Relationship of degenerative changes of the temporomandibular joint (TMJ) with the angle of eminentia.

The purposes of this study were threefold: (i) to assess the degenerative changes of the temporomandibular joint [TMJ (condyles and articular eminence of the glenoid fossa)], (ii) to determine whether the TMJ degeneration levels differ by ethnic group and gender and (iii) to assess the association between the angles of eminentia and TMJ degeneration, while controlling for gender, ethnicity, age and number of teeth. The sample included 245 20th century dry skulls: 130 African-American (82 male and 48 female) and 115 European-American (75 male and 40 female), with a mean age of 46.4 +/- 19.9 years. The angles of eminentia were measured in a sagittal plane. The medial, central and lateral portions of the articular slope and anterior portion of the condyle were assessed for degenerative changes. Degeneration scores were calculated for the eminentia and condyles. Statistical analyses included two-way anovas, Pearson's correlation coefficients and linear regression models. There were differences in the degree of TMJ degeneration of the African-American and European-American males and females. European-American females retained fewer teeth, had the highest TMJ degeneration scores and exhibited significant relationships between the eminentia angles and degeneration. When the independent variables were entered into the regression model, only the degeneration of the eminentia was significantly associated with the angles of eminentia. Although the degeneration of the eminentia explained some of the variation of the eminentia angles, it is clear that the inclusion of multiple factors is essential to study the remodelling of the glenoid fossa.

Asymmetry of the articular eminence in dentate and partially edentulous populations.

The purpose of this study was to assess the degree of right-left asymmetry of the glenoid fossa. The specific aims were (1) to determine whether there were relationships between age, number of teeth, slope of the articular eminence, fossa depth, and the degree of right-left asymmetry, and (2) to compare the right-left asymmetry of two populations, one characterized by an acceptable occlusion (A-Occ), the other by an unacceptable occlusion (partially edentulous; Un-Occ). A-Occ was defined as possessing a minimum of 28 teeth that would allow for hand articulation of the mandibular teeth to the maxillary teeth. Un-Occ had fewer than 17 teeth, which would make it impossible to articulate the mandible with the maxilla. The sample included 20th century dry skulls: 70 African-American (44 male, 26 female) and 64 European-American (49 male, 15 female), ranging in age from 21-105 (mean 47.1 +/- 19.9). The medial (M), central (C), and lateral (Lat) aspects of the right (R) and left (L) slopes of the articular eminence were measured in a sagittal plane. The R and L fossa depth also were measured. The raw absolute differences IR-LI and relative differences [IR-LI/IR+Llx100] of the articular slope angles (M, C, and Lat) and fossa depths were computed. Statistical analysis included paired t-tests, independent t-tests, and Pearson's correlation coefficients, significance at p < or = 0.05. Ninety percent (90%) of the population exhibited right-left asymmetry of the glenoid fossa. The right articular slopes (M, C, and Lat) were significantly steeper than the left articular slopes; the right fossa depths were significantly deeper than the left. There generally were no differences in the articular slope steepness or fossa depths between the partially dentate and the dentate, nor were there statistical differences between the two groups in the raw absolute differences or relative differences of the M, C, and Lat slopes or fossa depths. No significant relationships were found between right-left asymmetry, age, or number of teeth. With only 10% of the subjects exhibiting symmetry of the glenoid fossa depths or articular slope angles, clinicians should consider bilateral asymmetry the norm and not an anomaly.

Coping with tooth pain: a qualitative study of lay management strategies and professional consultation.

This research analyzes transcripts of semi-structured interviews with patients presenting with tooth pain at a rural dental clinic in North Florida. The primary objectives are to identify the strategies patients use to manage their pain and to elucidate the decision-making process leading to the clinic visit. Although respondents understood that their condition was not self-limiting, only about one-half contacted the clinic within several days of the onset of their pain. Most tried one or more lay management strategies.

Prevalence of elevated blood pressure in students attending a college oral health program.

Physical evaluation of dental patients prior to treatment can reveal signs and symptoms of diagnosed and undiagnosed disease. This cross-sectional study examined the prevalence of elevated blood pressure readings in a group of college students attending an annual oral health program. The data were collected at the annual session on one day in three consecutive years. While the risk of hypertension increases with age, unless the blood pressure is recorded in all adult patients, a significant number of occult high blood pressure readings may go undetected. Since untreated hypertension can cause morbidity and mortality in some patients, the recording of the blood pressure for all adult patients is indicated. The results of this study revealed that 56 of 416 (13.4%) college students with recorded blood pressure values had elevated blood pressure readings within the ranges of mild to severe elevations. Male gender was associated with elevated readings (x2 = 18.57, p < 0.001). Self-reported high blood pressure was associated with age differences, current care by a physician, and medication use. Routine recording of blood pressure is essential for the comprehensive evaluation of adult dental patients, regardless of age. Inconsistent application of physical evaluation principles based on age and disease-related abnormalities may exclude younger individuals at risk for occult disease and associated morbidity. Screening for blood pressure elevation, even in younger adult groups not usually associated with hypertensive disease, can Identify individuals needing further medical evaluation.

