Oral cancer screening and dental care use among women from Ohio Appalachia.

INTRODUCTION: Residents of Appalachia may benefit from oral cancer screening given the region's higher oral and pharyngeal cancer mortality rates. The current study examined the oral cancer screening behaviors and recent dental care (since dentists perform most screening examinations) of women from Ohio Appalachia. METHODS: Women from Ohio Appalachia were surveyed for the Community Awareness Resources Education (CARE) study, which was completed in 2006. A secondary aim of the CARE baseline survey was to examine oral cancer screening and dental care use among women from this region. Outcomes included whether women (n=477; cooperation rate = 71%) had ever had an oral cancer screening examination and when their most recent dental visit had occurred. Various demographic characteristics, health behaviors and psychosocial factors were examined as potential correlates. Analyses used multivariate logistic regression. RESULTS: Most women identified tobacco-related products as risk factors for oral cancer, but 43% of women did not know an early sign of oral cancer. Only 15% of women reported ever having had an oral cancer screening examination, with approximately 80% of these women indicating that a dentist had performed their most recent examination. Women were less likely to have reported a previous examination if they were from urban areas (OR=0.33, 95% CI: 0.13-0.85) or perceived a lower locus of health control (OR=0.94, 95% CI: 0.89-0.98). Women were more likely to have reported a previous examination if they had had a dental visit within the last year (OR=2.24, 95% CI: 1.03-4.88). Only 65% of women, however, indicated a dental visit within the last year. Women were more likely to have reported a recent dental visit if they were of a high socioeconomic status (OR=2.83, 95% CI: 1.58-5.06), had private health insurance (OR=2.20, 95% CI: 1.21-3.97) or had consumed alcohol in the last month (OR=2.03, 95% CI: 1.20-3.42). CONCLUSION: Oral cancer screening was not common among women from Ohio Appalachia, with many missed opportunities having occurred at dental visits. Education programs targeting dentists and other healthcare providers (given dental providers are lacking in some areas of Ohio Appalachia) about opportunistic oral cancer screening may help to improve screening in Appalachia. These programs should include information about populations at high risk for oral cancer (eg smokers) and how screening may be especially beneficial for them. Future research is needed to examine the acceptability of such education programs to healthcare providers in the Appalachian region and to explore why screening was less common among women living in urban areas of Ohio Appalachia.

Assessing tooth color differences in digital facial portraits.

Although a large body of scientific literature shows that background color and luminance affect color perception, previous measurements of tooth color difference thresholds have not taken the effects of viewing context into account. The present study tested the hypothesis that differences in skin/gingival color influence individuals' judgments of tooth color differences. Perceptibility and acceptability thresholds were determined in 10 individuals using a signal detection paradigm. They evaluated 500 pseudo-random presentations of two facial portraits: an African-American and a Caucasian. These portraits varied trial-to-trial only in the direction (CIELAB +L*, +a*, or +b*) or magnitude of the color difference between a portrait's two central incisors. The individuals were significantly less sensitive to tooth color differences in the +L* direction in the Caucasian portrait than for any other combination of color direction or portrait type. Furthermore, comparable perceptibility and acceptability thresholds were generally not statistically significant from each other.

Asymmetric synthesis of (-)-eburnamonine and (+)-epi-eburnamonine from (4S)-4-ethyl-4-[2-(hydroxycarbonyl)ethyl]-2-butyrolactone.

The key chiral nonracemic 4,4-disubstituted 2-butyrolactone carboxylic acid, (S)-4, is readily accessible via an efficient and stereospecific dirhodium(II) tetraacetate catalyzed tertiary C-H insertion reaction of the diazomalonate (S)-5. The coupling of the acid (S)-4 with tryptamine produces the amide (S)-3, which is then transformed into the aldehyde 23 and hydroxy-lactam 24. Acid-mediated Pictet-Spengler cyclization of 23 and 24 produces the tetracyclic indole lactams (1S,12bS)-25a and (1S,12bR)-25b. Compounds 25a and 25b are converted, via the lactam alcohols 30a and 30b, to (-)-eburnamonine (1a) and (+)-epi-eburnamonine (1b).

