Profile of the oral healthcare team in countries with emerging economies.

Health is a critical dimension of human well-being and flourishing, and oral health is an integral component of health: one is not healthy without oral health. Significant barriers exist to ensuring the world's people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. Emerging economies are encouraged to develop a national strategic plan for oral health. International organizations have developed goals for oral health that can be referenced and adapted by emerging economies as they seek to formulate specific objectives for their countries. Demographic data that assess the nature and extent of oral diseases in a country are essential to sound planning and the development of an oral healthcare system that is relevant, effective and economically viable. Prevention should be emphasized and priority consideration be given to oral healthcare for children. The types and numbers of members of the oral healthcare team (workforce) will vary from country to country depending on the system developed. Potential members of the workforce include: generalist dentists, specialist dentists, dental therapists, dental hygienists, denturists, expanded function dental assistants (dental nurses) and community oral health workers/aides. Competences for dentists, and other members of the team, should be developed to ensure quality care and developed economies should cooperate with emerging economies. The development, by more advanced economies, of digital, virtual curricula, which could be used by emerging economies for educating and training members of the oral healthcare team, should be an important initiative. The International Federation of Dental Educators and Associations (IFDEA) should lead in such an effort.

A comparison of periodontal disease in HIV-infected children and household peers: a two year report.

PURPOSE: The purpose of this study was to compare the incidence and progression of periodontal disease in HIV-infected children to HIV-negative household peers. This paper reports the findings after two years. METHODS: Children diagnosed as HIV-infected and their household peers were recruited from the Children's Hospital AIDS Program in Newark NJ. A periodontal examination was performed at baseline and at six-month intervals for two years. A total of 121 subjects were examined two years after baseline (68 HIV-infected and 53 controls). These children ranged in age from 2-15 years at baseline. RESULTS: Plaque assessment (PHP-M) in HIV-infected cases showed a seven-fold increase over controls for the period. However, there were no significant differences between the two groups in changes over the two years for Bleeding on Probing, Gingival Index or Pocket Depths. There was virtually no recession or pathologic mobility in either group. One-fourth of the HIV-infected group exhibited Linear Gingival Erythema at both baseline and year two. Although the number of subjects with LGE did not increase, there was an increase in the severity of LGE at year 2. CONCLUSION: This study suggests that in a medically well-controlled HIV-infected population, with the exception of the prevalence of Linear Gingival Erythema, the periodontal findings are similar to their HIV-negative household peers and to the general pediatric population.

Dental caries in HIV-infected children versus household peers: two-year findings.

PURPOSE: This report will present a two-year comparison of the incidence and baseline prevalence of dental caries found in both the primary and permanent dentition among a cohort of HIV-infected children as compared to household peer control subjects who were not HIV-infected. METHODS: The subjects in this report were from an initial cohort of 171 children (104 HIV positive and 67 HIV negative), who were participants in the Children's Hospital AIDS Program in Newark, New Jersey, from 1993-1995. This two year analysis reports the findings on the children who completed baseline through Year 02 examinations (N = 121), aged 2-15 years old (68 HIV positive, 53 HIV negative). RESULTS: While the DMFS incidence at Year 02 among the 6-11 year old control subjects was 17% higher than that of the HIV-infected cases (2.1 vs. 1.8, respectively) this same incidence was eight-fold higher for the control subjects among the 12-15 year olds (e.g., 8.1 vs. 1.0, respectively). The mean cumulative dmfs score to date for HIV-infected cases was higher than for the control subjects for both the 2-5 year olds and the 6-11 year olds, (11.0 vs. 7.0) and (10.0 vs. 4.0, P = .02), respectively. In all three age groups, HIV-infected cases had a greater number of primary teeth and fewer number of permanent teeth than the control subjects (P < .01). CONCLUSION: Given that HIV-infected cases had lower DMFS scores and higher dmfs scores than their household peer controls, the fewer mean number of permanent teeth among the HIV-infected cases suggests that this delayed tooth eruption pattern in permanent teeth contributed to the lower DMFS scores seen in the HIV-infected cases.

Oral soft tissue manifestations in HIV-positive vs. HIV-negative children from an inner city population: a two-year observational study.

PURPOSE: Data accrued after two years of longitudinal observation of oral soft tissue lesions in a cohort of HIV-infected children and comparisons to a group of uninfected controls is presented. SUBJECTS AND METHODS: One hundred and four HIV-positive subjects were enrolled from an inner city pediatric HIV clinic and HIV-negative household peers served as control. Oral exams were performed at six-month intervals while laboratory data of interest were obtained from the children's medical records. RESULTS: HIV-positive children had significantly more oral soft tissue lesions than their HIV-negative peers. In particular, the prevalence of candidiasis, linear gingival erythema and median rhomboid glossitis were high. However, oral lesions were not good predictors of mortality and only candidiasis was associated with a low CD4 count. CONCLUSIONS: Oral soft tissue lesions were common among HIV-positive children. While candidiasis was correlated with advanced disease, oral lesions were not good predictors of mortality.

