Trends in Dental Implant Use in the U.S., 1999-2016, and Projections to 2026.

Dental implants have become an increasingly popular treatment choice for replacing missing teeth. Yet, little is known about the prevalence and sociodemographic distribution of dental implant use in the United States. To address this knowledge gap, we analyzed data from 7 National Health and Nutrition Examination Surveys from 1999 to 2016. We estimated dental implant prevalence among adults missing any teeth for each survey period overall as stratified by sociodemographic characteristics. We calculated absolute and relative differences from 1999-2000 to 2015-2016 and fit logistic regression models to estimate changes over time. We also used multivariable logistic regression to estimate independent associations of sociodemographic covariates with the presence of any implant. We projected the proportion of patients treated with dental implants into the year 2026 under varying assumptions of how the temporal trend would continue. There has been a large increase in the prevalence of dental implants, from 0.7% in 1999 to 2000 to 5.7% in 2015 to 2016. The largest absolute increase in prevalence (12.9%) was among individuals 65 to 74 y old, whereas the largest relative increase was ~1,000% among those 55 to 64 y old. There was an average covariate-adjusted increase in dental implant prevalence of 14% per year (95% CI, 11% to 18%). Having private insurance (vs. none or public insurance) or more than a high school education (vs. high school or less) was each associated with a 2-fold increase in prevalence, with an almost 13-fold (95% CI, 8 to21) increase for older adults. Dental implant prevalence projected to 2026 ranged from 5.7% in the most conservative scenario to 23% in the least. This study demonstrates that dental implant prevalence among US adults with missing teeth has substantially increased since 1999. Yet access overall is still very low, and prevalence was consistently higher among more advantaged groups.

Predicting dental school performance based on prior dental experience and exposure.

PURPOSE: The purpose of this study was to evaluate whether the variables of students with prior dental assisting experience and students with a parent who is a dentist can be used as predictors of students' pre-clinical and clinical course performance in dental school. MATERIALS AND METHODS: The study population consisted of a cohort of 159 students in the Harvard School of Dental Medicine (HSDM) DMD graduation classes of 2001-2005. Data were collected via self-report using students' applications for admission to the HSDM DMD programme on which students provided information regarding whether they had prior dental assisting experience, including the type and duration of the experience and whether one or both of their parents were dentists. Data on the students' undergraduate science grade point average, Dental Admission Test academic average, Perceptual Ability Test (PAT) score, NBDE Part I and HSDM course grades (three pre-clinical and five clinical assessment categories) were collected from the Office of the Registrar. The pre-clinical categories included the first Oral Comprehensive Exam and the first two classes of the pre-clinical portion of the dental school, Treatment of Active Disease (TxAD) and Restorative Treatment (RTx). The clinical categories included the second Oral Comprehensive Exam and the cumulative grades received for the clinical procedures performed during the third and fourth years in the fields of Endodontics, Operative Dentistry, Periodontics and Prosthodontics. Descriptive and bivariate statistical analyses were performed and included in a multiple logistic regression model. RESULTS: The results revealed that for the variable of prior dental-assisting experience, no statistically significant differences were noted in the pre-clinical and clinical assessment categories. However, students who had any amount of assisting experience were 2.2 times more likely to earn a grade of honours in TxAD compared with students who did not have assisting experience (P = 0.05). Students with a parent who was a dentist performed better only in Operative Dentistry clinical assessment compared with students without a dentist parent (P < 0.05). CONCLUSIONS: Information on prior dental-assisting experience and having a parent who is a dentist have minimal merits for use as predictive agents based on these findings. Dental school admissions committees should continue to review a full spectrum of variables and ensure an applicant's true interest and motivation to pursue a career in dentistry.

Optical phenomenon of peri-implant soft tissue. Part II. Preferred implant neck color to improve soft tissue esthetics.