A dirhodium(II)-carbenoid route to (-)- and (+)-Geissman-Waiss lactone: synthesis of (1R,7R,8R)-(-)-turneforcidine.

(-)- and (+)-Geissman-Waiss lactone, 4b, was efficiently prepared via the intramolecular C-H insertion reaction of the chiral nonracemic diazoacetates (-)-5a and (+)-5b catalyzed by dirhodium(II) tetrakis[methyl (5R and 5S)-3-phenylpropanoyl-2-imidazolidinone-5-carboxylate]. The cyclization was found to proceed with excellent regioselectivity and cis-diastereoselectivity. The bicyclic lactone (-)-4b was successfully used in the synthesis of the necine base, (-)-turneforcidine 2.

Vacuum-formed tooth position record as an index for the fabrication of an endosseous implant-supported prosthesis.

An endosseous implant-supported prosthesis usually requires a metal substructure and/or retentive elements in addition to the prosthetic teeth and soft tissue substitute. It is crucial that the metal substructure and all of the prosthetic components of an implant-supported prosthesis be confined within the contour of the prosthesis. This article describes a procedure for fabricating an index to record and maintain the anatomic contour of the trial denture to the master cast.

Accuracy and pourability of gypsum preweighed packages.

PURPOSE: The purpose of this study was to determine the amount of gypsum provided by the manufacturers in their preweighed packages and to determine the amount of gypsum dispensed from the packages as a function of the method used. MATERIALS AND METHODS: One hundred twenty unopened packages from 8 manufacturers were weighed. Ten packages from each manufacturer were opened with the contents completely removed by tapping the packages, and the contents were weighed (thorough method). The other 5 packages from each manufacturer were opened, quickly poured, and the contents weighed (quick method). All packages were then slit open on all sides and completely cleaned. The cleaned packages were then weighed. Calculations were made to determine (1) the amount of gypsum that was "supplied" by the manufacturer and (2) the amount removed from the packages using the "quick" and "thorough" methods. The raw data was normalized to percentage of stated weight. A Welch analysis of variance was used to evaluate the heteroscedastic data at a 95% confidence level. Thereafter, a post hoc Student t test was used to determine if the percentages of stated weight for (1) supplied, (2) thorough, and (3) quick were significantly different from 100%. RESULTS: A statistically significant difference was found for the amount of gypsum supplied by the manufacturers (p <.001) and the amount of material removed from the packages via the 2 different methods used (p <.001). Seven of the 8 manufacturers' preweighed packages were remarkably close to their stated weight for amounts "supplied" and the "thorough" method. High standard deviations from the mean were found for the "quick" method of gypsum removal. CONCLUSION: Within the limits of this study, results indicate that the use of a "thorough" method to remove gypsum from preweighed packages was important. Ideally, gypsum supplied in preweighed packages should be weighed initially to ensure an optimal water/powder ratio.

Maxillofacial prosthetic rehabilitation of a midfacial defect complicated by microstomia: a clinical report.

Severe limitation in the oral opening, though an uncommon clinical presentation, makes gaining access to the oral cavity difficult for any dental procedure. This article describes the maxillofacial prosthetic management of a patient with a midfacial defect complicated by postsurgical microstomia. Intraoral and extraoral prostheses restored the patient's speech, dental articulation, mastication, lip support, esthetics, and anterior oral seal.

Utilization of the neutral zone technique for a maxillofacial patient.

The use of a neutral zone technique to fabricate a more stable complete mandibular denture for a maxillofacial patient is presented. The technique incorporates an altered sequence from traditional denture fabrication, resulting in a shortened treatment period.

Fabrication of a two-piece superstructure for a fixed detachable implant-supported mandibular complete denture.

