Malnutrition and dental caries: a review of the literature.

Protein-energy malnutrition occurs when there are deficiencies in protein, energy foods or both, relative to a body's needs. This paper reviews the association of early childhood malnutrition with: (1) dental caries, (2) enamel hypoplasia, (3) salivary gland hypofunction, and (4) delayed eruption. Studies suggest that caries of the primary dentition is associated with early childhood malnutrition, though the effect on caries of the permanent dentition has essentially not been studied. Enamel hypoplasia, salivary glandular hypofunction and saliva compositional changes may be mechanisms through which malnutrition is associated with caries, while altered eruption timing may create a challenge in the analysis of age-specific caries rates.

Computerized local dental anesthetic systems: patient and dentist satisfaction.

A computer controlled dental anesthetic delivery system was studied with the OBJECTIVE of evaluating and comparing the unit to the traditional method of anesthetic delivery. The research design and METHOD of study involved the use of trained dentists who used both types of delivery systems on patients seen during their routine practice of dentistry. After the dental appointment was finished each dentist completed a survey concerning the injection. Patients completed a survey before the injection concerning their previous anesthetic experiences and completed another survey at the end of the dental appointment concerning the injection they had just received. Statistical analyses yielded RESULTS showing the two methods were rated very similarly by both patients and dentists. CONCLUSIONS resulting from the study are that computer controlled dental anesthetic injections and traditional anesthetic injections were accepted equally well by both dentists and patients.

Comorbidity and survival of elderly head and neck carcinoma patients.

BACKGROUND: Alcohol and tobacco, the primary etiologic agents for head and neck carcinoma (HNCA), cause other chronic diseases and may contribute to the high prevalence of comorbid conditions and generally poor survival of persons with HNCA. METHODS: The authors explored the prognostic role of comorbidity in persons with HNCA using Health Care Finance Administration Medicare (HCFA) files linked with the appropriate files of the Surveillance, Epidemiology, and End Results (SEER) Program. The Charlson comorbidity index was applied to in-patient data from the HCFA files. The SEER data were used to ascertain survival and identify persons with HNCA diagnosed from 1985 to 1993 (n = 9386). RESULTS: In a proportional hazards regression model adjusted for age and historic stage at diagnosis, race, gender, marital status, socioeconomic status, histologic grade, anatomic site, treatment, and pre-1991 diagnosis, Charlson index scores of 0, 1, and 2+ had estimated relative hazards (RHs) with 95 confidence intervals (CIs) of 1.00, 1.33 (95% CI, 1.21-1.47), and 1.83 (95% CI, 1.64-2.05), respectively (P value for trend < 0.0001). The adjusted RH for a Charlson index score of 1 or more compared with 0, using stratified models, was found to be greater in whites (RH, 1.55; 95% CI, 1.43-1.67) than blacks (RH, 1.24; 95% CI, 0.96-1.60), local (RH, 1.72; 95% CI, 1.50-1.96) versus distant stage (RH, 1.25; 95% CI, 1.00-1.56), and age 65-74 years (RH, 1.53; 95% CI, 1.38-1.69) versus age 85+ years (RH, 1.42; 95% CI, 1.09-1.84). CONCLUSIONS: This study establishes comorbidity as a predictor of survival in an elderly HNCA population and lends support to the inclusion of comorbidity assessment in prognostic staging of patients with HNCA diagnosed after 65 years of age.

The American Society of Anesthesiologists' class as a comorbidity index in a cohort of head and neck cancer surgical patients.

BACKGROUND: We assessed the American Society of Anesthesiologists' (ASA) class, as a measure of comorbidity in comparison to the commonly used Charlson index for prognostic ability in a HNCA population. METHODS: Proportional hazards methods were applied to head and neck cancer patients whose treatment included surgery by the Johns Hopkins Otolaryngology service (n = 388). RESULTS: The Charlson index and ASA class were modestly correlated (Spearman 0.36, p <.001). Compared with patients with ASA class 1 or 2, those with ASA class 3 or 4 had a two-fold elevated mortality rate (Relative Hazard (RH) = 2.00, 95% CI, 1.38-2.89). This association was stronger than observed for a Charlson index score of 1 or more compared with 0 (RH = 1.59, 95% CI, 1.17-2.17). Both the Charlson index and ASA class adjusted RHs displayed dose-response patterns (p value for trend <.001). CONCLUSIONS: Compared with the Charlson index, the ASA class had comparable if not greater prognostic ability for mortality in this elderly HNCA population.

Head and neck in situ carcinoma: incidence, trends, and survival.

This analysis describes the epidemiology of in situ head and neck carcinomas (anatomic sites of lip, oral cavity, pharynx, larynx) about which there is limited knowledge. Data were derived from nine population-based cancer registries participating in the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. SEER annual age-adjusted incidence rates for in situ head and neck carcinomas increased from 6.33/1,000,000 person-years (PY) in 1976 to 8.04/1,000,000 PY in 1995 [percent change (PC)=35%, P<0. 001]. From 1976 to 1995 age-adjusted changes in incidence by anatomic site ranged from 53% PC (larynx) to -11% PC (lip) (both P<0. 005). Incidence and survival associated with in situ head and neck carcinomas varied by anatomic site, age, sex, and race and did so in a pattern similar to that seen for invasive carcinomas of this region. However, the climbing incidence of in situ carcinoma, which may be related to increased surveillance, contrasts sharply with the declining incidence of invasive carcinoma.

Assessing the construct validity of the AIDS Attitude Scale.

To assess the construct validity of the AIDS Attitude Scale (AAS) (Shrum, Turner, & Bruce, 1989), we administered it and related attitude scales to introductory psychology students (n = 279) and gay/lesbian support group members (n = 38). A subset of the students (n = 105) participated in a concurrent validity study; students donating items to an AIDS food pantry scored more tolerantly on the AAS than other students. AAS scores also differentiated subjects expected to have more tolerant attitudes toward people living with HIV and AIDS from other respondents, indicating known groups validity. As expected, AAS scores were positively correlated with attitudes about homosexuals and negatively correlated with authoritarian beliefs. However, AAS scores were not related to death anxiety. Attitudes about AIDS were distinguishable from related constructs using factor analysis. Together, these data provide evidence for the construct validity of the AAS. The need for valid assessment tools and uses of the AAS are discussed.

Surface mechanical properties of stone, resin, and metal dies.

Two improved stone die materials (Duroc and Silky Rock) used with water and with a hardener, one resin die material with dispersed metal powder (Die-Met), and copper and silver electroplated metal die materials were evaluated for surface mechanical properties. The improved stone dies had the highest surface roughness, intermediate surface hardness and the highest loss of material in two-body abrasion. The use of a hardener decreased the surface roughness, but did not improve abrasion resistance. The improved stone dies, with or without hardener, showed brittle failure in single-pass sliding at low normal loads. The resin dies had the lowest hardness. The unfilled resin die had low surface roughness and was similar to metal dies. The resin-metal die had a surface roughness similar to the improved stone dies. The presence of dispersed metal powder in the resin did not increase the hardness. Both resin die materials had intermediate values of material loss in two-body abrasion and showing tensile cracking and loss had intermediate values of material loss in two-body abrasion and showed tensile cracking and loss of material on single-pass sliding at medium normal loads. The metal dies had the highest hardness and the least surface roughness. They also had the lowest material loss in two-body abrasion. The metal dies showed ductile behavior in single-pass sliding.