Early-life factors affect risk of pain and fever in infants during teething periods.

AIM: This longitudinal study aimed to investigate the prevalence of teething-related pain and fever and the early-life factors that may affect the risk of experiencing these disturbances within the first 1.5 years of life. MATERIALS AND METHODS: Participants were recruited (n = 1033) through the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort (n = 1237). Interviews were performed tri-monthly regarding the prevalence of teething pain and fever in children from 6 to 18 months of age. Crude and multivariable analyses were conducted using Poisson-log regression models. RESULTS: Prevalence rates for teething pain and fever were 35.5 and 49.9 % respectively. Multivariable Poisson regression analysis showed maternal second-hand tobacco smoke (SHS) exposure to increase the risk of both pain (mean ratio = 1.35; p = 0.006) and fever (mean ratio = 1.22; p = 0.025), whereas SHS exposure plus active smoking further increased risk of teething pain in the children (mean ratio = 1.89; p = 0.029). Delivery via Caesarean section increased risk of teething pain (mean ratio = 1.27; p = 0.033), while prenatal plasma vitamin D insufficiency lowered such a risk (mean ratio = 0.62; p = 0.012). Compared to Chinese infants, Indian babies exhibited lower risk of teething pain and fever (both p ≤ 0.001). CONCLUSIONS: Early-life factors such as tobacco smoke exposure and vitamin insufficiency during pregnancy, ethnicity and childbirth via Caesarean section may significantly affect the child's susceptibility to teething-related pain and fever. CLINICAL RELEVANCE: Knowledge of prevalence and risk factors of teething disturbances may better equip primary caregivers and healthcare professionals to accurately detect teething-related local and/or systemic signs/symptoms and effectively facilitate tobacco cessation among pregnant women.

Influence of metabolic-linked early life factors on the eruption timing of the first primary tooth.

AIM: Early eruption of permanent teeth has been associated with childhood obesity and diabetes mellitus, suggesting links between tooth eruption and metabolic conditions. This longitudinal study aimed to identify pre-, peri- and postnatal factors with metabolic consequences during infancy that may affect the eruption timing of the first primary tooth (ETFT) in children from an ethnically heterogeneous population residing within the same community. MATERIAL AND METHODS: Participants were recruited (n = 1033) through the GUSTO (Growing Up in Singapore Towards healthy Outcomes) birth cohort (n = 1237). Oral examinations were performed at 3-month intervals from 6 to 18 months of age. Crude and adjusted analyses, with generalized linear modelling, were conducted to link ETFT to potential determinants occurring during pregnancy, delivery/birth and early infancy. RESULTS: Overall mean eruption age of the first primary tooth was 8.5 (SD 2.6) months. Earlier tooth eruption was significantly associated with infant's rate of weight gain during the first 3 months of life and increased maternal childbearing age. Compared to their Chinese counterparts, Malay and Indian children experienced significantly delayed tooth eruption by 1.2 and 1.7 months, respectively. CONCLUSIONS: Infant weight gain from birth to 3 months, ethnicity and maternal childbearing age were significant determinants of first tooth eruption timing. Early life influences can affect primary tooth development, possibly via metabolic pathways. CLINICAL RELEVANCE: Timing of tooth eruption is linked to general growth and metabolic function. Therefore, it has potential in forecasting oral and systemic conditions such as caries and obesity.

Differences in willingness to pay for an extraction, a filling, and cleaning teeth at various levels of oral health-related quality of life, as measured by oral impacts on daily performance, among older adults in Singapore.

