FISH and IHC were performed on parallel-cut formalin-fixed paraffin-embedded tissue sections. HER-2/neu AMP was detected by FISH in 31% and HER-2/neu EXP was measured by IHC in 41% of the cases. In 13% of the tumors, both AMP and EXP were found. FISH and IHC results were concordant in 56% of all analyzed cases. In univariate analysis, HER-2/neu AMP significantly predicted both disease-free (DFS) and overall survival (OS). HER-2/neu EXP was significant for OS, only. In multivariate analysis of all analyzed prognostic factors, HER-2/neu AMP was the only independent predictive factor for both DFS and OS. CART analysis revealed that HER-2/neu AMP together with the combination uPA/PAI-1 allowed optimal risk-group assessment after a 7-year median follow-up: patients with low levels of both uPA and PAI-1 and no HER-2/neu AMP had a significantly lower relapse rate (4.6%) than the remaining patients (32%). In conclusion, HER-2/neu gene AMP determined by FISH allowed a more accurate risk-group assessment than HER-2/neu protein EXP measured by IHC. Combining the HER-2/neu gene status measured by FISH with levels of tumor invasion markers uPA and PAI-1 improves clinically relevant risk-group assessment. In addition to its prognostic strength, the significant impact of HER-2/neu AMP on OS may reflect its ability to predict resistance to systemic therapy. <137> UI - 99287067 AU - Fuzzi M AU - Rappelli G IN - SAOS-FUZZI@mail.asianet.it TI - Ceramic inlays: clinical assessment and survival rate. SO - Journal of Adhesive Dentistry 1999;1(1):71-9 AB - PURPOSE: This study evaluates the clinical behavior of ceramic inlays placed during the past decade. MATERIALS AND METHODS: One hundred eighty-two inlays were examined in 66 patients. The interval between placement and assessment was on average 5.9 years +/- 2.7, ranging from 2 to 11.7 years. Restorations still present at the time of evaluation were clinically assessed according to modified USPHS criteria. Kaplan-Meier statistical analysis was used to assess the survival rate. RESULTS: According to USPHS criteria, good results were obtained for color match, marginal discoloration, recurrent caries, contour, and marginal integrity. Six inlays failed: four for endodontic reasons, one due to recurrent caries, and the other due to fracture. The results indicate that a success rate of 95% could be predicted at 11.5 years. CONCLUSION: The lack of recurrent caries, the only slight changes in marginal discoloration and color match, combined with the excellent longevity prove that ceramic inlays are a valuable tool for the restoration of posterior teeth. <138> UI - 99243305 AU - Gaughwin A AU - Spencer AJ AU - Brennan DS AU - Moss J IN - South Australian Dental Service, University of Adelaide, Australia. aihw.dsru@dentistry.adelaide.edu.au TI - Oral health of children in South Australia by socio-demographic characteristics and choice of provider. SO - Community Dentistry & Oral Epidemiology 1999 Apr;27(2):93-102 AB - Australia has a highly developed school dental program for providing dental care to schoolchildren which operates alongside well-established private practice delivery of dental care. While free school-based dental care has high utilisation where offered, little is known about the oral health outcomes of groups of children across different providers of dental care, or patterns of service use. This paper investigates the effects of socio-demographic characteristics and choice of dental provider on oral health amongst a random sample of secondary school students residing in Adelaide, South Australia. OBJECTIVES: To describe the oral health of children by different dental provider groups, to describe the association of socio-demographic characteristics with oral health outcomes; and to describe the differences in oral health that remained after controlling for socio-demographic confounding, by dental provider group. METHODS: The study included metropolitan Adelaide schoolchildren from Year 9 and 10 school grades (n = 373). RESULTS: Children who received care from the School Dental Service (SDS) and from both the SDS and private dentists (Mixed) had significantly lower caries experience (DMFS) than children who received care from private dentists (Private) or who had not received any care for at least 2 years (No Recent Care). There were differences in the socio-demographic characteristics between children who used different dental providers, and these socio-demographic characteristics were significantly associated with levels of decayed, missing and filled surfaces and surfaces which had been fissure sealed. After controlling for socio-demographic characteristics using multiple regression, significant differences were seen in mean caries experience (DMFS) and mean numbers of decayed surfaces and filled surfaces. CONCLUSION: Although from less advantaged backgrounds, children seen through the SDS had more favourable oral health outcomes than children seen by a private dentist. <139> UI - 99221170 AU - Larsen MJ AU - Jensen AF AU - Madsen DM AU - Pearce EI IN - Royal Dental College, Faculty of Health Sciences, University of Aarhus, Aarhus C, Denmark. joost@odont.aau.dk TI - Individual variations of pH, buffer capacity, and concentrations of calcium and phosphate in unstimulated whole saliva. SO - Archives of Oral Biology 1999 Feb;44(2):111-7 AB - In order to evaluate the risk of development of dental caries and/or of formation of dental calculus, salivary variables have often been used, but not with particular success. A reason for the apparent lack of association could be that the individual temporal variation of a characteristic was so substantial relative to the overall variation that it is not possible to characterize an individual by a single salivary measurement. The aim here was to examine the individual variation of pH, buffer capacity, and concentrations of calcium and phosphate and to compare it with the overall variation of the characteristics in order to shed light on the above problem. Eight weekly samples of up to 4 ml of unstimulated whole saliva were collected from 11 dental students before tooth brushing on their arrival at 8 a.m. in the dental school. Calcium was determined by atomic absorption spectroscopy, phosphate colorimetrically, and pH electrometrically. The buffer capacity was assessed by titration of the saliva sample from the pH initially observed to pH 3. It was found that within each individual the concentration of calcium and of phosphate, pH, the hydroxyapatite ion product and the buffer capacity varied considerably over the 7 weeks. The individual range frequently covered more than a third of the total range. Further, within each of the variables, single individuals could be found whose samples covered 60% or more of the overall range, whilst others covered less than 10% of the range. It was therefore concluded that, although collected at the same time of the day, pH, buffer capacity and concentrations of calcium and phosphate in unstimulated whole saliva in the single individual vary so much that characterization of individuals and of their saliva based on a single salivary analysis is unreliable and hazardous. <140> UI - 99275573 AU - Benn DK AU - Clark TD AU - Dankel DD 2nd AU - Kostewicz SH IN - Department of Operative Dentistry, University of Florida College of Dentistry, Gainesville 32610-0414, USA. TI - Practical approach to evidence-based management of caries. SO - Journal of the American College of Dentists 1999 Spring;66(1):27-35 AB - This paper discusses evidence-based management of dental caries with regard to: (1) need to adopt new office methods, (2) potential barriers to change, and (3) possible practical solutions to aid change. The need for classifying individual patients into low-, medium-, and high-risk caries groups is justified from a review of the epidemiological characteristics of caries. In addition, a deficiency is identified in traditional caries recording methods since they are unable to grade the severity and activity of individual lesions. The traditional basis of six-monthly recall examinations for all patients is shown from the literature to have no scientific support. It is suggested a three-twelve month recall interval be used, depending on a patient's risk group classification. Some barriers to change are identified as: (1) the collection of more comprehensive history and clinical caries data, (2) the complexity of evidence-based decision-making, and (3) dentists' difficulty in standardizing decision-making. A new pictorial classification for caries severity and activity is described. A demonstration decision-support system is presented in terms of assisting collection of data, automatic identification of risk factors, patient risk classification, and generation of a suggested treatment plan. Evidence-based management may result in change of professional manpower levels. <141> UI - 99259205 AU - Moore PA AU - Weyant RJ AU - Mongelluzzo MB AU - Myers DE AU - Rossie K AU - Guggenheimer J AU - Block HM AU - Huber H AU - Orchard T IN - University of Pittsburgh, School of Dental Medicine, Department of Dental Public Health, PA 15261, USA. PAM7@pitt.edu TI - Type 1 diabetes mellitus and oral health: assessment of periodontal disease. SO - Journal of Periodontology 1999 Apr;70(4):409-17 AB - BACKGROUND: The periodontal disease status of 320 dentate adults, diagnosed 23.7 years previously with Type 1 insulin dependent diabetes mellitus, was evaluated. These patients had been monitored at 2-year intervals as part of a large University of Pittsburgh longitudinal study assessing the medical complications associated with insulin dependent diabetes. METHODS: During one of their regularly scheduled medical examinations, a group of 320 adult dentate subjects (mean age of 32.1 years) received a periodontal examination as part of a comprehensive oral health assessment. The oral health assessment collected data regarding demographics, oral health behaviors, tooth loss, coronal and root caries, salivary functions, and soft tissue pathologies. For the periodontal assessments, 3 facial sites (mesial, midcervical, distal) of the teeth in the right maxillary/left mandibular or left maxillary/right mandibular quadrants were evaluated for calculus, bleeding on probing (BOP) and loss of gingival attachment (LOA). RESULTS: Attachment loss was significantly greater for older patients whereas BOP and calculus levels were relatively constant across age categories. Univariate analyses of factors possibly related to extensive periodontal disease (LOA > or =4 mm for at least 10% of sites examined) indicated an association with older age; lower income and education; past and current cigarette smoking; infrequent visits to the dentist; tooth brushing less than once per day; older age of onset; longer duration of diabetes; and the diabetic complication of neuropathy. A multivariate regression model of all possibly significant factors found current cigarette use (odds ratio [OR] = 9.73), insulin dependent diabetes onset after 8.4 years of age (OR = 3.36), and age greater than 32 years (OR = 3.00) explained the majority of the extensive periodontal disease in this group of diabetic patients. CONCLUSIONS: Management and prevention of extensive periodontal disease for Type 1 diabetic patients should include strong recommendations to discontinue cigarette smoking. <142> UI - 99300503 AU - Bergman B AU - Nilson H AU - Andersson M IN - Department of Prosthetic Dentistry, Faculty of Odontology, Umea University, Sweden. TI - A longitudinal clinical study of Procera ceramic-veneered titanium copings. SO - International Journal of Prosthodontics 1999 Mar-Apr;12(2):135-9 AB - PURPOSE: The purpose of the present paper was to study the long-term clinical results with ceramic-veneered Procera titanium copings. MATERIALS AND METHODS: A total of 44 titanium copings (fabricated for 22 patients) veneered with a low-fusing ceramic were followed for 60 to 78 months. The clinical examinations were performed by licensed specialists in prosthetic dentistry. The crowns were rated according to the California Dental Association system. In addition, Bleeding Index and Margin Index were also evaluated. RESULTS: In 3 crowns ceramic fractures necessitated their replacement. Two crowns had to be replaced because of caries. The ratings for surface and color had changed markedly, from excellent to acceptable. Regarding anatomic form, with the exception of the 3 fractured ceramic crowns, there were no obvious changes. The margin integrity, aside from the 2 crowned teeth with caries, was recorded as satisfactory (excellent or acceptable) for all other crowns; in fact, a large majority were rated excellent. Regarding Bleeding Index, there were no differences between crowned teeth and control teeth. Changes in Margin Index showed that the gingiva of the crowned teeth had retracted. CONCLUSION: Of the various clinical factors evaluated, only surface and color-related to the low-fusing ceramic used for veneering-showed any obvious change during the follow-up period. Otherwise the veneered titanium copings had, in general, performed well. <143> UI - 99238091 AU - Toljanic JA AU - Bedard JF AU - Larson RA AU - Fox JP IN - Zoller Dental Clinics, The University of Chicago, Illinois 60637, USA. TI - A prospective pilot study to evaluate a new dental assessment and treatment paradigm for patients scheduled to undergo intensive chemotherapy for cancer. SO - Cancer 1999 Apr 15;85(8):1843-8 AB - BACKGROUND: Patients scheduled to receive chemotherapy frequently undergo pretherapy dental treatment to eliminate potential sources of odontogenic infection. A prospective study was conducted to assess a new protocol emphasizing minimal pretherapy dental treatment. METHODS: Forty-eight consecutive patients diagnosed with solid or hematologic neoplasms underwent dental examination prior to intensive chemotherapy. All chronic dental pathology was scored as either mild-to-moderate or severe based on the likelihood of conversion to an acute state during chemotherapy. No pretherapy dental treatment was given to patients with chronic dental disease. Intertherapy dental complications and the overall impact on chemotherapy outcomes were assessed. RESULTS: Thirty-eight patients (79%) were diagnosed with pretherapy chronic dental pathology. Twenty-one of these patients (44% of the total population) were identified as having severe pathology and considered at risk for acute intertherapy dental complications. Two patients (4%) experienced acute intertherapy episodes, each presenting as oral abscesses. In both cases, resolution was achieved with antibiotics without interruption of chemotherapy. Oncologic treatment outcomes for all patients were judged to be unaffected by either the presence of chronic pretherapy dental disease or acute intertherapy exacerbations of these disease states. CONCLUSIONS: These results demonstrate that patients with chronic dental pathology can safely proceed with chemotherapy without dental intervention, as conversion of chronic dental disease to an acute state during chemotherapy occurs infrequently. If intertherapy dental infections do arise, they can be managed effectively without interrupting therapy or adversely affecting oncologic treatment outcomes. <144> UI - 99184724 AU - Barmes DE IN - Oral Health Unit, World Health Organization, Geneva, Switzerland. TI - A global view of oral diseases: today and tomorrow. SO - Community Dentistry & Oral Epidemiology 1999 Feb;27(1):2-7 <145> UI - 99265699 AU - Meijer-van Gelder ME AU - Look MP AU - Bolt-de Vries J AU - Peters HA AU - Klijn JG AU - Foekens JA IN - Department of Medical Oncology, Rotterdam Cancer Institute, Dr. Daniel den Hoed Kliniek/Academic Hospital Rotterdam, The Netherlands. TI - Breast-conserving therapy: proteases as risk factors in relation to survival after local relapse. SO - Journal of Clinical Oncology 1999 May;17(5):1449-57 AB - PURPOSE: To evaluate whether cathepsin D, urokinase-type plasminogen activator (uPA), its inhibitor, plasminogen activator inhibitor-1 (PAI-1), or clinical factors can predict which patients are at risk for developing distant metastases after local recurrence (LR). PATIENTS AND METHODS: Of 1,630 patients treated with breast-conserving surgery and radiotherapy of the breast between 1980 and 1992, LR developed in 171 as a first event. From the available primary tumor tissues, we determined the cytosolic levels of cathepsin D, uPA and PAI-1. RESULTS: In patients with LR, a short (< or = 2 years) disease-free interval (DFI) and skin involvement of LR were associated with poor postrelapse distant metastasis-free survival (PR-DMFS, P = .001, both) and postrelapse overall survival (PR-OS; P < .0001 and P < .0002, respectively). The primary tumor levels of uPA and PAI-1 were elevated for patients with a short DFI (P < .01), but such a relation was not observed for patients with skin involvement. In univariate analyses, high levels of uPA and PAI-1 in the primary tumor were associated with poor PR-OS (P = .038 and P = .040, respectively) but not PR-DMFS. In Cox multivariate analyses for PR-DMFS and PR-OS, only a short DFI and skin involvement of the LR were independently associated with a poor clinical outcome. CONCLUSION: In patients treated with breast-conserving therapy who had LR as a first event, a short DFI and skin involvement were strong indicators for poor PR-DMFS and PR-OS. The proteases studied did not contribute significantly to the final multivariate model. <146> UI - 99227754 AU - Epstein JB AU - Emerton S AU - Lunn R AU - Le N AU - Wong FL IN - Division of Dentistry, British Columbia Cancer Agency, Vancouver, Canada. TI - Pretreatment assessment and dental management of patients with nasopharyngeal carcinoma. SO - Oral Oncology 1999 Jan;35(1):33-9 AB - Patients who present with nasopharyngeal carcinoma (NPC) require through oral and dental assessment prior to treatment of the malignancy. We assessed the oral status of 57 consecutive patients with a diagnosis of NPC. In this study, identified risk factors for NPC were seen to be different in Asian versus non-Asian patients. Epstein-Barr virus seropositivity was seen in all Asian patients and in 69% of non-Asian patients (P = 0.00006), and reported alcohol use was greater in the non-Asian patients. In this study it was found that 68% of dentate patients required dental extractions primarily due to periodontal disease. Even in patients who reported receiving regular dental care (28%) extractions prior to radiation therapy were suggested. Oral complications of radiation therapy were reported by 84% of patients, with the most common being xerostomia. Clinical diagnosis of candidiasis (16%), rampant caries (10% of dentate patients) and difficulties with dentures (25% of denture wearers) were noted. In addition to pretreatment assessment, continuing oral and dental management is needed for patients with NPC. <147> UI - 99200729 AU - Heaven TJ AU - Firestone AR AU - Weems RA IN - Department of Restorative Dentistry, University of Alabama at Birmingham, 35294-0007, USA. TI - The effect of multiple examinations on the diagnosis of approximal caries and the restoration of approximal surfaces. SO - Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics 1999 Mar;87(3):386-91 AB - OBJECTIVE: The aim of this study was to determine the effect of multiple examinations on sensitivity and specificity in the diagnosis and restoration of approximal caries. STUDY DESIGN: In 2 studies, dentists examined bitewing radiographic films for approximal caries and the need for restoration. To model the clinical situation of multiple examinations over time, all groups of combinations of 2 to 10 dentists were constructed. Mean sensitivity and specificity were determined. In addition, 2 new variables were created: the first, "sensitivity any," was calculated by assigning a correct diagnosis for disease if any dentist in the group identified the diseased surface correctly; the second, "specificity all," was calculated by assigning a correct response only when all dentists in the group correctly identify a nondiseased surface. RESULTS: The sensitivity and specificity means were the same for all group sizes. The "sensitivity any" means increased monotonically from group size 1 to group size 10, whereas the "specificity all" means decreased continually. There was a statistically significant difference between sensitivity and "sensitivity any" and between specificity and "specificity all" for all group sizes in both studies. CONCLUSIONS: Multiple examinations increase the number of carious surfaces correctly diagnosed and the number of surfaces appropriately restored; however, multiple examinations also increase the number of sound surfaces diagnosed as carious and the number of intact surfaces receiving restorations. <148> UI - 99254460 AU - Jessee SA AU - Makins SR AU - Bretz WA IN - Department of Restorative Surgery and Biomaterial, University of Texas Health Science Center at Houston, USA. TI - Accuracy of proximal caries depth determination using two intraoral film speeds. SO - General Dentistry 1999 Jan-Feb;47(1):88-93 AB - Bite-wing radiographs are an integral part of a thorough diagnostic evaluation for interproximal caries. This study evaluates the observers' ability to assess correctly proximal carious lesion depth with two different speeds of intraoral film. Significant underestimation of lesion depths by the observers with both imaging modalities are shown, with no significant diagnostic difference between the two film types for both the presence and extent of caries. <149> UI - 99242304 AU - Burdock GA AU - Flamm WG IN - Burdock & Associates, Vero Beach, FL 32963, USA. TI - A review of the studies of the safety of polydextrose in food. [Review] [21 refs] SO - Food & Chemical Toxicology 1999 Feb-Mar;37(2-3):233-64 AB - Polydextrose (CAS no. 68424-04-4) is a water-soluble polymer of glucose that provides to foods the bulk and texture of sucrose. There are two main forms of polydextrose, an acidic form (PD-A) and a neutralized potassium salt (PD-N). Polydextrose is resistant to mammalian metabolic and microbial degeneration, rendering it both low in caloric value and non-cariogenic. Little polydextrose is absorbed intact although some is metabolized by caecal/colonic bacteria. At high enough levels of ingestion, this bacterial metabolism results in flatus, bloating, loose stools and ultimately a frank diarrhoea. Microbial metabolism also produces some volatile fatty acids that are absorbed by the animal and have calorigenic value. The species and dose threshold for persistent loose stools/watery diarrhoea determines the degree of electrolyte loss by the animal. In the dog, an obligate carnivore, sodium-sparing activity by the kidney and concomitant and obligatory calcium reuptake result in a well-defined aetiology of hypercalcaemia and subsequent nephrocalcinosis, particularly for PD-N. Of the species tested, the dog was the most sensitive to this carbohydrate with a no-effect level of 2000 mg/kg body weight/day. Omnivores, including the rat, mouse and monkey, have a no-effect level ranging from 2500 to 10,000 mg/kg body weight/day. No toxicity has been demonstrated in man, although the dose for laxation (to be distinguished from diarrhoea) is approximately 90 g/day (v. sorbitol at 70 g/day). Polydextrose did not show any reproductive toxicity, teratology, carcinogenesis, mutagenicity or genotoxicity. Polydextrose has been approved for food additive use (21 CFR 172.841) in the US, and an "ADI not specified" by the Joint WHO/FAO Expert Committee on Food Additives (JECFA, 1987). It has been approved in over 50 countries around the world and has been used extensively in the diet for over15 years. Specification monographs are published in the Food Chemicals Codex (FCC) (NAS, 1996) and the FAO Compendium (JECFA, 1995). This review provides an overview of the studies and salient data, not previously reported in the scientific literature, which had been submitted to regulatory agencies in support of these approvals. [References: 21] <150> UI - 99224489 AU - Costelloe MA TI - Decline of caries in New Zealand [letter; comment]. CM - Comment on: N Z Dent J 1998 Sep;94(417):109-13 SO - New Zealand Dental Journal 1999 Mar;95(419):24-5 <151> UI - 99189707 AU - Neuzner J AU - Liebrich A AU - Jung J AU - Himmrich E AU - Pitschner HF AU - Winter J AU - Vester EG AU - Michel U AU - Nisam S AU - Heisel A IN - Kerckhoff Clinic, Bad Nauheim, Germany. TI - Safety and efficacy of implantable defibrillator therapy with programmed shock energy at twice the augmented step-down defibrillation threshold: results of the prospective, randomized, multicenter Low-Energy Endotak Trial. SO - American Journal of Cardiology 1999 Mar 11;83(5B):34D-39D AB - Whether the safety and efficacy of implantable cardioverter defibrillator (ICD) therapy can be assured with lower output devices is an important question. The purpose of this study was to evaluate whether programming the device output at twice the augmented defibrillation threshold was as safe and effective as using the maximum energy. Patients indicated for ICD therapy, but without slow monomorphic ventricular tachycardia (MVT), who achieved an augmented defibrillation threshold (DFT plus) < or = 15 joules (J) with a single endocardial lead system and a biphasic defibrillator were included in the study. Prior to ICD implantation, patients were randomized into 2 groups. The shock energies in test group patient were set as follows: first shock at twice DFT plus, the second to fifth shocks at maximum output (34 J). In control group patients, all shocks were programmed at 34 J. The study population consisted of 166 consecutive patients (mean age 57.4 +/- 12.1 years, mean left ventricular ejection fraction 36.8 +/- 13.8%). Mean DFT plus was 9.6 +/- 3.2 J in test group patients and 10.1 +/- 3.5 J in control group patients (p = 0.36). During a mean follow-up of 24.2 +/- 9.6 months, 736 arrhythmia episodes were analyzed. The first shock efficacy was 98.3% in the test group patients versus 97.4% in the control group (p = 0.45). Total mortality was 6%, equally distributed in both study groups. The results of this study prove that the method of doubling the defibrillation energy at the DFT plus level provides an adequate safety margin in defibrillator therapy. <152> UI - 99183256 AU - Jones G AU - Riley M AU - Couper D AU - Dwyer T IN - Menzies Centre for Population Health Research, Tasmania. G.Jones@utas.edu.au TI - Water fluoridation, bone mass and fracture: a quantitative overview of the literature. SO - Australian & New Zealand Journal of Public Health 1999 Feb;23(1):34-40 AB - OBJECTIVE: To use the technique of meta-analysis to address the following research questions: Is water fluoridation associated with altered fracture risk at a population level and are the differences between studies consistent with confounding or chance variation between studies? METHOD: The data sources utilised were Medline 1966-97, reviews and bibliographies. The search terms were fluoridation, bone mass and/or fracture. We included all observational studies published in English relating water fluoridation to bone mass and/or fracture in the initial assessment. RESULTS: Water fluoridation had no evident effect on fracture risk (RR 1.02, 95% CI 0.96-1.09, n = 18 studies). There was marked heterogeneity between studies which could be explained, in part, by the combination of gender, urbanicity and study quality (R2 0.25, p = 0.05, weighted analysis). CONCLUSIONS: Water fluoridation both at levels aimed at preventing dental caries and, possibly, at higher naturally occurring levels appears to have little effect on fracture risk, either protective or deleterious, at a population level. The small effect on bone mass seen in studies performed at the individual level is consistent with this finding. Variation between studies is also likely to be due to differences in the distribution of other recognised fracture risk factors between different populations. Confirmation of these findings is required in large studies performed at the individual level. <153> UI - 99218753 AU - Ludlow JB AU - Abreu M Jr IN - Department of Diagnostic Sciences, University of North Carolina School of Dentistry 27599-7450, USA. TI - Performance of film, desktop monitor and laptop displays in caries detection. SO - Dento-Maxillo-Facial Radiology 1999 Jan;28(1):26-30 AB - OBJECTIVES: To compare film, desktop monitor and laptop displays of digitized film images for accuracy of caries detection. METHODS: Sixty-four extracted teeth were mounted in eight models and radiographed with E-speed bitewing film. Films were digitized and displayed on a desktop monitor and a laptop display. Six observers scored the presence or absence of enamel and dentinal caries for each proximal surface for film, desktop and laptop displays. Results were compared with the histology of ground sections. ROC curve areas for each display mode and observer were assessed for significant differences with ANOVA. RESULTS: Diagnostic accuracy for proximal surface caries detection was not significantly different for conventional film or desktop monitor and laptop displays for detection of enamel caries (P = 0.9112) or dentin caries (P = 0.2796). CONCLUSIONS: Current laptop active matrix liquid crystal displays provide diagnostic quality for caries detection comparable with conventional film and desktop monitor displays. <154> UI - 99218750 AU - Janhom A AU - van der Stelt PF AU - van Ginkel FC AU - Geraets WG IN - Department of Oral Radiology, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. TI - Effect of noise on the compressibility and diagnostic accuracy for caries detection of digital bitewing radiographs. SO - Dento-Maxillo-Facial Radiology 1999 Jan;28(1):6-12 AB - OBJECTIVES: To determine the effect of noise on the compressibility and the diagnostic accuracy for caries detection of digital bitewing radiographs. METHODS: Bitewing radiographs of patients were obtained with a storage phosphor (Digora, Soredex, Helsinki, Finland) and compressed at different JPEG compression levels (2, 27, 53 and 128). A just noticeable difference study was performed to select a compression level to study the added noise effect. Gaussian noise was added at low, medium, and high levels to both the original and compressed images. Seven observers examined the selected approximal surfaces to identify the caries depth. ROC analysis was performed together with ANOVA at P = 0.05. RESULTS: The compressibility of the images decreased as the noise level increased. ROC analysis revealed no significant difference between the original and compressed images within the same noise level (P > 0.06). With added noise compressed/decompressed images had a higher Az than the corresponding original images. CONCLUSIONS: JPEG compression at level 27 can be used without a significant deterioration in diagnostic accuracy. Compression at this level seemed to reduce the effect of noise to some extent. <155> UI - 99160133 AU - Albandar JM AU - Kingman A IN - National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA. Jasim.Albandar@odont.uib.no TI - Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. SO - Journal of Periodontology 1999 Jan;70(1):30-43 AB - BACKGROUND: The aim of this study was to assess the prevalence and extent of gingival recession, gingival bleeding, and dental calculus in United States adults, using data collected in the third National Health and Nutrition Examination Survey (NHANES III). METHODS: The study group consisted of 9,689 persons 30 to 90 years of age obtained by a stratified, multi-stage probability sampling method in 1988 to 1994. The weighted sample is representative of U.S. adults 30 years or older and represents approximately 105.8 million civilian, non-institutionalized Americans. Gingival recession, gingival bleeding, and dental calculus were assessed at the mesio-buccal and mid-buccal surfaces in 2 randomly selected quadrants, one maxillary and one mandibular. Data analysis accounted for the complex sampling design used. RESULTS: We estimate that 23.8 million persons have one or more tooth surfaces with > or = 3 mm gingival recession; 53.2 million have gingival bleeding; 97.1 million have calculus; and 58.3 million have subgingival calculus; and the corresponding percentages are 22.5%, 50.3%, 91.8%, and 55.1% of persons, respectively. The prevalence, extent, and severity of gingival recession increased with age, as did the prevalence of subgingival calculus and the extent of teeth with calculus and gingival bleeding. Males had significantly more gingival recession, gingival bleeding, subgingival calculus, and more teeth with total calculus than females. Of the 3 race/ethnic groups studied, non-Hispanic blacks had the highest prevalence and extent of gingival recession and dental calculus, whereas Mexican Americans had the highest prevalence and extent of gingival bleeding. Mexican Americans had similar prevalence and extent of gingival recession compared with non-Hispanic whites. Gingival recession was much more prevalent and also more severe at the buccal than the mesial surfaces of teeth. Gingival bleeding also was more prevalent at the buccal than mesial surfaces, whereas calculus was most often present at the mesial than buccal surfaces. CONCLUSIONS: Dental calculus, gingival bleeding, and gingival recession are common in the U.S. adult population. In addition to their unfavorable effect on esthetics and self-esteem, these conditions also are associated with destructive periodontal diseases and root caries. Appropriate measures to prevent or control these conditions are desirable, and this may also be effective in improving the oral health of the U.S. adult population. <156> UI - 99144432 AU - de Jongh AL AU - Entcheva EG AU - Replogle JA AU - Booker RS 3rd AU - Kenknight BH AU - Claydon FJ IN - Department of Biomedical Engineering, University of Memphis, Tennessee 38152-6582, USA. TI - Defibrillation efficacy of different electrode placements in a human thorax model. SO - Pacing & Clinical Electrophysiology 1999 Jan;22(1 Pt 2):152-7 AB - The objective of this study was to measure the defibrillation threshold (DFT) associated with different electrode placements using a three-dimensional anatomically realistic finite element model of the human thorax. Coil electrodes (Endotak DSP, model 125, Guidant/CPI) were placed in the RV apex along the lateral wall (RV), withdrawn 10 mm away from the RV apex along the lateral wall (RVprox), in the RV apex along the anterior septum (RVseptal), and in the SVC. An active pulse generator (can) was placed in the subcutaneous prepectoral space. Five electrode configurations were studied: RV-->SVC, RVprox-->SVC, RVSEPTAL-->SVC, RV-->Can, and RV-->SVC + Can. DFTs are defined as the energy required to produce a potential gradient of at least 5 V/cm in 95% of the ventricular myocardium. DFTs for RV-->SVC, RVprox-->SVC, RVseptal-->SVC, RV-->Can, and RV-->SVC + Can were 10, 16, 7, 9, and 6 J, respectively. The DFTs measured at each configuration fell within one standard deviation of the mean DFTs reported in clinical studies using the Endotak leads. The relative changes in DFT among electrode configurations also compared favorably. This computer model allows measurements of DFT or other defibrillation parameters with several different electrode configurations saving time and cost of clinical studies. <157> UI - 99144441 AU - Zilo P AU - Weiss DN AU - Luceri RM IN - Florida Arrhythmia Consultants, Fort Lauderdale 33308, USA. rluceri@gate.net TI - Late retesting of system performance in ICD patients without spontaneous shocks. SO - Pacing & Clinical Electrophysiology 1999 Jan;22(1 Pt 2):197-201 AB - One hundred five implantable cardioverter defibrillator (ICD) patients (71 +/- 9 years of age, 83% men) without spontaneous ICD discharges for > or = 12 months were tested to assess high voltage (HV) circuit integrity and the system's ability to recognize and terminate ventricular fibrillation (VF). Indications for ICD implantation were sustained ventricular tachycardia (VT) (35%), cardiac arrest (27%), and inducible VT (38%). Eighty-two percent of the patients had coronary artery disease (CAD), and the mean left ventricular ejection fraction (LVEF) was 36% +/- 13%. RESULTS: One hundred patients had inducible VF and five did not. Testing led to ICD reprogramming in 50 (49%) patients. Two (1.9%) patients required ICD replacement: (1) a 45-year-old patient with a Ventritex 110 ICD implanted for 13 months interfaced with a CPI 0062 lead implanted for 46 months could not be defibrillated internally (impedance nonmeasurable); (2) an 82-year-old patient with a 23-month-old Medtronic 7219 ICD interfaced with 6936 and 6933 leads whose defibrillation threshold (DFT) had doubled since implantation (24 J from 12 J). Lead fractures were found in both cases (proximal coil of the 0062, and subcutaneously in the 6933). Based on DFT determinations, the first shock output was programmed lower in 37 patients and higher in 10 patients. Shock pulse width was changed in one patient and the ventricular refractory period in another. No programming changes were made in 54 (51%) patients. CONCLUSIONS: (1) Late testing of HV circuit integrity in ICD patients without an ICD shock in > or = 12 months identifies previously unsuspected HV lead fractures; (2) chronic DFT testing resulted in HV output reprogramming in one-half of the patients. <158> UI - 99156433 AU - Elter JR AU - Beck JD AU - Slade GD AU - Offenbacher S IN - Center for Oral and Systemic Diseases, Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, 27599-7450, USA. TI - Etiologic models for incident periodontal attachment loss in older adults. SO - Journal of Clinical Periodontology 1999 Feb;26(2):113-23 AB - Etiologic factors for incident periodontal attachment loss (ALOSS) have not been conclusively identified. The purpose of this study was to develop etiologic models for ALOSS in older adults. Data on 697 older blacks and whites were obtained from 5 sequential examinations over 7 years in the Piedmont 65+ dental study, a complex random sample of older adults in North Carolina. Multivariable Poisson regression models were fit for average number of ALOSS events per person or site month at risk. In models for whites, molar sites, sites with adjacent caries, sites in persons who had: Porphyromonas gingivalis (P.g.) at least 2% of total microbial count (TMC), never had a dental checkup, more depression symptoms, fewer than 12 years of education, higher BANA score, or smoked, had significantly higher rates of ALOSS. In a separate model for blacks, interproximal and molar sites, sites in blacks who had: P.g. at least 2% of TMC, higher BANA score, never had a dental checkup, lower socioeconomic status (SES), or smoked, had significantly higher rates of ALOSS. These results confirm a multifactorial etiology for ALOSS in older adults and indicate that interventions aimed at infection, smoking, and preventive dental care utilization, may be most useful. <159> UI - 99202134 AU - Milosevic A TI - Eating disorders and the dentist. [Review] [45 refs] SO - British Dental Journal 1999 Feb 13;186(3):109-13 AB - Dentists are likely to encounter patients who have eating disorders. The paper explains the various types and considers both the risk factors, and the psychological and medical complications. The effect on oral health and the principles of dental management are outlined. Dentists have an important part to play in the overall care of these patients. [References: 45] <160> UI - 99179417 AU - Iannello JM IN - Iannello Dental Assoc., P.C., Long Island, USA. TI - Outcomes data made easy. SO - New York State Dental Journal 1999 Jan;65(1):30-1 AB - Dx Index is a quick and easy method for quantifying patients' oral health. A number scale from 1 to 10 provides an easy-to-understand assessment of the dental health status of either an individual or a large group. During routine oral examinations, areas such as decayed teeth, pocket depth, inflammation and oral hygiene are numbered by level. Reading the lowest number on a chart pertaining to these categories gives a rapid overall score of dental health. <161> UI - 99128667 AU - Syme SE AU - Fried JL IN - Department of Dental Hygiene, Baltimore College of Dental Surgery, Dental School, University of Maryland, USA. TI - Maintaining the oral health of splinted teeth. SO - Dental Clinics of North America 1999 Jan;43(1):179-96 AB - The combined and concerted efforts of patients and providers in poststabilization maintenance promote long-term health for the dental splint and its surrounding and supporting soft and hard tissues. Dental splints that are properly placed and contoured enable effective patient self-care and contribute to a positive prognosis. The provider's role in fabrication, placement, and oral hygiene instruction cannot be overemphasized. Professional follow-up concerning periodontal and caries risk assessment, periodontal debridement, and needed preventive interventions are critical to splint longevity. Continued success cannot occur without scrupulous patient self-care. The professional team must provide patients with comprehensive oral care instruction. A host of home care aids are available to assist patients in effective home care practices. With the combination of proficient clinical skill, appropriate dental material selection, good communication, and comprehensive health education, both providers and patients can benefit from esthetic, functional, and healthy dental splints. <162> UI - 99110703 AU - Mejare I AU - Kallest l C AU - Stenlund H IN - Department of Paediatric Dentistry, Eastman Dental Institute, Stockholm, Sweden.ingegerd.mejare@ftv.sll.se TI - Incidence and progression of approximal caries from 11 to 22 years of age in Sweden: A prospective radiographic study. SO - Caries Research 1999;33(2):93-100 AB - Using annual bite-wing radiographs, the incidence and progression of approximal caries (4d-7m) were assessed longitudinally in teenagers and adolescents whose treatment had been based on remineralizing rather than restorative strategies. A closed cohort of 536 children initially was followed from 11 to 22 years of age. The scoring system was: 0 = no visible radiolucency; 1-2 = radiolucency in the enamel up to the enamel-dentin border; 3 = radiolucency with a broken enamel-dentin border but with no obvious progression in the dentin; 4 = radiolucency with obvious spread in the outer half of the dentin, and 5 = radiolucency in the inner half of the dentin. Caries rates were estimated as the number of new lesions/100 tooth surface-years, and the Kaplan-Meier estimate was used to calculate the cumulative survival time of each approximal surface. Three events were used: the transitions from states 0 to 2, 2 to 4 and 3 to 4. The results showed a considerable variation between the surfaces in both caries rates and survival time. For all surfaces combined, the median caries rate from state 0 to 2 was 3.9 new lesions/100 tooth surface-years; from state 2 to 4, the rate was 5.4, and from state 3 to 4 it was 20.3. Of the sound surfaces (state 0), 75% survived 6.3 years without reaching state 2. Given state 2, 75% survived 4.8 years without reaching the outer half of the dentin (state 4), while given a lesion at the enamel-dentin border (state 3), 75% survived 1.3 years without doing the same. The median survival time of lesions from state 3 to 4 was 3.1 years. The group with DMFSappr>1 at the age of 11-12 years had a risk of new approximal enamel lesions (state 0-2) that was 2.5 times greater than that of the group with DMFSappr = 0-1. <163> UI - 99131704 AU - Windecker S AU - Ideker RE AU - Plumb VJ AU - Kay GN AU - Walcott GP AU - Epstein AE IN - Department of Medicine, The University of Alabama at Birmingham, 35294, USA. TI - The influence of ventricular fibrillation duration on defibrillation efficacy using biphasic waveforms in humans. SO - Journal of the American College of Cardiology 1999 Jan;33(1):33-8 AB - OBJECTIVES: The purpose of this study was to prospectively investigate the influence of ventricular fibrillation (VF) durations of 5, 10 and 20 s on the defibrillation threshold (DFT) during implantable cardioverter-defibrillator (ICD) implantation. BACKGROUND: Although the DFT using monophasic waveforms has been shown to increase with VF duration in humans, the effect of VF duration on defibrillation efficacy using biphasic waveforms in humans is not known. METHODS: Thirty patients undergoing primary ICD implantation or pulse generator replacement were randomly assigned to have the DFT determined using biphasic shocks at two durations of VF each (5 and 10 s, 10 and 20 s or 5 and 20 s). RESULTS: There was no statistically significant difference in the mean DFT comparing VF durations of 5 s (9.5+/-6.0 J) and 10 s (10.8+/-7.0 J) (p=0.4). The mean DFT significantly increased from 10.9+/-6.1 J at 10 s of VF to 12.6+/-5.6 J (p=0.03) at 20 s of VF, and from 7.0+/-3.5 J at 5 s of VF to 10.5+/-6.3 J (p=0.04) at 20 s of VF. An increase in the DFT was observed in 14 patients as VF duration increased. There were no clinical characteristics that differentiated patients with and without an increase in the DFT. CONCLUSIONS: Defibrillation efficacy decreases with increasing VF duration using biphasic waveforms in humans. Ventricular fibrillation durations greater than 10 s may negatively affect the effectiveness of ICD therapy. <164> UI - 99117676 AU - Krall EA AU - Garvey AJ AU - Garcia RI IN - VA Outpatient Clinic, Boston, USA. TI - Alveolar bone loss and tooth loss in male cigar and pipe smokers. SO - Journal of the American Dental Association 1999 Jan;130(1):57-64 AB - BACKGROUND: While cigarette smoking is recognized as being detrimental to oral health, the effects of cigar and pipe smoking on tooth-loss risk, alveolar bone loss and periodontal disease are not known. The authors conducted this study to determine whether cigar and pipe smokers were at greater risk of experiencing tooth loss and alveolar bone loss than were nonsmokers. METHODS: The authors studied 690 dentate men who participate in the Veterans Affairs Dental Longitudinal Study. Subjects are not VA patients, and they receive medical and dental care in the private sector. A board-certified periodontist conducted clinical examinations triennially for 23 years. These examinations included the number of teeth remaining, number of decayed and filled surfaces per tooth, and indicator scores for plaque, calculus, pocket probing depth, gingival bleeding and tooth mobility. Alveolar bone loss was assessed at each examination on intraoral periapical radiographs using the Schei ruler method, which measures loss of bone height in 20 percent increments. Multivariate analyses of tooth-loss rates and alveolar bone loss controlled for demographic and oral hygiene measures. RESULTS: The relative risk, or RR, of tooth loss compared with that of nonsmokers was significantly elevated in cigar smokers (RR = 1.3, 95 percent confidence interval, or CI, = 1.2, 1.5), pipe smokers (RR = 1.6, 95 percent CI = 1.4, 1.9) and cigarette smokers (RR = 1.6, 95 percent CI = 1.5, 1.7). The percentages of mesial and distal sites with moderate-to-severe progression of alveolar bone loss (a change of 40 percent or more from baseline) were 8 +/- 1 percent (mean +/- standard error) in nonsmokers, 16 +/- 3 percent in cigar smokers (P < .05), 13 +/- 4 percent in pipe smokers (P = .17), and 16 +/- 3 percent in cigarette smokers (P < .001). Pipe and cigar smokers did not differ significantly from nonsmokers with respect to the percentage of sites at baseline with moderate-to-severe scores for calculus, pocket probing depth, gingival bleeding or tooth mobility. Pipe smokers had fewer sites with moderate-to-severe plaque accumulation than did nonsmokers (7 +/- 11 vs. 13 +/- 17, P < .05). CONCLUSIONS: The authors found that men who smoke cigars or pipes were at increased risk of experiencing tooth loss. Cigar smokers also were at increased risk of experiencing alveolar bone loss. These elevations in risk are similar in magnitude to those observed in cigarette smokers. CLINICAL IMPLICATIONS: The increases in risk related to cigar and pipe smoking provide a strong rationale for targeting smoking prevention and smoking cessation programs to smokers of all tobacco products. <165> UI - 99051262 AU - Verdonschot EH AU - Angmar-Mansson B AU - ten Bosch JJ AU - Deery CH AU - Huysmans MC AU - Pitts NB AU - Waller E IN - Department of Cariology and Endodontology, College of Dental Science, Medical Faculty, University of Nijmegen, The Netherlands. e.verdonschot@dent.kun.nl TI - Developments in caries diagnosis and their relationship to treatment decisions and quality of care. ORCA Saturday Afternoon Symposium 1997. SO - Caries Research 1999;33(1):32-40 AB - This symposium report evaluates the achievements made in caries diagnostic research since the previous symposium held in 1992. The symposium aimed at presenting the state of the art of caries diagnostic methods, on presenting the links between caries diagnosis and subsequent treatment decisions and their effect on the treatment outcomes, particularly the quality of dental care. The variation among dentists in diagnosing (small) caries lesions and in treatment decision making is considerable. This has been explained by the imperfection of caries decision making tests, but also by making incorrect treatment decisions due to incorrect or partial understanding of diagnostic test parameters. Meta-analyses into the performance of caries diagnostic tests revealed that the available quantitative methods are very promising. It was concluded that these methods had high correlations with lesion depth. They were considered suitable to monitor small changes in lesions. Many obstacles have been experienced in attempting to transfer the outcomes of diagnostic research into clinical practice and it was concluded that caries diagnosis researchers should co-operate with manufacturers to introducing valid new diagnostic tools to the market. Main research priorities for the coming 10 years are to conduct cost-effectiveness and cost-utility studies of caries diagnostic tools, to continue to review the performances of diagnostic tests, to transfer diagnostic knowledge and experience to the general practitioners particularly by constructing evidence-based clinical guide-lines, to study the relationship between diagnosis and treatment decision, and to assess the effect of diagnostic and treatment decisions on the outcome of care. <166> UI - 99051260 AU - Caplan DJ AU - Slade GD AU - Biesbrock AR AU - Bartizek RD AU - McClanahan SF AU - Beck JD IN - Department of Dental Ecology, University of North Carolina and Chapel Hill, N.C. 27599-7450, USA; The Procter & Gamble Company, Mason, Ohio, USA. dan:caplan@unc.edu TI - A comparison of increment and incidence density analyses in evaluating the anticaries effects of two dentifrices. SO - Caries Research 1999;33(1):16-22 AB - This study aimed to determine whether incidence density (ID) calculations of caries incidence rates would provide a more sensitive means of detecting caries-preventive effects than would traditional techniques. A secondary analysis was conducted using data from a 1981 study in which three dentifrices were compared in a double-blind randomized clinical trial. Subjects were examined at baseline and 1, 2 and 3 years after baseline. Three-year DMFS increments were calculated for 1,754 subjects attending the baseline and 3-year examinations. Caries ID rates then were calculated for 2, 661 subjects who had at least two examinations, using each surface's net increment (-1, 0 or +1) as the numerator and the surface's time at risk as the denominator. Despite theoretical advantages, the ID method did not alter the conclusions drawn using DMFS increments, apparently because (a) subjects lost to follow-up were similar to those completing the study, and (b) loss to follow-up was similar among treatment groups. <167> UI - 20019859 AU - Haidekker MA AU - Andresen R AU - Werner HJ IN - MeVis, Center for Medical Diagnostic Systems and Visualization, University of Bremen, Bremen. TI - Relationship between structural parameters, bone mineral density and fracture load in lumbar vertebrae, based on high-resolution computed tomography, quantitative computed tomography and compression tests. SO - Osteoporosis International 1999;9(5):433-40 AB - Different noninvasive techniques for the assessment of the individual fracture risk in osteoporosis are introduced, and the relation between structural properties of high-resolution computed tomography (HR-CT) images of vertebral bodies, their bone mineral density (BMD) and the fracture load is analyzed. In 24 unfractured lumbar vertebrae with different degrees of demineralization from six specimens, the trabecular and cortical BMD was determined using quantitative CT. A lateral X-ray image revealed the number of fractures in the entire spine. A structural analysis of spongy and cortical bone was performed based on the HR-CT images. In the spongiosa, the fractal dimension was calculated as a function of the threshold value. In the cortical shell, the maximum number of clusters of low BMD was determined at varying threshold values. After the CT measurements the vertebrae were excised and compressed until fractured. On the basis of the spongiosa BMD and the number of fractures, 3 cases were found to be severely osteoporotic; the other 3 cases showed osteopenia. The average fracture loads were determined as 3533 N for the non-osteoporotic cases (range 2602-5802 N) and 1725 N for the osteoporotic cases (range 1311-2490 N). The parameters were determined as follows: average spongiosa BMD 115.2 mg/ml (101.8-135.3 mg/ml) for the non-osteoporotic cases, 46.2 mg/ml (34.8-57.6 mg/ml) for the osteoporotic cases; average cortical BMD 285.1 mg/ml (216.4-361.9 mg/ml) for the non-osteoporotic cases, 136. 1 mg/ml (142.5-215.2 mg/ml) for the osteoporotic cases; spongiosa structure: average 0.5 (range 0.32-0.75) for the non-osteoporotic cases, average 1.05 (range 0.87-1.24) for the osteoporotic cases; cortical structure: average 81 (range 55-104) for the non-osteoporotic cases), average 136 (range 102-159) for the osteoporotic cases. Single parameters (BMD and structure) and weighted sums of these parameters were correlated with the fracture load, resulting in correlation coefficients of r(sBMD) = 0.82 (spongiosa BMD), r(cBMD) = 0.82 (cortical BMD), r(sStr) = -0.75 (spongiosa structure) and r(cStr) = -0.86 (cortical structure). The weighted sum of cortical and spongiosa BMD resulted in r(BMD) = 0.86, of cortical and spongiosa structure in r(Str) = -0.86. A weighted combination of all four parameters correlates with the fracture load at r(4) = 0.89, all correlations being statistically significant (p<0.0001). The four individual parameters show only a slight overlap between non-osteoporotic and osteoporotic subjects. The high correlation of the cortical BMD and the structural parameter in cortical bone indicates the important contribution of the cortical shell to vertebral stability. A weighted sum of multiple parameters results in a higher correlation with the fracture load and does not show an overlap between the two groups. It is best suited to estimate the individual fracture risk. The presented methods are generally applicable in vivo; and allow an improvement of the diagnosis of osteoporosis compared with the measurement of the BMD alone. <168> UI - 99449854 AU - Pajukoski H AU - Meurman JH AU - Snellman-Grohn S AU - Sulkava R IN - Institute of Dentistry, University of Helsinki, Finland. TI - Oral health in hospitalized and nonhospitalized community-dwelling elderly patients. SO - Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics 1999 Oct;88(4):437-43 AB - OBJECTIVE: The purpose of this study was to compare hospitalized and nonhospitalized home-dwelling elderly patients in a single community with respect to oral health and general health and to study risk factors for edentulousness in these patients. The study hypothesis was that hospitalized elderly patients would have poorer oral health than nonhospitalized elderly patients. STUDY DESIGN: Oral health status was examined according to the World Health Organization's guidelines for 181 hospitalized patients (mean age, 81.9 +/- 5.8 years) in a geriatric ward and for 254 home-living patients (mean age, 76.9 +/- 5.6 years). Data regarding the patients diseases and medications came from hospital records and doctors prescriptions and were categorized on the basis of the International Classification of Diseases. Differences between the hospitalized and nonhospitalized patients, between genders, between age groups, and between the various disease and medication groups were analyzed. Logistic regression was used to analyze the effects of study variables on edentulousness. RESULTS: The mean number of teeth was 10. 3 +/- 7.6 in the hospitalized patients and 16.3 +/- 7.4 in the nonhospitalized patients (P <.001). The mean number of decayed teeth was 1.3 +/- 2.2 in the hospitalized patients and 0.6 +/- 0.9 in the nonhospitalized patients (P <.01). All dentate patients had poor periodontal health. Community Periodontal Index scores were between 2 and 4 in 94.8% of the hospitalized patients and 98.6% of the nonhospitalized patients. Edentulousness was observed in 66.3% of the hospitalized patients and 42.1% of the nonhospitalized patients (P <.001). In both groups, female gender (odds ratio, 2.0; CI, 1.3-3. 1) and age between 80 and 89 years (odds ratio, 2.5; CI, 1.5-4.4) were the strongest risk factors for edentulousness. The number of drugs used daily also correlated significantly with the loss of teeth (P <.05). In the nonhospitalized patients, edentulousness correlated significantly with cardiovascular diseases and drugs taken daily (P <.01), whereas in the hospitalized patients such an association was not found. CONCLUSIONS: The results of this study confirmed our hypothesis that hospitalized elderly patients who had many concomitant diseases and used many drugs daily had worse dental health than nonhospitalized home-dwelling elderly patients. The nature of a patient's illness was not a significant factor in this respect. Female gender and age between 80 and 89 years were the strongest factors for edentulousness in both patient groups. <169> UI - 20002312 AU - Hintze H AU - Wenzel A AU - Danielsen B IN - Department of Oral Radiology, Royal Dental College, Faculty of Health Sciences, University of Aarhus, Denmark. hhintze@odont.aau.dk TI - Behaviour of approximal carious lesions assessed by clinical examination after tooth separation and radiography: a 2.5-year longitudinal study in young adults. SO - Caries Research 1999 Nov-Dec;33(6):415-22 AB - This study aimed to record and monitor over a 2.5-year period the occurrence of cavitation and lesion depth progression in approximal surfaces with radiographic caries at baseline. In total, 66 approximal sites (in 29 students), where at least one of the contacting surfaces had radiographic caries, were selected to take part in the study. A clinical examination undertaken before and after tooth separation in order to assess the presence/absence of cavitation was repeated every sixth month. To monitor lesion progression bite-wing radiographs were taken every sixth month, too. After each series of examinations, surfaces judged to be prone for disease progression were referred to operative caries treatment. In surfaces with radiographic dentinal caries at baseline the cavitation prevalence following tooth separation found at the various recall examinations ranged from 20 to 44%. In surfaces with radiographic enamel caries at baseline this prevalence ranged from 4 to 8% at the various recall examinations. In dentinal lesions found with an intact surface at baseline, the risk of cavitation development during the first 1.5-year period was assessed to be up to 22%. After this period no new cavitations were found in previously intact dentinal lesions. In intact enamel lesions the risk of cavitation formation was found to be 3% during the first 1-year period. After this period no new cavitations developed in previously intact enamel lesions. Three of 7 lesions, which showed radiographic caries progression from the outer one third to the inner two thirds of the dentine during the observation period, had intact surfaces at baseline. On the basis of these results it is recommended to re-examine carefully intact, dentinal lesions by repeated clinical examination after tooth separation and by radiography about 1-1.5 years after baseline. <170> UI - 99419915 AU - Horwitz EM AU - Hanlon AL AU - Pinover WH AU - Hanks GE IN - Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA. EM:Horwitz@fccc.edu TI - Is there a role for short-term hormone use in the treatment of nonmetastatic prostate cancer?. SO - Radiation Oncology Investigations 1999;7(4):249-59 AB - We reviewed our institution's experience treating patients with prostate cancer with 3-dimensional conformal radiation therapy (3DCRT) and short-term adjuvant hormonal therapy to determine biochemical no evidence of disease (bNED) and clinical outcome compared with patients treated with 3DCRT alone. Between 4/1/89 and 11/30/94, 558 patients with clinically localized prostate cancer received treatment at Fox Chase Cancer Center (Philadelphia, Pa.); 484 patients were treated with 3DCRT alone (Group I); 74 patients were treated with 3DCRT and hormones (Group II). Five-year actuarial rates of bNED control, distant metastasis-free survival (DMFS), cause-specific survival (CSS), and overall survival (OS) were calculated for pretreatment PSA, Gleason score, T stage, use of hormones, treatment field size, age, and dose. A matched case/control analysis was performed to further evaluate the effect of hormones on treatment with 3DCRT. Median follow-up was 47 months (range: 2-97 months). The 5-year actuarial rates of bNED control, DMFS, CSS, and OS were 66%, 93%, 98%, and 86%, respectively, for Group I patients and 68%, 93%, 98%, and 89%, respectively, for Group II patients. Multivariate analysis demonstrated that hormone use was an independent predictor of bNED control only. A significant difference in bNED control was observed between Group I and II (43% vs. 71%) using the matched case/control analysis (P = 0.02). A trend towards significance was observed for different rates of DMFS between Group I and II (79% vs. 94%, P = 0.09). Patients with clinically localized prostate cancer with poor prognostic features (pretreatment PSA > or = 10 ng/ml, Gleason score > or = 7, and/or T2c or greater palpation stage) show improved rates of bNED control and a trend towards improved DMFS when treated with 3DCRT and short-term adjuvant hormones compared with 3DCRT alone. Long-term observation will be necessary to see if improvements in bNED control will translate into improvements in overall survival. <171> UI - 20004889 AU - Benson PE AU - Pender N AU - Higham SM IN - Department of Clinical Dental Sciences, University of Liverpool, UK. p.benson@liverpool.ac.uk TI - An in situ caries model to study demineralisation during fixed orthodontics. SO - Clinical Orthodontics & Research 1999 Aug;2(3):143-53 AB - OBJECTIVES: To investigate de/remineralization of enamel during the early stages of orthodontic treatment using the in situ caries model. DESIGN: A prospective, longitudinal study, using the in situ caries model. SETTING AND SAMPLE POPULATION: The Department of Orthodontics at the University of Liverpool School of Dentistry. Fifteen orthodontic patients undergoing fixed appliance treatment with extraction of premolar teeth. EXPERIMENTAL VARIABLE: Two enamel samples with pre-formed caries-like lesions were placed bilaterally, in specially constructed holders, on an orthodontic fixed appliance. One sample was bonded with a small bracket base. OUTCOME MEASURE: The parameters of the pre-formed carious lesion, expressed as mineral loss (delta Z), lesion depth (ld), lesion width (lw) and ratio (delta Z/ld) were compared between the bracketed, the non-bracketed and a control sample that had not been placed in the mouth. The difference between brackets place on the dominant (toothbrush hand) side and non-dominant side were also investigated. The correlation between mineral loss and length of time the sample was in the mouth was also analysed. RESULTS: There was considerable individual variation; however, a one-factor repeated analysis of variance showed a significant difference in ratio values between the three groups (p = 0.006). A pairwise comparison showed a significant reduction in ratio value for the non-bracketed sample compared with the control, but not the bracketed sample. There was no significant difference in mineral loss between the dominant and non-dominant sides. There was no linear correlation between the length of time the sample was in the mouth. CONCLUSION: An enamel sample with a pre-formed carious lesion, when placed in the mouth of an orthodontic patient, showed reduced remineralization in the presence of a simulated orthodontic bracket. Consistently effective preventive regimes to prevent demineralization in patients with fixed orthodontic appliances need to be developed. The technique described will be a valuable tool in this process. <172> UI - 99431123 AU - Gilbert GH AU - Miller MK AU - Duncan RP AU - Ringelberg ML AU - Dolan TA AU - Foerster U IN - Department of Oral & Maxillofacial Surgery & Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville 32610-0416, USA. gilbert@nersp.nerdc.ufl.edu TI - Tooth-specific and person-level predictors of 24-month tooth loss among older adults. SO - Community Dentistry & Oral Epidemiology 1999 Oct;27(5):372-85 AB - OBJECTIVES: To describe: (1) the 24-month incidence of tooth loss in a diverse sample of dentate adults; and (2) the clinical, attitudinal, behavioral, and sociodemographic correlates of tooth loss incidence. METHODS: The Florida Dental Care Study is a prospective longitudinal cohort study of persons who at baseline had at least one tooth, were 45 years or older, and who resided in north Florida. An in-person interview and clinical examination were conducted at baseline and 24-months after baseline, with 6-monthly telephone interviews between those times. A two-level hierarchical generalized linear regression (logit model) was used to quantify tooth-specific and person-level factors simultaneously. RESULTS: Of the 739 persons who attended for a 24-month examination, 24% lost one or more teeth during follow-up. Tooth loss was more common in persons with dental disease at baseline, incident dental signs or symptoms, those with negative attitudes toward dental care and dental health, those with limited financial resources, older adults, blacks, females, and problem-oriented users of dental care (as distinct from regular attenders). Although disease presence at baseline was a major factor associated with incident tooth loss, most diseased teeth were in fact still present 24 months after baseline. CONCLUSIONS: Other than periodontal attachment loss, severe tooth mobility, and dental caries, no single factor was a dominant predictor of tooth loss; instead, numerous factors made statistically significant but small contributions to variation in tooth loss. Tooth loss apparently is the result of complex interactions among dental disease, incident dental signs and symptoms, tendency to use dental care in response to specific dental problems, dental attitudes, and ability to afford non-extraction treatment alternatives. <173> UI - 20020814 AU - Clarkson BH IN - School of Dentistry, University of Michigan, Ann Arbor, USA. briclar@umich.edu TI - Introduction to cariology. SO - Dental Clinics of North America 1999 Oct;43(4):569-78, v AB - This article examines the discipline of cariology. A brief history is presented, and an overview of the origin and management of caries is discussed. This article frames the picture that the other authors in this issue paint. <174> UI - 20020819 AU - Stookey GK AU - Jackson RD AU - Zandona AG AU - Analoui M IN - Indiana University School of Dentistry, Oral Health Research Institute, Indianapolis, USA. TI - Dental caries diagnosis. [Review] [77 refs] SO - Dental Clinics of North America 1999 Oct;43(4):665-77, vi AB - As with any disease process, the early initiation of therapy for dental caries