Clinical periodontal status of regularly attending patients in general dental practices.

Periodontal status of regular patients of general practitioners in the United States is unknown. A project assessing the effectiveness of continuing professional education in altering provider behavior and patient periodontal health provided the opportunity to clinically examine 1092 patients in the offices of 36 general practitioners. These regularly attending patients were selected by a random start systematic sample of patient records. The examination included recording missing teeth and assessing plaque, gingivitis, calculus, probing depth, and attachment loss on the facial and facial-mesial surfaces of the Ramfjord teeth (PDI). The mean patient age was 48 years, and 63% were female. The mean number of missing teeth, not including third molars, was 3.9. Almost 78% of the patients had no sites with a P1I score greater than 1, but 52% of the patients had at least one site with bleeding. Calculus was present in 62% of the patients. Deepest pocket depth was 4 mm or greater in 9% of patients and 3.8% had sites with 4 mm or greater attachment loss. Mean attachment loss was 1.6 mm across all sites. Although the majority of these regular patients had plaque, calculus, and gingivitis, only a minority exhibited periodontitis at the index sites.

Factors associated with job and career satisfaction among dental hygienists.

Information concerning dental hygienists' job and career satisfaction is dated and incomplete. Because satisfaction may be important in retention of dental hygienists, a survey of all active dental hygienists in private practices in North Carolina was performed to ascertain dimensions and levels of job and career satisfaction, as well as factors associated with these constructs. Of 2,099 eligible hygienists, 51 percent responded to a survey instrument containing 202 items addressing overall satisfaction, as well as satisfaction with a variety of work-related factors. Factor analysis was used to develop scales for job and career satisfaction, and for the work-related factors. Final reduced regression models indicated that the constructs of job and career satisfaction are separate and that each has distinct general and intrinsic dimensions. Models for general job and career satisfaction had R2 values of .45 and .27, respectively, and included a variety of work-related factors such as supervisory style and satisfaction with salary. Models for intrinsic job and career satisfaction were not as strong, with R2 values of .06 and .09, respectively. These models also included work-related factors such as satisfaction with hours of work, office safety arrangements, and supervisory style. These results suggest that general job and career satisfaction levels should be amenable to change through management interventions.

Estimates of the effects of a statewide sealant initiative on dentists' knowledge and attitudes.

The effects of a statewide initiative promoting the use of dental sealants were evaluated by assessing dentists' knowledge and attitudes before the initiative and 18 months later. Immediate changes also were determined for participants in continuing education (CE) sessions, a principal component of the initiative. Results of these assessments indicate that minor improvements in knowledge and attitudes occurred, that the effects were stronger but still modest for those dentists who participated in CE sessions, and that respondents believed the initiative had resulted in increased use of sealants. This evaluation highlights the need for controlled assessments of the effectiveness of future promotional campaigns.

Evaluating and influencing periodontal diagnostic and treatment behaviors in general practice.

Providers' periodontal diagnostic and treatment behaviors were assessed in 34 practices in two North Carolina counties. Regularly attending patients had a low prevalence of gingival pocketing on index teeth, moderate attachment loss, and fairly prevalent bleeding and calculus. Treatment frequency and patient knowledge were generally adequate, but the notation of periodontal status in the patient record was insufficient. A continuing education intervention resulted in substantial and significant improvement in notation rates. Changes in rates with which services were provided, and changes in patient periodontal status were smaller and mixed. The study shows that continuing education can be effective in helping some but not all providers adopt needed, appropriate behaviors.

Pit and fissure sealant application using a drying agent.

This clinical investigation assessed the retention of pit and fissure sealants with and without the use of a post-etching drying agent in pediatric dental patients. Twenty eight healthy patients with four fully erupted, non-carious first permanent molars participated. Sixteen males and 12 females, 5-12 years of age, each received four sealants, two with and two without a drying agent. Sealants were placed by three dental operators. Assignment for sealant application (with and without drying agent) was based on a computer-generated randomization table. Sealant application involved cleansing of the teeth with a non-fluoridated prophylaxis paste followed by rinsing 60 seconds with air/water spray, enamel conditioning with 40% phosphoric acid for 60 seconds, rinsing with air/water spray for 60 seconds, application of drying agent for 5 seconds, application of sealant material, and light curing for 60 seconds. Modified USPHS (Ryge) criteria were used to evaluate interfacial staining, secondary caries, marginal integrity, and surface texture. Sealant retention was evaluated as fully retained or lost (failed). All 28 participants returned for the 12-month recall visit. Four evaluators reported a 91% overall retention rate. Of the 56 teeth sealed without a drying agent, there was a 13% (n = 7) failure rate compared to 5% (n = 3) failure rate for the 56 teeth sealed with a drying agent. These results were not statistically significant (P > 0.05) based on the log-rank test.