OBJECTIVE: To examine the differences in Willingness to pay (WTP) for an extraction, a filling, and cleaning of teeth among older adults with varying levels of Oral Health-related Quality of Life (OHQoL). BACKGROUND: OHQoL has been used extensively to measure utilities as reported by individuals of interest. Currently there are no reports that examine the WTP of individuals at various levels of OHQoL. METHODS: A convenience sample of adults 60 years or older were recruited. Besides other domains, questionnaires were used to assess WTP (extraction, filling, and cleaning of teeth), OHQoL (using Oral Impacts on Daily Performance-OIDP), McArthur scale, and access to care. RESULTS: Tamil ethnicity was related to higher WTP for an extraction (mean ratio, 1.63-3.98; 95% Confidence Interval [CI]), increase of age in years was related to lower WTP for extraction (mean ratio, 0.96-1.00 [95%CI]) and increasing OIDP score was related to lower WTP for extractions (mean ratio, 0.80-0.99 [95%CI]). Tamil ethnicity was associated with higher WTP for fillings (mean ratio, 2.69-6.44 [95%CI]); higher age in years was associated with lower WTP for fillings (mean ratio, 0.94-0.99 [95%CI]), and higher OIDP scores was trending to be associated to lower WTP for filling (mean ratio, 0.80-1.00 [95%CI]). Tamil Ethnicity was also associated with higher WTP for cleaning (mean ratio, 2.14-7.19 [95%CI]), higher age in years was also associated with cleaning (mean ratio, 0.94-0.99 [95%CI]). CONCLUSION: Individuals with higher OIDP scores tended to have lower WTP for extraction, filling and cleaning; with significant differences reported for extraction.

Oral health status and complete denture status of independent-living Singaporean elderly residing in a community home.

AIM: Past studies have examined the oral health status of elderly Singaporean adults residing in long term care facilities and living in residential housing but no oral health research has been conducted on elderly Singaporeans residing in community homes. The aim of this paper is to report on the oral health status and complete denture status of a group of free living (community dwelling) elderly in Singapore from the AWWA Community Home for Senior Citizens, and investigate the relation between the clinical findings and demographic data. MATERIALS AND METHODS: This research used a cross-sectional design and was conducted in the month of December 2011. Consenting residents of the AWWA home who were over the age of 60 participated in this study. Sampling strategy was census. Two calibrated interviewers collected demographic information from the participants and four calibrated dentists conducted extra-oral and intra-oral soft tissue examinations along with assessment of dentition, periodontal and denture status. STATISTICAL ANALYSIS: All data were input into Microsoft Excel 2010(™) and analysed in SPSS 21.0(™). Descriptive analysis and bivariate analysis were performed on the demographic factors and other variables of interest. The Spearman׳s test, Mann-Whitney U and Chi-Square test were used to examine the correlation between the clinical findings and age, gender and education level respectively. RESULTS: Among the 70 participants, two subjects (2.9%) had complete dentition, 34 (48.6%) were partially dentate, and 34 (48.6%) had no teeth. The mean number of teeth among the partially dentate participants was 11.28 while the mean number of anterior, posterior and total occlusal contacts were 1.61, 2.17 and 3.78 respectively. The mean number of decayed teeth (DT) and filled teeth (FT) were 2.81 and 0.25, giving a mean DFT score of 3.06. The mean Root Caries Index was 0.13. Periodontal examination revealed that only 5 (13.9%) individuals had healthy periodontal tissues, while 2 (5.6%) had the highest score of 1, 9 (25.0%) had the highest score of 2, 11 (30.6%) had the highest score of 3 and 7 (19.4%) had the highest score of 4. Amongst the partially dentate, 14 had dentures and 20 had none. There were 34 edentulous participants and 23 had at least one denture while 11 did not have any complete dentures. The most frequent unsatisfactory finding for complete dentures was inadequate retention of the mandibular dentures. When the dentures were grouped into those that were satisfactory and those that had at least one unsatisfactory factor, 11 of the 26 maxillary dentures and 17 of the 23 mandibular dentures fell to the latter category. Analysis revealed that there was a correlation between age and the number of teeth with a correlation coefficient of -0.43 (p=0.01) and age with the mean DFT, -0.33 (p=0.05). CONCLUSION: The findings of this study revealed a high treatment need for this group of elderly.

Two consecutive clusters of toxic anterior segment syndrome.