This article describes a procedure to fabricate a 2-piece superstructure for a fixed detachable implant-supported mandibular complete denture prosthesis. With this unique technique, unsuitable implant angulation can be corrected, and retention of the second superstructure is accomplished with 2 esthetically positioned screws and an antirotational attachment.

A new approach to macrocyclization via alkene formation in catalytic diazo decomposition. Synthesis of patulolides A and B.

[reaction: see text] Effective synthetic uses of bisdiazocarbonyl compounds for the selective construction of diverse macrocycles, including the synthesis of patulolides A and B, by catalytic "carbene dimer" formation are reported. Control of stereochemistry and efficient methods for product isomerization or kinetic isomer differentiation have been achieved.

Comparison of impression materials for direct multi-implant impressions.

STATEMENT OF PROBLEM: Given that meticulous implant prosthodontic procedures are recommended to obtain the best possible intraoral fit, impression materials that are suitable for use with a direct impression technique warrant further investigation. PURPOSE: This in vitro study compared the amount of torque required to rotate a square impression coping in an impression and evaluated the accuracy of solid implant casts fabricated from different impression materials. MATERIAL AND METHODS: Two direct transfer implant impressions were made using 8 impression materials; the torque required to rotate an impression coping in the impressions was calculated. Ten direct transfer implant impressions were made from the master model and poured in a die stone (Resin Rock) for 3 of the 8 initial impression material groups. Linear distances between steel balls placed on each abutment replica were measured with a traveling microscope to determine distortion in the impression procedure for each group. Data were analyzed (P =.05) with ANOVA and Ryan-Einot-Gabriel-Welsch multiple range test for post hoc. RESULTS: With a 1-way ANOVA, average torque values among the material groups differed significantly (P =.001). Polyether (medium consistency) was found to produce the highest overall torque values, followed by addition silicone (high consistency), and then polysulfide (medium consistency). Statistically significant difference was also found among the 3 material groups' mean absolute cast error using a 1-way ANOVA (P =.0086). Implant casts made from polyether (medium) or addition silicone (high) impressions were significantly more accurate than casts made from polysulfide medium impressions. CONCLUSION: On the basis of the results of this study, the use of either polyether (medium) or addition silicone (high) impression is recommended for direct implant impressions.

Evaluating porcelain color match of different porcelain shade-matching systems.

PURPOSE: This in vitro study was designed to evaluate the new ShadeEye-EX Chroma Meter and a new visual porcelain shade-matching system (Vitapan 3-D Master, Omega 900) in comparison to the traditionally used visual porcelain shade-matching system (Vita Lumin Vacuum, VMK 68). MATERIALS AND METHODS: Shade matches and porcelain fabrications on individualized shade tabs were carried out. The fabricated porcelain tabs were evaluated against the respective natural tooth using the United States Public Health Service (USPHS) criteria to determine clinically acceptable match. The tabs also were ranked according to the final-color match to the corresponding natural tooth. RESULTS: The percentage of clinically acceptable color matches were as follows: Vita Lumin Vacuum (46.67%), ShadeEye-EX (40%), and Vitapan 3-D Master (56.67%). The generalized estimating equation (alpha = 0.5) showed no statistically significant difference between systems in obtaining a clinically acceptable match (p = .5729). The chi-squared test (alpha = 0.5) showed no statistically significant difference between systems in terms of rank order (p = .5017). The two new systems do not produce color match that is better than the conventional visual porcelain shade-matching system.

Reconstruction of cranial bone defects using alloplastic implants produced from a stereolithographically-generated cranial model.

Larger cranial bone defects can cause cranial disfigurement as well as potential mechanical brain trauma. Conventionally pre-fabricated acrylic cranioplasty implants require complicated procedures and result in potential dimensional and contour inaccuracies. The development of stereolithographic techniques for generating acrylic resin skull models allows the pre-fabrication of custom acrylic resin cranial implants with greater clinical predictability.

Strategies to achieve fit in implant prosthodontics: a review of the literature.