OBJECTIVES: The purpose of this study was to investigate an optical solution to eliminate the undesirable shine-through effect of implants on peri-implant mucosa by selecting an optimized implant neck color based on an objective and quantifiable method. MATERIAL AND METHODS: The optical effect of color strips on 15 peri-implant mucosal sites of 14 patients with Straumann single-tooth implant replacements in the maxillary anterior region was analyzed. The color differences between the peri-implant mucosa with insertion of each of eight different color strips (white, black, light pink, pink, light orange, orange, gold, violet) and the gingiva of an adjacent or contralateral tooth without any color strips were compared for the selection of optimal color of implant neck. Spectrophotometric color measurements were performed to compare the color difference index (DeltaE) and color coordinates (DeltaL*, Deltaa*, Deltab* and DeltaC*). RESULTS: The colors of the peri-implant mucosa with color strips and the gingiva of natural tooth demonstrated that the test site soft tissue with color strips of light pink, pink, light orange and orange showed a significantly smaller DeltaE value (P<0.05). Moreover, light pink exhibited the lowest mean DeltaE value of 2.6+/-0.6, indicating a clinically indistinguishable color difference. CONCLUSIONS: The results suggest that it is possible to improve gingival esthetics by coloring the implant neck, most effectively with light pink, to mask the impact of the underlying titanium implant. The use of implants with optimized neck colors to correct an esthetic deficiency may be a feasible approach to establish improved peri-implant soft tissue esthetics.

[Ischemic cardiopathy in the hypertensive]. / Cardiopatia isquémica no hipertenso.

Arterial hypertension and coronary heart disease (CHD) are the clinical expression of cardiovascular remodelling, the altered cell population of the cardiovascular system being the result from many biological, psychological and social factors and genetic, enzymatic, humoral and metabolic dysfunction of the individual subject. Both diseases are affected by many common factors and have some similar aspects of the remodeling process, and these are reasons for their simultaneous presence in many patients. The assessment of the total burden of CHD risk in the hypertensive patient and the strategy to modify lifestyle and reduce not only the blood pressure, but also the total burden of risk, is therefore important.

Dot enzyme-linked immunosorbent assay (dot-ELISA) for schistosomiasis diagnosis using dacron as solid-phase.

Dacron and nitrocellulose were evaluated as matrices for the dot enzyme linked immunosorbent assay (dot-ELISA) for schistosomiasis and compared to indirect immunofluorescence (IMF). Titration of sera from 18 schistosomiasis patients against soluble worm antigen preparation (SWAP) was carried out and sera from healthy individuals from non-endemic areas were used as controls. The IMF was less sensitive than the dot-ELISAs, although the difference was not statistically significant (p > 0.05). The dot-ELISA based on nitrocellulose was as sensitive as that using dacron. Stability did not differ between nitrocellulose and dacron. Specificity was lower when dacron was used than when nitrocellulose was used, although the difference was not statistically significant (p > 0.05). In conclusion, this work showed that nitrocellulose and dacron performed similarly in dot-ELISA, suggesting that they may be used alternatively in population surveillance in endemic areas.

Chemical and immunological characterization of a low molecular weight outer membrane protein of Salmonella typhi.

A new immunogenic outer membrane protein, Omp-28 (MW 28,000 and pI 4.6), was isolated from smooth Salmonella typhi cells by the use of an extracting medium containing 6 M urea, 1% deoxycholate and 5 mM EDTA. The purification of Omp-28 was performed by gel filtration and fast ion exchange chromatography. This protein showed to be the prevalent component isolated by the latter methodology. Omp-28 is formed by three identical subunits (MW 9,000), not linked by disulfide bonds. The partial N-terminal amino acid sequence of Omp-28 presented great homology with part of the sequence of an Escherichia coli protein found in a precursor whose sequence was predicted by c-DNA. ELISA and Western blotting identified Omp-28 as the major antigenic protein present in the outer membrane protein fraction, isolated by gel filtration. Antibodies against Omp-28 were detected by ELISA in 43% of 28 sera from typhoid fever convalescent patients. The antisera from mice immunized with Omp-28 and the highest positive typhoid fever convalescent serum gave a positive bactericidal test, killing 50% of Salmonella typhi cells in serum dilutions of 1/80 and 1/320, respectively. These results indicate the immunogenic importance of Omp-28 isolated from Salmonella typhi outer membrane and strongly suggest it should be used in further studies of animal protection against the disease caused by this pathogenic bacteria.

[Chronic angina pectoris in the patient with arterial hypertension]. / Alguns aspectos da angina de peito crónica no doente com hipertensão arterial.

Reference is made to the close relationship between high prevalent arterial hypertension and coronary heart disease, including the vascular risk factor as well as the common genetic and psychosocial factors that influence the development and parallel evolution of vascular and heart diseases. The importance of assessing of the total burden of coronary heart disease risk and its general management is emphasized and some aspects of the treatment of angina pectoris in hypertensive patients are mentioned.

[Hypertensive reaction to exercise. Retrospective studies of 1363 consecutive exercise tests]. / Reacção hipertensiva ao esforço dinâmico. Estudo retrospectivo em 1363 provas de esforço consecutivas.

