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.

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.

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.

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.

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.

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.

Central mucoepidermoid carcinoma.

A case of central mucoepidermoid carcinoma of the mandible is presented along with a review of the literature. The histogenesis of this tumor and the histologic similarity of the predominantly cystic low-grade central mucoepidermoid carcinoma to the glandular odontogenic cyst are discussed.

Neuregulins promote survival and growth of cardiac myocytes. Persistence of ErbB2 and ErbB4 expression in neonatal and adult ventricular myocytes.

Neuregulins (i.e. neuregulin-1 (NRG1), also called neu differentiation factor, heregulin, glial growth factor, and acetylcholine receptor-inducing activity) are known to induce growth and differentiation of epithelial, glial, neuronal, and skeletal muscle cells. Unexpectedly, mice with loss of function mutations of NRG1 or of either of two of their cognate receptors, ErbB2 and ErbB4, die during midembryogenesis due to the aborted development of myocardial trabeculae in ventricular muscle. To examine the role of NRG and their receptors in developing and postnatal myocardium, we studied the ability of a soluble NRG1 (recombinant human glial growth factor 2) to promote proliferation, survival, and growth of isolated neonatal and adult rat cardiac myocytes. Both ErbB2 and ErbB4 receptors were found to be expressed by neonatal and adult ventricular myocytes and activated by rhGGF2. rhGGF2 (30 ng/ml) provoked an approximate 2-fold increase in embryonic cardiac myocyte proliferation. rhGGF2 also promoted survival and inhibited apoptosis of subconfluent, serum-deprived myocyte primary cultures and also induced hypertrophic growth in both neonatal and adult ventricular myocytes, which was accompanied by enhanced expression of prepro-atrial natriuretic factor and skeletal alpha-actin. Moreover, NRG1 mRNA could be detected in coronary microvascular endothelial cell primary cultures prepared from adult rat ventricular muscle. NRG1 expression in these cells was increased by endothelin-1, another locally acting cardiotropic peptide within the heart. The persistent expression of both a neuregulin and its cognate receptors in the postnatal and adult heart suggests a continuing role for neuregulins in the myocardial adaption to physiologic stress or injury.

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.

Barrett's esophagus: a review.

Complications of Barrett's esophagus include ulceration, stricture, hemorrhage, perforation, and the development of malignancy. Barrett's esophagus and adenocarcinoma may be diagnosed simultaneously and that gastroesophageal reflux symptoms may be absent in many cases. Although endoscopic surveillance is justified, no agreement on the frequency can be made. Survival of patients with adenocarcinoma in Barrett's esophagus depends on the stage at diagnosis.

Styloid chain ossification: report of a case with articulations.

A bilateral ossified stylohyoid ligament was observed in a cadaver specimen. On the left side, the stylohyoid chain was markedly enlarged. The stylohyoid ligament was completely ossified into two segments separated by a diarthrodial-like joint. An articulation was also observed between the enlarged styloid process and the ossified ligament. On the right side, the styloid process had a normal appearance. The middle part of the stylohyoid ligament was ossified and it was attached to the styloid process and to the hyoid bone by a fibrous band. Proposed theories to account for the ossification of this ligament are discussed. Since the presence of an enlarged and ossified stylohyoid chain can cause much discomfort and pain, a greater understanding of the causative factors responsible for this anomaly is needed to provide for more effective diagnosis and treatment.

Dens evaginatus in a Chilean population.

A high rate of occurrence on dens evaginatus (DE) is reported in certain cultural groups in a Chilean population. Factors affecting the reported incidence of DE are discussed as are the clinical complications and treatment requirements related to this anomaly.

Oral cancer. Etiology, recognition, and management.

The cure rate for oral cancers remains dismally low at approximately 50%. The dental profession is, to a large extent, responsible for decreasing the morbidity and mortality of oral cancer even though 50% of the population do not present for routine examination and care. The dental office team must accept the charge of educating all patients concerning the devastating role of tobacco and ethanol in promoting oral cancer, as well as malignancies at other sites. Dental clinicians play a vital role on the oral cancer team. Therefore, they must make themselves well aware of the diverse nature of oral cancer and must have an appropriate triage protocol in place so that lesions will be identified and managed correctly or referred promptly to the correct tertiary health care professionals. Early detection and prompt proper management can make a difference as we await the development of new and better ways of treating oral and oropharyngeal cancers.

Survey of medicinal plants used as antimalarials in the Amazon.

Plants traditionally employed for the treatment of malaria in certain areas of Brazil, where this disease is prevalent, were surveyed by interviewing natives and migrants in the Amazon Region. Forty-one plants used for malarial treatment and/or for the related symptoms (fever and liver disorders) were collected and identified. Given the potential of Brazil's forests and medicinal plants, research on traditional plant-based remedies in this country may lead to the development of new drugs.