PURPOSE: To present clinical findings and etiologic investigation of two consecutive clusters of toxic anterior segment syndrome (TASS) after uncomplicated phacoemulsification cataract surgery. CASE REPORT: At the Veterans Affairs Northern Indiana Health Care System Fort Wayne campus, 11 consecutive patients on two separate days in 2011 underwent clear corneal incision phacoemulsification cataract surgery by the same surgeon. On the first postoperative day, all patients had 1+ to 2+ diffuse limbus to limbus stromal edema and 2+ to 4+ anterior chamber white blood cells. Five eyes had inflammatory plaques on the surface of the intraocular implant, six had fibrin, three had hypopyon, and one had inflammatory debris "puff ball." Visual acuity ranged 20/70 to 20/400. Treatment included moxifloxacin four times a day, diclofenac four times a day, and prednisolone acetate 1% every 1 to 2 hours. In all patients, active inflammation and corneal edema resolved within 6 weeks, and visual outcome was 20/20. Cataract surgery was paused for 5 months after the first cluster of TASS and then immediately paused again after restarting because of a second cluster. Although no specific causes were identified, etiologic investigation resulted in the implementation of multiple changes. The changes included new replacement surgical instruments, disposable irrigation/aspirator tip and handle, risk of residue on reusable instruments minimized, preservative-free medications used when available, ophthalmic ointment eliminated, manufacturers' recommendations followed exactly, and eye instruments processed separately. Toxic anterior segment syndrome did not occur when surgery resumed 11 months after the last cluster. CONCLUSIONS: There are multiple possible etiologies of TASS. However, as in our clusters, specific causes are often not identified. Thorough review of all steps in surgery, processing of equipment and preparation of injectable solutions and materials, and adoption of best practices can prevent additional cases of TASS. Prompt diagnosis and treatment of TASS are extremely important because this leads to a desirable outcome.

Political priority of global oral health: an analysis of reasons for international neglect.

Global Oral Health suffers from a lack of political attention, particularly in low- and middle-income countries. This paper analyses the reasons for this political neglect through the lens of four areas of political power: the power of the ideas, the power of the issue, the power of the actors, and the power of the political context (using a modified Political Power Framework by Shiffman and Smith. Lancet370 [2007] 1370). The analysis reveals that political priority for global oral health is low, resulting from a set of complex issues deeply rooted in the current global oral health sector, its stakeholders and their remit, the lack of coherence and coalescence; as well as the lack of agreement on the problem, its portrayal and possible solutions. The shortcomings and weaknesses demonstrated in the analysis range from rather basic matters, such as defining the issue in an agreed way, to complex and multi-levelled issues concerning appropriate data collection and agreement on adequate solutions. The political priority of Global Oral Health can only be improved by addressing the underlying reasons that resulted in the wide disconnection between the international health discourse and the small sector of Global Oral Health. We hope that this analysis may serve as a starting point for a long overdue, broad and candid international analysis of political, social, cultural, communication, financial and other factors related to better prioritisation of oral health. Without such an analysis and the resulting concerted action the inequities in Global Oral Health will grow and increasingly impact on health systems, development and, most importantly, human lives.

The periodontal health of adult Nepalese.

PURPOSE: There exists meagre information on the prevalence of periodontal conditions among adults in Nepal. Therefore, appropriate data on periodontal conditions are needed to facilitate planning, monitoring and evaluation of oral health programmes. The objective of the present study was to determine the prevalence of periodontal conditions among adults aged between 33 and 97 years in Nepal and also to elucidate any possible risk predictors of periodontal problems. MATERIALS AND METHODS: The total subjects included in the present study were 1210 (33 to 49 years [n = 596] and 50 to 97 years [n = 614]). Community Periodontal Index scores were used to assess the periodontal status of the selected subjects. Self-reported data were used to ascertain oral health behaviour. RESULTS: Logistic regression analyses showed the following observations for the age group 33 to 49 years: (1) bleeding was more likely found among those subjects who resided in rural areas and upper hill terrain, and among those who used non-fluoridated dentifrice; (2) bleeding was, however, less likely to be observed among those with primary or unfinished secondary school education (PSE); (3) calculus deposits were accentuated in illiterates, whereas less calculus formation was experienced by alcohol users; (4) periodontal pocket 4 to 5 mm was predominantly seen among illiterates and those with PSE, smokers and those who used non-fluoridated dentifrice; (5) periodontal pocket v 6 mm was observed among illiterates and those with PSE and those who used non-fluoridated dentifrice. With regard to 50 years old and above, the following observations were noticed: (1) bleeding was associated with the use of non-fluoridated dentifrice; (2) chewing betel nut showed a protective effect with regard to calculus formation; (3) being illiterate increased the likelihood of having periodontal pockets 6 mm or more in depth. CONCLUSIONS: Several findings of the present study are in concordance with empirical evidence. However, the protective effect of alcohol and betel nut against calculus formation needs to be investigated further.