Public perception of DDS versus DMD degrees.

There are currently two degrees awarded to dental graduates from U.S. dental schools. The aim of this study was two-fold: (1) to determine the level of confusion among lay personnel concerning these degrees and (2) to identify and explore any basis for any public opinion. Five hundred and twenty-four lay persons were interviewed in Cleveland and the surrounding area. Chi-square analyses were employed to determine the effects of gender, frequency of dental visits, types of dental insurance, education level, age, income, and race on public perception of the DDS and DMD degrees. Fewer than 20% of those interviewed knew that a DDS and DMD received the same level of training. Of those who indicated there was a difference in training, 69% felt that DMDs had more training than DDSs. Since the majority of lay persons were confused about the two degrees, the establishment of one unified dental degree may contribute to a better public understanding of the education and capabilities of dentists.

Dental student perceptions of the elderly: measuring negative perceptions with projective tests.

Stereotypic perceptions of older patients have been documented to influence relationships with older adults. To assess the impact of age and dentate status on dental student treatment decisions and perceptions of patients, we designed a qualitative study utilizing projective tests. Seventy first- and third-year dental students wrote stories about two "cue" statements, one describing a young patient and one an older patient. Each cue varied by dentate status, having either a complete dentition or seven remaining teeth. The stories were evaluated for negativity and for general themes of stereotypic statements. The results indicated that while patient age did not influence the dental care prescribed, a high level of negativity existed toward old patients in general (45%, older patient with teeth; 47%, older patient with seven teeth) and toward a younger patient with few remaining teeth (57.6%). The level of negativity expressed toward the young patient with full dentition (27%) may suggest a patient gender bias among dental students in this sample.

Prevalence and implications of accessory retromolar foramina in clinical dentistry.

The occurrence of retromolar foramina (RMF) was examined in a sample of dry skulls (African American n = 249; Causcasian n = 226) to consider the potential clinical impact. A prevalence rate of 7.8% of RMF was found. There were no statistical differences based on race or gender. The prevalence may contribute to the explanation of a portion of inferior alveolar nerve block failures and provide insight into potential implications of surgery in the posterior mandible.

Blood pressure measurement by community dentists.

The benefit and implications of blood pressure (BP) measurement in dental patients are a standard curricular component of most physical evaluation courses in dental schools. However, previous research has indicated that preventive procedures such as oral cancer examinations frequently are not completed or documented. A survey of practicing dentists was conducted in a Midwest metropolitan area to determine the frequency of BP measurement and conditions under which this vital sign is likely to be measured. Two hundred four responses were obtained from a telephone survey which included questions characterizing BP measurement on the basis of patient age and medical diagnosis. The results of the survey indicated that 57.4% of respondents do not check the BP of new patients over the age of 65, while 74% do not check the BP of new patients under 30 years of age. Fourteen percent admitted never measuring BP. The results varied by graduation years and by dentist's completion of AEGD or GPR programs. The results suggest great variation in the recording of BP and the criteria which are applied to those decisions. Further study should investigate factors contributing to low compliance with screening procedures such as the clinical measurement of BP and other health-promotion measures.

Nursing assistants' opinions of oral health care provision.

Understanding the attitudes and perceptions about oral health in nursing assistants (NAs) may facilitate efforts to improve daily oral care in long-term-care settings. By exploring the attitudes of individuals charged with daily oral care, we may gain insight into the level of care provided for the residents. To explore motivation for oral care by NAs, we developed a 28-item survey. The survey included descriptive information and a 20-item Likert-type instrument dealing with oral care for self-care and dependent individuals. Factor analysis was used to test the validity of the constructs intended to be measured by the survey items. The results indicated favorable responses to knowledge items and items related to the importance of oral health in general. However, the responses to questions related to amount of time to perform mouth care, the risk of being bitten by a resident, resident cooperation, and myths about oral health in aging revealed significant variation by NAs descriptive variables. An understanding of the implications of NAs' perceptions, values, and knowledge may provide impetus for new strategies for improving oral health and daily care in long-term-care facilities.

Perineural spread of squamous cell carcinoma of the lip: the importance of follow-up and collaboration.