is often the most effective means to ensure resolution. However, for any therapy to be effective, early diagnosis is paramount to success. Unfortunately, current tools used in dental caries detection are not sensitive enough to diagnose the disease process in its early stages and, frequently, once a diagnosis is made restoration is the only effective means of treatment. Quantitative light-induced fluorescence, electrical conductance measurements, direct digital radiography, and direct fiber optic transillumination are methods that may offer promise as effective tools in diagnosing early dental caries. This article describes some of the research that has been performed to make these methods a reality. [References: 77] <175> UI - 20020823 AU - Kidd EA IN - Division of Conservative Dentistry, Dental School of Guy's and King's and St Thomas' Hospital, London, England. TI - Caries management. [Review] [55 refs] SO - Dental Clinics of North America 1999 Oct;43(4):743-64 AB - This article has attempted to gather up the evidence presented in the rest of this issue to give dentists a practical overview of the management of the carious process. The major points are that a caries risk assessment is not only logical, it is achievable; management of caries is by preventive treatment, but operative dentistry has a role to play; in the final analysis, it is the patient who manages caries. [References: 55] <176> UI - 99435298 AU - Sloan AJ AU - Matthews JB AU - Smith AJ IN - Unit of Oral Biology, School of Dentistry, University of Birmingham, UK. TI - TGF-beta receptor expression in human odontoblasts and pulpal cells. SO - Histochemical Journal 1999 Aug;31(8):565-9 AB - Transforming growth factor-beta (TGF-beta) isoform expression by odontoblasts leads to their sequestration within the dentine matrix, from where they may be released during caries and participate in the reparative processes. Two receptor types for TGF-beta have been implicated in TGF-beta induced signalling. The aim of this study was to characterise immunohistochemically the expression of these receptors in sound and carious human teeth to facilitate our understanding of the ability of these cells to respond to TGF-beta stimulation. Sound and carious human teeth were routinely processed and paraffin sections stained for TGF-beta receptors I and II, using the StrAviGen immunoperoxidase method. Strong specific staining for both receptor types was observed in the odontoblasts of healthy teeth with the greatest intensity seen with receptor I. Staining of weaker intensity was also observed for both receptors in the underlying cell rich area and pulp core. Similar patterns of staining were observed within carious tissues. We conclude that odontoblasts and other cells of the pulp of mature human molar teeth show the presence of both TGF-beta receptors I and II in health and disease with odontoblasts showing the strongest expression. Such findings may be important in the response of these cells to tissue injury. <177> UI - 99456240 AU - Keltjens HM AU - Creugers TJ AU - van't Hof MA AU - Creugers NH IN - Department of Occlusal Reconstruction and Oral Function, College of Dental Science, Faculty of Medical Sciences, University of Nijmegen, The Netherlands. secr:of@dent.kun.nl TI - A 4-year clinical study on amalgam, resin composite and resin-modified glass ionomer cement restorations in overdenture abutments. SO - Journal of Dentistry 1999 Nov;27(8):551-5 AB - OBJECTIVE: To assess the performance of three different filling materials in overdenture abutment teeth. METHODS: In 49 patients amalgam, resin composite and resin-modified glass ionomer cement were used to seal the root canal orifices of 155 overdenture abutment teeth. After initial preparation of the cavities, the three restorative materials were randomly assigned to the abutment teeth using a number of balancing criteria. All patients were reviewed every six months and received the same preventive regimen. Survival was assessed at two levels: Sorig (survival of the restoration independent from eventual maintenance treatments) and Scomp (restorations survived even without maintenance treatments). RESULTS: The calculated overall survival percentage of the original restorations (Sorig) after four years was 63 +/- 6% (mean +/- SE). Calculation for the overall complete survival (Scomp) revealed a percentage survival of 57 +/- 6%. At both levels, the differences between the survivals of the investigated materials were not statistically significant (p-values > 0.05). Two abutments were lost, severe caries was the reason for one extraction and another abutment tooth was extracted for periodontal reasons. CONCLUSIONS: The results of this study did not point out a superior restorative material for the seal of root canal orifices of overdenture abutments. The distribution of failures over the patients indicates a certain patient dependency. <178> UI - 99456297 AU - Cantor SB AU - Sun CC AU - Tortolero-Luna G AU - Richards-Kortum R AU - Follen M IN - Department of Internal Medicine Specialties, The University of Texas M.D. Anderson Cancer Center, Houston 77030-4095, USA. TI - A comparison of C/B ratios from studies using receiver operating characteristic curve analysis. SO - Journal of Clinical Epidemiology 1999 Sep;52(9):885-92 AB - In receiver operating characteristic (ROC) curve analysis, the optimal cutoff value for a diagnostic test can be found on the ROC curve where the slope of the curve is equal to (C/B) x (1-p[D])/p[D], where p[D] is the disease prevalence and C/B is the ratio of net costs of treating nondiseased individuals to net benefits of treating diseased individuals. We conducted a structured review of the medical literature to examine C/B ratios found in ROC curve analysis. Only two studies were found in which a C/B ratio was explicitly calculated; in another 11 studies, a C/B ratio was based on a so-called holistic estimate, an all-encompassing educated estimate of the relative costs and benefits relevant to the clinical situation. The C/B ratios ranged from 0.0025 (tuberculosis screening) to 2.7 (teeth restoration for carious lesions). Clinical scenarios that are directly life threatening but curable had C/B ratios of less than 0.05. This analysis led us to construct a table of ordered C/B ratios that may be used by investigators to approximate C/B ratios for other clinical situations in order to establish cutpoints for new diagnostic tests. <179> UI - 99448216 AU - Bouabdallah R AU - Lefrere F AU - Rose C AU - Chaibi P AU - Harousseau JL AU - Vernant JP AU - Castaigne S AU - Bauduer F AU - Zini JM AU - Coso D AU - Varet B AU - Robert J AU - Fenaux P IN - Department of Hematology of Institut J Paoli-I Calmettes-Universite de la Mediterranee, Marseille, France. TI - A phase II trial of induction and consolidation therapy of acute myeloid leukemia with weekly oral idarubicin alone in poor risk elderly patients. SO - Leukemia 1999 Oct;13(10):1491-6 AB - We have conducted a phase II outpatient trial testing weekly oral administration of idarubicin (ZAVEDOS-ZVD) alone to determine the rate of objective response and toxicity in poor risk acute myeloid leukemia (AML) patients over 60 years of age. The treatment consisted of three phases: induction, with 20 mg/m2 of ZVD on days 1, 8, 15 and 22; consolidation with 20 mg/m2 of ZVD for 4 weeks; and maintenance with six cycles lasting 3 months and consisting of oral 6 mercapto-purine 2 mg/kg/day, 4 days a week for 2 months; subcutaneous cytarabine 1 mg/kg, once a week for 2 months; and oral ZVD 20 mg/m2 on day 1 and day 8 of the third month. In case of failure after induction course, patients received salvage treatment with 4 weekly oral doses of 40 mg/m2 ZVD. Fifty-one patients with a median age of 76 years were enrolled and could receive induction course. Of these 51 patients, 37 could receive subsequent courses, which consisted either of consolidation, or salvage. Only 11 patients underwent maintenance treatment. Sixty-three percent of patients had to be hospitalized during induction, for a median duration of 14.5 days, and 87% required hospitalization during salvage for a median duration of 17.5 days. Only five patients (38%) required hospitalization during consolidation. There were three toxic deaths (6%), two from hemorrhage and one from pulmonary embolism. The overall response rate was 29%, with 12 patients in complete response (25%) and two in partial response (4%). The median overall survival rate is 4 months for the whole population, and the median DFS is 9.6 months among the 14 responding patients. The results of this trial show that this new weekly schedule of oral ZVD chemotherapy is feasible and effective in poor risk elderly patients with AML. This regimen may be helpful for patients unable to tolerate intensive intravenous regimens, and is a real alternative to palliative treatments. <180> UI - 99448351 AU - Frencken JE AU - Sithole WD IN - Department of Preventive and Community Dentistry, University of Nijmegen, The Netherlands. TI - National oral health survey Zimbabwe 1995: quality of restorations. SO - SADJ 1998 Sep;53(8):435-8 AB - In 1995, a second national oral health survey was carried out, ten years after the first. Application of a multi-stage sampling procedure resulted in 3709 persons being examined. The restorations were assessed using the criteria described by Kroeze et al (1990). Only ditches on the tooth/restoration margins that were wider than 0.4 mm were considered to be carious. The background variables studied were age, gender, type of location, socioeconomic status (SES) and level of education. The prevalence of restorations in all persons examined was 3.4 per cent. Restorations were found much more often among urban (95.5 per cent) than rural people (4.5 per cent) and also among those living in high (75 per cent) compared to low SES suburbs (25 per cent). Amalgam was more often used (89 per cent) than composite resin (10 per cent). The most frequently observed type of restoration was Class I (45 per cent) followed by Class II (39 per cent) and Class III (7 per cent). The prevalence of satisfactory restorations was 83.9 per cent. Failures were due to 'fractured restorations' (6.3 per cent), 'caries at the margin' and 'breakdown of restoration margin', both 4 per cent. Amongst adults, multiple-surface amalgam restorations failed more often than single-surface ones. It is concluded that the prevalence of restorations found was very low. There is a need to extend the provision of preventive and restorative oral health care by a more equitable distribution of oral health personnel and by making more finance available to rural and low-SES suburban areas. <181> UI - 99407419 AU - Kidd EA IN - Medical School, Guy's Hospital, King's College, University of London. TI - Assessment of caries risk. [Review] [30 refs] SO - Dental Update 1998 Nov;25(9):385-90 AB - This paper examines the importance of caries risk assessment, identifies relevant risk factors, including clinical evidence, which has been considered to be the best predictor of caries risk. [References: 30] <182> UI - 99300389 AU - Kukleva M AU - Kondeva V IN - Department of Pediatric Dentistry, Faculty of Dentistry, Higher Medical Institute, Plovdiv, Bulgaria. TI - A study on the prevalence of caries incipiens in 7-, 12- and 14-year-old children from Plovdiv. SO - Folia Medica (Plovdiv) 1998;40(4):54-9 AB - INTRODUCTION: The decline in dental caries prevalence in many countries of the world in the last decades requires the adoption of new approaches towards determination of prevention strategies. The individuals and groups at high risk of developing caries should be differentiated from the rest of the population with the aim of carrying out selective prevention. Of particular interest is the determination of the risk of developing caries before it is clinically manifested as this would allow execution of a timely and adequate prevention. The aim of the present study was to determine the prevalence of caries incipiens on the teeth and on the dental surfaces in 7-, 12- and 14-year-old children and to compare it with the prevalence of clinical caries in the same population groups. METHODS: The study is representative by design and compares 600 children aged 7, 12 and 14 years from Plovdiv. The study is designed and carried out in compliance with the guidelines of WHO for conducting clinico-statistical study of dental caries. The diagnostic procedure of caries incipiens is visual-tactile. The test of vital staining with 2% water solution of Methylene Blau was also used. RESULTS: Caries incipiens prevalence was found to be higher than that of clinical caries in 7-year-old children (P < 0.001). In 12- and 14-year-old children the ratio of caries incipiens to clinical caries shifts in favour of clinical caries (P < 0.001). CONCLUSIONS: The higher prevalence of caries incipiens compared to clinical caries in 7-year-old children (P < 0.001) justifies its more extensive investigation as a predictive factor for developing caries in the 7-12 years age range groups. <183> UI - 99285029 AU - Boyd LD AU - Dwyer JT IN - Department of Periodontology, Oregon Health Sciences University School of Dentistry, Portland, USA. TI - Guidelines for nutrition screening, assessment, and intervention in the dental office. SO - Journal of Dental Hygiene 1998 Fall;72(4):31-43 AB - Patients with complicated disease and medication histories are being seen with increasing frequency in the dental office. Many are at high nutritional risk, which can impact their oral health status. Nutrition is an integral part of health promotion and prevention, but it often is a poorly utilized component of preventive dentistry. This article provides the dental hygienist with a systematic approach to determining which patients are in need of nutrition intervention, and discusses screening, assessment, counseling, and referral. Dental hygienists, as part of a multidisciplinary healthcare team, are in an ideal position to identify patients at nutritional and oral health risk, help them attain optimal oral and general health, and improve overall quality of life. <184> UI - 99251378 AU - Chim CS AU - Kwong YL AU - Lie AK AU - Lee CK AU - Liang R IN - Department of Medicine, Queen Mary Hospital, University of Hong Kong. jcschim@hkucc.hku.h TI - CEOP treatment results and validity of the International Prognostic Index in Chinese patients with aggressive non-Hodgkin's lymphoma. SO - Hematological Oncology 1998 Sep;16(3):117-23 AB - From 1991 to 1997, we have treated 78 newly diagnosed patients with aggressive non-Hodgkin's lymphoma with a modified CHOP regimen in which epirubicin (60 mg/m2) was used in place of doxorubicin (50 mg/m2), i.e. CEOP (cyclophosphamide, epirubicin, vincristine and prednisolone). The median age was 41 years (range: 17 to 67). Sixty-four (82 per cent) had diffuse large cell (Working Formulation category G) histology. The median LDH level was 453 u/l. Thirty-three (42.3 per cent) and 45 (57.7 per cent) had stage I/II and stage III/IV disease, respectively. Fifty-five of 78 (71 per cent) CEOP-treated patients achieved CR, and the projected DFS and OS were both 65 per cent. In an earlier cohort of patients (from 1985-1991) treated with second or third-generation chemotherapy regimens (m-BACOD, MACOP-B, ProMACE-CytaBOM), CR was achieved in 95/123 (77 per cent) patients and the projected DFS and OS were 62 per cent and 55 per cent. There was no significant difference in the clinical characteristics, CR rates (p = 0.26), DFS (p = 0.38) or OS (p = 0.68) between patients who received CEOP or second/third-generation chemotherapy regimens. Of the patients treated with CEOP, 37.9 per cent, 28.8 per cent, 24.2 per cent and 9.1 per cent were in the age-adjusted International Index L, LI, HI and H risk groups, with CR rates of 82 per cent and 57 per cent in the L/LI and HI/H risk groups (p = 0.03). Moreover, patients in the L, LI and HI/H risk groups had significantly different projected DFS (87 per cent, 62 per cent and 39 per cent, p = 0.02) and OS (85 per cent, 80 per cent and 36 per cent, p = 0.006). In conclusion, CEOP is an effective regimen and the age-adjusted International Index is valid for Chinese patients with aggressive NHL. <185> UI - 99201931 AU - Robinson PG AU - Nadanovsky P AU - Sheiham A IN - Department of Dental Public Health and Community Dental Education, Kings College School of Medicine and Dentistry, London, UK. peter.g.robinson@kcl.ac.uk TI - Can questionnaires replace clinical surveys to assess dental treatment needs of adults?. SO - Journal of Public Health Dentistry 1998 Summer;58(3):250-3 AB - OBJECTIVE: The purpose of this study was to ascertain whether questionnaires can be used to replace clinical surveys by comparing normative and perceived caries status and treatment needs in a sample of adults living in East London, UK. METHODS: A cross-sectional study was conducted in two stages: a structured interview inquired about perceived dental caries status and treatment needs, and dental examinations were performed to determine oral health status and normative treatment needs. Perceived and normative assessments were compared for overall proportions, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), using the dental examination as a gold standard. RESULTS: Of 139 people examined, 122 were dentate. The PPVs for perceived caries and treatment need were 0.58 and 0.67, respectively. Overall agreement was 65.4 percent for the presence of caries and 64.7 percent for the presence of treatment need. However, no net error was found between the proportions of participants with decay, and a small net error (7.4%) was found between perceived and normative treatment need. CONCLUSIONS: Self-assessment is not useful to assess individual dental treatment need, but is of possible value in assessing the needs of adult communities. <186> UI - 99201926 AU - Lo EC AU - Schwarz E IN - Faculty of Dentistry, University of Hong Kong, Hong Kong. hrdplcm@hkucc.hku.hk TI - Determinants for dental visit behavior among Hong Kong Chinese in a longitudinal study. SO - Journal of Public Health Dentistry 1998 Summer;58(3):220-7 AB - OBJECTIVES: The aim of this research was to study the major determinants for dental services utilization among middle-aged Hong Kong Chinese in a longitudinal study using an expanded Andersen and Newman model as the theoretical framework. METHODS: A random sample of 372 middle-aged Hong Kong Chinese were interviewed and clinically examined in an oral health survey. The findings were explained to the subjects and they were advised to seek care from their own dentist as appropriate. RESULTS: A total of 322 subjects were interviewed over the telephone after 12 months. About half had visited a dentist within the study period. Results of the bivariate analysis showed that proportionally more subjects who had dental benefit coverage, had prevention-oriented attitudes, were regular users of dental services, had received counseling from a dentist, or had more filled teeth at the baseline examination had visited a dentist within the study period. Logistic regression analysis produced a final model consisting of seven factors and three interaction terms that was able to classify 68 percent of the subjects into the correct user category. CONCLUSION: The expanded Andersen and Newman model was useful as a theoretical framework in studying the dental services utilization behaviors of the Hong Kong adults. <187> UI - 99193228 AU - Thompson GW AU - Schuller PD AU - Lewis DW IN - University of Alberta, Edmonton, Canada. TI - Dental caries knowledge in a group of Northwest Territories children. SO - International Journal of Circumpolar Health 1998;57 Suppl 1:169-73 AB - A total of 953 children in schools in communities in the Northwest Territories was surveyed to determine their attitudes and knowledge about dental decay. A questionnaire was answered by these Native and non-Native children in the Northwest Territories. The median age of the children was 12.5 years. The girls tended to brush their teeth more frequently and consumed less sugared sweets between meals. More of the girls and in particular the Native girls knew about "nursing" caries. The Native students more often than not went for dental treatment when it was necessary. The Native students brushed their teeth less frequently and often learned to brush their teeth on their own. The consumption of sugared sweets between meals was greater in the Native sample. The knowledge level of the factors that affect dental decay rates was lower in the Native group, but was not extremely high in either group. These children should receive more information on oral health practices and be given an opportunity to improve their oral health knowledge. <188> UI - 99234685 AU - Shapira J AU - Efrat J AU - Berkey D AU - Mann J IN - Department of Pediatric Dentistry, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel. TI - Dental health profile of a population with mental retardation in Israel. SO - Special Care in Dentistry 1998 Jul-Aug;18(4):149-55 AB - The dental status and treatment needs of Israeli children and adults with mental retardation were studied in a random sample of 387 subjects. Four levels of mental retardation were represented: (1) educable (n = 70), (2) trainable (n = 92), (3) with mental retardation and behavioral problems (n = 106), and (4) with mental retardation and severe physical handicap (n = 119). The total age-adjusted DMF-T was 12.78 and differed significantly by behavioral group (p < 0.001); the M-T was 10.70 for the educable group compared with 5.52 for the group with mental retardation and severe physical handicap. Total treatment needs included a participant mean of 3.32 for restorations and 0.61 for extractions. Institutions having dental clinics had higher participant mean DMF-T, D-T, M-T, and F-T values (p < 0.05) compared with those institutions which had no clinics (16.04 vs. 9.74; 5.17 vs. 5.06; 9.45 vs. 4.16; 1.41 vs. 0.52). Age-adjusted CPITN scores significantly differed by behavioral group; the group with mental retardation and severe physical handicap had the highest CPITN 3 category mean score of 2.93 compared with x = 1.89 for the educable group; however, the educable group had the most sextants with no teeth (x = 2.48). Findings confirm high dental morbidity and significant oral health differences by behavior group, age, and dental clinic status. Advanced training is recommended for dental providers and the staffs of institutions to enhance oral health outcomes. <189> UI - 99139973 AU - Rajkumar T AU - Rajan S AU - Baruah RK AU - Majhi U AU - Selvaluxmi G AU - Vasanthan A IN - Department of Molecular Oncology Cancer Institute (WIA), Adyar, Madras, India. TI - Prognostic significance of Bcl-2 and p53 protein expression in stage IIB and IIIB squamous cell carcinoma of the cervix. SO - European Journal of Gynaecological Oncology 1998;19(6):556-60 AB - Cervical cancer is the most common cancer among women in South India. More than 70% of the cases present in stage IIB and IIIB and of these more than 50% fail conventional treatment. The purpose of the present study was to determine the prognostic significance of Bcl-2 and p53 expression in squamous cell carcinomas of the cervix. Using immunohistochemistry, 40 cases of stage IIB and IIIB squamous cell carcinomas of the cervix treated with radiotherapy were studied for the expression of Bcl-2 and p53 protein and their prognostic value ascertained. Bcl-2 was expressed in 65% (n=26) of the tumours. There was a statistically significant association (p=<0.025) between Bcl-2 expression and poorer DFS and OS in stage IIB cases. In stage IIIB, these associations were not obvious probably due to additional genetic events overshadowing the significance of Bcl-2 expression. Only 4/40 (10%) of the cases were positive for p53 protein expression and there was an inverse correlation between p53 expression and Bcl-2 expression. This study suggests that Bcl-2 can be a useful marker to identify the poor prognostic group in stage IIB cases and needs to be confirmed in a larger series. <190> UI - 99139796 AU - Lundman UA AU - Bolin AK AU - Rangne Y AU - Bolin A IN - Public Dental Service, Stockholm County Council, Sweden. TI - Dental survey at school with the purpose to select children with no actual need of dental treatment. SO - Swedish Dental Journal 1998;22(5-6):203-10 AB - The purpose of this study was to develop an examination method to select children without from children with need of dental treatment. Furthermore the objective was that these examinations could be performed as a survey at school, without utilizing an expensive and fully equipped dental clinic but still maintain the certainty for the individual not to be at increased risk to be declared false caries-free, in comparison with ordinary examination at a dental clinic. The material comprised 88 children 10-13 years old. The children were subject to a survey-examination at school and a few weeks later at a dental clinic by the same examiner. Initially the children were examined at school by two examiners in order to measure the inter-examiner variability. The results showed that 2 of the 88 examined children (2.3%) were judged false healthy at school examination with respect to caries. The inter-examiner variability in diagnosing caries was greater than the intra-examiner variability between survey at school and examination at the dental clinic. <191> UI - 99089474 AU - Boriani G AU - Frabetti L AU - Biffi M AU - Sallusti L IN - Institute of Cardiology, University of Bologna, Italy. cardio1@almadns.unibo.it TI - Clinical experience with downsized lower energy output implantable cardioverter defibrillators. Ventak Mini II Clinical Investigators. SO - International Journal of Cardiology 1998 Oct 30;66(3):261-6 AB - BACKGROUND AND STUDY OBJECTIVE: Technical improvements in cardioverter defibrillators technology has resulted in decrease in can size coupled with improved electrodes technology. A decrease in maximum energy output allows further decrease in device size. The aim of this study was to evaluate the feasibility of a single lead transvenous implant employing a downsized cardioverter-defibrillator (volume 59 cm3), with a related decrease in maximum energy output (29-31 joules as stored energy and 25-27 joules as delivered energy). METHODS AND RESULTS: Fifty-five patients with ventricular tachyarrhythmias were enrolled in 17 European institutions for implantation. At implantation step-down defibrillation threshold (DFT) was determined and the device was implanted only if a safety margin > or =10 joules was maintained between DFT and maximum programmable output. Implantation was performed in 54 of the 55 referred patients (98%) in a single electrode-device configuration. Step-down DFT testing was performed in 44 patients (43 finally implanted) and DFT was 7.77+/-4.41 joules (range 3-20). In 20 of the tested patients (45%) DFT was < or =5 joules, in 26 patients (59%) was < or =8 joules and in 34 patients (77%) it was < or =10 joules. No differences were found in DFT comparing patients with left ventricular ejection fraction < or = or >40% or patients treated or not with antiarrhythmic drugs or beta-blockers. Mean implant duration was 85+/-34 min. CONCLUSIONS: Employing a downsized cardioverter defibrillator, successful transvenous implantation can be achieved in 98% of the patients, with maintenance of adequate defibrillation safety margins despite a reduction in stored energy to 29 joules. <192> UI - 99123190 AU - Benn DK AU - Dankel DD AU - Kostewicz SH IN - University of Florida College of Dentistry 32610-0414, USA. TI - Can low accuracy disease risk predictor models improve health care using decision support systems?. SO - Proceedings / AMIA Annual Symposium 1998;:577-81 AB - A prototype decision support system has been designed for managing dental caries using a risk assessment model. Caries is a multifactorial disease with risk prediction models having low sensitivity (65%) and moderate specificity (80%) for 2 or more new lesions. These models are inaccurate for targeting resources at high risk people. However, low risk individuals can be more accurately identified. If the activity of early tooth decay lesions, in low risk people, are monitored over time and only lesions beyond 1/3 of the dentin depth are filled, the number of annual fillings may be reduced by 50%. Currently, most US dental schools do not teach risk assessment for caries and encourage early treatment of lesions leading to a repair destruction cycle. The combination of a decision support system with a moderate accuracy specificity risk model for predicting low risk individuals may produce a significant improvement in caries management. <193> UI - 99139135 AU - Pitts NB IN - Dental Health Services Research Unit, University of Dundee, UK. TI - Inequalities in children's caries experience: the nature and size of the UK problem. SO - Community Dental Health 1998 Dec;15 Suppl 1:296-300 AB - OBJECTIVE: To discuss, as part of a symposium on 'Dental Care for the Disadvantaged Child', the inequalities in caries experience between a minority of children who demonstrate substantial dental disease and have, as a consequence, a considerable need for dental care and the majority who have little disease. METHOD: 1) Analysing data from regular NHS surveys of the dental health of British children in a number of defined age groups and examining socio-economic factors which operate and influence levels of dental caries to answer questions such as "Do we understand which children need and get appropriate dental care?". 