Anesthesia of the chorda tympani nerve and taste phantoms.

The chorda tympani nerve innervates the anterior two-thirds and the glossopharyngeal nerve, the posterior one-third, of each side of the tongue. Previous work showed that anesthesia of one chorda tympani increased the perceived intensity of quinine applied to an area innervated by the contralateral glossopharyngeal nerve, but decreased the perceived intensity of NaCl applied to an area innervated by the ipsilateral glossopharyngeal nerve. The data presented here corroborate that earlier finding and show that if both chorda tympani nerves are anesthetized, the taste of quinine is intensified and the taste of NaCl diminished at areas innervated by the glossopharyngeal on both sides of the tongue. In about 40% of the subjects, tastes occurred in the absence of stimulation (we call these tastes phantoms). The phantoms were usually localized to the posterior tongue contralateral to the anesthesia and they were abolished when a topical anesthetic was applied to the area where they were perceived. Phantoms like these may be a source of clinical dysgeusia in patients with localized taste damage. The phantoms may result because the anesthesia releases inhibition normally occurring between the central projection areas of different taste nerves.

Caries experience and cariogenic markers in HIV-positive children and their siblings.

The purpose of this cross-sectional, masked study was to compare the oral status of perinatally HIV-infected children with their uninfected siblings living in the same environment. A secondary purpose was to compare HIV-positive children for differences in oral health with respect to disease advancement. One hundred forty-seven children were examined in their homes and meeting places, using NIH criteria for caries diagnosis. Significant differences were found in the number of caries-free children (P < 0.05), past caries experience (P < 0.003), subsurface demineralizations (P < 0.0001), and caries-related bacteria (P < 0.05). However, differences in caries prevalence were not found in the 3- to 6-year-old subgroup. Caries prevalence (P < 0.001) and levels of caries-related flora in saliva were correlated to years since diagnosis (mutans streptococci P < 0.008, lactobacilli P < 0.02). Children with a more advanced disease stage had significantly more caries (P < 0.02). Among the HIV-infected children, the frequency of carbohydrate intake was clearly correlated to caries (P < 0.003) and to lactobacilli levels (P < 0.0001). It is concluded that children with perinatally acquired HIV are at greater risk for caries than their siblings, more so with advancing disease.

Effect of anesthesia of the chorda tympani nerve on taste perception in humans.

Individuals who have sustained considerable damage to parts of the taste system often fail to experience changes in everyday taste experience. The two halves of the tongue are independently innervated: the chorda tympani (branch of the facial or VIIth cranial nerve) innervating the anterior two-thirds and the glossopharyngeal (IXth cranial nerve) innervating the posterior one-third. Anesthesia of the chorda tympani nerve on one side produced increased taste intensities for some stimuli on the area innervated by the glossopharyngeal nerve on the other side. Because this effect occurs across the midline and taste projects ipsilaterally, the effect must occur in the central nervous system (CNS). This supports Halpern and Nelson's release-of-inhibition hypothesis that the area to which the chorda tympani projects in the CNS must normally inhibit that of the glossopharyngeal nerve. Anesthesia of the chorda tympani abolishes that inhibition and leads to perception of increased taste intensities from areas innervated by the glossopharyngeal nerve.

Zinc profiles in rheumatoid arthritis.

Evidence has accumulated which suggests that zinc may play an important role in immune function and inflammation. In this study we examined the zinc status in patients with rheumatoid arthritis (RA), osteoarthritis, other rheumatic diseases and healthy controls. Results indicate that serum and plasma zinc levels are decreased significantly in patients with RA. Reduced zinc values may be due to decreased albumin-bound and micromolecular protein-bound zinc.

Quality-specific taste impairment following the application of chlorhexidine digluconate mouthrinses.