Visual scanning and cognitive performance in prediagnostic and early-stage Huntington's disease.

The objective of this study was to evaluate visual scanning strategies in carriers of the Huntington disease (HD) gene expansion and to test whether there is an association between measures of visual scanning and cognitive performance. The study sample included control (NC, n = 23), prediagnostic (PDHD, n = 21), and subjects recently diagnosed with HD (HD, n = 19). All participants completed a uniform clinical evaluation that included examination by neurologist and molecular testing. Eye movements were recorded during completion of the Digit Symbol Subscale (DS) test. Quantitative measures of the subject's visual scanning were evaluated using joint analysis of eye movements and performance on the DS test. All participants employed a simple visual scanning strategy when completing the DS test. There was a significant group effect and a linear trend of decreasing frequency and regularity of visual scanning from NC to PDHD to HD. The performance of all groups improved slightly and in a parallel fashion across the duration of the DS test. There was a strong correlation between visual scanning measures and the DS cognitive scores. While all individuals employed a similar visual scanning strategy, the visual scanning measures grew progressively worse from NC to PDHD to HD. The deficits in visual scanning accounted, at least in part, for the decrease in the DS score.

Global affordability of fluoride toothpaste.

OBJECTIVE: Dental caries remains the most common disease worldwide and the use of fluoride toothpaste is a most effective preventive public health measure to prevent it. Changes in diets following globalization contribute to the development of dental caries in emerging economies. The aim of this paper is to compare the cost and relative affordability of fluoride toothpaste in high-, middle- and low-income countries. The hypothesis is that fluoride toothpaste is not equally affordable in high-, middle- and low-income countries. METHODS: Data on consumer prices of fluoride toothpastes were obtained from a self-completion questionnaire from 48 countries. The cost of fluoride toothpaste in high-, middle- and low-income countries was compared and related to annual household expenditure as well as to days of work needed to purchase the average annual usage of toothpaste per head. RESULTS: The general trend seems to be that the proportion of household expenditure required to purchase the annual dosage of toothpaste increases as the country's per capita household expenditure decreases. While in the UK for the poorest 30% of the population only 0.037 days of household expenditure is needed to purchase the annual average dosage (182.5 g) of the lowest cost toothpaste, 10.75 days are needed in Kenya. The proportion of annual household expenditure ranged from 0.02% in the UK to 4% in Zambia to buy the annual average amount of lowest cost toothpaste per head. CONCLUSION: Significant inequalities in the affordability of this essential preventive care product indicate the necessity for action to make it more affordable. Various measures to improve affordability based on experiences from essential pharmaceuticals are proposed.

Situational analysis of dental caries and existing oral health care of children and adolescents in Hubei Province, People's Republic of China: implications for change.