PURPOSE: This paper reviews the literature on advanced strategies that attempt to improve fit in implant prosthodontics with reference to the concept of the "distortion equation." MATERIALS AND METHODS: The majority of the articles reviewed were either clinical or technique articles that advocated strategies to improve fit in implant prosthodontics. A limited number of retrospective and prospective clinical trial studies were included as they related to the topic. Reviewed articles were limited to those that addressed advanced strategies to improve fit. All of the scientific studies included in this review used an in vitro experimental design. The advanced strategies were categorized into methods that address intraoral indexing and methods that use the implant master cast. RESULTS: Relatively few methods have been scientifically proven to improve fit in implant prosthodontics. Most of the tested strategies still resulted in a slight misfit of the frameworks to the implant abutments/analogues. CONCLUSION: Multiple factors preclude that the concept of "passive fit" can be achieved in implant prosthodontics, even with the use of advanced strategies. The use of meticulous, accurate implant prosthodontic procedures and the appropriate use of advanced strategies continue to be the recommended means of achieving precise fit of the implant prosthesis to the intraoral abutments.

Hinged mandibular removable complete denture for post-mandibulectomy patients.

The presence of excessive lingual undercuts after mandibulectomy and surgical reconstruction is a rare clinical condition and presents unique prosthodontic challenges. The goals of prosthodontic treatment include: providing lip support, improving articulation, reducing drooling, and regaining favorable esthetics. This article describes the fabrication of a hinged removable mandibular complete denture prosthesis using a sectional impression tray technique and a custom-made hinge mechanism. Clinical and laboratory procedures of the prosthetic treatment are described, and the advantages and disadvantages are reviewed.

Using a facsimile (fax) as an aid for communication in maxillectomy planning between the prosthodontist and surgeon.

Preoperative communication between the prosthodontist and surgeon is required for properly planning the surgical prostheses that are often indicated for maxillectomy patients. When geography or long distances preclude face-to-face consultation, electronic means of correspondence are necessary to minimize delays in the fabrication of surgical prostheses. This article presents a time-efficient procedure for facilitation of the necessary communication between the prosthodontist and surgeon before maxillectomy surgical procedures.

Evaluation of the accuracy of solid implant casts.

PURPOSE: Materials used to fabricate the most dimensionally accurate implant casts have not been identified experimentally. The purpose of this investigation was to examine the dimensional accuracy of implant casts fabricated with different materials. Measurements of linear horizontal dimensional change and strain produced on a master framework were evaluated and correlated. MATERIALS AND METHODS: A master framework was fabricated to fit an aluminum five-implant model. Forty polyether implant impressions of the aluminium model were randomly grouped and poured in either Vel-mix, Die Keen, Resin Rock, or Low Fusing Alloy. A digital veneer caliper was used to measure linear distance between the most distal abutments on each of the experimental implant casts and the master model. In addition, strain values were recorded from strain gauges bonded in the mesiodistal axis of the framework, which was secured by prosthetic retaining screws torqued to 10 Ncm. RESULTS: A one-way ANOVA showed a significant difference among the four die materials in dimensional change of the experimental casts (p = .0001). A post-hoc Duncan's multiple-range test (p < .05) showed that casts fabricated with Low Fusing Alloy had the least linear dimensional change from the master cast, but the material exhibited the greatest dimensional variability. A MANOVA (Wilks' Lambda) showed significant differences in strain on the framework based upon die material (p = .015). A post-hoc Duncan's multiple-range test (p < .05) showed that Resin Rock casts induced significantly less strain on the framework than the other materials. Negligible correlation was found between the linear horizontal dimensional change and the total absolute strain on the framework. CONCLUSION: Experimental implant casts made of Resin Rock minimized strain on the master framework and decreased the amount of framework distortion on casts of this material. Low Fusing Alloy yielded accurate casts, but highly variable linear dimensional changes in the horizontal dimension may preclude its clinical benefit.