Although chlorhexidine has been widely used in the prevention and treatment of gingivitis, its effects on taste sensation have not been well studied. The purpose of the present study was to evaluate taste alterations following regular applications of 0.2% chlorhexidine mouthrinses. 24 healthy and non-smoking clinical instructors, dental assistants and dental students were divided into 3 groups after having reached a status of clinical gingival health by 4 weeks of supervised oral hygiene procedures. Following this, they were asked to abolish all mechanical oral hygiene for a period of 14 days, during which time they rinsed twice daily with different mouthrinses. Group A rinsed with a 0.2% chlorhexidine solution, group B served as control and utilized a 0.001 molar solution of quinine hydrochloride as a placebo rinse. A second control group (C) rinsed with distilled water. At days -3 and -2, as well as at days 1, 2, 13 and 14 of the experimental period, and 1 and 2 days after cessation of the rinsing, taste sensitivity was evaluated by a magnitude estimation, suprathreshold scaling procedure for the 4 taste qualities--sweet, salty, sour and bitter. 6 different concentrations of each of sucrose, sodium chloride, citric acid and quinine hydrochloride were utilized. Magnitude estimations of the perceived intensities of each series of test solutions were calculated. The analysis of co-variance revealed significant differences at the short-term and treatment-related suprathreshold scaling responses between both control groups (B, C) and the test group (A) for the sodium chloride magnitude estimation function. However, no significant inter-group differences in the magnitude estimation function were found for the remaining taste qualities.(ABSTRACT TRUNCATED AT 250 WORDS)

Taste and smell problems: validation of questions for the clinical history.

Complaints of taste and smell dysfunction unaccompanied by symptoms of neurological or nasal problems are not uncommon. However, "I can't taste" is not necessarily an accurate symptom description. Complaints tend to reflect the common confusion between taste sensations (that is, salt, sour, sweet, bitter) and flavor sensations (including taste, smell, temperature, and texture). A number of questions have been identified that help classify symptoms according to the type of dysfunction (taste, smell, or both): whether the problem is quantitative (reduced or absent sensation) or qualitative (distorted sensations); and what might have caused the dysfunction. Directed questioning can yield a clinical history that predicts chemosensory function and identifies the most likely cause of the problem. Questions were assessed by comparing the self-reports of taste and smell symptoms to the clinical evaluation of chemosensory function for 101 new patients seen in the Taste and Smell Center at the University of Connecticut Health Center in 1983.

Chemosensory dysfunction. Clinical evaluation results from a taste and smell clinic.

Findings from 441 patient evaluations performed at the Taste and Smell Clinic of the Connecticut Chemosensory Clinical Research Center are presented. Taste and smell dysfunction was the chief complaint in all patients. The diagnostic approach included tests of taste and smell function; history taking; physical, neurologic, otorhinolaryngologic, and nutritional examinations; and clinical laboratory screening tests. Results indicate that the most common chemosensory dysfunction is probably olfactory: 86% of patients in this series had measurable loss of smell function. The most common cause of olfactory deficit was nasal and/or sinus disease (30% of patients), followed by idiopathic conditions (26%) and prior upper respiratory infection (19%). Assessment of individual components of the evaluation suggests that a total circulating eosinophil count may be useful as a screening test for nasal and/or sinus disease among patients whose chief complaint is chemosensory dysfunction.

Zinc in multiple sclerosis. II: Correlation with disease activity and elevated plasma membrane-bound zinc in erythrocytes from patients with multiple sclerosis.

Previous studies have shown that zinc levels in erythrocytes are significantly elevated in patients with multiple sclerosis (MS). To examine the correlation between erythrocyte Zn levels and disease activity, we measured erythrocyte Zn levels longitudinally. Levels were dramatically decreased during a clinically documented exacerbation of MS. To determine the localization of increased Zn levels in MS erythrocytes, we employed standard techniques for the isolation of nonhemoglobin erythrocyte membrane ghosts. Patients with MS had three times more Zn in ghost material than did controls. Chloroform-methanol extraction in erythrocyte ghosts followed by determination of Zn levels indicated that most of the membrane-bound Zn was associated with the lipid-soluble fraction. Non-lipid-associated Zn and total membrane protein concentration were similar in MS and control samples. Results suggest that mechanisms which govern cellular availability, compartmentalization of Zn, or the binding of Zn to cell surface membranes may be altered in patients with MS, and that these mechanisms vary with disease activity.

Quality-specific taste changes in multiple sclerosis.

Taste sensitivity in 79 patients with multiple sclerosis (MS) and 65 age- and sex-matched control subjects was measured with a sip-and-spit, suprathreshold scaling, magnitude estimation procedure using six concentrations each of sodium chloride, sucrose, citric acid, and quinine hydrochloride. Results were analyzed with a taste scoring system and by plotting psychophysical functions (log concentration versus log magnitude estimate) normalized to 1.0 M sucrose. Gender did not affect taste scores, but age was inversely related, so the results were analyzed by an analysis of covariance with age as the covariant. There was a significant alteration in taste sensitivity in the subjects with MS for sodium chloride and quinine hydrochloride stimuli but not for sucrose and citric acid; these results were confirmed by a separate analysis of the psychophysical functions. Some of the MS taste scores correlated with MS functional and physical disability scores. Taste sensitivity was not correlated with clinical history or presence of facial symptoms.