PURPOSE: (1) To evaluate trends in dental caries of children and adolescents of Hubei Province and Wuhan Municipality over the last two decades. (2) To conduct a situational analysis of existing oral health care and to recommend changes to improve this care for children. MATERIALS AND METHODS: An analysis was performed on data from national oral health surveys carried out in China at the provincial level, and data on 12-year-old children of Wuhan Municipality. A review of the literature was conducted on available and utilised oral health care facilities by children. RESULTS: In 1983, the mean decayed, missing and filled teeth (DMFT) of 12-year-olds in Hubei Province was 1.0, and in 1995 it was 0.6. The studies in Wuhan Municipality in 1993-1995 among 12-year-olds reported DMFT values ranging from 0.7-1.5, however different methods of caries assessment were performed in the various studies making comparisons difficult. The caries prevalence and the mean dmft score of 5-year-old children in 1995 in Hubei Province were 69% and 3.6, respectively. The percentage of untreated caries for all age groups in Hubei Province was very high. CONCLUSIONS: Analysis of epidemiological information over the last two decades does not provide any conclusive evidence supporting either an increasing or decreasing trend of dental caries in the child and adolescent population of Hubei Province and Wuhan Municipality. There is, however, a clear need to prevent the incidence of dental caries from increasing and to provide care to address the treatment needs of pre-school and school-age children. The promotion of twice-daily tooth brushing with fluoride toothpaste at maternal and child health care centres, and the establishment of daily tooth brushing with pea-size amounts of fluoride toothpaste in the pre-school and primary school setting are recommended preventive strategies. Establishment of school-based oral health promotion should be accompanied with the provision of Atraumatic Restorative Treatment (ART) sealants and ART restorations which can be provided by dental nurses at dramatically lower costs than the traditional high-tech approach.

Gains in oral health and improved quality of life of 12-13-year-old Nepali schoolchildren: outcomes of an advocacy project to fluoridate toothpaste.

OBJECTIVES: To report on gains in oral health and improved quality of life of 12-13-year-old Nepali schoolchildren five and six years after the introduction of fluoride toothpaste in 1999. DESIGN: Cross sectional baseline surveys in 1999 and 2001, and follow up surveys in 2004 and 2005 were multi-stage cluster sampling in design. SETTING: Urban and rural schools in Central, Far Western, Mid Western and Western Developmental Regions of Nepal. PARTICIPANTS: 2,770, 12-13-year-olds in 1999 and 1,001, 12-13-year-olds in 2004 were examined regionally. 637 12-13-year-olds from Kathmandu valley and 448 12-13-year-olds from Tansen municipality were examined in 1999. The same schools in Kathmandu valley and Tansen were visited in 2005 and 761 and 482 12-13-years from Kathmandu valley and Tansen were examined. 6,064 8-15-year-olds in 2001 and 1,001 12-13-year-olds in 2004 participated in the collection of information on oral hygiene practice and quality of life. METHOD: Examinations were carried out by trained and calibrated examiners using the WHO diagnostic criteria for caries and questionnaires were interview administered by trained interviewers. INTERVENTION: Advocacy for fluoride toothpaste between 1997 and 2002. RESULTS: There was a 26.6% decline in caries prevalence and 38.0% decrease in 12-13-year old DMFT from 1999 to 2004 throughout four of five regions of Nepal. Approximately 65-75% of the 12-13-year-olds used fluoride toothpaste from 1999 to 2004. School specific data reveals a reduction in DMFT of 43.8% in Tansen and 53.6% in the Kathmandu valley from 1999 to 2005. From 2001 to 2004, report of oral pain decreased by 10%. CONCLUSIONS: The most likely reason for the decline in dental caries and reduction in oral pain is the widespread consumption of fluoride toothpaste by the 12-13-year-old schoolchildren.

Adult perceptions of dental fluorosis and select dental conditions-an Asian perspective.