Perineural spread (PNS) of mucosal squamous cell carcinoma of the head and neck region occurs with a reported frequency of 2% to more than 27%. Patients previously diagnosed with and treated for head and neck cancer should be closely followed by both their physician and their dentist in order to facilitate the coordination of care. This case history demonstrates the results that can occur when a team approach to head and neck cancer is not followed, especially in a patient who is an infrequent and somewhat reluctant health care utilizer. Despite mandibular pain, the patient, who had a history of a carcinoma of the lower lip and had developed PNS, was not referred to a dentist. In patients with a previous history of squamous cell carcinoma, sensory and/or motor changes must be closely monitored when there is a suspicion of PNS. The outcome of this case supports improved collaborations between physicians and dentists in following head and neck cancer patients.

The frequency of accessory mental foramina in four ethnic groups.

The frequency of accessory mental foramina (AMF) was studied in four population groups: 20th century Asian Indians, African Americans and American Whites, and Pre-Columbian Nazca Indians. AMF were found less frequently in the American White and Asian Indian populations than in the other groups (American White, 1.4%; Asian Indian, 1.5%; African American, 5.7% and Nazca, 9.0%). The incidence of AMFs did not differ significantly between right- and left-hand sides. In certain ethnic groups, i.e., African American, AMF may occur more often in males. Additional studies with larger samples are needed to show whether AMFs are more common in males.

A pilot study on improving oral care in long-term care settings. Part I: Oral health assessment.

Surveys of oral health in long-term care (LTC) settings have consistently documented low levels of health. In the complex LTC environment, programs to improve oral health have yet to be well defined. The purpose of this pilot project was to determine if a program of training for nursing assistants in combination with adjunctive aids to oral care could improve resident oral health indicators. This pilot study demonstrated improved oral health indexes among residents cared for by trained nursing assistants who had access to adjunctive oral care aids. Additional studies are needed to define the nature of oral caregiving in LTC settings as well as specific regimens which can assure continued oral health improvement in this environment.

A pilot study on improving oral care in long-term care settings. Part II: Procedures and outcomes.

This pilot study attempts to determine if a program of training for nursing assistants in combination with adjunctive aids to oral care could improve resident oral health indicators. Twelve residents of a county long-term care (LTC) facility cared for by a group of nursing assistants who completed a 6-week oral health training program constituted the experimental group. Resident Plaque Index (PI) and Gingival Index (GI) scores were compared at baseline, and 6 weeks and 12 weeks after nursing assistant training to a matched group of residents (n = 11) cared for by nursing assistants who had not completed oral health training. Both the PI and GI scores of the experimental residents improved significantly compared to the control residents between baseline and 12 weeks (Student t test, p = .039, p = .017, respectively). This pilot study demonstrated improved oral health indexes among residents cared for by trained nursing assistants who had access to adjunctive oral care aids. Additional studies are needed to define the nature of oral caregiving in LTC settings as well as specific regimens which can assure continued oral health improvement in this environment.

Comparison of hospitals' dental consultation rates for head and neck cancer patients.

Significant morbidity can result in patients being treated for head and neck cancer (H&NC) if dental disease is not under control before medical therapy is initiated. This study compared the rates of dental consultation in three teaching hospitals in a midwestern metropolitan area for patients being treated for H&NC. One of the hospitals has an oral and maxillofacial surgery (OMFS) clinic, while the other two hospitals have general dental and OMFS clinics. The medical records of 104 H&NC patients were retrospectively examined for a rate of referral to dental professionals, type of medical treatment, and oral complications with medical/surgical therapies. The results of the study showed statistically significant differences between hospitals related to the rates of dental consultation and oral complications. The dental consultation rates were low overall, ranging from 12.1 to 39.5%. These rates were not influenced by the presence of a general dental clinic. Because dental interventions can reduce the severity or prevent oral complications in H&NC patients, efforts to explain these results and enhance cooperative protocols represent a significant need.

Oral disease in the geriatric patient: the physician's role.

In the elderly, oral health has a profound impact on general well-being. The ability to quickly identify potentially harmful oral health problems is valuable to the physician, who generally will see an older patient more often than the dentist will.

Pharmacologic considerations in geriatric dentistry.

Drug administration to geriatric patients in the dental office requires special care. The margin of safety, or therapeutic window, in which the drug is safely effective may be greatly decreased because of physiologic changes with age, and pharmacokinetic and pharmacodynamic alterations. Realizing that the elderly are, as a group, more susceptible to adverse drug reactions, the addition of new medications must be undertaken with caution. Consulting with the patient's physician and a close working relationship with clinical pharmacists specializing in geriatrics can facilitate safe and effective drug prescribing.

Adverse drug effects.

It has been emphasized repeatedly that drugs seldom exert their beneficial effects without also causing adverse side effects. The frequency of clinically important adverse effects is difficult to estimate, but the potential for drug-drug and drug-disease interactions and drug-induced illness is high and lends credence to the statement that there are no safe biologically active agents.