OBJECTIVE: To study exercise hypertensive reaction and its relation with rest blood pressure, hypertension type and hypertensive cardiac disease. DESIGN: Retrospective study of treadmill exercise testes (ET) performed from January/89 to June/91: (n: 1703). SETTING: Stress tests Laboratory of Cardiology Service of a Military Hospital. METHODS: 1363 consecutive ET of male subjects, performing at least the 3rd stage of the Bruce protocol, were studied. From each ET record were obtained general data, including the reason for test, medication and the rest and exercise blood pressure. Exercise hypertensive reaction was defined as a Bruce protocol 3rd stage systolic blood pressure above 187 mmHg, which corresponds to mean +2SD of 130 normal male subjects previously studied. The Echocardiograms of non-treated hypertensives, obtained less than a month from ET, were reviewed. The diagnosis of borderline or moderate hypertension was base on the clinical records. RESULTS: 1) The 1363 ET included 132 (9.7%) ET to study hypertensive subjects, and 68 of these had hypertensive reaction. 86 ET were performed by non-treated hypertensive subjects, of whom 73 had Echocardiogram. 43 (3.5%) from 1231 ET performed by non-hypertensive subjects also had exercise hypertensive reaction. 2) The left ventricular (LV) mass index of non-treated hypertensive patients had a positive correlation with exercise systolic pressure (r: 0.45; p < 0.001), more important than with rest blood pressure or exercise systolic pressure response; there was a relation with LV wall thickness, but not with internal ventricular dimensions, that was only observed in hypertensive subjects that also had hypertensive reaction to exercise. 3) Exercise systolic blood pressure was usually normal in borderline and elevated in moderate hypertensives (Qui2: 27.249; p < 0.001). 4) Subjects with exercise hypertensive reaction, but not previously diagnosed as hypertensives, were usually true hypertensives. CONCLUSIONS: 1) Hypertensive peaks seem to be an important determinant factor in LV hypertrophy of hypertension, but its influence is felt only above a certain blood pressure threshold; it results on LV concentric type hypertrophy. 2) Exercise systolic blood pressure had a discrimination power of about 80% to separate borderline and moderate hypertensive subjects. 3) All subjects having an exercise hypertensive reaction must be carefully observed, even if their blood pressure at rest is normal, because most of them are true hypertensive patients.

[Changes in cardiac output in the initial phases of hypertension]. / Modificações do débito cardíaco nas fases iniciais da hipertensão.

In what concerns to the early phases of arterial hypertension, the difficulty of definition, the usually found hemodynamic changes, especially of cardiac output, and its changes during evolution to established hypertension, are referred. The role of genetic determinants of predisposition to hypertension and of strain situations as factors of precipitation, with acute rise of blood pressure and cardiac output, is emphasized. It is also referred the importance of the early detection of true hypertensives by studying their reaction to strain situations, being particularly promising the mental stress tests and the dynamic exercise tests.

[Pressure response to dynamic exercise and antihypertensive therapy]. / Resposta tensional ao esforço dinâmico e terapêutica antihipertensiva.

OBJECTIVES: To study the exercise systolic pressure (SP) in hypertensive patients, its relation with left ventricular (LV) mass and the efficacy of its control by some antihypertensive drugs. DESIGN: To study the echocardiogram (ECHO) and exercise test (ET) in hypertensives (HT), before and after rest blood pressure (BP) control. SETTING: Out-patient cardiology clinic in a military hospital. METHODS: 53 male moderate HT, 30 to 60 years old, without other pathology, were studied with ECHO and ET. 28 HT repeated ET after rest BP control: Group A--Diuretic (Hchlt/Triam), n: 7; Group B--Atenolol, n: 10; Group C--Nifedipine, n: 11. RESULTS: 1. There was a positive correlation between LV mass index and exercise SP (r: 0.37; p less than 0.01), but not rest blood pressure. 2. Exercise test duration was increased only in group C. 3. Hypertensives with rest BP control had also normal exercise SP in group B, but not in groups A or C (Qui2: 11 735; p less than 0.001). CONCLUSIONS: 1. Exercise systolic blood pressure seems to be more important than rest blood pressure to the development of LVH in hypertensive patients. 2. The observed increase of exercise capacity in Nifedipine group must be considered in the treatment of physically active hypertensives. 3. Hypertensives with rest BP controlled by Atenolol have also, very probably, a normal exercise systolic pressure. 4. In physically active HT with rest BP controlled by Diuretic or Nifedipine may be useful an exercise test to evaluate exercise systolic pressure.