OBJECTIVE: To compare lay people's perceptions with regard to various levels of dental fluorosis and select dental defects versus normal dentition. METHODS: Adults rated digitally created photographs made showing lips (without retraction) and teeth depicting the following conditions: no apparent aesthetic defects (normal, Thylstrup- Fejerskov score 0 - TF0), 6 levels of fluorosis (TF1-6), carious lesions (two cavitated and one noncavitated), malocclusions (Class II, Class III, anterior open bite and greater spacing), extrinsic staining and an incisal chip. The photographs were displayed on colour-calibrated iPads(™) . Participants used a self-administered questionnaire to rate their perceptions on (Item 1) how normal teeth were, (Item 2) how attractive the teeth were, (Item 3) need to seek correction of teeth, (Item 4) how well the person took care of their teeth and (Item 5) whether the person was born like this. Data from Item 5 were excluded due to low reliability. RESULTS: Ratings for Item 1 showed that TF1-4 was similar or significantly better than TF0. For Item 2, TF1 and TF4 were significantly better than TF0, with TF2 and TF3 being similar. For Item 3, there was significantly lower need to seek correction with TF2 and TF4 versus TF0, whereas TF1 and TF3 were similar to TF0. TF5 and TF6 were rated significantly lower than TF0 for Item 1 and Item 2, and significantly higher rating for Item 3 (need to seek correction). Ratings for Item 4 were similar, with TF1, TF2 and TF4 being rated significantly higher than TF0, and TF5 and TF6 being rated lower. Cavitated caries and staining were generally perceived as being significantly less favourable than TF6, with higher need to seek correction as well. Noncavitated carious lesion and incisal chip were rated similar to TF0. Cavitated carious lesions were rated aesthetically similar or significantly worse than TF0 and TF6. CONCLUSIONS: Severe fluorosis (TF5 and 6) was perceived to be less aesthetically pleasing and received higher ratings for need to seek correction than normal teeth. Mild-to-moderate fluorosis (TF1-4) showed similar or better aesthetic perceptions and similar or lower need to seek correction, when compared to normal teeth (TF0). Easily visible cavitated dental caries was rated worse than teeth with severe fluorosis (TF6) and normal teeth (TF0).

Partnering globally and acting locally for infection control in Nepal.

AIMS: To describe the process and outputs of an international collaborative oral health promotion project to develop a national infection control policy and training programme for oral health care workers in the low income country of Nepal between April, 2003 and May, 2004. METHOD: The project process was implemented in phases: 1) extensive review of national and international infection control documents; 2) development of draft infection control policies and protocols; 3) development of instruments to assess knowledge, attitude and behaviour and infection control practices; 4) baseline survey to assess these factors; 5) development of training programmes and training of oral health care providers; 6) revision of infection control policies and protocols, survey questions, assessment instruments, and training programme. OUTPUTS: Project outputs include a national infection control policy and protocols, infection control assessment instruments, infection control training materials and programmes, and oral health care providers trained in infection control. SUMMARY: The results of the project to develop a national infection control policy and training programme for oral health care workers in dental clinics, dental education institutions and the Nepal Primary Health Care System, required the collaboration of policy makers, health professionals, health managers, oral health care providers and educators from the government sector, private sector, Non-Government Organisations (NGOs) and International Non-Government Organisations (INGOs).

Anterior ischemic optic neuropathy in eyes with optic disc drusen.

BACKGROUND: There have been anecdotal reports of anterior ischemic optic neuropathy (AION) occurring in eyes with optic disc drusen (ODD), but the clinical features of this condition have not been well characterized. OBJECTIVES: To better describe the clinical features of AION associated with ODD and to compare the clinical features of this condition with those of "garden variety" nonarteritic AION. METHODS: We reviewed the medical records of 20 patients who experienced an episode of AION in an eye with ODD. In 4 patients, both eyes were affected; thus, 24 eyes were studied. The diagnosis of ODD was made by ophthalmoscopic identification, orbital ultrasonography, or computed tomographic scanning. We recorded age, sex, vascular risk factors, symptoms, visual acuity, visual fields, and results of the follow-up examination in all patients. These findings were compared with data from previously reported series of patients with nonarteritic AION. RESULTS: Our 20 patients included 14 men and 6 women (age range, 18-69 years; mean, 49.4 years). Vascular risk factors were identified in 10 patients (50%). Three patients reported episodes of transient visual loss before their fixed deficit. The visual acuity at the initial examination was 20/60 or better in 15 (62%) of the 24 eyes; 8 had a visual acuity of 20/20. The predominant pattern of visual field loss was an altitudinal or arcuate defect in 19 (79%) and a centrocecal scotoma in 5 (21%) of the 24 eyes. There was subjective worsening of vision before the initial neuro-ophthalmic examination in 11 eyes (46%) and objective documentation of progression in 7 eyes (29%). The final visual acuity was 20/40 or better in 13 (62%) of 21 eyes and 20/200 or worse in 3 (14%) of 21 eyes. CONCLUSIONS: Our patients were strikingly similar to those with nonarteritic AION unassociated with drusen in regard to prevalence of vascular risk factors, pattern of visual field loss, and occurrence of a subsequent similar event in the fellow eye. In contrast, however, patients with ODD-AION were younger than those with nonarteritic AION, were more likely to report preceding episodes of transient visual obscuration, and enjoyed a more favorable visual outcome.