2) Considering how appropriate future needs may be identified and addressed, and the gap between academic acceptance of new methodology and use by dental professionals may be narrowed. CONCLUSIONS: Integrated approaches to prevention should be focused on those children who have the greatest need in addition to the provision of appropriate, clinically effective, preventive and operative care for all children. <194> UI - 99139126 AU - Birch S AU - Gafni A AU - Markham B AU - Marriott M AU - Lewis D AU - Main P IN - Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada. TI - Health years equivalents as a measurement of preferences for dental interventions. SO - Community Dental Health 1998 Dec;15(4):233-42 AB - OBJECTIVE: To test the feasibility and importance of measuring preferences among treatment choices using Healthy Years Equivalents (HYE). DESIGN: Development of scenarios for alternative approaches to caries treatment. Completion of category rating and standard gamble questions elicited in personal interviews. SETTING: The provision of dental care to children in a public-funded dental health clinic. PARTICIPANTS: Random sample of the adult population of Hamilton, Ontario. MAIN OUTCOME MEASURES: The percentage of the sample unable to complete the interviews, time taken to perform interviews, ease of understanding of interviews, correlation between rank ordering and HYE scores. RESULTS: Ninety-six per cent of the sample were able to complete the HYE exercise. Inconsistencies between HYE scores and rank orders implying preference reversal occurred in 6% of those completing HYE scores for the two scenarios. The additional time taken by the HYE was of the order of 17 minutes but increased with the age of the subject. Where problems occurred, they were related to the method of measurement or the sensitivity of the chosen scale as opposed to additional requirements of the HYE. There was some evidence that HYEs and QALYs produced different scores even in the context of chronic constant health states. CONCLUSIONS: HYEs are a feasible and important practical method of measuring preferences among interventions. Alternative utility-based approaches, such as willingness to pay, may be required to detect differences in modest improvements in temporary health states. <195> UI - 99094527 AU - Petersson LG AU - Svanholm I AU - Andersson H AU - Magnusson K IN - Department of Preventive Dentistry, Medical and Dental Health Centre, Halmstad, Sweden. lars.g.petersson@lih.lthalland.se TI - Approximal caries development following intensive fluoride mouthrinsing in teenagers. A 3-year radiographic study [published erratum appears in Eur J Oral Sci 1999 Apr;107(2):154]. SO - European Journal of Oral Sciences 1998 Dec;106(6):1048-51 AB - Caries development on approximal surfaces was studied in 139 adolescents for a period of 3 yr. A test group was randomly sampled (n=69) and subjected to a new intensive mode of fluoride (F) mouthrinsings using 10 ml of 0.045% NaF neutral solution once a day for 3 d, twice a year in all, i.e., 6 rinses per year. A control group (n = 70) rinsed in a similar mode using fluoride-free tap water. The two groups received the same basic prophylactic program during the trial. Detection of approximal caries lesions and fillings was based on bitewing radiographs at baseline and after 3 yr. The test group developed an average of 2.75 + 4.76 (mean +/- SD) approximal DFS compared with 3.21 + 4.74 DFS in the control group (n.s.). However, among those teenagers who were caries free (DFS = 0) at baseline, the incidence of approximal carious and filled surfaces was 1.76+/-4.52 in the F-rinsing group (n = 26) compared with 2.76+/-5.01 DFS in the control group (n = 32), a 36% caries reduction which was statistically significant. The intensified mouthrinsing procedure seems to be a promising prophylactic mode for collective caries prevention. <196> UI - 99121521 AU - Burke FJ AU - Wilson NH IN - University of Glasgow Dental School, United Kingdom. f.j.t.burke@dental.gla.ac.uk TI - When is caries caries, and what should we do about it?. SO - Quintessence International 1998 Oct;29(10):668-72 AB - Treatment of initial caries, albeit an everyday occurrence for the dental practitioner, presents considerable demands of patient assessment and diagnosis. Whatever decisions are made--to restore caries or to attempt to arrest its progress--the adoption of a maintenance program is of paramount importance. Patient motivation, in respect to dietary control and satisfactory oral hygiene, is central to a successful outcome, and in the future, practice management programs may include RAC as a diagnostic aid. New methods of caries management are more dynamic than traditional methods and place restoration of the lesion toward the bottom of the list of possible treatments, with the biologic rather than the mechanistic approach being a priority. However, the teaching of RAC in dental schools and the third-party funding of diagnostic tests and diagnosis are also required to reflect the increasing complexity of management of initial caries. If restorative intervention is indicated following diagnosis and RAC, treatment of initial caries should involve a minimal-intervention adhesive technique. <197> UI - 99086082 AU - Powell LV IN - Restorative Dentistry, University of Washington, Seattle 98126, USA. lvpowell@u.washington.edu TI - Caries prediction: a review of the literature. [Review] [48 refs] SO - Community Dentistry & Oral Epidemiology 1998 Dec;26(6):361-71 AB - For over a decade researchers have been looking for the formula that will allow caries prediction. The purpose of this summary is to review recent multifactorial prediction models for adults and children with the aim of identifying the most successful and consistent methods. Conclusions from this review include the following: Clinical variables, especially past caries experience, are confirmed as the most significant predictors of future caries development. The status of the most recently erupted/exposed surface is the most successful measure of past caries experience. Bacterial levels are included in the most accurate prediction models. Sociodemographic variables are most important to caries prediction models for young children and older adults. [References: 48] <198> UI - 99086087 AU - Chestnutt IG AU - Schafer F AU - Jacobson AP AU - Stephen KW IN - Lanarkshire Health Board, Hamilton, Scotland. TI - The influence of toothbrushing frequency and post-brushing rinsing on caries experience in a caries clinical trial. SO - Community Dentistry & Oral Epidemiology 1998 Dec;26(6):406-11 AB - OBJECTIVE: To examine the effect of reported toothbrushing frequency and method of rinsing after brushing on caries experience and increment. METHODS: Data are presented from 2621 adolescents (mean age 12.5 years at outset) participating in a 3-year double-blind caries clinical trial. At baseline, examiners questioned each participant about their toothbrushing habits, and at subsequent examinations, this information was obtained using a self-administered computer-based questionnaire. Participants used a fluoride-containing dentifrice throughout and clinical examinations were conducted using a mirror, CPITN probe and fibre-optic transillumination. RESULTS: The reported brushing frequency increased throughout the trial. Caries experience at baseline was inversely related to toothbrushing frequency with mean DMFS=9.66, 8.12 and 7.63 respectively for <1/day, 1/day and >1/day brushers (P<0.001). Mean 3-year DMFS increments of 8.90, 6.63 and 5.48 (P<0.01) were observed in those reporting to brush <1/day, 1/day or >1/day, on not less than two of the three clinical examinations during the trial. Caries increment was also significantly related to the claimed method used to rinse post-brushing. Overall frequency of brushing and rinsing method accounted for over 50% of the explained variance in the ANOVA model used to analyse the DMFS increments. CONCLUSIONS: Stated toothbrushing frequency and rinsing method after brushing were found to be strongly correlated with caries experience and caries increment. These factors should be reflected in the design of oral health education material and taken into account in the design and analysis of caries clinical trials. <199> UI - 99067542 AU - Holst A AU - Brannstrom M IN - Department of Paediatric Dentistry, Blekinge County Council, Karlskrona, Sweden. TI - Restoration of small proximal dentin lesions with the tunnel technique. A 3-year clinical study performed in Public Dental Service clinics. SO - Swedish Dental Journal 1998;22(4):143-8 AB - The aim of this study was to evaluate the 3-year performance of tunnel restorations in Public Dental Service clinics in the county of Blekinge, Sweden. The restorations were made at the indication of a radiographically observed small proximal caries lesion extending into the outer part of dentin in permanent premolars and molars. A total of 302 restorations made by 17 dentists were evaluated 1 yr, 2 yrs and 3 yrs after placement using modified USPHS criteria. The preparations were filled with a cermet glass polyalkenoate cement (Ketac Silver, ESPE Gmbh, Germany). Evaluation was carried out by clinical and radiographical means. The percentage of successful and acceptable restorations was 92.7% after 1 yr, 89.5% after 2 yrs and 84.3% after 3 yrs. Eight % of the restorations failed due to caries, 6% fractured and 1% were replaced due to deep margin discoloration. The results indicate that tunnel restoration is a useful technique in small proximal dentin lesions in permanent premolars and molars. <200> UI - 99121510 AU - Wenzel A AU - Hintze H AU - Horsted-Bindslev P IN - Department of Oral Radiology, Royal Dental College, University of Aarhus, Denmark. TI - Discrimination between restorative dental materials by their radiopacity measured in film radiographs and digital images. SO - Journal of Forensic Odonto-Stomatology 1998 Jun;16(1):8-13 AB - The aim of this study was to investigate the possibility of differentiating between various dental restorative materials by means of their radiopacity. Ten extracted molars and ten canines/anterior teeth were selected for the study. In the molar group a class II cavity and in the canines/anterior teeth group a class III cavity were cut by airrotor. The cavities were coated with vaseline before filling with five molar- and three anterior tooth restorative materials in the following sequence: for molars: amalgam, light-cured composite, glass ionomer cement, reinforced glass ionomer cement and light-cured composite. After each filling sequence radiographs were taken of the teeth on conventional film (Ektaspeed Plus) and by two digital systems: a storage phosphor plate (Digora) and a ccd-based sensor (Sidexis). Density was measured in the films with a densitometer in three areas of "air", in three areas of the class II fillings and one area of the class III fillings. The same areas were measured in the digital images where the program calculated automatically the mean grey shade values. The density values obtained from the filling areas were taken as a proportion of the values obtained from the areas of "air". Statistically significant differences in material density when related to "air" density (Wilcoxon's test) were observed between all materials in film (p < 0.01 for molars and p < 0.02 for canines/anterior teeth). For Digora only half of the materials differed significantly which was also the case for the Sidexis system (none of the CF materials were significantly different). In conclusion, the molar filling materials could be distinguished with a high probability in film while the two digital systems were less reliable. The results may be useful in forensic dentistry. <201> UI - 99095318 AU - Karp WB IN - Medical College of Georgia, School of Dentistry, Augusta 30912, USA. TI - Childhood and adolescent obesity: a national epidemic. SO - Journal of the California Dental Association 1998 Oct;26(10):771-3 AB - Have you ever wondered if children coming into your dental operatory these days really are fatter, or is it just your imagination? And if they are fatter, how does it relate to what they are eating and what is the approach to treatment? This review article is written for dental health professionals, their own children, and their young patients and families, and will briefly address these issues. <202> UI - 99095292 AU - Cederberg RA AU - Frederiksen NL AU - Benson BW AU - Shulman JD IN - Baylor College of Dentistry/Texas A&M University System Dallas, USA. TI - Effect of different background lighting conditions on diagnostic performance of digital and film images. SO - Dento-Maxillo-Facial Radiology 1998 Sep;27(5):293-7 AB - OBJECTIVE: To compare the performance of a photostimulable phosphor (PSP) imaging system with radiographic film for the detection of approximal lesions under two background lighting conditions. METHODS: Bitewing exposures were made of the extracted human teeth with artificial approximal lesions using D-speed and E-speed radiographic film and a PSP imaging plate. Eight dentists rated 12 approximal surfaces in each image on a 5-point scale. Images were viewed with overhead fluorescent room lighting on and off. ROC curves were generated for each image receptor and lighting condition. Repeated measures analysis of variance ANOVA tested differences between observers, lesion size, image receptor, lighting condition. RESULTS: Mean ROC curve areas for D-speed film viewed in full ambient light scored highest (0.8030) followed by E-speed film using dark conditions (0.7386). The lowest mean curve area was found when PSP (enhanced mode) images were viewed in a dark room (0.6726). Significant differences were found between observers, lesion size, image receptor and image receptor-lesion size interaction. No significant difference was found with background lighting. CONCLUSIONS: Background lighting does not appear to effect the ability to detect artificial approximal lesions. <203> UI - 99048347 AU - Kang BC AU - Goldsmith LJ AU - Farman AG IN - Oral and Maxillofacial Radiology, School of Dentistry, Chonnam National University, Kwangju, Korea. TI - Observer differentiation of mechanical defects versus natural dental caries cavitations on monitor-displayed images with imaging plate readout. SO - Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics 1998 Nov;86(5):595-600 AB - OBJECTIVE: The purpose of this study was to compare the ability of dentists to detect mechanically created defects vs natural dental caries cavitations on the proximal surfaces of extracted teeth by means of storage phosphor imaging plate technology. STUDY DESIGN: Fifty-two extracted molar and premolar teeth were blocked into sets for bitewing radiographs through use of the DIGORA digital imaging system. Sixteen natural caries cavities and 28 artificial lesions were present in the 80 proximal surfaces included in the study. A group of 16 dentists assessed proximal lesions on unenhanced images on the monitor and 1 month later on contrast-enhanced images. A different group of 16 dentists assessed proximal lesions on contrast-enhanced images and 1 month later on unenhanced images. The Mann-Whitney U test was used to check for a reading-order effect. The Zelen test of odds ratio was used to test for homogeneity, and the Mantel-Haenszel analysis or stratified logistic regression was used for inference about the common odds ratio. Alpha was set at P < .05. RESULTS AND CONCLUSIONS: With the DIGORA system, there was little difference between the detection rates of mechanical defects and natural carious cavities with unenhanced images, but the mechanical defects were more readily detected when contrast-enhanced images were used. Cavity depth positively affected the odds of diagnosis of lesions, with deeper lesions being more readily detected than more superficial ones irrespective of whether they were natural or artificial. In comparison with findings of previous studies in which film and a charge-coupled device detector were used, the overall detection rate for natural dental caries was remarkably constant across the modalities. <204> UI - 99045538 AU - Mitchell PA AU - Waggoner S AU - Rotmensch J AU - Mundt AJ IN - Department of Radiation and Cellular Oncology, Section of Gynecology Oncology, Chicago, Illinois, 60637, USA. TI - Cervical cancer in the elderly treated with radiation therapy. SO - Gynecologic Oncology 1998 Nov;71(2):291-8 AB - OBJECTIVES: The aim of this study was to evaluate the tolerance and outcome of elderly cervical carcinoma patients treated with radiation therapy (RT). METHODS: Three hundred ninety-eight patients with stage I-III cervical carcinoma treated with definitive RT were analyzed. Patients were divided into nonelderly (ages 35-69) (n = 338) and elderly (ages >/= 70) (n = 60) groups. A comparison of patient, tumor and treatment factors, morbidity, and outcome was performed. Median follow-up was 81 months. RESULTS: Elderly patients had a higher rate of comorbid conditions including diabetes (P = 0. 02), coronary artery disease (P = 0.003), and hypertension (P = 0. 001) than younger patients. Comorbid conditions in the elderly resulted in more frequent treatment breaks and less ability to undergo definitive treatment with intracavitary RT (ICRT). While the 5-year actuarial disease-free (DFS) and cause-specific (CSS) survival rates were comparable between the two groups, disease recurrence and death from cervical cancer were more common beyond 5 years in the elderly group. When patients not undergoing ICRT and those with treatment protraction were excluded, differences in the DFS and CSS curves were no longer evident. The frequency and severity of acute and chronic sequelae were similar. CONCLUSIONS: Elderly cervical carcinoma patients have an equivalent overall outcome following radiation therapy to younger patients when comparable treatment is delivered. Age per se is not associated with a higher rate of acute or chronic sequelae. Comorbid conditions adversely impacted on the quality and delivery of RT in the elderly group and help explain observed differences in outcome based on age. Copyright 1998 Academic Press. <205> UI - 99064348 AU - Hume WR IN - Office of the Chancellor, University of California, Los Angeles, 90015-1405, USA. TI - Restorative dentistry: current status and future directions. SO - Journal of Dental Education 1998 Oct;62(10):781-90 <206> UI - 99064347 AU - Angmar-Mansson BE AU - al-Khateeb S AU - Tranaeus S IN - Department of Cariology and Endodontology, Faculty of Odontology, Karolinska Institutet, Huddinge, Sweden. Birgit.Angmar-Mansson@ofa.ki.se TI - Caries diagnosis. [Review] [75 refs] SO - Journal of Dental Education 1998 Oct;62(10):771-80 <207> UI - 99064346 AU - Pitts NB IN - Dental Health Services Reseach Unit, Dundee Dental Hospital and School, Scotland, UK. n.b.pitts@dundee.ac.uk TI - Risk assessment and caries prediction. [Review] [72 refs] SO - Journal of Dental Education 1998 Oct;62(10):762-70 <208> UI - 99083375 AU - Erickson PR AU - McClintock KL AU - Green N AU - LaFleur J TI - Estimation of the caries-related risk associated with infant formulas. SO - Pediatric Dentistry 1998 Nov-Dec;20(7):395-403 AB - PURPOSE: Baby bottle tooth decay (BBTD) affects 6% of children under three years of age and is associated with inappropriate bottle use. The objective of this study was to estimate the caries-related risk associated with 26 infant formulas and whole milk. METHODS: First, the plaque pH of adult volunteers was monitored before and after an oral rinse with infant formula to determine the minimum pH obtained in response to each formula. Second, Streptococcus sobrinus 6715 was cultured in each infant formula, and the increase in the number of colony forming units was measured. Third, each infant formula was incubated with powdered enamel and the solubility of enamel mineral was calculated in the absence of bacteria. Fourth, each formula was mixed with standardized concentrations of acid to determine the buffering capabilities. Finally, enamel windows were created on extracted permanent molars and exfoliated primary incisor crowns that were then colonized with mutans streptococci and incubated with infant formula. Caries was assessed visually and radiographically for 18 weeks. The length of time required for the development of enamel caries, dentinal caries and pulpal involvement was recorded. RESULTS: One-way or two-way ANOVA of these five assays demonstrated that 1. Plaque pH varied in response to oral rinsing with infant formula and most formulas did have the ability to reduce the pH significantly below the pH obtained after rinsing with water 2. Some infant formulas supported significant bacterial growth 3. Enamel mineral was dissolved by incubation with certain infant formula 4. The buffer capacity varied among the infant formulas tested 5. The length of time required for caries to reach dentin or pulp differed for the formulas, with some formulas causing dentinal caries by 3.4 weeks and pulpal involvement by 7.2 weeks. <209> UI - 99044097 AU - Sandstedt B AU - Kennergren C AU - Schaumann A AU - Herse B AU - Neuzner J IN - Division of Cardiology, Sahlgrenska University Hospital, Goteborg Sweden. TI - Short- and long-term performance of a tripolar down-sized single lead for implantable cardioverter defibrillator treatment: a randomized prospective European multicenter study. European Endotak DSP Investigator Group. SO - Pacing & Clinical Electrophysiology 1998 Nov;21(11 Pt 1):2087-94 AB - A new, thinner (10 Fr) and more flexible, single-pass transvenous endocardial ICD lead, Endotak DSP, was compared with a conventional lead, Endotak C, as a control in a prospective randomized multicenter study in combination with a nonactive can ICD. A total of 123 patients were enrolled, 55 of whom received a down-sized DSP lead. Lead-alone configuration was successfully implanted in 95% of the DSP patients vs 88% in the control group. The mean defibrillation threshold (DFT) was determined by means of a step-down protocol, and was identical in the two groups, 10.5 +/- 4.8 J in the DSP group versus 10.5 +/- 4.8 J in the control group. At implantation, the DSP mean pacing threshold was lower, 0.51 +/- 0.18 V versus 0.62 +/- 0.35 V (p < 0.05) in the control group, and the mean pacing impedance higher, 594 +/- 110 omega vs 523 +/- 135 omega (p < 0.05). During the follow-up period, the statistically significant difference in thresholds disappeared, while the difference in impedance remained. Tachyarrhythmia treatment by shock or antitachycardia pacing (ATP) was delivered in 53% and 41%, respectively, of the patients with a 100% success rate. In the DSP group, all 28 episodes of polymorphic ventricular tachycardia or ventricular fibrillation were converted by the first shock as compared to 57 of 69 episodes (83%) in the control group (p < 0.05). Monomorphic ventricular tachycardias were terminated by ATP alone in 96% versus 94%. Lead related problems were minor and observed in 5% and 7%, respectively. In summary, both leads were safe and efficacious in the detection and treatment of ventricular tachyarrhythmias. There were no differences between the DSP and control groups regarding short- or long-term lead related complications. <210> UI - 99109387 AU - Dostalova T AU - Jelinkova H AU - Kucerova H AU - Krejsa O AU - Hamal K AU - Kubelka J AU - Prochazka S IN - Institute of Dental Research, Prague, Czech Republic. dostalova@vus.cz TI - Noncontact Er:YAG laser ablation: clinical evaluation. SO - Journal of Clinical Laser Medicine & Surgery 1998 Oct;16(5):273-82 AB - OBJECTIVE: The aim of this study is to evaluate the quality of laser ablation in comparison with the classical drilling preparation. METHODS: For the experiment, the Er:YAG laser drilling machine was used. The system had a laser head, water cooler, and power supply with automatic control. Spot size of 300-350 microns was used for the preparation. Repetition rate of 1-4 Hz, and pulse energies of 100-400 mJ with water spray were chosen. Cavity shape in comparison with classical drill, time of preparation, and influence of cavity shape on filling materials retention in accordance with the U.S. Public Health Service System were used. The evaluation criteria for noncontact Er:YAG ablation were done. RESULTS: The cavity shape is irregular, but spot surface has larger area and microretentive appearance. Caries of enamel and dentin were treated with a noncontact preparation. It was possible to remove the old insufficient fillings, except for amalgam or metal alloys. The average number of pulses was 111.22 (SE 67.57). Vibrations of microexplosions during preparation were felt by patients on 14 cavities; however, nobody felt unpleasant pain. The qualities of filling materials in laser cavities were very stable; however, cavo surface margin discoloration of 82-86% of Alfa rating could be a problem. Changes of the color and anatomic form of the tooth were observed in 4-8%. CONCLUSIONS: In comparison with the classical treatment, it could be said that the retention and quality of filling materials is the same or very similar. <211> UI - 99035981 AU - Winston AE AU - Bhaskar SN IN - Technology and Clinical Research, Enamelon Inc., Brunswick, N.J. 08816, USA. TI - Caries prevention in the 21st century [see comments]. [Review] [87 refs] CM - Comment in: J Am Dent Assoc 1999 Feb;130(2):160, 162 SO - Journal of the American Dental Association 1998 Nov;129(11):1579-87 AB - While the incidence of caries has decreased during the past 50 years because of the introduction of water fluoridation and fluoride toothpastes, it is still widespread. Improved therapies, using topical treatments to replace lost calcium and phosphate minerals from early carious lesions, will reduce the need for surgical intervention in the future. Early caries detection techniques currently being developed will allow dentists to maximize the usefulness of these treatments. [References: 87] <212> UI - 99052546 AU - Biesbrock AR AU - Faller RV AU - Bartizek RD AU - Court LK AU - McClanahan SF IN - Procter & Gamble Company, Health Care Research Center, Cincinnati, Ohio, USA. biesbrock.ar@pg.com TI - Reversal of incipient and radiographic caries through the use of sodium and stannous fluoride dentifrices in a clinical trial. SO - Journal of Clinical Dentistry 1998;9(1):5-10 AB - Experimental evidence has clearly demonstrated that the early stages of lesion formation (enamel demineralization) are reversible following exposure to saliva and/or fluoride. Clinical evidence for remineralization has also been reported extensively in the literature. However, the literature is lacking with respect to data from well-controlled clinical studies regarding the quantitative contribution of remineralization to arrestment and reversal of caries. Retrospective analysis of an existing clinical trial database provided an opportunity to examine the incidence of clinical lesion reversals in a placebo-controlled, double-blinded caries clinical study. The clinical study examined three treatment groups: 1) 0.243% sodium fluoride/silica dentifrice, 2) 0.4% stannous fluoride/calcium pyrophosphate (positive control) dentifrice and 3) non-fluoridated placebo/calcium pyrophosphate (negative control) dentifrice. Clinical measures in this study included both radiographic and visual-tactile assessments of caries. Examination of all subjects revealed a statistically greater frequency for caries reversals in the sodium fluoride group as compared to the placebo group at Year 3, for both total and radiographic caries. In contrast, while caries reversals in the stannous fluoride group occurred with greater frequency than in the placebo group at Year 3, for both total and radiographic caries, the differences were not statistically significant. When only subjects who were "at risk" for potential reversals (i.e., those with a minimum of one carious lesion at baseline) were examined, a statistically greater frequency in caries reversals was observed in both the sodium fluoride (total, incipient, and radiographic caries) and stannous fluoride (total and radiographic caries) groups as compared to the placebo group at Year 3. Collectively, these data confirm the ability of both 0.243% sodium fluoride/silica and 0.4% stannous fluoride/calcium pyrophosphate dentifrices to clinically reverse caries. The results suggest that sodium fluoride may deliver a greater frequency of caries reversals than stannous fluoride, although these treatments were not found to be significantly different. <213> UI - 98396871 AU - Fenner DN AU - Robinson PB AU - Cheung PM IN - Department of Mechanical Engineering, King's College London, UK. TI - Three-dimensional finite element analysis of thermal shock in a premolar with a composite resin MOD restoration. SO - Medical Engineering & Physics 1998 Jun;20(4):269-75 AB - A three-dimensional finite element model of a human premolar with a composite resin Class II MOD has been used to investigate the temperature changes and induced thermal stresses associated with the imbibing of a hot liquid. Regions of high tensile stress were revealed and their possible clinical significance with respect to microleakage and failure in the approximal region of the restoration are discussed. <214> UI - 99006593 AU - Kruger E AU - Thomson WM AU - Poulton R AU - Davies S AU - Brown RH AU - Silva PA IN - Department of Oral Health, School of Dentistry, The University of Otago, Dunedin, New Zealand. esther.kruger@stonebow.otago.ac.nz TI - Dental caries and changes in dental anxiety in late adolescence. SO - Community Dentistry & Oral Epidemiology 1998 Oct;26(5):355-9 AB - Little is known about changes in dental anxiety with ageing and their association with changes in oral health. This study examined the relationship between changes in dental caries experience and dental anxiety from 15 to 18 years of age among adolescent participants in the Dunedin Multidisciplinary Health and Development Study. Dental anxiety was estimated using the Corah Dental Anxiety Scale (DAS), and individuals with a DAS score of 13+ were identified as being dentally anxious. Dental examinations were performed on 649 individuals at ages 15 and 18, and a DMFS score was computed for each. Caries prevalence among those who were dentally anxious at both 15 and 18 years was significantly higher than for those who were not at either age. Regression analysis revealed that dental anxiety predicted caries incidence between ages 15 and 18 years. Dental anxiety is likely to be a significant predictor of dental caries experience, and may be a risk factor for dental caries incidence. <215> UI - 99058531 AU - Kumar JV AU - Swango PA AU - Lininger LL AU - Leske GS AU - Green EL AU - Haley VB IN - New York State Department of Health, Albany 12237-0619, USA. TI - Changes in dental fluorosis and dental caries in Newburgh and Kingston, New York. SO - American Journal of Public Health 1998 Dec;88(12):1866-70 AB - OBJECTIVES: This study sought to determine whether the prevalence of dental fluorosis and dental caries had changed in a fluoridated community and a nonfluoridated community since an earlier study conducted in 1986. METHODS: Dental fluorosis and dental caries data were collected on 7- to 14-year-old lifelong residents (n = 1493) of Newburgh and Kingston, NY. RESULTS: Estimated dental fluorosis prevalence rates were 19.6% in Newburgh and 11.7% in Kingston. The greatest disparity in caries scores was observed between poor and nonpoor children in nonfluoridated Kingston. CONCLUSIONS: The prevalence of dental fluorosis has not declined in Newburgh and Kingston, whereas the prevalence of dental caries has continued to decline. <216> UI - 98452125 AU - Ong G IN - Department of Preventive Dentistry, National University of Singapore, Singapore. TI - Periodontal disease and tooth loss. [Review] [47 refs] SO - International Dental Journal 1998 Jun;48(3 Suppl 1):233-8 AB - Numerous epidemiological studies have shown that caries is the main reason for tooth loss. More recent epidemiological data seem to show an increasing trend of tooth loss due to periodontal reasons rather than caries. In considering the issue of periodontal disease and tooth loss the following observations were made. The presence of initial attachment loss, bone height and the habit of smoking significantly increase the risk of tooth mortality. There is a strong correlation between smoking, the severity of periodontal disease and tooth mortality. Cross-sectional population surveys of tooth loss reported lower anterior teeth to be the most frequently extracted due to periodontal reasons, followed by upper anteriors and upper second molars. However, in long term maintenance studies, molars were lost most frequently. Periodontal reasons for tooth loss were mainly mobility followed by furcation involvement. Periodontal surgery did not significantly enhance tooth retention in high risk groups. Ethnic differences observed were not significant and would need further investigations to address variables such as cultural differences, health habits, diet and socio-economic status. In conclusion, periodontal tooth mortality was found to be associated with the loss of periodontal attachment and risk groups with advanced periodontitis contributing to major tooth loss in a minority of the population. [References: 47] <217> UI - 98415977 AU - Sananes C AU - Giaroli A AU - Soderini A AU - Guardado N AU - Snaidas L AU - Bermudez A AU - Ferreira M AU - di Paola G AU - Sardi J IN - Gynecologic Oncologic Unit, 1st Clinic of Gynecology, Buenos Aires University Hospital, Argentina. TI - Neoadjuvant chemotherapy followed by radical hysterectomy and postoperative adjuvant chemotherapy in the treatment of carcinoma of the cervix uteri: long-term follow-up of a pilot study. SO - European Journal of Gynaecological Oncology 1998;19(4):368-73 AB - OBJECTIVE: The aim of the study was to determine if ACH given after NCH followed by RH could decrease the incidence of distant metastases in patients with locally advanced carcinoma of cervix uteri. MATERIAL: 56 pts (34 Ib, 18 IIb, 4 IIIb) with confirmed diagnosis of squamous cervical cancer were enrolled in this phase II trial. The methodology used was: 1) Figo clinical staging; 2) Ultrasonographic determination of tumor volume in < or > 4 cms; 3) V.B.P. scheme: cis-platinum 50 mg/m2/day 1; vincristine 1 mg/m2/day 1; bleomycin 25 mg/m2/days 1-2-3 (3 courses with 10 days interval); 4) Clinical and sonographic tumor response evaluation following U.I.C.C. response criteria; 5) Radical hysterectomy; 6) Pathological risk factor evaluation; 7) ACH with P.M.C. (cis-platinum 50 mg/m2, methotrexate 30 mg/m2, cyclophosphamide 500 mg/m2) 3 courses every 21 days; 8) Comparison and location of recurrences with a neoadjuvant group (NCH + RH + RT to whole pelvis), and with a control group treated with conventional radiotherapy were done. For statistical analysis the Chi-Square was used and D.F.S. and overall survival (O.S.) were calculated according to the Kaplan Meier and Log Rank Test. RESULTS: After a median follow-up of 75 months (range 42-108), O. S. for stage Ib was 88%, Stage IIb 78%, and 50% for IIIb. The recurrences were 12% (4/34) for Stage Ib (3 local and 1 distant); 28% for IIb (5/18) (4 pelvic and 1 distant); 50% (2/4) for IIIb (2 pelvic recurrences). When residual tumor volume was < 2 cm in the surgical specimen (n=39) there were 4 recurrences (3 pelvic and 1 distant), and 7 (6 pelvic and 1 distant) for tumors > 2 cm. (p<0.01 for pelvic recurrences). For the stage Ib with residual tumor <2 cm (n=14) there were no pelvic recurrences and only 1 distant. Comparing for Stage Ib with previous tumor volume >4 cm of the ACH Group (n=17) with a classical NCH (n=51) and control (n=51) groups, there were observed 2 (11.7%) pelvic and 1 (5,8%) distant relapses for the 1st Group, 3 (5.9%) pelvic and 3 (5.9%) distant relapses for the 2nd, and 11 (21.6%) pelvic and 5 (9.8%) distant relapses for the 3rd Group. From the comparison of locally advanced tumors (Stages IIb + IIIb) of ACH group (n=22), with a Stage IIIb surgically removed of classical NCH group (n=38) and with a control group of conventional RT (n=51), there were observed 6 (27%) pelvic and 1 (4.5%) distant relapses for the 1st Group, 4 (11%) pelvic and 7 (18.4%) distant relapses for the 2nd, and 31 (60.7%) pelvic and 5 (9.8%) distant for the 3rd one. CONCLUSION: ACH after NCH + RH could be used for stage Ib with tumor volume > 4 cm, with complete clinical response or residual tumor < 2 cm. The results of this group of tumors suggest the importance of going on phase III trials comparing NCH+RH alone vs. NCH+RH+ACH. ACH could also be used to try to obtain better control of distant metastases in Stages IIb and IIIb. In these cases radiotherapy to the whole pelvis must not be excluded. <218> UI - 98429394 AU - Wang NJ AU - Kalletstal C AU - Petersen PE AU - Arnadottir IB IN - Faculty of Dentistry, University of Oslo, Norway. ninaw@odont.uio.no TI - Caries preventive services for children and adolescents in Denmark, Iceland, Norway and Sweden: strategies and resource allocation. SO - Community Dentistry & Oral Epidemiology 1998 Aug;26(4):263-71 AB - According to the dental acts of Denmark, Iceland, Norway and Sweden, emphasis is placed on preventive dental care. The purpose of this study was to describe and compare two aspects of the caries preventive services: the strategies and the resource allocation for preventive dental care of children and adolescents in Denmark, Iceland, Norway and Sweden. Questionnaires were sent to samples of dentists and other dental personnel who provided preventive care to children during 1995 and 1996. Comparisons between the countries showed significant differences in recall routines and in implementation of risk-based and population-based preventive strategies. Multivariate analyses showed that the time used for preventive care varied by country and was not associated with the DMFT of the children. More time was allocated for prevention when more operating dental auxiliaries were available at the clinic, when the recall interval was shorter, when the time used for routine examination was longer and when the clinician was an auxiliary rather than a dentist. In conclusion, resource allocation and strategies used for prevention were not consistent between the countries. <219> UI - 99009621 AU - Coulter ID AU - Marcus M AU - Freed JR IN - School of Dentistry, University of California, Los Angeles 90095-1668, USA. TI - Consistency across panels of ratings of appropriateness of dental care treatment procedures. SO - Community Dental Health 1998 Jun;15(2):97-104 AB - OBJECTIVE: To report on a study investigating the consistency across different consensus panels of ratings of appropriateness for dental procedures. RESEARCH