A cost-benefit analysis of an advocacy project to fluoridate toothpastes in Nepal.

OBJECTIVES: The aim of this paper is to provide a limited cost-benefit analysis of a health promotion project based on advocacy to increase the availability and consumption of fluoride toothpaste. BASIC RESEARCH DESIGN: The cost-benefit analysis method uses the cost-of-illness approach to analyse the costs and benefits of the health promotion project. SETTING: The setting for the health promotion project was the country of Nepal. PARTICIPANTS: A sub-set of the population (6-18 year-olds) was used to compute the financial burden of treating projected caries in the permanent dentition. INTERVENTIONS: The paper compares the projected effect of fluoride toothpaste versus non-fluoride toothpaste on the financial burden of dental caries for a sub-set of the Nepali population over a period of 6 years. OUTCOME MEASURES: The net present value (NPV) and the benefit-cost ratio are the main outcome measures. RESULTS: Over a period of 6 years the NPV was US dollar 594,466 for a projected 10% reduction in dental caries of this population group as a result of fluoridation of toothpastes: US dollar 1,035,640 for a projected 20% reduction; and US dollar 2,442,333 for a projected 40% reduction in caries increment. For every US dollar 1 spent on the advocacy project to increase the availability and consumption of fluoride toothpaste, there is a potential saving in the direct cost of treating caries ranging from US dollar 87 to US dollar 356. CONCLUSIONS: The cost benefit analysis presented shows the project was efficient. Tangible benefits resulting from the intervention of fluoride toothpaste were quantified as well as the risks from having no intervention.

The burden of restorative dental treatment for children in Third World countries.

OBJECTIVE: To analyse whether developing countries have sufficient health dollars to treat existing diseases in general and dental caries in particular in their child population. METHODS: Assessments of the costs of treating existing and future caries by the conventional approach. Analysis of WHO dental databases and spreadsheet calculations of costs based upon population projections, prevalence and trends in patterns of caries. FINDINGS: Even though the caries levels are low and most of the disease occurs on the occlusal and the buccal/lingual surfaces, more than 90% of the dental caries remains untreated in Third World countries. Calculations reveal that to restore the permanent dentition of the child population of low-income nations using traditional amalgam restorative dentistry would cost between pounds 1,024 ($US1618) and pounds 2,224 ($US3513) per 1,000 children of mixed ages from 6 to 18 years. This exceeds the available resources for the provision of an essential public health care package for the children of 15 to 29 low-income countries. CONCLUSIONS: To treat caries with the traditional method of restorative dentistry is beyond the financial capabilities of the majority of low-income nations, as three-quarters of these countries do not even have sufficient resources to finance an essential package of health care services for their children.

Apnea and seizures following retrobulbar local anesthetic injection.

Surgery on the eye is performed using topical anesthesia, retrobulbar anesthesia, peribulbar anesthesia, and general anesthesia. Retrobulbar anesthesia is associated with a number of complications that include apnea (respiratory arrest), seizures, or both. Although these complications are transient and self-limiting, they can be life-threatening if not recognized and treated early. We report two patients who developed apnea, one of whom had cardiorespiratory arrest; and two other patients who presented with seizures. We provided ventilation with 100% oxygen, treated the hypertension with nicardipine, and the tachycardia with esmolol. The patients did not have any residual complications.

Incidence and impact of painful exacerbations in a cohort with post-treatment persistent endodontic lesions.

INTRODUCTION: Painful exacerbations of persistent periapical lesions have unknown incidence and impact on quality of life. This study examined the incidence and impact of painful exacerbations and evaluated potential predictive factors of pain associated with root-filled teeth with persistent lesions after root canal treatment. METHODS: Patients from a university hospital clinic were screened to identify root-filled teeth with periapical lesions at time of treatment and not resolved at least 4 years later. A clinical and radiographic examination and questionnaire survey were conducted. Patient and treatment characteristics and details of pain experience were studied. Statistical analysis was carried out by using SPSS (version 18). RESULTS: One hundred twenty-seven patients with 185 persistent lesions were recruited. Median age of patients at recruitment was 56 years (range, 21-82 years). Median time since treatment was 5 years (range, 4-38 years). Overall incidence of flare-up (requiring an unscheduled dental visit) was only 5.8% 20 years after treatment. Less severe pain was more frequent, with a combined incidence of 45% pain at 20 years after treatment. Female patients (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.2-6.0; P < .05), treatment involving a mandibular molar or maxillary premolar (OR, 3.7; 95% CI, 1.6-8.6; P < .05), and preoperative pain (OR, 2.9; 95% CI, 1.3-6.7; P < .05) were significantly associated with pain after treatment. The most commonly affected activities during painful exacerbations were eating and tooth brushing, with minimal impact on daily living. CONCLUSIONS: The risk of flare-up among persistent lesions was very low. A lower degree of pain was more common, but generally with minimal impact on daily activities.

Lesion progression in post-treatment persistent endodontic lesions.

INTRODUCTION: Radiographic lesions related to root-filled teeth may persist for long periods after treatment and are considered to indicate failure of initial treatment. Persistent lesions are found in a proportion of cases, but information on lesion progression is lacking. This study examined the incidence of lesion improvement, remaining unchanged, and deterioration among persistent lesions in a group of patients recruited from a university-based clinic and identified potential predictors for lesion progression. METHODS: Patients of a university clinic with persistent endodontic lesions at least 4 years since treatment and with original treatment radiographs available were recruited with informed consent. Data were obtained by interview and from dental records and clinical and radiographic examinations. Univariate and multivariate statistical analyses were carried out by using SPSS (version 19). RESULTS: One hundred fifty-one persistent lesions were identified in 114 patients. A majority of the lesions (107, 70.9%) received treatment between 4 and 5 years prior. Eighty-six lesions (57.0%) improved, 18 (11.9%) remained unchanged, and 47 (31.1%) deteriorated since treatment. Potential predictors for lesions that did not improve included recall lesion size, pain on biting at recall examination, history of a postobturation flare-up, and a non-ideal root-filling length (P < .05). Lesions that had persisted for a longer period appeared less likely to be improving (relative risk, 1.038; 95% confidence interval, 1.000-1.077). CONCLUSIONS: A specific time interval alone should not be used to conclude that a lesion will not resolve without intervention. This study identified several clinical factors that are associated with deteriorating persistent lesions, which should aid in identifying lesions that require further intervention.

Gaze pursuit responses in nucleus reticularis tegmenti pontis of head-unrestrained macaques.

Eye-head gaze pursuit-related activity was recorded in rostral portions of the nucleus reticularis tegmenti pontis (rNRTP) in alert macaques. The head was unrestrained in the horizontal plane, and macaques were trained to pursue a moving target either with their head, with the eyes stationary in the orbits, or with their eyes, with their head voluntarily held stationary in space. Head-pursuit-related modulations in rNRTP activity were observed with some cells exhibiting increases in firing rate with increases in head-pursuit frequency. For many units, this head-pursuit response appeared to saturate at higher frequencies (>0.6 Hz). The response phase re:peak head-pursuit velocity formed a continuum, containing cells that could encode head-pursuit velocity and those encoding head-pursuit acceleration. The latter cells did not exhibit head position-related activity. Sensitivities were calculated with respect to peak head-pursuit velocity and averaged 1.8 spikes/s/deg/s. Of the cells that were tested for both head- and eye-pursuit-related activity, 86% exhibited responses to both head- and eye-pursuit and therefore carried a putative gaze-pursuit signal. For these gaze-pursuit units, the ratio of head to eye response sensitivities averaged approximately 1.4. Pursuit eccentricity seemed to affect head-pursuit response amplitude even in the absence of a head position response per se. The results indicated that rNRTP is a strong candidate for the source of an active head-pursuit signal that projects to the cerebellum, specifically to the target-velocity and gaze-velocity Purkinje cells that have been observed in vermal lobules VI and VII.