DESIGN: The study conducted four consensus panels to determine, under various conditions, the appropriateness of five options for patients: no treatment; filling; crown; root canal with a filling or crown; extraction. The patients were categorised according to age; regular versus irregular use of dental care; degree of caries; degree of pain; degree of periodontal disease. PARTICIPANTS: The panellists were dentists enrolled in a continuing education programme on assessing the quality of dental care. The panellists were all individuals employed by various dental plans to evaluate the quality of care plans operating in California. RESULTS: The results indicate that the method does distinguish the dimensions of appropriateness used by the panellists in making their decisions, and that it is possible to substantially increase consensus among a diverse group of dentists and across separate panels on some procedures. However, it also showed that the process is sensitive to varying panels and that different variables had different outcomes in the ratings from the various panels. CONCLUSION: The consensus panel method holds some promise for determining the appropriateness of dental care. However the results of this study question whether it results in consistent ratings across different panels. <220> UI - 99009619 AU - Vigild M AU - Brinck JJ AU - Hede B IN - Department of Community Dentistry, Faculty of Health Sciences, University of Copenhagen, Denmark. TI - A one-year follow-up of an oral health care programme for residents with severe behavioural disorders at special nursing homes in Denmark. SO - Community Dental Health 1998 Jun;15(2):88-92 AB - OBJECTIVES: To describe a one-year follow-up study of an oral health care programme in special nursing homes for citizens with severe behavioural disorders. METHODS: An oral health care programme for residents (n = 264) at special nursing homes, which included an initial oral examination, subsequent dental treatment based on the principles of realistic treatment need and visits by a hygienist every three months, was evaluated one year after implementation. RESULTS: The follow-up data revealed a significant decrease in the mean number of teeth with primary decay and periodontal treatment need. Also less calculus and visible plaque were present. Regarding denture related conditions, a decrease was found in the presence of traumatic ulcers, denture stomatitis and the need for prosthodontic treatment. Finally, an improvement in denture hygiene was observed. A high rate of participation in the programme was obtained. CONCLUSION: Professional dental intervention has an effect on oral health indicators even when introduced to rather unapproachable recipients of dental care services. <221> UI - 99007825 AU - Downer MC AU - Moles DR IN - National Centre for Transcultural Oral Health, Eastman Dental Institute for Oral Health Care Sciences, London, UK. TI - Health gain from restorative dental treatment evaluated by computer simulation. SO - Community Dental Health 1998 Mar;15(1):32-9 AB - OBJECTIVE: To simulate the influence over time of relevant factors on health gain from restorative dental treatment under varying assumptions and to compare outcomes with those resulting under a 'do nothing' scenario. DESIGN: A decision model was used in a computer simulation of the caries process in posterior approximal tooth surfaces. The effect of superimposing restorative treatment, based on bitewing radiology, was incorporated. Input data came from current observational studies and included caries progression rates, notional survival times of restorations, and sensitivity (Sn) and specificity (Sp) of treatment decision making by a high (A) and a low (B) performing dentist. Utility values, on a scale 0-1, for different tooth health states were obtained from questioning 92 adults of appropriate age. SETTING: By assumption, the primary dental care sector. PARTICIPANTS: A hypothetical population, initially 14-15 years old. INTERVENTIONS: Class II amalgam restorations. OUTCOME: Computed in utility based units (UBUs) as sums of the product of numbers of sound, carious and restored surfaces and their utility values. Health gain (in UBUs) was assessed relative to interim end point UBUs pertaining under 'do nothing'. RESULTS: One thousand approximal surfaces, designated initially as 920 sound, 51 carious and 29 filled were followed in the model over 10 years. The greatest health gain (33.16 UBUs) was from dentist A (Sn = 0.23, Sp = 0.99, 50 per cent restoration survival rate = 10 years, caries rate = 4.4% per annum). The least was from dentist B (Sn = 0.52, Sp = 0.88, 50% survival = 5 years, caries rate = 0.0% per annum) representing a loss of 17.07 UBUs compared with 'do nothing'. CONCLUSIONS: Results suggest that caution is advisable when making positive decisions to restore on the basis of bitewing radiographs. <222> UI - 99025052 AU - Mandall NA AU - McCord JF AU - Blinkhorn AS AU - Worthington HV AU - O'Brien KD IN - Department of Dental Medicine and Surgery, University of Manchester. TI - Does the ethnicity of teenage children influence oral self perception and prevalence of dental disease?. SO - British Dental Journal 1998 Oct 10;185(7):358-62 AB - AIM: The primary aim was to evaluate the effect of ethnicity, social deprivation and oral health on oral self perceptions of 14-15-year-old Asians and Whites. A secondary aim was to assess the influence of ethnicity and social deprivation on oral treatment need in the same sample. DESIGN: A cross-sectional epidemiological study. DATA SOURCE: A stratified, random sample of 408 14-15-year-old Asian and White children from schools in Manchester. METHOD: Information was collected on oral self perceptions using a questionnaire and on oral treatment need with a clinical examination. RESULTS: Multivariate data analysis revealed that oral treatment need, but not ethnicity or social deprivation, was an important predictive variable with respect to oral self perceptions. Ethnicity was the only variable to influence periodontal treatment need. Social deprivation influenced the level of untreated caries. CONCLUSIONS: 1. Socially deprived children have higher caries levels than their more affluent counterparts and this is evident regardless of ethnic background. 2. Although Asian 14-15-year-old children have a higher periodontal treatment need than Whites, there was no ethnic influence on how they perceive their oral health. 3. Oral treatment need is an important factor with respect to oral self perceptions. <223> UI - 98413377 AU - Nishimura M AU - Bhuiyan MM AU - Matsumura S AU - Shimono T IN - Department of Pediatric Dentistry, Okayama University Dental School, Japan. TI - Assessment of the caries activity test (Cariostat) based on the infection levels of mutans streptococci and lactobacilli in 2- to 13-year-old children's dental plaque. SO - ASDC Journal of Dentistry for Children 1998 Jul-Aug;65(4):248-51, 229 AB - It is generally agreed that mutans streptococci and lactobacilli are associated etiologically with dental caries. The caries activity test, Cariostat, was designed to measure the pH decrease caused by microorganisms in the plaque sample obtained from the buccal surfaces. Researchers found the test to be a reliable, diagnostic, and predictive device. Incubation was done on MS and MSB plates in an atmosphere of 95 percent N and 5 percent CO at 37 degrees C and for 48 hours. The relationship of the Cariostat scores and the pH values are shown in a table. The test scores are shown for two age-groups: Ages two-to-six years with primary dentitions, and ages five-to-thirteen years with mixed dentitions. The advantages of the Cariostat test are: the sampling method is simple and the time of analysis is short; the test can be used for the very young and for patients difficult to manage; and it requires no specialized knowledge or equipment. <224> UI - 99024259 AU - Mair LH IN - Department of Clinical Dental Sciences, School of Dentistry, University of Liverpool, England. TI - Ten-year clinical assessment of three posterior resin composites and two amalgams. SO - Quintessence International 1998 Aug;29(8):483-90 AB - OBJECTIVE: The long-term clinical performance of three posterior resin composites and two amalgams was assessed. METHOD AND MATERIALS: Thirty Class II restorations each of P-30, Occlusin, Clearfil Posterior (composites), New True Dentalloy, and Solila Nova (amalgams) were placed. Reviews took place at 6 months and at 1, 2, 3, 4, 5, and 10 years. At each visit the gingival condition, the contact point status, and the presence of ledges, gaps, or recurrent caries were assessed. The color match, cavosurface marginal stain, general surface stain, tarnish, and corrosion were also scored where applicable. Epoxy resin replicas were used to measure the maximum depth of wear. RESULTS: After 10 years, there had been corrosion of both the high- and low-copper amalgams and a slight deterioration in color match of a number of composite restorations. Eighteen (of 20) Occlusin restorations had obvious cavosurface marginal stain, attributed to staining of the unfilled bonding resin layer. Statistical analysis indicated that New True Dentalloy, Solila Nova, and Clearfil-P exhibited significantly less wear than Occlusin and P-30. None of the restorations examined at the 10-year recall required replacement. CONCLUSION: The five materials, placed in a dental school environment, provided adequate clinical service for 10 years. <225> UI - 99016937 AU - Owens BM IN - Department of General Dentistry, University of Tennessee, College of Dentistry, Memphis, USA. TI - Replacement and initial placement of tooth colored restorations: a review and discussion. [Review] [34 refs] SO - Journal of the Tennessee Dental Association 1998 Jan;78(1):26-9 AB - Disagreement exists among dentists concerning reasons for initial placement and replacement of composite restorations, although specific criteria have been established by several reports. According to numerous studies, the longevity of composite restorations appears to be lower than for amalgam restorations; however, with advances in dental materials, composite resin longevity should increase. Inadequate operator technique and poor patient compliance are contributing factors for restoration failure. Research regarding enamel and dentin bonding systems will produce better quality and more durable results for composite restorations. [References: 34] <226> UI - 98368979 AU - Huysmans MC AU - Longbottom C AU - Pitts N IN - Department of Cariology and Endodontology, University of Nijmegen, The Netherlands.m.huysmans@dent.kun.nl TI - Electrical methods in occlusal caries diagnosis: An in vitro comparison with visual inspection and bite-wing radiography. SO - Caries Research 1998;32(5):324-9 AB - The aim of this study was to compare in vitro diagnostic performance of three electrical methods for occlusal caries diagnosis with that of visual inspection and bite-wing radiography. One hundred and seven extracted molar and premolar teeth were subjected to the diagnostic methods by 2 operators and subsequently sectioned for histological validation. Electrical measurements were made at site level and at surface level using two different instruments. The diagnostic parameters calculated from the results were: sensitivity, specificity, diagnostic accuracy at a theoretical caries prevalence of 10% and area under the ROC curve. The electrical methods and bite-wing radiography showed higher sensitivity and lower specificity than visual inspection. Diagnostic accuracy was significantly lower for bite-wing radiography and one electrical method than for visual inspection. Overall diagnostic performance of two electrical methods was superior. <227> UI - 98368980 AU - Huysmans MC AU - Longbottom C AU - Hintze H AU - Verdonschot EH IN - Department of Cariology and Endodontology, University of Nijmegen, The Netherlands. m.huysmans@dent.kun.nl TI - Surface-specific electrical occlusal caries diagnosis: reproducibility, correlation with histological lesion depth, and tooth type dependence. SO - Caries Research 1998;32(5):330-6 AB - Electrical conductance measurements are being used experimentally for occlusal caries detection. Recently, it was suggested to cover the fissure system with a conducting medium, resulting in a surface-specific measurement. It was the aim of this study to determine in vitro the reproducibility of this modified technique for occlusal caries in posterior teeth, to determine for a large study sample the correlation between the electrical measurements and histological lesion depth, and to evaluate the difference between results for premolars and molars. For the reproducibility determination, surface-specific electrical resistance measurements were made using a sample of 68 posterior teeth. Eight operators performed measurements on all teeth, and repeated measurements on 24 teeth. The validity study included the previous sample and the collected samples from two more studies, resulting in a total sample of 325 posterior teeth. One operator had performed electrical resistance measurements on all teeth in the sample. Reproducibility was good: mean Pearson's correlation coefficient 0.89 (+/-0.05) for interexaminer correlation, and 0.86 (+/-0.12) for intra-examiner correlation, using log (resistance) as the result parameter. The correlation coefficient between log(resistance) and histological lesion depth for the large sample was -0.78 for all teeth, -0.64 for premolars, and -0.73 for molars. The regression line for molars was located below the regression line for premolars: at a hypothetical histology score of 2.5 (a dentine caries threshold) the estimated resistance threshold would be 507 kOmega for premolars, and 233 kOmega for molars. Converted to Electronic Caries Monitor (ECM) readings, the difference is about 1.4 on the ECM scale. It was concluded that the in vitro reproducibility of the described surface-specific method for electrical resistance measurement is very good, even for inexperienced operators. The correlation between measurements and histological lesion depth is moderate to good. The method is sensitive to electrode area differences, which will result in different clinical cut-offs for caries diagnosis in premolar and molar teeth. <228> UI - 98418590 AU - Movsas B AU - Hanlon AL AU - Lanciano R AU - Scher RM AU - Weiner LM AU - Sigurdson ER AU - Hoffman JP AU - Eisenberg BL AU - Cooper HS AU - Provins S AU - Coia LR IN - Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA. B:Movsas@FCCC.edu TI - Phase I dose escalating trial of hyperfractionated pre-operative chemoradiation for locally advanced rectal cancer. SO - International Journal of Radiation Oncology, Biology, Physics 1998 Aug 1;42(1):43-50 AB - PURPOSE: To determine the acute toxicity, post-operative complications, pathologic response and extent of downstaging to high dose pre-operative radiation using a hyperfractionated radiation boost and concurrent chemotherapy in a prospective Phase I trial. MATERIALS & METHODS: To be eligible for this study, patients had to have adenocarcinoma of the rectum less than 12 cm from the anal verge with either Stage T4 or T3 but greater than 4 cm or greater than 40% of the bowel circumference. All patients received 45 Gy pelvic radiation (1.8 Gy per fraction). Subsequent radiation was given to the region of the gross tumor with a 2 cm margin. This "boost" treatment was given at 1.2 Gy twice daily to a total dose of 54.6 Gy for Level I, 57 Gy for Level II, and 61.8 Gy for Level III. 5-FU was given at 1g/m2 over 24 hours for a four day infusion during the first and sixth weeks of radiation, with the second course concurrent with the hyperfractionated radiation. Surgical resection was carried out 4-6 weeks following completion of chemoradiation (in curative cases) and additional adjuvant chemotherapy consisting of 5-FU and Leucovorin was given for an additional 4 monthly cycles Days 1 through 5 beginning four weeks post surgery. RESULTS: Twenty-seven patients, age 40-82 (median 61), completed the initial course of chemoradiation and are included in the analysis of toxicity. The median follow-up is 27 months (range 8-68). Eleven patients were treated to a dose of 54.6 Gy, nine patients to 57 Gy, and seven patients to 61.8 Gy. Twenty-one patients had T3 tumors, and six patients T4 tumors. Grade III acute toxicity from chemoradiation included proctitis (5 patients), dermatitis (9), diarrhea (five), leukopenia (1), cardiac (1). Grade IV toxicities included one patient with diarrhea (on dose Level I) and one patient (on dose Level III) with cardiac toxicity (unrelated to radiation). Surgical resection consisted of abdominal perineal resection in 16 and low anterior resection in 7. Four patients did not undergo a curative resection; three initially presented with metastases and one developed metastasis during the pre-operative regimen. Post-operative complications included pelvic or perineal abscess in two (on dose Levels I & II), and delayed wound healing in two (one of whom, on dose Level III, developed perineal wound dehiscence requiring surgical reconstruction). Of the 23 patients who had a curative resection, four manifested pathologic complete responses (17.4%). Thirteen of 23 patients (57%) had evidence of pathologic downstaging and only 1/23 patients (on dose Level I) had a positive resection margin. Of these 23 patients (with a minimum follow-up of 8 months), the patient with positive margins was the only one who developed a local failure (Fisher's Exact p=.04). The 3-year actuarial OS, DFS and LC rates are 82%, 72% and 96%, respectively. Twelve of 13 patients (92% at 3 years) > or = 61 years vs. 5/10 patients (45% at 3 years) < 61 years remained disease-free (log-rank p=0.017). CONCLUSION: This regimen of high dose pre-operative chemoradiation employing a hyperfractionated radiation boost is feasible and tolerable and results in significant downstaging in locally advanced rectal cancer. The vast majority of patients (96%) achieved negative margins, which appears to be a prerequisite for local control (p= 0.04). Older age (> or =61 years) was a significant predictor for improved DFS. This regimen (at dose Level III, 61.8 Gy) is currently being tested in a Phase II setting. <229> UI - 98372391 AU - Skaret E AU - Raadal M AU - Berg E AU - Kvale G IN - Center for Odontophobia, Faculty of Odontology, University of Bergen, Norway. erik.skaret@odont.uib.no TI - Dental anxiety among 18-yr-olds in Norway. Prevalence and related factors. SO - European Journal of Oral Sciences 1998 Aug;106(4):835-43 AB - The aims of this study were to determine the prevalence of dental anxiety at the time when adolescents are leaving the public dental service, and to explore the relationship at this stage between dental anxiety and some possible etiologic factors. The sample consisted of 571 18-yr-olds in high school who completed a questionnaire and three psychometric scales, the Dental Fear Scale (DFS), the Dental Beliefs Survey (DBS) and the Geer Fear Scale (GFS), in the classroom. The relationship between dental anxiety (DFS and DBS) and a total of nine possible etiologic factors was explored by the use of stepwise regression analyses, and risk estimates (odds ratio) were calculated in cross-tables. There were significant sex differences for DFS and for GFS, but not for DBS. Nineteen percent of the total sample were classified as having high dental anxiety (DFS > 59). Previous experiences of pain, phobic anxiety indexed by GFS and pain at the last dental visit entered into the stepwise regression models of both dental anxiety indices explaining 50% of the variance of DFS, but only 18% of DBS. Students who reported more than one previous experience of pain were 9.9 times more likely to report high dental anxiety as recorded by DFS than the rest of the group. The corresponding risk factor for DBS was 3.4. <230> UI - 98430471 AU - Phipps KR AU - Orwoll ES AU - Bevan L IN - Oregon Health Sciences University, School of Dentistry, Portland 97201, USA. TI - The association between water-borne fluoride and bone mineral density in older adults. SO - Journal of Dental Research 1998 Sep;77(9):1739-48 AB - While the benefit of fluoridation in the prevention of dental caries has been overwhelmingly substantiated, the effect of fluoride on bone mineral density is less clear. This cross-sectional study was designed to compare the bone mineral densities of older adults exposed to various levels of fluoride from community water systems. Participants were recruited from 3 rural communities with naturally occurring fluoride in their water systems at 0.03, 0.7, and 2.5 mg/L. All adults, age 60 and over, were eligible if they were ambulatory and had a long-term history (> or = 20 yrs) of ingesting city water. Bone mineral density (BMD) was measured by means of dual-energy x-ray absorptiometry at 3 anatomical sites: lumbar spine, proximal femur, and forearm. A total of 353 white non-Hispanic women and 317 white non-Hispanic men took part in the study. When the data were stratified by city of residence and gender, men and women living in the community with high levels of fluoride in their community water system had significantly higher lumbar spine BMD than their counterparts from the communities with low and moderate fluoride levels. The women in the high-fluoride community had significantly higher proximal femur BMD, but there were no statistically significant differences among men in either proximal femur or forearm BMD. Long-term exposure (> or = 20 yrs) to higher levels of fluoride appears to have a positive impact on lumbar spine and proximal femur BMD. Based on the results of this study, exposure to fluoride at levels considered "optimal" for the prevention of dental caries (from 0.7 to 1.2 mg/L) appears to have no significant impact on bone mineral density. The relationship between higher levels of fluoride exposure and bone mineral density requires further investigation. <231> UI - 98351513 AU - Wang NJ IN - Faculty of Dentistry, University of Oslo, Norway. TI - Preventive dental care of children and adolescents in the 1990s: Denmark, Iceland, Norway, and Sweden. SO - Acta Odontologica Scandinavica 1998 Jun;56(3):169-72 AB - This article describes the provision of preventive care for children and adolescents in Denmark, Iceland, Norway, and Sweden in the 1990s. It includes information on personnel giving preventive care, administration of the dental care system, strategies and methods used for prevention, and resources allocated for preventive dental care. In all these countries comprehensive and systematic dental care, subsidized or free of charge, has been instituted for children and adolescents. However, comparisons between the countries show significant differences in the organization of the dental care for children, the time used for preventive care, the recall routines, and the implementation of risk-based and population-based preventive strategies. The relative importance of different caries-prevention methods (fluorides, hygiene, and diet) reported by the clinicians varied between Denmark, Iceland, Norway, and Sweden. While variation poses rather than answers questions concerning effectiveness, available data provide evidence of differences in the input of resources. Unless the dental profession addresses the issue of effectiveness of preventive dental care, politicians and administrators in a cost-containment context will easily conclude that least is best. <232> UI - 98351517 AU - Schwarz E IN - Faculty of Dentistry, University of Hong Kong, Hong Kong Special Administrative Region of China. TI - Is caries prevention cost-effective? Does anybody care?. SO - Acta Odontologica Scandinavica 1998 Jun;56(3):187-92 AB - The aim of this article is to review current issues concerning the cost-effectiveness of caries prevention. Several decades after considerable improvements in the oral disease situation were documented in Scandinavia, doubts are still expressed about whether preventive measures are cost-effective. An analytic model is suggested to explore the relationships between the dental profession, which provides the prevention, the research and development activities, which provide the material and data basis for prevention, and political/societal responses to the professional input. The four elements considered were the definition of prevention, the practical perception of effective prevention, the appropriateness of traditional cost-effectiveness analysis, and the time factor with regard to when a preventive effect should be evaluated. The main arguments of the discussion are that caries prevention is not uniformly defined by the profession, that dental research is casting doubt on the effectiveness of traditionally accepted preventive measures, that political pressures on health care are motivated by economic pressures, but that traditional cost benefit/effectiveness analyses have not been able to help the decision-makers choose wisely. Often the time perspective for the real effects of prevention lies beyond the interests of decision-makers. Although caries prevention may be viewed as an investment in health by the profession, this contention may not be acceptable to a society with very short-term perspectives. <233> UI - 98353063 AU - Angelillo IF AU - Anfosso R AU - Nobile CG AU - Pavia M IN - Medical School, University of Reggio Calabria, Catanzaro, Italy. TI - Prevalence of dental caries in schoolchildren in Italy [published erratum appears in Eur J Epidemiol 1998 Oct;14(7):733]. SO - European Journal of Epidemiology 1998 Jun;14(4):351-7 AB - The caries experience and its potential risk indicators such as socioeconomic status, sweets consumption, toothbrushing habits, dental visit attendance pattern and salivary mutans streptococci (in 12 year old only), were assessed in schoolchildren raised and living in low fluoridated areas (Catanzaro, Italy). Caries-free prevalence in the 6-year-old was 52.9% in their primary dentition; the dmft and dmfs were 2.1 and 5.1, and both DMFT and DMFS were 0.1. Almost 91% of the dmft was attributable to active decay. The proportion of children with a dmft+DMFT > or = 1 and the dmft and dmfs were significantly higher in those with low socio-economic status. In the 12-year-old, 52.7% had a history of caries and the DMFT and DMFS were 1.5 and 2.6; the filled component was the dominant proportion. The more likely they visited a dentist for routine checkup, the higher socio-economic status (it was not associated with DMFT), the less frequently they had sweets, and the low level of Streptococcus mutans, the more likely they were caries-free and the less likely they were to have a high DMFT, DMFS, and DT. In the 15-year-old, 68.8% had a history of caries and the DMFT and DMFS were 2.8 and 4.8, with a higher prevalence of the F component. The children who visited a dentist for routine checkup had a significantly lower caries experience, DMFT, DMFS, and DT than the irregular attenders, and those with low socio-economic background were more likely to have a high DMFS. <234> UI - 98439241 AU - Vargas CM AU - Crall JJ AU - Schneider DA IN - National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md. 20782, USA. TI - Sociodemographic distribution of pediatric dental caries: NHANES III, 1988-1994 [see comments]. CM - Comment in: J Am Dent Assoc 1998 Nov;129(11):1526 SO - Journal of the American Dental Association 1998 Sep;129(9):1229-38 AB - This article examines the extent to which caries prevalence and untreated caries vary in children by ethnicity and household income level. Data from the Third National Health and Nutrition Examination Survey, 1988-1994, for 10,332 children 2 to 18 years of age indicate that lower-income children and Mexican-American and African-American children are more likely to have a higher prevalence of caries and more unmet treatment needs than their higher-income and non-Hispanic white counterparts. <235> UI - 98389925 AU - Joshipura KJ AU - Douglass CW AU - Willett WC IN - Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA. USA. hpkaj@gauss.med.harvard.edu TI - Possible explanations for the tooth loss and cardiovascular disease relationship. [Review] [47 refs] SO - Annals of Periodontology 1998 Jul;3(1):175-83 AB - Several studies have shown relationships between periodontal disease and cardiovascular disease (CVD). A few studies have also shown that tooth loss may be associated with increased risk of coronary heart disease and stroke. We have reviewed the relevant literature to assess possible explanations for the reported associations between tooth loss and CVD. In particular, we considered whether the reported association between tooth loss and CVD could be explained by antecedent periodontal disease, antecedent caries, the extraction process, dietary changes following tooth loss, or confounding or bias from other sources. Since access to care and attitudes to health care may influence the decision to extract teeth, as well as cardiovascular disease risk, one needs to be cautious about confounding from behaviorally related factors. Available evidence suggests that further studies are needed to rule out that confounding is a possible explanation for the tooth loss and CVD relationship, that prior periodontal disease may not completely explain the tooth loss-CVD relationship, and that the role of diet needs to be further explored [References: 47] <236> UI - 98389928 AU - Dasanayake AP IN - Department of Oral Biology, School of Dentistry, University of Alabama at Birmingham. USA. Ananda@epi.soph.uab.edu TI - Poor periodontal health of the pregnant woman as a risk factor for low birth weight. SO - Annals of Periodontology 1998 Jul;3(1):206-12 AB - In both developed and developing countries, low birth weight (LBW) has a tremendous impact on both the health care system and the individual families affected. This warrants the continuous search for risk factors for LBW that are amenable to prevention. Can poor oral health of the pregnant woman be one such factor? In a 1:1 matched case-control study (N = 55 pairs), we evaluated the hypothesis that poor oral health of the pregnant woman is a risk factor for LBW. The effect of periodontal and dental caries status of the woman at the time of delivery on the birth weight of the infant was evaluated by using conditional logistic regression analyses, while controlling for known risk factors for LBW. Mothers of LBW infants were shorter, less educated, married to men of lower occupational class, had less healthy areas of gingiva and more areas with bleeding and calculus, and gained less weight during the pregnancy. Conditional logistic regression analyses indicated that mothers with more healthy areas of gingiva (OR = 0.3, 95% CI = 0.12 - 0.72) and those who were taller (OR = 0.86, 95% CI = 0.75 - 0.98) had a lower risk of giving birth to an LBW infant. Risk of LBW was higher in mothers who had no or late prenatal care (OR = 3.9, 95% CI = 1.24 - 12.2). We conclude that poor periodontal health of the mother is a potential independent risk factor for LBW. <237> UI - 98389924 AU - Loesche WJ AU - Schork A AU - Terpenning MS AU - Chen YM AU - Kerr C AU - Dominguez BL IN - University of Michigan, School of Dentistry, Department of Biologic and Materials Science, Ann Arbor, MI, USA. WLoesche@umich.edu TI - The relationship between dental disease and cerebral vascular accident in elderly United States veterans. SO - Annals of Periodontology 1998 Jul;3(1):161-74 AB - We report here information obtained from a cross-sectional study of 401 veterans, who were at least 60 years of age, which showed that several dental/oral conditions can be significantly associated with the diagnosis of a cerebral vascular accident (CVA), when included in a multivariate logistic regression model with and without many of the known risk factors for a CVA. The dental findings relative to the prevalence of dental caries and periodontal disease were not distinctly different between the subjects with and without a CVA in the bivariate analysis. A higher stimulated salivary flow was negatively associated with a CVA in the multivariate models. The plaque index and oral hygiene habits relating to brushing, flossing, and frequency of having teeth cleaned by a dentist/hygienist were significantly associated with a CVA in the bivariate analysis. Among these oral hygiene parameters, *needing help in brushing one's teeth" and the reported annual visit to the dentist/hygienist for teeth cleaning remained significant in the multivariate models involving the dependent-living subjects. The need for help in brushing one's teeth could reflect the fact that many subjects had reduced manual dexterity as a result of the CVA and required this extra care. However, the finding that those dependent-living individuals who reported that they did not have their teeth cleaned at least once a year were 4.76 times more likely to have had a CVA, suggests that a pattern of oral neglect might be associated with developing a CVA. The implications of this in terms of an intervention strategy for CVA warrants further consideration. However, caution is recommended because the data were obtained from a convenience sampling of older veterans and may not be generalizable to other populations. <238> UI - 98318868 AU - Levallois P AU - Grondin J AU - Gingras S IN - Centre de sante publique de Quebec, Beauport. patrick.levallois@msp.ulaval.ca TI - Knowledge, perception and behaviour of the general public concerning the addition of fluoride in drinking water. SO - Canadian Journal of Public Health. Revue Canadienne de Sante Publique 1998 May-Jun;89(3):162-5 AB - A telephone survey was carried out in 1994, in the Quebec City region, among 1006 people living in two municipalities where tap water is fluoridated and 1003 people living in two municipalities where there is no fluoridation. Knowledge of the main benefit associated with the use of fluoride (prevention of tooth decay) in drinking water was not different in fluorated versus non-fluoridated municipalities (20.4% vs 19.4%, p = 0.57). Knowledge of its main disadvantage (increase of dental fluorosis) was very low and similar in both groups (3.1% vs 2.0%, p = 0.11). Opposition to fluoridation was slightly higher in fluoridated areas (22.0% vs 18.3%, p = 0.04), and the use of fluoridated supplements for children was much less important in fluoridated areas (4.4% vs 12.4%, p = 0.001). No changes in the measures of association (odds ratios) were found after adjustment for the different characteristics of the participants (age, family income, education). Opposition to fluoridation was lower among those who believed their tap water was fluoridated (even if not): 19.9% vs 34.5%, p < 0.001. This study demonstrates that there is still need for public health education on the uses of fluorides. <239> UI - 98368412 AU - Levesque MA AU - Yu H AU - Clark GM AU - Diamandis EP IN - Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada. TI - Enzyme-linked immunoabsorbent assay-detected p53 protein accumulation: a prognostic factor in a large breast cancer cohort. SO - Journal of Clinical Oncology 1998 Aug;16(8):2641-50 AB - PURPOSE: This study was designed to evaluate whether patients with an unfavorable breast cancer prognosis could be identified by p53 protein overexpression detected by a quantitative enzyme-linked immunoabsorbent assay (ELISA). PATIENTS AND METHODS: Extracts from 998 breast carcinomas were assayed for p53 protein by an ELISA that used both DO-1 monoclonal and CM-1 polyclonal antibodies. Relative risks (RRs) for cancer relapse and death after 6 years of follow-up for patients with p53-positive tumors based on different dichotomization criteria were determined by multivariate Cox regression, adjusted for patient age, tumor size, S-phase fraction, estrogen (ER) and progesterone (PR) receptor concentrations, DNA ploidy, and lymph node metastases. Disease-free (DFS) and overall (OS) survival probabilities of p53-positive and p53-negative groups, using a median cutoff, were also estimated by the Kaplan-Meier method and the log-rank test. These analyses were performed for all patients and for subgroups defined by ER status, node status, and primary postoperative treatment. RESULTS: Univariate analysis showed that p53 concentrations that exceeded the median indicated significantly increased risks for relapse (P < .01) and death (P = .02). Multivariate analyses confirmed these observations (RR = 1.40; P = .02 for DFS and RR = 1.50; P < .01 for OS) and showed trends for increasing risks for relapse (P = .02) and death (P = .06) when p53 was considered as a four-level categoric variable, and identified p53 positivity as a significant predictor of outcome in node-positive patients (RR = 1.67; P < .01 and RR = 2.10; P < .01 for DFS and OS, respectively), ER-positive patients (RR = 1.45; P = .02 and RR = 1.50; P = .01 for DFS and OS, respectively), and in patients treated with chemotherapy (RR = 1.73; P = .04 for relapse and RR = 2.04; P = .03 for death). CONCLUSION: Assessment of p53 overexpression by ELISA, easily incorporated into the routine biochemical work-up of breast tumors, may be an independent predictor of reduced survival of breast cancer patients. <240> UI - 98291970 AU - Angerer J AU - Goen T AU - Kramer A AU - Kafferlein HU IN - Institute and Outpatient Clinic of Occupational- Social and Environmental Medicine, University Erlangen-Nurnberg, Erlangen, Germany. TI - N-methylcarbamoyl adducts at the N-terminal valine of globin in workers exposed to N,N-dimethylformamide. SO - Archives of Toxicology 1998 Apr;72(5):309-13 AB - N,N-dimethylformamide (DMF) is a commonly used industrial solvent. The formation of some metabolites of DMF in humans occurs via N-methyl-carbamoylated species (e.g. N-methylcarbamoylated glutathione). The aim of our study was to investigate whether DMF leads to N-methylcarbamoylated adducts at the N-terminal valine of haemoglobin (Hb). Therefore, Hb adduct levels of ten DMF exposed workers and ten controls were analysed by a specific and sensitive detection method using capillary gas chromatography and a mass selective detector (GC/MS). Using this method we were able to show for the first time that Hb adducts are formed during the metabolism of DMF in humans. The general population, however, shows still unidentified background levels of this adduct which are on average lower by a factor of 50. The pathway for the formation of the investigated DMF-Hb adduct in workers exposed to DMF is still unknown. As identical adducts were also found after exposure to methylisocyanate (MIC), our work indicates the formation of MIC during the metabolism of DMF. The formation of Hb adducts with DMF and its relevance for occupational health is a subject of further research. <241> UI - 98341935 AU - Tomas JF AU - Lopez-Lorenzo JL AU - Requena MJ AU - Aguilar R AU - Steegmann JL AU - Camara R AU - Alegre A AU - Arranz R AU - Figuera A AU - Fernandez-Ranada JM IN - Department of Hematology, Universidad Autonoma de Madrid, Hospital Universitario La Princesa, Spain. TI - Absence of influence of prior treatment with interferon on the outcome of allogeneic bone marrow transplantation for chronic myeloid leukemia. SO - Bone Marrow Transplantation 1998 Jul;22(1):47-51 AB - Timing of transplantation in the chronic phase of chronic myeloid leukemia (CML) and previous treatment with interferon remains controversial. We have tried to discover what influence pretreatment with interferon alpha (IFN-A) has on the results of allogeneic bone marrow transplantation for CML patients treated in a single institution. Fifty-one consecutive patients with chronic phase Ph-positive CML who received an allogeneic bone marrow transplantation from a HLA-identical familial donor were evaluated. Thirty had been treated with IFN-A (IFN+ group) prior to BMT and twenty-one had not (IFN- group). Both groups were homogeneous for clinical characteristics such as age, sex, previous chemotherapy, disease status, and time from diagnosis to transplant. No difference was found in neutrophil and platelet count recovery between the IFN+ and IFN- group. The incidence of acute and chronic GVHD, VOD and severe mucositis was not significantly different. Relapse and both overall survival and DFS were similar for both groups. No adverse effects of prior IFN exposure on the outcome of HLA-identical sibling donor BMT for chronic phase CML patients were found in this study. <242> UI - 98364585 AU - Fennis-Ie YL AU - Verdonschot EH AU - van't Hof MA IN - Department of Cariology and Endodontology/117, Faculty of Medical Sciences, University of Nijmegen, The Netherlands. Y.Fennis-Ie@dent.kun.nl TI - Performance of some diagnostic systems in the prediction of occlusal caries in permanent molars in 6- and 11-year-old children. SO - Journal of Dentistry 1998 Jul-Aug;26(5-6):403-8 AB - OBJECTIVES: Attempts have been made to develop diagnostic methods which enable an early diagnosis of occlusal lesions which are not detectable by visual inspection. The aim of this study was to compare the performance of visual inspection focused on finding signs of fissure decalcification and discoloration, visual inspection upon fibre-optic transillumination (FOTI), and electrical conductance measurements (ECMs) in predicting the onset of occlusal caries in 6- and 11-year-old children. METHODS: Fifty children aged 5-7 and 11-15 years, having first or second permanent molar teeth that were not exposed to the oral environment for more than half a year, participated in the study. Following baseline data recording, the diagnostic measurements were repeated six times at 6-month intervals over a period of 2.5 years. RESULTS: Data were collected at predefined sites in the fissures. During the study, 220 of the 652 sites, i.e. 75 of 197 molars in 31 of the 50 children were judged to require a sealant or a sealant restoration. Two examiners jointly decided on the decay status at the sites. Survival plots showed that ECMs were superior to FOTI and fissure discoloration in predicting the onset of occlusal caries, although the differences were small. CONCLUSION: ECM is a better predictor of occlusal caries than fissure discoloration and FOTI, although the differences among the performance of the three methods in this study were very small. A cost-effective analysis is envisaged to obtain insight into the practical value of ECMs in the prediction of occlusal caries and, thus, into the effectiveness of sealant application. <243> UI - 98332254 AU - Utriainen P AU - Pahkala K AU - Kentala J AU - Laippala P AU - Mattila K IN - Seinajoki Health Care Centre, Finland. seinajoen.terveyskeskus@co.inet.fi TI - Changes in the oral health of adolescents treated by the Finnish public dental services between the ages of 13 and 15 years. SO - Community Dentistry & Oral Epidemiology 1998 Jun;26(3):149-54 AB - Oral cavity health was monitored in 2422 young people aged 13-15 years attending four health centres in Finland between 1992 and 1995. Assessments were made in terms of DMF, D and CPITN indices at clinical examinations. Of those who had no carious teeth at the initial examination, 60% did not develop cavities during the whole period, whereas half of those who had at least two carious teeth at the initial examination developed at least three new carious teeth. The treatment time needed by the latter accounted for half of the total time expended by the researchers until the end of the period. Costs can be saved or new patients brought into the dental care system by reorganizing the treatment of the patients who suffer from abundant caries and by reducing the resources devoted to the treatment of healthy patients. <244> UI - 98316795 AU - Ellenbogen KA AU - Wood MA AU - Gilligan DM AU - Crofts T AU - London W AU - McClish D IN - Department of Medicine, Virginia Commonwealth University and Medical College of Virginia, Richmond 23298-0053, USA. Kellenbogen@pol.net TI - Immediate reproducibility of upper limit of vulnerability measurements in patients undergoing transvenous implantable cardioverter defibrillator implantation. SO - Journal of Cardiovascular Electrophysiology 1998 Jun;9(6):588-95 AB - INTRODUCTION: Measurement of the upper limit of vulnerability (ULV) with monophasic T wave shocks has been proposed as a patient-specific measurement of defibrillation efficacy that results in fewer episodes of ventricular fibrillation (VF) than measurement of a defibrillation efficacy curve. METHODS AND RESULTS: We sought to determine the magnitude of variance in ULV in 63 consecutive patients undergoing implantation of an implantable cardioverter defibrillator (ICD). We measured ULV as the strength at or above which VF is not induced when a stimulus is delivered at 310 msec after an 8-beat ventricular pacing drive at 400 msec. Defibrillation threshold (DFT) was measured in patients with an active can device using a biphasic waveform and the binary search method beginning at 12 J. Sixty-three patients were studied; they had a mean age of 62 +/- 12 years and a mean ejection fraction of 35% +/- 15%. Three quarters of patients had an ischemic cardiomyopathy. Each patient underwent 4.5 +/- 0.8 measurements of ULV. Monophasic ULV correlated poorly with biphasic DFT (R between 0.19 and 0.28, P = 0.04 to 0.17). There was no change in ULV between second to third, third to fourth, and first to last measurement in 22% to 41% of patients. The reliability coefficient was 0.87. A ULV > or = 20 J was found in eight patients. The only predictor of high ULV was a high DFT. CONCLUSION: Monophasic ULVs do not closely predict biphasic active can DFTs using a standard protocol. High DFTs were predicted by high ULVs. There was little variation in the acute measurement of ULV between trials. These findings have important implications for using ULV measurements to determine changes in DFTs after interventions. The methodology of determining ULV is critical to its use for predicting DFTs and programming ICDs. <245> UI - 98270596 AU - Sans M AU - Andreu V AU - Bordas JM AU - Llach J AU - Lopez-Guillermo A AU - Cervantes F AU - Bruguera M AU - Mondelo F AU - Montserrat E AU - Teres J AU - Rodes J IN - Liver Unit and Hematology Department Hospital Clinic i Provincial, Barcelona, Spain. TI - Usefulness of laparoscopy with liver biopsy in the assessment of liver involvement at diagnosis of Hodgkin's and non-Hodgkin's lymphomas. SO - Gastrointestinal Endoscopy 1998 May;47(5):391-5 AB - BACKGROUND: Staging of lymphoma at diagnosis determines therapeutic strategy and disease prognosis. Hepatic involvement, demonstrated by laparotomy or laparoscopy, is frequent in Hodgkin's and non-Hodgkin's lymphoma. However, it is unclear whether these procedures are still necessary or whether they should be replaced by less invasive techniques. METHODS: Laparoscopy-assisted liver biopsies, as well as laboratory studies, bone marrow biopsy, and thoracic and abdominal computed tomography, were performed as an initial staging evaluation in 112 consecutive patients who were diagnosed with Hodgkin's or non-Hodgkin's lymphoma. RESULTS: Hepatic lymphomatous involvement was demonstrated in 18 patients (16%). It was more frequent in non-Hodgkin's (24%) than in Hodgkin's (8%) lymphomas (p < 0.04) and among stage III and IV (24%) than stage I and 11 (10%) patients (p < 0.05). The laparoscopic finding of white spots or nodules on the liver surface had a 100% specificity in the diagnosis of lymphomatous liver involvement. Conversely, hepatomegaly on both laparoscopy and computed tomography, as well as laboratory studies, had a low sensitivity and specificity. CONCLUSIONS: Laparoscopy-assisted liver biopsy was a useful technique to establish hepatic lymphomatous involvement, which was not identified by either computed tomography or laboratory studies. <246> UI - 98280449 AU - Lopez Del Valle L AU - Velazquez-Quintana Y AU - Weinstein P AU - Domoto P AU - Leroux B IN - University of Puerto Rico. TI - Early childhood caries and risk factors in rural Puerto Rican children. SO - ASDC Journal of Dentistry for Children 1998 Mar-Apr;65(2):132-5 AB - A sample of 167 Puerto Rican children whose ages ranged from six months to forty-seven months (mean = 23 months) were studied. Children were examined for Early Childhood Caries with light and mirror and a structured interview was administered to parents and caretakers to identify risk factors. Results indicated that only 37.4 percent of the children were free of decalcification lesions or frank decay. While 53.9 percent of the children had lesions on maxillary incisors, 40.0 percent had molars affected by decalcification lesions and caries. Analysis of risk factors indicate that giving the baby a bottle when crying at night, number of adults and children in the family, use of fluoridated dentifrice, and age of the child were associated with the caries process in these children. Bottle and breast feeding, per se, were not risk factors. Disease patterns suggest other dietary risk factors, such as frequent snacking on food/drinks with sugar. <247> UI - 98345902 AU - Kambhu PP AU - Warren JJ AU - Hand JS AU - Levy SM AU - Cowen HJ IN - Department of Preventive and Community Dentistry, University of Iowa College of Dentistry, Iowa City 52242, USA. TI - Dental treatment outcomes among dentate nursing facility residents: an initial study. SO - Special Care in Dentistry 1998 May-Jun;18(3):128-32 AB - This investigation used retrospective methodology to examine the outcomes of previous dental treatment and the incidence of developing restorative and extraction needs, including dental caries, among nursing facility residents. Data were taken from treatment records of 48 dentate residents in 10 nursing facilities who received comprehensive dental treatment delivered through the Geriatric Mobile Unit (GMU) program operated by the University of Iowa College of Dentistry and were examined an average of 2.9 years after initial examination. Residents had a mean age of 84 years at the second exam, and 90% were female. About 18% of all previously placed restorations needed to be replaced, and an additional 11% of teeth that received a restoration needed to be extracted at follow-up. At follow-up, nearly 70% (33/48) of residents needed restorative care, while 44% (21/48) needed extractions. The mean incidence of teeth developing new treatment needs between the two visits was 2.7 teeth/person (14.9% of teeth) for restorative need and 1.1 teeth/person (6.6% of teeth) for extraction need. Results suggest that successful treatment outcomes can be achieved for nursing facility residents, but that dental disease and treatment needs develop at a high rate among these residents. <248> UI - 98271290 AU - Kuroda N AU - Nakashima K AU - Akiyama S AU - Sato N AU - Imi N AU - Shirakawa K AU - Uemura A IN - School of Pharmaceutical Sciences, Nagasaki University, Japan. TI - Chemiluminescent derivatization of adenyl compounds with glyoxal derivatives in the presence of heteropoly acids and its application to the simple and sensitive determination of DNA. SO - Journal of Bioluminescence & Chemiluminescence 1998 Jan-Feb;13(1):25-9 AB - A chemiluminescence (CL) determination of adenyl compounds is described. CL derivatization of adenyl compounds with methylglyoxal dimethyl acetal was performed in the presence of tungstosilicic acid and propan-2-ol. CL from adenyl compounds was produced by hydrogen peroxide and L-cysteine ethyl ester in DMF and water. The proposed method is highly sensitive and specific to compounds containing adenine. Adenine was determined in the range 1.0 x 10(-3)-5.0 x 10(-8) M with the detection limit of 3.0 x 10(-8) M (150 fmol per assay). The method was applied to the determination of DNA and detection limits of a few nanograms of DNA achieved. <249> UI - 98305522 AU - Haugejorden O AU - Tveit AB TI - The effect of fluoridation on the occurrence of hidden caries in clinically sound occlusal surfaces [letter]. SO - Caries Research 1998;32(4):266 <250> UI - 98305519 AU - Ekstrand KR AU - Ricketts DN AU - Kidd EA AU - Qvist V AU - Schou S IN - Department of Cariology and Endodontics, Faculty of Health Sciences, University of Copenhagen, Denmark. KIM.EKSTRAND@ODONT.KU.DK TI - Detection, diagnosing, monitoring and logical treatment of occlusal caries in relation to lesion activity and severity: an in vivo examination with histological validation. SO - Caries Research 1998;32(4):247-54 AB - The aims of the present study were to investigate the ability of 3 experienced clinicians to detect occlusal carious lesions, assess their depth, diagnose their activity and define a logical management for each lesion. The material consisted of 35 third molars scheduled for extraction or surgical removal making it possible to validate the accuracy of the clinical recordings histologically. Examinations were carried out at baseline and after 4 months in order to monitor lesion progression. At the first visit a radiograph was taken; the number of filled surfaces was counted and the oral hygiene assessed generally and by disclosing occlusal plaque of the tooth under examination. After cleaning the occlusal surface caries was recorded in a selected investigation site using a visual ranked caries scoring system, as well as an electrical conductance recording (ECM). Apart from counting fillings and taking new radiographs the same procedure was performed at the second visit, which then was followed by extraction of the tooth. After sectioning the tooth lesion depth was recorded, and lesion activity, based on acid production, was assessed using methyl red dye. Lesion activity was also judged by means of polarized light microscopic examinations of the sections. Results showed strong relationships between the visual, ECM and radiographic assessments and both lesion depth and lesion activity. In contrast, all other parameters were poorly related to lesion activity. Changes in visual assessments and in conductance readings from first to second examination were poorly associated with lesion activity. In conclusion, clinicians are able to detect lesions, predict activity and severity and define a logical management of occlusal caries on the basis of a single examination. <251> UI - 98302557 AU - Collin HL AU - Uusitupa M AU - Niskanen L AU - Koivisto AM AU - Markkanen H AU - Meurman JH IN - Department of Oral and Dental Diseases, University of Kuopio, Finland. TI - Caries in patients with non-insulin-dependent diabetes mellitus. SO - Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics 1998 Jun;85(6):680-5 AB - OBJECTIVE: The purpose of this study was to investigate the prevalence and risk factors of dental caries in patients with non-insulin-dependent diabetes mellitus and to determine whether these factors are associated with metabolic control and vascular complications of the disease. STUDY DESIGN: Both the occurrence of caries, acidogenic oral bacteria, and yeasts and salivary flow were studied in 25 patients with non-insulin-dependent diabetes mellitus whose diagnosis had been set 13 to 14 years earlier and in whom the metabolic evolution of the disease was well established. The patients' glycemic control was determined by means of analysis of the blood hemoglobin A1C concentration at the time of dental examination. The control group consisted of 40 nondiabetic subjects in the same age group. Decayed, missing, and filled teeth indices and numbers of surfaces with caries, filled surfaces, and root caries were determined by means of clinical dental caries examination. Stimulated salivary flow was measured, and levels of Streptococcus mutans, lactobacilli, and yeasts were analyzed. RESULTS: The median hemoglobin A1C concentration of the patients was 8.6%, which indicates poor metabolic control of diabetes. No association was found between the metabolic control of disease and dental caries. The occurrence of dental caries was not increased in the patients with non-insulin-dependent diabetes mellitus in comparison with the control subjects. The counts of acidogenic microbes and yeasts did not differ statistically significantly between the groups. There was no association of caries with the prevalence of coronary artery disease or hypertension in either the patients or the control subjects. In a stepwise logistic regression model, a salivary flow of at least 0.8 ml/min was related to the occurrence of dental caries in patients with non-insulin-dependent diabetes mellitus, whereas negligence with respect to dental care was the most important risk predictor in the control group. CONCLUSION: Our results showed no effect of diabetes on the prevalence of caries. However, the caries-protective effect of saliva was partly lost in patients with non-insulin-dependent diabetes mellitus. <252> UI - 98375327 AU - Smedberg JI AU - Ekenback J AU - Lothigius E AU - Arvidson K IN - Department of Prosthetic Dentistry, St Erik Hospital, Stockholm, Sweden. JI.Smedberg@protetik.Pl.se TI - Two-year follow-up study of Procera-ceramic fixed partial dentures. SO - International Journal of Prosthodontics 1998 Mar-Apr;11(2):145-9 AB - PURPOSE: The aim of this prospective study was to determine whether a machine-fabricated titanium fixed partial denture veneered with a low-temperature fused porcelain is an acceptable treatment modality. MATERIALS AND METHODS: The study originally included 25 patients with 37 fixed partial dentures of three to seven units, with a total of 151 units including 98 abutments. A clinical examination using the California Dental Association quality evaluation system and radiologic examination and registration of complications was conducted at the time of insertion and after 1 and 2 years. RESULTS: After 2 years, 123 units (including 80 abutments) remained for examination. Twenty-eight units (including 18 abutments) were lost during the follow-up period. The losses were because of drop-out (eight cases), root fracture (two cases), caries (six cases), and periodontitis (two cases). One fixed partial denture fractured after 18 months and was therefore remade. In all, porcelain fractures occurred in two patients, both with severe parafunctional habits. At baseline, the California Dental Association rating system for marginal integrity was "excellent" for 72 abutments and "acceptable" for 26 abutments. At the 2-year follow-up the corresponding rating was "excellent" for 46 abutments, "acceptable" for 30 abutments, and "not acceptable" for four abutments. The latter marginal defects were corrected with restorations. For surface and color the corresponding ratings were "excellent" for 137 units and "acceptable" for 14 units at baseline, and "excellent" for 80 units and "acceptable" for 43 units at the 2-year follow-up. Bleeding index increased from 24% at baseline to 33% after 2 years. CONCLUSION: The study confirms that for an observation period of 2 years, fixed partial dentures made by the Procera method seem to be an acceptable treatment modality. They are a suitable alternative to fixed partial dentures with porcelain fused to high-noble alloys. <253> UI - 98307307 AU - Hujoel PP IN - Department of Dental Public Health Sciences, School of Dentistry, University of Washington, Seattle 98195, USA. TI - Design and analysis issues in split mouth clinical trials [comment]. CM - Comment on: Community Dent Oral Epidemiol 1998 Apr;26(2):80-3; discussion 84 SO - Community Dentistry & Oral Epidemiology 1998 Apr;26(2):85-6 <254> UI - 98307306 AU - Vaeth M AU - Poulsen S IN - Department of Biostatistics, Faculty of Health Sciences, University of Aarhus, Denmark. vaeth@biostat.aau.dk TI - Comments on a commentary: statistical evaluation of split mouth caries trials [see comments]. CM - Comment in: Community Dent Oral Epidemiol 1998 Apr;26(2):85-6 SO - Community Dentistry & Oral Epidemiology 1998 Apr;26(2):80-3; discussion 84 AB - When results of split mouth caries trials are reported, the most frequently used outcome measures are "effectiveness" and "net gain". In a recent review by Riordan & FitzGerald (Community Dent Oral Epidemiol 1994;22:192-7) of the statistical analysis of data from such trials, the close connection between effectiveness and the traditional epidemiological outcome measure, relative risk, was pointed out and the latter measure was recommended. The confidence intervals for these parameters were, however, incorrect. This note provides valid confidence intervals for net gain, effectiveness and relative risk based on data from split mouth trials and presents examples of the calculations. <255> UI - 98307312 AU - Arnadottir IB AU - Rozier RG AU - Saemundsson SR AU - Sigurjons H AU - Holbrook WP IN - University of Iceland Faculty of Odontology, Reykjavik. TI - Approximal caries and sugar consumption in Icelandic teenagers. SO - Community Dentistry & Oral Epidemiology 1998 Apr;26(2):115-21 AB - The aim of this study, conducted in 1994, was to examine the association between approximal caries and sugar consumption in teenagers residing in three fluoride-deficient areas in Iceland while controlling for a number of behavioral, residential and microbiological factors. One hundred and fifty subjects (mean age 14 years) selected from the Icelandic Nutritional Survey (INS) were examined radiographically and they completed questionnaires about sugar consumption frequency. Total grams of sugar intake were obtained from the INS for each subject. Caries experience on approximal surfaces, diagnosed from radiographs, was used as the dependent variable in the analyses. Altogether 45.2% of subjects were caries free on approximal surfaces. The overall sample was found to have a mean DFS on approximal surfaces of 2.73 (s=4.36) per subject. Average daily total sugar intake was 170 g per subject and the mean number of sugar-eating occasions between meals was 5.32 (s=6.29) per subject. The regression model indicated that the frequency of between-meal sugar consumption was associated with approximal caries, with frequency of candy consumption being the most important of the sugar variables. In multivariate analysis, no relationship was found between dental caries and total daily intake of sugar, although a significant relationship between total sugar consumption and presence of caries was seen in bivariate analysis. Between-meal consumption of sugar remains a risk factor for the occurrence of dental caries, especially in populations with moderate-to-high levels of dental caries experience. <256> UI - 98307311 AU - Suominen-Taipale L AU - Widstrom E IN - Department of Community Dental Health, Institute of Dentistry, University of Turku, Finland. liisa.suominentaipale@polaris.cc.utu.fi TI - Does dental service utilization drop during economic recession? The example of Finland, 1991-94. SO - Community Dentistry & Oral Epidemiology 1998 Apr;26(2):107-14 AB - After enjoying rapid economic growth in the 1980s, Finland suffered a deep economic recession that began in 1990. It has been claimed that recession and uneven subsidies influence the use of dental services negatively. Finnish adults born after 1956 and world war veterans are entitled to subsidized dental care either in the Public Dental Service (PDS) or in the private sector. Other adults pay their treatment costs. OBJECTIVES: The purpose of this paper is to determine whether the economic recession in Finland during the early 1990s affected the use of dental services. METHODS: The data were collected by the National Research and Development Centre for Welfare and Health using a method called CATI (Computer Assisted Telephone Interview). The target population was non-institutionalized persons aged 25-79 years. RESULTS: About one-third of those interviewed had visited a dentist during the previous 6 months and this proportion was stable during the years studied. Number of teeth, length of education, income and sex had the highest predictive values for use of dental services as analyzed by multiple logistic regression. Two-thirds had visited a private practitioner, one-third a PDS clinic and a small percentage some other dentist or denturist. CONCLUSIONS: The results showed that the dental service utilization by Finns was stable during this period of economic downturn and only minor changes occurred in the mean number of visits. The most prominent change was seen in the youngest age group, among whom dental utilization decreased by almost 10%. The study indicated that subsidies do not strongly affect dental utilization today. <257> UI - 98364556 AU - van der Linden RP AU - Dermaut LR IN - Department of Orthodontics, University of Gent, Belgium. TI - White spot formation under orthodontic bands cemented with glass ionomer with or without Fluor Protector. SO - European Journal of Orthodontics 1998 Jun;20(3):219-24 AB - The purpose of this study was to determine whether an additional application of Fluor Protector before band cementation with glass ionomer cement reduces white spot formation compared with band cementation with glass ionomer cement. In the in vitro study, 80 premolars were divided in half, creating a control and a test group. All specimens were divided into four different groups to simulate different clinical situations and stored in a demineralizing solution to induce white spot formation. In the in vivo investigation, 18 orthodontic patients were incorporated in the study. One lower and one upper first molar band (randomly selected) were coated with Fluor Protector and then cemented with a glass ionomer cement (test group). The other two uncoated first molars were cemented with glass ionomer cement and served as the control group. The application of Fluor Protector in combination with Aquacem did not contribute to a reduction of white spot formation underneath molar bands compared with the use of Aquacem for banding. <258> UI - 98219235 AU - Mallow PK AU - Durward CS AU - Klaipo M IN - World Concern, Phnom Penh, Cambodia. TI - Restoration of permanent teeth in young rural children in Cambodia using the atraumatic restorative treatment (ART) technique and Fuji II glass ionomer cement. SO - International Journal of Paediatric Dentistry 1998 Mar;8(1):35-40 AB - Several recent studies have demonstrated the success of the ART (atraumatic restorative treatment) technique under field conditions in developing countries. The ART technique involves removal of caries using only hand instruments, and placing a glass ionomer cement (GIC) restoration. OBJECTIVES: To estimate the longevity of Fuji II GIC ART restorations placed in permanent teeth by dental nurse students under field conditions in rural Cambodia. DESIGN: Clinical field trial. SETTING: One high school in rural Cambodia. SAMPLE AND METHODS: 53 subjects between the ages of 12 and 17 who had dental caries were selected to participate. Subjects were randomly assigned to a dental nurse student for cavity preparation and placement of ART restorations (without cavity conditioning). RESULTS: 92.1% of the carious lesions required class I or class V restorations, and 85.4% were in the lower molars. 89 teeth were filled. At 1 and 3 years 86.4% and 79.5% of restorations were still present. Restorations were assessed by one dentist according to standard criteria. 76.3% of the restorations were judged to be successful at 1 year, and 57.9% at 3 years. CONCLUSIONS: Factors which may have affected the success rates included: the material used, technical factors, failure to condition the cavity prior to restoration, and inexperience of the operators. The results suggest that ART restorations in permanent teeth using Fuji II GIC are only moderately successful after 3 years. Better results could be expected by using a dentine conditioner in conjunction with one of the newer stronger glass ionomer cements. <259> UI - 98237096 AU - Hintze H AU - Wenzel A AU - Danielsen B AU - Nyvad B IN - Department of Oral Radiology, Royal Dental College, Faculty of Health Sciences, University of Aarhus, Denmark. hhintze@odont.aau.dk TI - Reliability of visual examination, fibre-optic transillumination, and bite-wing radiography, and reproducibility of direct visual examination following tooth separation for the identification of cavitated carious lesions in contacting approximal surfaces. SO - Caries Research 1998;32(3):204-9 AB - The aim of this study was to evaluate the diagnostic accuracy of visual, fibreoptic transillumination (FOTI), and bite-wing radiographic examination performed by 4 observers for the identification of cavitated carious lesions in contacting approximal surfaces, and to assess the inter-observer agreement with these methods and with direct visual examination conducted after tooth separation, the method used as validation for definitive determination of cavitation. A total of 338 unrestored approximal surfaces in 53 students were examined independently by 4 dentists using the diagnostic methods under study. The results from the diagnostic methods were compared with the results from the validation method for each observer. The sensitivities for identification of cavitated lesions using visual examination ranged from 0.12 to 0.50. For FOTI and radiography, the sensitivities ranged from 0.00 to 0.08 and from 0.56 to 0.69, respectively. The specificities exceeded 0.90 for all observers with all methods. Kappa values expressing inter-observer reproducibility were lowest for FOTI, followed by visual and radiographic examination. On the basis of these results, it was concluded that FOTI was the least reliable of the diagnostic methods tested. For the validation method, the inter-observer agreement was only 'substantial'. This implies that the method cannot be used as a validation for other diagnostic methods applied for the identification of cavitated carious lesions in contacting approximal surfaces. However, visual inspection after tooth separation may serve as a supplementary diagnostic tool to conventional visual and radiographic examination for clinical management of aproximal carious lesions. <260> UI - 98237097 AU - Ferreira Zandona AG AU - Analoui M AU - Beiswanger BB AU - Isaacs RL AU - Kafrawy AH AU - Eckert GJ AU - Stookey GK IN - Oral Health Research Institute, Indiana University School of Medicine, Indianapolis 46202, USA. azandona@iusd.iupui.edu TI - An in vitro comparison between laser fluorescence and visual examination for detection of demineralization in occlusal pits and fissures. SO - Caries Research 1998;32(3):210-8 AB - It has been demonstrated that when excited by laser light carious enamel appears dark compared to luminescent sound enamel. The aim of this study was to compare the sensitivity and specificity of visual exams (V), laser fluorescence (LF) and dye-enhanced LF (DELF) for detecting demineralization in occlusal pits and fissures. The actual presence of lesions was determined by subsequent confocal laser microscopy (CM), which was compared to histology (H). Independent clinical examiners visually graded three sites on occlusal surfaces of extracted, human premolars as sound or carious and also rated the color of each graded site as: 0 = same as surrounding enamel; 1 = white; 2 = light brown, or 3 = brown/dark brown. An argon laser was used to illuminate the teeth for LF and DELF; the images were captured with a CCD camera and then analyzed. DELF images were captured after the teeth had been exposed to 0.075% sodium fluorescein. Sections were then cut from each specimen and analyzed by CM and H for the presence or absence of caries. Results showed that DELF (0.72) was significantly more sensitive (p<0.05) than LF (0.49) and V (0.03) for detecting caries, but there were no significant differences among the methods in specificity (V 1.00; LF 0.67; DELF 0.60). When color was used as an indication of caries in V (VC, sensitivity 0.47; specificity 0.70), V exams were not different from LF. The area under the ROC curve, using H as the gold standard and CM as the test, was 0.78. Results indicated that DELF was the best diagnostic tool and that VC and LF were equally effective as diagnostic methods, when color of fissures was included as an indication of demineralization in the visual exam. <261> UI - 98259893 AU - Fischer HC AU - Funk GF AU - Karnell LH AU - Arcuri MR IN - University of Iowa College of Medicine, Iowa City, USA. TI - Associations between selected demographic parameters and dental status: potential implications for orodental rehabilitation. SO - Journal of Prosthetic Dentistry 1998 May;79(5):526-31 AB - PURPOSE: This pilot study evaluated potential relationships between dental status and various sociodemographic variables in the age group segment of the United States population at greatest risk for the disruption of dental function due to treatment of an oral cavity cancer. METHODS: The Dental Health Supplement of the 1989 National Health Interview Survey was used to evaluate the self-reported status of natural dentition and prior dental rehabilitation among the population of persons 45 years or older. RESULTS: Sociodemographic variables, which showed a significant association with status of natural dentition, were level of income and occupation at lower income levels (p < 0.05). Increased levels of prior dental rehabilitation were significantly associated with lower age, female gender, increased level of income, and occupation (p < 0.05). Occupations that required social interaction had the highest levels of both status of natural dentition and prior dental rehabilitation (p < 0.05). CONCLUSIONS: Overall dental status after treatment of oral cancer may be related to the occupational status of many persons. Sociodemographic factors that influence the dental rehabilitation needs of individual patients after treatment of an oral cancer should be considered in policy decisions affecting accessibility of dental rehabilitative care. A follow-up, survey study that would further define the identified relationships between a person's demographic status and dental rehabilitation needs is recommended. <262> UI - 98259903 AU - Maupome G IN - Faculty of Dentistry, University of British Columbia, Vancouver, Canada. TI - A comparison of senior dental students and normative standards with regard to caries assessment and treatment decisions to restore occlusal surfaces of permanent teeth. SO - Journal of Prosthetic Dentistry 1998 May;79(5):596-603 AB - STATEMENT OF PROBLEM: Even though assessments of borderline restorative items in terms of accuracy and interexaminer variation have been reported, no attempt has been made to simultaneously evaluate diagnostic and treatment planning decision using objective normative standards. PURPOSE: This study established the accuracy of caries presence assessment as compared with gold standards, interexaminer agreement in assessment of caries presence and restorative needs, and influences of perceived caries status and restoration quality on treatment planning in borderline restorative situations. MATERIALS AND METHODS: Fifteen senior dental students in Mexico City (66% women; mean age 23.2 years) evaluated predetermined areas in 109 restored and unrestored posterior teeth in an in vitro model. Teeth were subsequently assessed for restoration quality and the presence of enamel and dentinal caries by use of histologic and specific dye techniques. Student's t test, Cohen's kappa, and Pearson's correlation analyses were used to analyze the data. RESULTS: There were significant caries misdiagnoses and substantial overtreatment proposed. In a few instances, teeth were left untreated, but usually they were programmed for restoration. Interexaminer agreement varied markedly and was not high. However, performance while correctly detecting lesions was better than in treatment planning. CONCLUSION: There was a high correlation between a diagnosis of caries and restorative treatment in unrestored teeth; the correlation was lower for restored teeth, although they were allocated to restorative treatment more often. This difference hinged on perceived quality of the restoration, an important factor in the frequency of proposed re-restoration. <263> UI - 98236128 AU - Hamid A AU - Okamoto A AU - Iwaku M AU - Hume WR IN - Department of Resorative Dentistry, University of California, San Francisco, CA, USA. TI - Component release from light-activated glass ionomer and compomer cements. SO - Journal of Oral Rehabilitation 1998 Feb;25(2):94-9 AB - The purpose of this study was to identify and quantify any component released from seven commercially available light-cured or resin-modified glass ionomer and compomer cements. Twenty-one separate cylindrical stainless steel moulds 6 mm in diameter and 1.0 mm deep were filled with one of seven glass ionomer or compomer cements, light activated and then immediately immersed in separate containers of distilled water. Water samples were retrieved over a time period of up to 30 days and retained for analysis. An occlusal cavity 6 mm in diameter was prepared in extracted human third molar teeth with a remaining dentin thickness of 1.6-2.0 mm. A polypropylene chamber was attached to the cemento-enamel junction of each tooth to contain 1 mL of distilled water. Ten teeth were each filled with one of three cements and light activated. Water samples (eluates) were retrieved over a period of time. All samples were analysed by high performance liquid chromatography. Only one component, hydroxyethyl methacrylate (HEMA), was detected in the eluates from both tooth and mould samples. Analysis of diffusion of the HEMA through dentin showed a relatively sustained movement into the pulp space during the first day, with exponential decline thereafter. Our data show that HEMA was released from all of the light activated glass ionomer cements studied and from the compomer, both directly into water and through dentin. This release may be relevant both to the risk of adverse pulpal responses in patients and to the risk of allergy in patients and dental personnel. <264> UI - 98261401 AU - Sone T AU - Imai Y AU - Tomomitsu T AU - Fukunaga M IN - Department of Nuclear Medicine, Kawasaki Medical School, Okayama, Japan. tsone@med.kawasaki-m.ac.jp TI - Calcaneus as a site for the assessment of bone mass. [Review] [28 refs] SO - Bone 1998 May;22(5 Suppl):155S-157S AB - The calcaneus is a skeletal site frequently used for monitoring bone loss after spaceflight, because it is sensitive to microgravity-induced bone mineral loss and reflects the degree of demineralization in the vertebra and the femoral neck. In this article, methods for assessing the calcaneus are reviewed, and their potential applications and limitations as the monitoring site for bone loss in weightlessness are discussed. Currently, single or dual energy X-ray absorptiometry appears to be most sensitive for monitoring bone mineral loss in weightlessness. The results of recent studies suggest two- to threefold longer follow-up times required for ultrasound techniques. However, ultrasound devices can be designed to be portable, making them attractive for inflight use, and ultrasound techniques are expected to provide information related to bone quality. Additional investigations that assess new ultrasound techniques would be important to determine and utilize the full potential of this technology for monitoring bone loss in weightlessness. [References: 28] <265> UI - 98264723 AU - Wong FW AU - King NM IN - Department of Health, Hong Kong Government, Hong Kong. TI - The oral health of children with clefts--a review. [Review] [50 refs] SO - Cleft Palate-Craniofacial Journal 1998 May;35(3):248-54 AB - A review of the studies of the caries prevalence and periodontal health of patients with cleft lip and palate (CLP) revealed that only five investigations of caries prevalence in CLP patients included children. One reported that CLP children did not have a higher caries prevalence in the permanent dentition, whereas more recent studies have reported a higher caries prevalence in both the primary and permanent dentitions of CLP children than in those of noncleft children. However, there is wide variation in the teeth examined and the method of presenting data on caries prevalence. Six papers have reported on the periodontal health of adult CLP patients, and only one has done so on that of children. The adult CLP patients had poorer oral hygiene and more gingivitis, but there is no conclusive evidence that they have a higher risk of developing periodontal disease. No data on the oral hygiene of CLP children were available, but it has been emphasized that they have significantly more gingivitis than noncleft children, especially in the maxillary anterior teeth. [References: 50] <266> UI - 98299674 AU - Al-Khateeb S AU - Forsberg CM AU - de Josselin de Jong E AU - Angmar-Mansson B IN - Department of Cariology, Karolinska Institutet, Huddinge, Sweden. susan.al-khateeb@ofa.ki.se TI - A longitudinal laser fluorescence study of white spot lesions in orthodontic patients. SO - American Journal of Orthodontics & Dentofacial Orthopedics 1998 Jun;113(6):595-602 AB - Orthodontic treatment with fixed appliances increases the caries risk in young persons. The aim of this study was to apply a new caries diagnostic method, quantitative laser fluorescence, for longitudinal in vivo quantification of changes in incipient enamel lesions related to fixed orthodontic appliances. Seven young patients with active caries lesions disclosed at removal of the orthodontic brackets and bands were enrolled in the study. Caries preventive measures were intensified, including dietary advice, oral hygiene instructions, and the regular use of a fluoride dentifrice. The caries lesions were monitored with the quantitative laser fluorescence method after removal of the brackets and once a month thereafter. For each lesion, three quantities were measured: lesion area (mm2), mean fluorescence loss (%) over the lesion, and maximum loss of fluorescence (%) in the lesion. During a 1-year follow-up period, the areas of the lesions decreased and the enamel fluorescence lost was partly regained indicating that a remineralization process had occurred. It was concluded that quantitative laser fluorescence seems suitable for in vivo monitoring of mineral changes in incipient enamel lesions, and useful for the evaluation of preventive measures in caries prone persons, such as orthodontic patients. <267> UI - 98331785 AU - Chisick MC AU - Poindexter FR AU - York AK IN - US Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, MD 21010-5422, USA. TI - Factors influencing perceived need for dental care by United States military recruits. SO - Clinical Oral Investigations 1998 Mar;2(1):47-51 AB - This study explores factors that influence perceived need for dental care among US military recruits. The data were collected on a systematic random sample of 2711 US Army, Air Force, Navy, and Marine Corps recruits between February and July 1994. Participants received a comprehensive oral examination from a dentist and answered perceived need queries 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, overall, 61% of US military recruits perceive a need for dental care, with statistically significant differences across many demographic and clinical factors. Logistic regression results show that the likelihood of perceived need is influenced by gender, branch of service, dental health class, home region of the US, calculus, bleeding gums, level of decay, and dental utilization. <268> UI - 98316810 AU - Major J AU - Hudak A AU - Kiss G AU - Jakab MG AU - Szaniszlo J AU - Naray M AU - Nagy I AU - Tompa A IN - National Institute of Occupational Health, Budapest, Hungary. TI - Follow-up biological and genotoxicological monitoring of acrylonitrile- and dimethylformamide-exposed viscose rayon plant workers. SO - Environmental & Molecular Mutagenesis 1998;31(4):301-10 AB - In order to investigate the genotoxic effects of occupational acrylonitrile (ACN) and dimethylformamide (DMF) exposures, clinical serum and urine parameters and genotoxicological endpoints such as chromosome aberration (CA), sister chromatid exchange (SCE), high frequency SCE (HFC), cell cycle kinetics, and UV-induced unscheduled DNA synthesis (UDS) were followed up three times during a 20-month period in peripheral blood lymphocytes (PBL) of 26 workers (13 maintainers and 13 fiber producers) occupationally exposed to ANC and/or DMF in a viscose rayon plant, 26 matched control subjects, and six industrial controls (all males). Six of the 26 exposed subjects were hospitalized because of liver dysfunction that had developed due to inhalative DMF exposure. The rate of smoking was estimated on the basis of serum thiocyanate (SCN) levels. Average peak air ACN and DMF concentrations were over the maximum concentration limits at the time of both investigations. Urine ACN and monomethyl-formamide (MMF) excretions of the exposed subjects were almost doubled after work shifts. An increase in lymphocyte count (in months 0 and 7), and severe alterations in the liver function were observed in the exposed subjects. In PBLs the proliferative rate index (PRI) was already increased in month 0 compared with the controls. In each study, significant increases in CA and SCE frequencies, as well as increases in UDS were found in PBLs of the exposed subjects. The frequencies of chromatid breaks and acentric fragments further increased in month 7 and remained constantly elevated in month 20. Increased yields of both chromatid and chromosome-type exchange aberrations first appeared in month 20, when HFCs were 2.72 times more frequent in fiber producers than in maintainers. The role of some important biological confounding factors (age, white blood cell count, and hematocrit) and lifestyle confounding factors (smoking and drinking habits) were subjected to an analysis of variance during the second study. Increased CA, SCE, and UDS were found both in control and exposed smokers when current smoking was established on the basis of the serum SCN levels. The cytogenetic data suggest that occupational exposures to ACN and DMF induce considerable genotoxic consequences and may increase the cancer risk in the exposed human populations. <269> UI - 98321027 AU - Nair MK AU - Tyndall DA AU - Ludlow JB AU - May K AU - Ye F IN - Department of Diagnostic Sciences, School of Dentistry, University of North Carolina at Chapel Hill, USA. TI - The effects of restorative material and location on the detection of simulated recurrent caries. A comparison of dental film, direct digital radiography and tuned aperture computed tomography. SO - Dento-Maxillo-Facial Radiology 1998 Mar;27(2):80-4 AB - OBJECTIVES: To explore the effects of restorative material and lesion location on the detection of recurrent caries using intra-oral film, direct digital radiography and unprocessed and iteratively restored tuned aperture computed tomography (TACT) images. METHODS: An in vitro model with simulated lesions in half the surfaces studied was used. Lesions of varying sizes were created at either the intersection of the facial or lingual wall and the gingival floor or on the gingival floor midway between the facial and lingual walls in the proximal boxes of 24 molar teeth with MOD inlay preparations that had been restored with amalgam, radiopaque composite or radiolucent composite. RESULTS: Sensitivity and specificity values based on restoration were: amalgam: 59 and 87%; radiopaque composite: 68 and 78%; radiolucent composite: 36 and 93%; based on lesion location, mid-cervical floor region: 51 and 97%; point angle region: 44 and 90%; based on imaging modality, film: 40 and 85%; digital: 44 and 76%; unprocessed TACT slices: 50 and 87%, iteratively restored TACT images: 83 and 96%. Iteratively restored TACT images had the best intra- and inter-reader agreement. CONCLUSIONS: The use of restorative materials with a density approximating that of enamel is more effective for the detection of recurrent caries. Lesions located at the buccal point angle or mid-gingival floor are more easily detected than at the lingual point angle region. The sensitivity and specificity of TACT and iteratively restored TACT images were superior to those of film and direct digital images. <270> UI - 98321026 AU - Skodje F AU - Espelid I AU - Kvile K AU - Tveit AB IN - Department of Odontology, Faculty of Dentistry, University of Bergen, Norway. TI - The influence of radiographic exposure factors on the diagnosis of occlusal caries. SO - Dento-Maxillo-Facial Radiology 1998 Mar;27(2):75-9 AB - OBJECTIVES: To assess the impact of variations in radiographic density on occlusal caries diagnosis and observers' diagnostic strategy. METHODS: Three series of radiographs of 60 extracted molars were examined by nine dental students and caries diagnosed using a five point confidence-rating scale. Film density in each series was varied by varying exposure time: 1 s (high density), 0.4 s (medium density) and 0.067 s (low density). The 'true' diagnoses were obtained by stereomicroscopy. Diagnostic quality was measured with ROC analysis as Az. RESULTS: The difference in Az, values between the low and medium density series was statistically significant. The sensitivity and the specificity values for students' diagnoses in outer third of dentine were 85% and 50% for the high density series, 76% and 56% for the medium density series and 42% and 77% for the light series. CONCLUSIONS: Occlusal caries was diagnosed best from the darkest radiographs. Specificity was higher with light radiographs but sensitivity increased with density. Therefore underdiagnosis is more frequent with light radiographs, while overdiagnosis occurs more often with dark. The awareness of these effects could be an important guideline in adjusting the density of digital images. <271> UI - 98241106 AU - Swerdlow CD AU - Kass RM AU - O'Connor ME AU - Chen PS IN - Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA. swerdlow@ucla.edu TI - Effect of shock waveform on relationship between upper limit of vulnerability and defibrillation threshold. SO - Journal of Cardiovascular Electrophysiology 1998 Apr;9(4):339-49 AB - INTRODUCTION: The upper limit of vulnerability (ULV) correlates with the defibrillation threshold (DFT). The ULV can be determined with a single episode of ventricular fibrillation and is more reproducible than the single-point DFT. The critical-point hypothesis of defibrillation predicts that the relation between the ULV and the DFT is independent of shock waveform. The principal goal of this study was to test this prediction. METHODS AND RESULTS: We studied 45 patients at implants of pectoral cardioverter defibrillators. In the monophasic-biphasic group (n = 15), DFT and ULV were determined for monophasic and biphasic pulses from a 120-microF capacitor. In the 60- to 110-microF group (n = 30), DFT and ULV were compared for a clinically used 110-microF waveform and a novel 60-microF waveform with 70% phase 1 tilt and 7-msec phase 2 duration. In the monophasic-biphasic group, all measures of ULV and DFT were greater for monophasic than biphasic waveforms (P < 0.0001). In the 60- to 110-microF group, the current and voltage at the ULV and DFT were higher for the 60-microF waveform (P < 0.0001), but stored energy was lower (ULV 17%, P < 0.0001; DFT 19%, P = 0.03). There was a close correlation between ULV and DFT for both the monophasic-biphasic group (monophasic r2 = 0.75, P < 0.001; biphasic r2 = 0.82, P < 0.001) and the 60- to 110-microF group (60 microF r2 = 0.81 P < 0.001; 110 microF r2 = 0.75, P < 0.001). The ratio of ULV to DFT was not significantly different for monophasic versus biphasic pulses (1.17 +/- 0.12 vs 1.14 +/- 0.19, P = 0.19) or 60-microF versus 110-microF pulses (1.15 +/- 0.16 vs 1.11 +/- 0.14, P = 0.82). The slopes of the ULV versus DFT regression lines also were not significantly different (monophasic vs biphasic pulses, P = 0.46; 60-microF vs 110-microF pulses, P = 0.99). The sample sizes required to detect the observed differences between experimental conditions (P < 0.05) were 4 for ULV versus 6 for DFT in the monophasic-biphasic group (95% power) and 11 for ULV versus 31 for DFT in the 60- to 110-microF group (75% power). CONCLUSION: The relation between ULV and DFT is independent of shock waveform. Fewer patients are required to detect a moderate difference in efficacy of defibrillation waveforms by ULV than by DFT. A small-capacitor biphasic waveform with a long second phase defibrillates with lower stored energy than a clinically used waveform. <272> UI - 98261500 AU - Gronroos L AU - Saarela M AU - Matto J AU - Tanner-Salo U AU - Vuorela A AU - Alaluusua S IN - Department of Pedodontics and Orthodontics, University of Helsinki, Finland. Lisa.Gronroos@Helsinki.fi TI - Mutacin production by Streptococcus mutans may promote transmission of bacteria from mother to child. SO - Infection & Immunity 1998 Jun;66(6):2595-600 AB - The production of bacteriocin-like inhibitory substances, mutacins, by mutans streptococci varies among isolates. To find if the degree of mutacin activity of an isolate was related to its transmission between mother and her child, 19 mothers and their 18-month- to 3-year-old children were sampled for their oral mutans streptococci. In addition, the stability of mutacin activity was studied with isolates from the mothers and with isolates from five unrelated 5-year-old children in 5- to 7-year follow-up studies. A total of 145 oral mutans streptococcal isolates were serotyped by immunodiffusion, ribotyped, and mutacin typed by the stab culture technique. Mutacin was produced by 88% of the strains against more than 1 of the 14 indicator strains, representing mutans streptococci, Streptococcus sanguis, Streptococcus salivarius, Streptococcus oralis, Streptococcus gordonii, and Streptococcus pyogenes. Streptococcus mutans isolates showed more inhibitory activity than did Streptococcus sobrinus isolates. Identical ribotypes had similar mutacin activity profiles within a subject, initially and in the follow-up studies, in all but two cases. The mothers harbored a total of 37 different mutans streptococcal ribotypes. Six children were negative for mutans streptococci. Transmission was probable in 9 of 20 mother-child pairs on the basis of the presence of identical strains, as determined by ribotyping and bacteriocin (mutacin) typing. S. mutans strains shared between a mother and her child showed a broader spectrum of inhibitory activity than did nontransmitted strains. In conclusion, the mutacin activity of clinical isolates is reasonably stable, and this virulence factor seems to be of clinical importance in early colonization by S. mutans. <273> UI - 98255338 AU - Bertini M AU - Rus C AU - Freilone R AU - Botto B AU - Calvi R AU - Novero D AU - Orsucci L AU - Vitolo U AU - Palestro G AU - Resegotti L IN - Divisione di Ematologia, Azienda Ospedaliera S. Giovanni Battista, Torino, Italy. TI - Mantle cell lymphoma: a retrospective study on 27 patients. Clinical features and natural history. SO - Haematologica 1998 Apr;83(4):312-6 AB - BACKGROUND AND OBJECTIVE: Mantle cell lymphoma (MCL) is a separate histological and clinical entity recently recognized in the new revised European-American Lymphoma Classification. Little information exists regarding its therapy. We report the results of a retrospective study of 27 patients affected by MCL evaluating the clinical characteristics and the results of different therapeutical options used during the period of observation. DESIGN AND METHODS: From 1983 to 1993, we observed 27 patients affected by MCL according to the criteria proposed by European Lymphoma Task Force in a revision of 55 cases classified as NHL E according to Working Formulation (WF) criteria. We analyzed the clinical characteristics, the prognostic factors and the O.S. of these patients. RESULTS: The clinical characteristics of our patients (pts) are similar to those observed in other series: male prevalence, median age 62 years, B symptoms in 9 cases, P.S. > 2 in 11 cases, 3 pts were in stage I and II, 4 in stage III, 20 in stage IV; 18 pts had a bone marrow involvement, 13 pts had spleen enlargement and 14 had extranodal localization; 8 pts had bulky tumor and 5 had LDH above normal. The CR rate was 51.8%, the median O.S. was 43 months, and DFS was 18 months; the pts without bulky disease and with localized disease had a better CR rate. The inclusion of an anthracycline in the regimen did not affect the results. INTERPRETATION AND CONCLUSIONS: Our results were not divergent from those present in literature. The mantle cell lymphoma is an incurable and highly aggressive disease. Autologous bone marrow transplantation as support of high dose chemotherapy or allogenic bone marrow transplantation may be a chance for some patients, but not for the majority of patients, which are older than 65 years. Studies of a larger series and different therapeutical approaches, i.e. using biological modifiers in association or as maintenance after chemotherapy are essential. <274> UI - 98274403 AU - Nordbo H AU - Leirskar J AU - von der Fehr FR IN - Department of Preclinical Techniques and Material Sciences, Dental Faculty, University of Oslo, Norway. hakonn@amalgam.uio.no TI - Saucer-shaped cavity preparations for posterior approximal resin composite restorations: observations up to 10 years. SO - Quintessence International 1998 Jan;29(1):5-11 AB - OBJECTIVE: This clinical trial aimed at studying the long-term performance in routine clinical practice of saucer-shaped Class II resin composite restorations. METHOD AND MATERIALS: Fifty-one preparations were completed and filled with either of two light-cured posterior composites by seven dentists of the Public Dental Service. The restorations were evaluated annually, using the US Public Health Service criteria, bitewing radiographs, and dies based on replica impressions. At the final evaluation, the recall rate was 100%. RESULTS: After a mean of 7.2 +/- 1.3 years of service (censored maximum of 9.6 years), 70% of the restorations were acceptable for continued use. Caries and technical deficiencies were the main causes of failure. CONCLUSION: The saucer configuration, by respecting and utilizing inherent properties of the resin composites, spares sound dentin and is preferable to the box preparation. <275> UI - 98227133 AU - Feigal RJ IN - Department of Pediatric Dentistry, University of Michigan, Ann Arbor, USA. TI - Sealants and preventive restorations: review of effectiveness and clinical changes for improvement. [Review] [38 refs] SO - Pediatric Dentistry 1998 Mar-Apr;20(2):85-92 AB - Sealants are effective caries-preventive agents to the extent they remain bonded to teeth. Preventive resin restorations (PRR) have a proven record, but are susceptible to failure as the overlying sealant fails. Careful analyses of studies reveal a measurable failure rate of sealants (5-10% per year) that must be addressed. Even under the best of circumstances, sealants fail. Therefore, dentistry (as well as third-party systems) must accept that sealants need vigilant recall and proper preventive maintenance. In addition, it is clear that cost-effective use of sealants will involve selective application on teeth with the greatest caries risk. Caries risk analysis of the patient as well as the tooth is an essential step in the treatment planning process. To improve sealant success, new material advances are suggested. Data from studies using an intermediate layer of dentin bonding agent between etched enamel and sealant show dramatic reduction of failure for sealants, particularly in instances of molars judged difficult to seal due to early stage of eruption. [References: 38] <276> UI - 98267256 AU - Hopman AH AU - Ramaekers FC AU - Speel EJ IN - Department of Molecular Cell Biology and Genetics, University Maastricht, Maastricht, The Netherlands. TI - Rapid synthesis of biotin-, digoxigenin-, trinitrophenyl-, and fluorochrome-labeled tyramides and their application for In situ hybridization using CARD amplification. SO - Journal of Histochemistry & Cytochemistry 1998 Jun;46(6):771-7 AB - A one-step procedure for the synthesis of different tyramide conjugates, which can be utilized in the catalyzed reporter deposition (CARD) amplification system, is described. Succinimidyl esters of biotin, digoxigenin, and of the fluorochromes fluorescein, rhodamine, aminomethylcoumarine acetic acid, and Cy3 were coupled to tyramine in dimethylformamide (DMF) adjusted to a pH of 7.0-8.0 with triethylamine (TEA). The coupling reaction can be performed within 2 hr and the reaction mixture can be applied without further purification steps. Furthermore, trinitrophenyl (TNP)-tyramide was prepared by adding 2,4,6,-trinitrobenzenesulfonic acid to tyramine dissolved in either MilliQ/DMF basified with TEA or in an NaHCO3 (pH 9.5) buffer. A subsequent precipitation of the TNP-tyramide resulted in a high-yield isolation of this conjugate. The synthesized tyramide conjugates were applied successfully in single- and multiple-target in situ hybridization (ISH) procedures to detect both repetitive and single-copy DNA target sequences in cell preparations with high efficiency. The described approach provides an easy and fast method to prepare a variety of tyramide conjugates in bulk amounts at relatively low cost. <277> UI - 98287303 AU - Jakesz R AU - Samonigg H AU - Gnant M AU - Kubista E AU - Steindorfer P AU - Hausmaninger H AU - Sevelda P AU - Tschurtschenthaler B AU - Fridrik M AU - Stierer M AU - Kolb R AU - Steger G TI - Very low-dose adjuvant chemotherapy in steroid receptor negative stage I breast cancer patients. Austrian Breast Cancer Study Group. SO - European Journal of Cancer 1998 Jan;34(1):66-70 AB - A randomised clinical trial was performed to test whether or not low-dose chemotherapy lasting only 35 days improves the outcome of breast cancer patients with stage I disease and negative oestrogen and progesterone receptors (ER-, PgR-). Between 1984 and 1990, 277 stage I breast cancer patients with tumours negative for both oestrogen and progesterone receptors were randomised to receive either low-dose short-term chemotherapy or no chemotherapy. Chemotherapy consisted of one cycle of doxorubicin, vincristin (AV) and one cycle of cyclophosphamide, methotrexate, fluorouracil (CMF). Patients were stratified for tumour stage, type of surgery, menopausal status and participating centre. Results were analysed both by univariate and multivariate statistical. After a median length of follow-up of 84 months, disease-free (DFS) and overall survival (OS) did not differ significantly between patients having received adjuvant chemotherapy and the control group. Uni- and multivariate analysis did not show any significant prognostic or therapy related factor. A low-dose short-term adjuvant chemotherapy is insufficient to improve the prognosis of patients with breast cancer stage I with ER-, PgR-tumours. <278> UI - 98234758 AU - Merli F AU - Federico M AU - Avanzini P AU - Ilariucci F AU - Stelitano C AU - Iannitto E AU - Colombi M AU - Vallisa D AU - Santagati G AU - Picinini L IN - Divisione di Medicina Interna, Azienda Ospedaliera ASMN, Reggio Emilia, Italy. TI - Weekly administration of vincristine, cyclophosphamide, mitoxantrone and bleomycin (VEMB) in the treatment of elderly aggressive non Hodgkin's lymphoma. Gruppo Italiano per lo Studio dei Linfomi. SO - Haematologica 1998 Mar;83(3):217-21 AB - BACKGROUND AND OBJECTIVE: Aim of the study was to assess the efficacy of VEMB, a short-lasting therapeutic regimen (50 days) which alternates two myelotoxic drugs (cyclophosphamide and mitoxantrone) every week with two less hematologically toxic drugs (vincristine and bleomycin) in the treatment of aggressive NHL in the elderly (over 70). DESIGN AND METHODS: Between November 1994 and March 1996, 37 patients aged more than 70 years, with highly or moderately malignant NHL (according to the Working Formulation) have been enrolled into the study. The stage of the disease ranged between II and IV according to Ann Arbor. Mean age was 77 years; 14 patients (38%) had stage IV; 19 patients (51%) had LDH higher than normal; 26 patients (70%) had extranodal and 9 patients (24%) had bulky disease at time of diagnosis. RESULTS: Sixty-two percent of patients achieved a complete and 22% a partial remission. Non-responders amounted to 5%. Four patients (11%) died during the therapy. Nine patients (24%) experienced grade III-IV neutropenia. The most frequently observed event was mild neurotoxicity (43% of cases). The overall survival rate at 30 months was 55%. DFS at 24 months was 66%. INTERPRETATION AND CONCLUSIONS: VEMB is a therapeutic regimen whose efficacy is comparable to that of the other derived MACOP-B therapeutic regimens used in the elderly NHL. It has proved to have a good feasibility, though the number of toxic deaths should not be neglected. <279> UI - 98168385 AU - Higgins SL AU - Rich DH AU - Haygood JR AU - Barone J AU - Greer SL AU - Meyer DB IN - Regional Cardiac Arrhythmia Center, Scripps Memorial Hospital, La Jolla, CA 92037, USA. TI - ICD restudy: results and potential benefit from routine predischarge and 2-month evaluation. SO - Pacing & Clinical Electrophysiology 1998 Feb;21(2):410-7 AB - Evaluation of ICD function can now be performed noninvasively with intravenous sedation. To determine the value of follow-up electrophysiological studies for ICD implants, we performed a retrospective review of predischarge and 2-month ICD re studies, identifying critical problems uncovered. Of the 123 patients implanted, 122 had a predischarge study, 105 had both predischarge and elective 2-month follow-up studies, and 1 patient expired prior to restudy. Patients who underwent 2-month studies for nonelective indications (e.g., frequent shocks) were excluded from analysis. Programming changes were made in 62% of the predischarge studies (n = 122) and 70% of the elective 2-month studies (n = 105). The average number of programming changes per study was 1.3 for predischarge testing and 1.1 for 2-month testing. The most common changes at predischarge testing were adjustment of the tachyarrhythmia rate cutoff (35%) and at 2-month study, reprogramming of bradycardia pacing parameters (41%). Of the patients who underwent both predischarge and 2-month testing, 91% had programming changes in at least one of their re studies. Of 227 re studies performed, 18 studies in 14 patients yielded 24 critical findings which included: DFT increases to > or = 25 J (n = 13); sensing abnormalities of induced ventricular arrhythmia (n = 6); dislodged lead (n = 2); and serious pacemaker interactions (n = 3). Six of these critical cases (5% of total patients) required reoperation. The data suggests that routine ICD restudy is a valuable tool for management of the ICD patient. Additionally, ICD restudy is likely to increase the diagnostic yield of clinically silent critical system problems that could result in device failure. <280> UI - 98201126 AU - Ashley PF AU - Blinkhorn AS AU - Davies RM IN - paul@s1.dhu.man.ac.uk TI - Occlusal caries diagnosis: an in vitro histological validation of the Electronic Caries Monitor (ECM) and other methods. SO - Journal of Dentistry 1998 Mar;26(2):83-8 AB - OBJECTIVES: The aim of this in vitro study was to validate the use of the Electronic Caries Monitor (ECM) for the detection of enamel and dentinal caries on the occlusal surfaces of posterior teeth, and to compare it with visual examination, fibre-optic transillumination, conventional and digital bitewing radiography. METHODS: One-hundred and three extracted posterior permanent teeth with no apparent occlusal cavitation were selected and examined using each system. Thirty teeth were re-examined with each system to assess repeatability. Each tooth was then serially sectioned and examined histologically for occlusal caries. RESULTS: The occlusal surfaces of 25 teeth had caries in enamel and 37 had dentinal carious lesions. The sensitivity and specificity of the ECM were 0.78 and 0.80 for the diagnosis of occlusal dentinal lesions (cut-off = 0.391) and 0.65 and 0.73 for enamel lesions (cut-off = 0.501). The weighted kappa value for repeatability of the ECM was 0.68. Of the other diagnostic systems, visual examination provided the best combination of sensitivity and specificity, 0.24 and 0.97 for dentinal caries and 0.60 and 0.73 for enamel caries, respectively. CONCLUSION: The ECM was the most accurate diagnostic tool for the in vitro diagnosis of early, non-cavitated occlusal lesions on posterior teeth. <281> UI - 98203986 AU - Chisick MC AU - Poindexter FR AU - York AK IN - U.S. Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, MD, USA. TI - The need for and prevalence of dental sealants in active duty U.S. military personnel. SO - Military Medicine 1998 Mar;163(3):155-8 AB - This paper explores the need for and the prevalence of dental sealants in active duty U.S. military personnel. The data come from the 1994 Tri-Service Comprehensive Oral health Survey. Data were collected on 13,050 Army, Air Force, Marine Corps, and Navy active duty personnel at 26 sites. Women and minorities were oversampled. Both bivariate and logistic regression analyses were done on the need for at least one dental sealant and the prevalence of at least one dental sealant in service members. Weighted data (1,669,662) were used for the bivariate analyses; unweighted data were used for the regressions. Results show that 3.6% of service members need dental sealants and that 6.8% have dental sealants. The need for dental sealants varies across age, rank, and branch of service. The prevalence of dental sealants varies across age, race, rank, and branch of service. The cost-effectiveness of dental sealants in this population should be established. <282> UI - 98222820 AU - Breistein B AU - Burden DJ IN - School of Clinical Dentistry, The Queen's University of Belfast, Northern Ireland, UK. TI - Equity and orthodontic treatment: a study among adolescents in Northern Ireland. SO - American Journal of Orthodontics & Dentofacial Orthopedics 1998 Apr;113(4):408-13 AB - This epidemiological study investigated the reasons why children in Northern Ireland who need orthodontic treatment do not receive treatment even when it is provided free by the state. A total of 1584 15- and 16-year-olds were examined in 23 high schools with the Index of Orthodontic Treatment Need. The characteristics of the adolescents who had received orthodontic treatment were compared with those who had a definite need for treatment and yet did not receive treatment or advice. One in 10 of the adolescents examined had an unmet need for orthodontic treatment. Logistic regression analysis was used to assess the influence of 11 variables including socioeconomic status, religion, and standard of dental health on the uptake of orthodontic care. This analysis revealed that the only significant predictors of whether an adolescent received orthodontic treatment was the dental attendance pattern of the adolescent, the adolescent's dental health, and the dental attendance pattern of the adolescent's mother. Those adolescents who had good dental health, who regularly attended a dentist, and whose mother regularly attended a dentist were more likely to receive orthodontic treatment. <283> UI - 98256829 AU - van Dijken JW AU - Hoglund-Aberg C AU - Olofsson AL IN - Department of Cariology, Dental School, Umea University, Sweden. Jan.van.Dijken@oralbio.umu.se TI - Fired ceramic inlays: a 6-year follow up. SO - Journal of Dentistry 1998 Mar;26(3):219-25 AB - OBJECTIVES: The aim of this study was to evaluate feldspathic ceramic inlays luted with dual-cured resin composite or glass polyalkenoate (ionomer) cement (GIC) during a 6-year follow-up. METHODS: One-hundred and eighteen Class II fired feldspathic ceramic inlays were placed in 50 patients. In each patient half of the inlays were luted with a dual-cured resin composite and the other half with a conventional glass ionomer cement. The inlays were evaluated clinically, according to modified USPHS criteria, at baseline, after 6 months and then annually over a 6-year period. RESULTS: Of the 115 inlays evaluated at 6 years, 12% in the resin composite group and 26% in the GIC group were assessed as having failed. The main reason for failure in both groups was partial fracture or total loss of the inlays. Secondary caries was found to be associated with three inlays in one high caries risk patient. One inlay was replaced because of postoperative sensitivity. CONCLUSION: A relatively high and increasing failure rate was observed over the 6-year period of the study. The failure rate was more pronounced in the GIC group. <284> UI - 98224952 AU - Axelsson P AU - Paulander J AU - Lindhe J IN - Department of Periodontology, Faculty of Odontology, Goteborg University, Sweden. TI - Relationship between smoking and dental status in 35-, 50-, 65-, and 75-year-old individuals. SO - Journal of Clinical Periodontology 1998 Apr;25(4):297-305 AB - The aim of the present study was to examine the dental status and smoking habits in randomized samples of 35-, 50-, 65-, and 75-year-old subjects (n = 1093), recruited for a cross-sectional epidemiological study in the County of Varmland, Sweden. The following clinical variables were recorded by 4 well-calibrated dentists: number of edentuolous subjects, number of missing teeth, probing attachment level, furcation involvement, CPITN scores, DMF surfaces, plaque and stimulated salivary secretion rate (SSSR). In addition, the subjects reported in a questionnaire their tobacco habits, oral hygiene habits, dietary habits etc. The percentage of smokers in 35-, 50-, 65-, and 75-year-olds was 35%, 35%, 24% and 12%, respectively. In 75-year-olds, 41% of the smokers were edentulous compared to 35% of non-smokers. The difference in number of missing teeth between smokers and non-smokers was 0.6 (p=0.15), 1.5 (p=0.013), 3.5 (p=0.0007) and 5.8 (p=0.005) in the 4 age groups. Smokers had the largest mean probing attachment loss in all age groups. The differences between smokers and non-smokers in mean attachment level were 0.37 (p=0.001), 0.88 (p=0.001), 0.85 (p=0.001) and 1.33 mm (p=0.002) in the 35-, 50-, 65-, and 75-year-olds, respectively. Treatment need assessed by CPITN was in all age groups greatest among smokers. The number of intact tooth surfaces was fewer in 35-, 50-, and 75-year-old smokers than in non-smokers. The number of missing surfaces (MS) was higher in 50-, 65-, and 75-year-old smokers than in non-smokers. In addition, 35-year-old smokers exhibited a significantly larger number of decayed and filled tooth surfaces (DFS) than non-smokers. Male smokers had significantly higher SSSR than non-smoking males (p=0.012). Plaque index and oral hygiene were similar in smokers and non-smokers. Smokers reported a more frequent intake of sugar containing soft drinks (p=0.000) and snacks (p=0.003) than non-smokers. The opposite was reported for consumption of fruit (p=0.003). It was concluded that smoking is a significant risk indicator for tooth loss, probing attachment loss and dental caries. <285> UI - 98203741 AU - Laurikainen K AU - Kuusisto P IN - School of Public Health, University of Tampere, Finland. TI - Comparison of the oral health status and salivary flow rate of asthmatic patients with those of nonasthmatic adults--results of a pilot study. SO - Allergy 1998 Mar;53(3):316-9 AB - The oral health status and stimulated salivary flow rate of 33 adult asthmatic outpatients were compared with those of 33 nonasthmatic controls. The groups were matched by age and sex, and an adjustment for education was made in the statistical analysis. In the oral examination, a small difference in the prevalence of caries was observed when the sums of decayed, missing, and filled teeth (DMFT) were compared. The mean (SD) crude DMFT score was 20.1 (5.8) in the asthma group and 18.4 (7.6) in the control group. A statistically significant difference was seen in the amount of periodontal inflammation and in the stimulated salivary flow rate between the groups. The mean (SD) crude periodontal status index (PSI) was 52.7% (23.8%) in the asthmatics and 37.1% (20.4%) in the controls. The 95% confidence interval (95% CI) for the difference in adjusted means of PSI ranged from 0.1% to 21.9% (P = 0.05). In the stimulated salivary flow rate, crude mean values were 1.0 (0.5) ml/min and 1.3 (0.5) ml/min, respectively, and the 95% CI for the difference was from 0.05 ml/min to 0.57 ml/min (P = 0.01). Mucosal lesions in the oral cavity were found in 15 asthmatics (45%) and in eight controls (24%). In conclusion, the results of this study support the hypothesis that adult asthmatics have a higher risk of oral diseases than nonasthmatic subjects. <286> UI - 98197083 AU - Rytomaa I AU - Jarvinen V AU - Kanerva R AU - Heinonen OP IN - Department of Cariology, Institute of Dentistry, Helsinki, Finland. TI - Bulimia and tooth erosion. SO - Acta Odontologica Scandinavica 1998 Feb;56(1):36-40 AB - Eating disorders are often associated with regurgitation of gastric contents into the mouth and dental erosion. In this study the dental status was evaluated in bulimic patients. Thirty-five bulimics, diagnosed in the Outpatient Departments of Psychiatry and Adolescent Psychiatry of the University Central Hospital in Helsinki, and 105 controls matched for age, sex, and educational level were examined clinically, and the factors associated with dental erosion and caries were evaluated in an interview. Severe dental erosion and dental caries were significantly commoner among bulimics than controls. Bulimics commonly had a low salivary flow rate, but other apparent risk factors of dental erosion did not differ from those of controls. A feeling of dry mouth was commoner among bulimics than controls, and bulimics had an increased tooth sensitivity to cold and touch. More should be done to protect teeth from dental erosion among bulimics, because loss of tooth tissue remains even if the eating disorder disappears. <287> UI - 98182272 AU - Dziuk TW AU - Woo S AU - Butler EB AU - Thornby J AU - Grossman R AU - Dennis WS AU - Lu H AU - Carpenter LS AU - Chiu JK IN - Texas Oncology, P.A., Dallas, USA. TI - Malignant meningioma: an indication for initial aggressive surgery and adjuvant radiotherapy. SO - Journal of Neuro-Oncology 1998 Apr;37(2):177-88 AB - Malignant meningiomas constitute a rare subset of meningiomas and display a marked propensity for postsurgical recurrence. This retrospective study evaluates the various parameters which alter the recurrence rate. The records of all malignant meningioma patients treated from 1984 through 1992 were reviewed, and the time to recurrence or current patient status was determined, and the influence of various patient and disease parameters were analyzed. Thirty-eight patients were treated with 48 malignant meningioma resections performed (28 total and 20 subtotal), 25 at initial presentation and 23 for recurrent disease; 19 patients received postoperative radiotherapy. Subtypes included 32 anaplastic meningioma, 11 hemangiopericytoma, 2 meningiosarcoma, and 3 papillary meningioma. Followup ranged from 3 to 144 months, with five patients excluded from analysis. Actuarial disease free/progression free survival (DFS) at 5 years was 39% following total resection versus 0% after subtotal resection (p=0.001). For all totally excised lesions, the 5-yr DFS was improved from 28% for surgery alone to 57% with adjuvant radiotherapy (p=NS). Adjuvant irradiation following initial resection increased the 5-yr DFS rates from 15% to 80% (p=0.002). When administered for recurrent lesions, adjuvant radiotherapy improved the 2-yr DFS from 50% to 89% (p=0.015), but had no impact on 5-yr DFS. Multivariate analysis indicates extent of resection, adjuvant radiotherapy, and recurrence status are independent prognostic factors. Malignant meningiomas display a tendency for post surgical recurrence, with recurrence significantly increased for multicentric and recurrent disease. Complete surgical resection and the administration of adjuvant irradiation following initial resection are crucial to long-term control. <288> UI - 98204425 AU - Boyle EL AU - Higham SM AU - Edgar WM IN - Department of Clinical Sciences, School of Dentistry, University of Liverpool, UK. elboy@liv.ac.uk TI - The production of subsurface artificial caries lesions on third molar teeth. SO - Caries Research 1998;32(2):154-8 <289> UI - 98204421 AU - Firestone AR AU - Sema D AU - Heaven TJ AU - Weems RA IN - Department of Orthodontics, Dental School, University of Bern, Switzerland. firestone@zmk.unibe.ch TI - The effect of a knowledge-based, image analysis and clinical decision support system on observer performance in the diagnosis of approximal caries from radiographic images. SO - Caries Research 1998;32(2):127-34 AB - The aim of this study was to investigate the effect of a knowledge-based image analysis and clinical decision support system (CariesFinder, CF) on diagnostic performance and therapeutic decisions. The study material consisted of radiographic images of 102 approximal surfaces, 35 sound, 67 caries (25 caries and cavitated and 42 caries). Sixteen general practitioners were presented with (1) radiographic film images and (2) digital filmless images with the results of CF. The viewers were asked to respond whether approximal caries was present and whether a restoration was indicated. Responses were analyzed for accuracy, sensitivity, specificity and agreement. Further, the practitioners were ranked according to the accuracy of their restorative decisions and assigned to ten overlapping groups of 7 practitioners. For each group the diagnostic and therapeutic decisions were then examined for unanimity. The parameters of accuracy, sensitivity and specificity were then established for each group based on only unanimous, correct decisions. The diagnostic and therapeutic accuracy of CF alone was equal or superior to the decisions of the practitioners viewing film images alone. For unanimous decisions, CF alone was more accurate than the most accurate group of practitioners and made fewer incorrect decisions to restore non-cavitated surfaces than the practitioners. In general, dental practitioners viewing the results of CF significantly increased their ability to diagnose caries correctly, their overall diagnostic accuracy, and their ability to recommend restorations for cavitated surfaces. There was a decrease in the accuracy of their restorative decisions overall and in the specificity in particular. <290> UI - 98149292 AU - Runde V AU - de Witte T AU - Arnold R AU - Gratwohl A AU - Hermans J AU - van Biezen A AU - Niederwieser D AU - Labopin M AU - Walter-Noel MP AU - Bacigalupo A AU - Jacobsen N AU - Ljungman P AU - Carreras E AU - Kolb HJ AU - Aul C AU - Apperley J IN - University Hospital of Essen, Germany. TI - Bone marrow transplantation from HLA-identical siblings as first-line treatment in patients with myelodysplastic syndromes: early transplantation is associated with improved outcome. Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation. SO - Bone Marrow Transplantation 1998 Feb;21(3):255-61 AB - Allogeneic bone marrow transplantation (BMT) offers a potential cure for younger patients with myelodysplastic syndromes (MDS) or secondary acute myeloid leukemia (sAML). More than 600 patients from 50 European centers have now been reported to the European Group for Blood and Marrow Transplantation (EBMT). We retrospectively analyzed 131 patients reported to the Chronic Leukemia Working Party of the EBMT who underwent BMT from HLA-identical siblings without prior remission induction chemotherapy. At the time of BMT 46 patients had refractory anemia (RA) or RA with ringed sideroblasts, 67 patients had more advanced MDS subtypes and 18 patients had progressed to sAML. The 5-year disease-free (DFS) and overall survival (OS) for the entire group of patients was 34 and 41%, respectively. Fifty patients died from transplant-related complications, most commonly graft-versus-host disease and/or infections. Relapse occurred in 28 patients between 1 and 33 months after BMT, resulting in an actuarial probability of relapse of 39% at 5 years. DFS and OS were dependent on pretransplant bone marrow blast counts. Patients with RA/RARS, RAEB, RAEB/T and sAML had a 5-year DFS of 52, 34, 19 and 26%, respectively. The 5-year OS for the respective patient groups was 57, 42, 24 and 28%. In a multivariate analysis, younger age, shorter disease duration, and absence of excess of blasts were associated with improved outcome. From these data we conclude that patients with myelodysplasia who have appropriate marrow donors, especially those aged less than 40 years and those with low medullary blast cell count should be treated with BMT as the primary treatment early in the course of their disease. Transplantation early after establishing the diagnosis of MDS may improve prognosis due to a lower treatment-related mortality and a lower relapse risk. <291> UI - 98109767 AU - Mertz-Fairhurst EJ AU - Curtis JW Jr AU - Ergle JW AU - Rueggeberg FA AU - Adair SM IN - Department of Oral Rehabilitation, Medical College of Georgia, School of Dentistry, Augusta, USA. TI - Ultraconservative and cariostatic sealed restorations: results at year 10 [see comments]. CM - Comment in: J Am Dent Assoc 1998 Apr;129(4):410, 412 SO - Journal of the American Dental Association 1998 Jan;129(1):55-66 AB - Changes in restorative techniques and the development of newer restorative materials have allowed for the use of more conservative cavity preparations. This 10-year study evaluated bonded and sealed composite restorations placed directly over frank cavitated lesions extending into dentin vs. sealed conservative amalgam restorations and conventional unsealed amalgam restorations. The results indicate that both types of sealed restorations exhibited superior clinical performance and longevity compared with unsealed amalgam restorations. Also, the bonded and sealed composite restorations placed over the frank cavitated lesions arrested the clinical progress of these lesions for 10 years. <292> UI - 98109772 AU - Slavkin HC IN - National Institute of Dental Research, Bethesda, Md. 20892-2290, USA. TI - Placing health promotion into the context of our lives [see comments]. CM - Comment in: J Am Dent Assoc 1998 Apr;129(4):406, 408, 410 SO - Journal of the American Dental Association 1998 Jan;129(1):91-5 <293> UI - 98109774 AU - Appelbaum MB AU - Arvay JM IN - Department of Prosthodontics and Biomaterials, University of Medicine and Dentistry of New Jersey, USA. TI - Phased-in comprehensive care: a concept and case report. SO - Journal of the American Dental Association 1998 Jan;129(1):98-102 AB - A complicated case often requires a multidisciplinary approach. But such an approach makes it difficult for the practitioner to offer the patient a definitive treatment plan. This article outlines the concept of a phased-in comprehensive treatment plan and reports on a case in which such a plan was used successfully. <294> UI - 98190715 AU - Powell LV IN - Department of Restorative Dentistry, University of Washington 98126, USA. TI - Caries risk assessment: relevance to the practitioner. [Review] [28 refs] SO - Journal of the American Dental Association 1998 Mar;129(3):349-53 AB - The dental literature is filled with recommendations for assessing the caries risk of patients. Some of these recommendations are based on sound research, some on clinical experience. This article attempts to explain the science of risk assessment. [References: 28] <295> UI - 98170790 AU - Locker D IN - Faculty of Dentistry, University of Toronto, Ontario, Canada. TI - Issues in measuring change in self-perceived oral health status. [Review] [28 refs] SO - Community Dentistry & Oral Epidemiology 1998 Feb;26(1):41-7 AB - An important goal of a health care intervention or system is to improve the health of an individual or a population. The challenge for health services research is to measure and explain this change. However, the issue of how changes in health status should be defined and measured has been given relatively little attention. This paper draws on the rather sparse literature to examine some issues involved in measuring changes in oral health status and illustrates these using data from a longitudinal study of the oral health of older adults. The paper draws a distinction between quantitative and qualitative change and the challenges involved with each. Four different ways of assessing change are reviewed and their strengths and weaknesses highlighted. Global transition judgements, although relatively simple measures of change, incorporate patients' values and avoid the statistical problems associated with measures such as change scores. Nevertheless, the measurement of change in oral health status is complex and controversial and no approach is universally accepted. Consequently, the decision as to which strategy to adopt is far from simple. [References: 28] <296> UI - 98144723 AU - Abrams K AU - Sanso B IN - Department of Epidemiology and Public Health, University of Leicester, U.K. kral@le.ac.uk TI - Approximate Bayesian inference for random effects meta-analysis. SO - Statistics in Medicine 1998 Jan 30;17(2):201-18 AB - Whilst meta-analysis is becoming a more commonplace statistical technique, Bayesian inference in meta-analysis requires complex computational techniques to be routinely applied. We consider simple approximations for the first and second moments of the parameters of a Bayesian random effects model for meta-analysis. These computationally inexpensive methods are based on simple analytical formulae that provide an efficient tool for a qualitative analysis and a quick numerical estimation of posterior quantities. They are shown to lead to sensible approximations in two examples of meta-analyses and to be in broad agreement with the more computationally intensive Gibbs sampling. <297> UI - 98174486 AU - Langmore SE AU - Terpenning MS AU - Schork A AU - Chen Y AU - Murray JT AU - Lopatin D AU - Loesche WJ IN - Audiology & Speech Pathology Department (126), VA Medical Center, Ann Arbor, MI 48105, USA. TI - Predictors of aspiration pneumonia: how important is dysphagia?. SO - Dysphagia 1998 Spring;13(2):69-81 AB - Aspiration pneumonia is a major cause of morbidity and mortality among the elderly who are hospitalized or in nursing homes. Multiple risk factors for pneumonia have been identified, but no study has effectively compared the relative risk of factors in several different categories, including dysphagia. In this prospective outcomes study, 189 elderly subjects were recruited from the outpatient clinics, inpatient acute care wards, and the nursing home care center at the VA Medical Center in Ann Arbor, Michigan. They were given a variety of assessments to determine oropharyngeal and esophageal swallowing and feeding status, functional status, medical status, and oral/dental status. The subjects were followed for up to 4 years for an outcome of verified aspiration pneumonia. Bivariate analyses identified several factors as significantly associated with pneumonia. Logistic regression analyses then identified the significant predictors of aspiration pneumonia. The best predictors, in one or more groups of subjects, were dependent for feeding, dependent for oral care, number of decayed teeth, tube feeding, more than one medical diagnosis, number of medications, and smoking. The role that each of the significant predictors might play was described in relation to the pathogenesis of aspiration pneumonia. Dysphagia was concluded to be an important risk for aspiration pneumonia, but generally not sufficient to cause pneumonia unless other risk factors are present as well. A dependency upon others for feeding emerged as the dominant risk factor, with an odds ratio of 19.98 in a logistic regression model that excluded tube-fed patients. <298> UI - 98139949 AU - Weyermann M AU - Brenner H IN - Department of Epidemiology, University of Ulm, Germany. TI - Factors affecting bone demineralization and blood lead levels of postmenopausal women--a population-based study from Germany. SO - Environmental Research 1998 Jan;76(1):19-25 AB - We investigated the influence of various lifestyle factors on blood lead levels in postmenopausal women from the general population of Germany. Particular consideration was given to those factors which are suspected to be related to bone demineralization. The study population consisted of 424 women, aged 45 to 80 years, who were examined in a substudy of the National Health and Nutrition Survey called VERA (Verbundstudie Ernahrungserhebung, und Risikofaktorenanalyse) from 1987 to 1988. Mean blood lead level was 61.4 micrograms/liter (SD, 27.3). In multiple linear regression analysis alcohol consumption, former use of oral contraception, hematocrit, and age were positively associated with blood lead levels, whereas calcium intake and high physical activity showed a negative association with blood lead levels. Some of the identified risk factors which are suspected to exert their influence on blood lead levels by affecting bone demineralization can be influenced by change of individual behavior. Thus, we conclude that reduction of alcohol consumption, adequate calcium intake, and physical activity may reduce blood lead levels as well as negative health effects of osteoporosis in postmenopausal women. <299> UI - 98143014 AU - Wenzel A IN - Department of Oral Radiology, Royal Dental College, University of Aarhus, Denmark. TI - Digital radiography and caries diagnosis. [Review] [76 refs] SO - Dento-Maxillo-Facial Radiology 1998 Jan;27(1):3-11 AB - Direct digital acquisition of intra-oral radiographs has been possible only in the last decade. Several studies have shown that, theoretically, there are a number of advantages of direct digital radiography compared with conventional film. Laboratory as well as controlled clinical studies are needed to determine whether new digital imaging systems alter diagnosis, treatment and prognosis compared with conventional methods. Most studies so far have evaluated their diagnostic performance only in laboratory settings. This review concentrates on what evidence we have for the diagnostic efficacy of digital systems for caries detection. Digital systems are compared with film and those studies which have evaluated the effects on diagnostic accuracy of contrast and edge enhancement, image size, variations in radiation dose and image compression are reviewed together with the use of automated image analysis for caries diagnosis. Digital intra-oral radiographic systems seem to be as accurate as the currently available dental films for the detection of caries. Sensitivities are relatively high (0.6-0.8) for detection of occlusal lesions into dentine with false positive fractions of 5-10%. A radiolucency in dentine is recognised as a good predictor for demineralisation. Radiography is of no value for the detection of initial (enamel) occlusal lesions. For detection of approximal dentinal lesions, sensitivities, specificities as well as the predictive values are fair, but are very poor for lesions known to be confined to enamel. Very little documented information exists, however, on the utilization of digital systems in the clinic. It is not known whether dose is actually reduced with the storage phosphor system, or whether collimator size is adjusted to fit sensor size in the CCD-based systems. There is no evidence that the number of retakes have been reduced. It is not known how many images are needed with the various CCD systems when compared with a conventional bitewing, nor how stable these systems are in the daily clinical use or whether proper cross-infection control can be maintained in relation to scanning the storage phosphor plates and the sensors and the cable. There is only sparse evidence that the enhancement facilities are used when interpreting images, and none that this has changed working practices or treatment decisions. The economic consequences for the patient, dentist and society require examination. [References: 76] <300> UI - 98150468 AU - Blinkhorn AS IN - Turner Dental School, University Dental Hospital of Manchester. TI - Dental health education: what lessons have we ignored? [see comments]. CM - Comment in: Br Dent J 1998 Mar 28;184(6):264-5, Comment in: Br Dent J 1998 Mar 28;184(6):265 SO - British Dental Journal 1998 Jan 24;184(2):58-9 AB - Dental health education is an important part of our professional activities given we provide day-to-day treatment of caries and periodontal disease which can mostly be controlled by our patients, provided they implement relatively simple changes in their daily oral health habits. However, efforts in the field of both patient and public education are not supported by research. This is partly due to a failure to include an evaluation of these activities; enthusiasm often takes precedence over scientific assessment.