Oxygen saturation and diffusion hypoxia in children following nitrous oxide sedation.

Oxygen saturation of arterial blood (SaO2) was assessed in children after discontinuing N2O/O2 sedation for dental procedures. Two post-treatment methods were used: breathing 100% O2 for 5 min after the procedure, and breathing room air for 5 min. Participants were 24 healthy children ages 41 to 113 months. Each child was treated twice and a crossover design was used. The mean length of procedures that were followed by O2 was 28.8 (+/- 10.9 SD) min; for those followed by room air, 28.3 (+/- 12.4 SD) min. SaO2 was monitored continuously by pulse oximetry and recorded at predetermined intervals before, during, and after N2O/O2 administration. When participants received post-treatment O2, the mean SaO2 at 1 min after N2O cessation (99.91 +/- 0.63 SD) and 5 min after cessation (99.94 +/- 0.17 SD) was statistically significantly higher than the pretreatment value of 99.28 (+/- 0.63 SD). When participants received post-treatment room air, the mean SaO2 1 min after N2O cessation (99.44 +/- 0.8) was also statistically significantly higher than the pretreatment mean (99.08 +/- 0.96). After 2 min, however, the mean SaO2 decreased and was statistically indistinguishable from the pretreatment level after 5 min (99.13 +/- 0.9 SD). Fluctuations in SaO2, though statistically significant, were less than 1%. Allowing children to breathe room air immediately after cessation of N2O/O2 inhalation did not reduce SaO2 below clinically acceptable levels. This study further documents the safety of N2O/O2 sedation, and gives the clinician additional information concerning the safe and effective administration of inhalation sedation. (Pediatr Dent 15:88-92, 1993).

Behavioral assessments of two drug combinations for oral sedation.

This study compares the efficacy of two drug regimens used for oral sedation in pediatric dental patients: chloral hydrate (50 mg/kg)/promethazine (1 mg/kg) and meperidine (1 mg/kg)/promethazine (1 mg/kg). Twenty-four pediatric dental patients, ASA Class I, were evaluated in this double-blind, randomized study. The patients ranged in age from 18 to 48 months. Each dental procedure under sedation was videotaped and rated independently by two raters. Intraoperative ratings of sleep, movement, crying, an overall behavior score for each treatment interval, and an overall behavior score for each sedation were also evaluated. No treatment was aborted for either regimen. In all cases, chloral hydrate/promethazine sedations had significantly better results for sleep (P = 0.0001), movement (P = 0.0168), crying (P = 0.0041), and overall behavior score (P = 0.0186) for the sedations compared to meperidine/promethazine sedations. Although chloral hydrate/promethazine sedations produced significantly better results, clinically, both drug regimens were equally effective.

An outcomes assessment of 15 years of patient care experiences in predoctoral pediatric dentistry.

The purpose of this study was to examine the trends in numbers, demographic characteristics, and treatment history of pediatric dental patients under the care of dental students over the period 1980 through 1994. Data were collected for: exams, sealants, surfaces of amalgam, composite resin surfaces, pulpotomies, stainless steel crowns, and extractions. Correlations were done across the 15-year period to determine significant trends over time. During the 15-year period, the average number of patient visits required for each student to complete the requisite number of patients, declined from 45 appointments to complete 10 patients in 1980, to 35 visits to complete 13 patients in 1994. Over time, the numbers of amalgam surfaces, pulpotomies, extractions and stainless steel crowns decreased significantly, while the number of composite resin surfaces increased (P < 0.05). Based on a previous outcome assessment that indicated declining numbers of procedures performed between 1980 and 1985, the required number of patients treated per student was raised from 10 to 13, beginning with the 1986 class.

Perceptions associated with dentists' decisions to report hypothetical cases of child maltreatment.

The purpose of this study was to examine case-specific perceptions associated with dentists' decisions to report hypothetical cases suggestive of child maltreatment. Surveys were mailed to 500 general dentists (GDs) in Georgia and all 200 pediatric dentists (PDs) in Georgia and Florida. The GDs were chosen from a pool of 1500 by a stratified randomization scheme. Each survey contained two brief vignettes suggestive of, but not conclusive for, child neglect and abuse. Identical questions followed each vignette that were designed to assess five perceptions of the incident and whether the respondent would be likely to report the case. Responses were received from 185 GDs (37%) and 103 PDs (51.5%), for a total of 288 (41.1%). A majority of respondents considered each vignette to be serious, but only a minority believed that they were required to report the neglect (7.3%) and the abuse (33.7%) vignettes. The percentages of likely reporters of the neglect (n = 28) and abuse (N = 103) vignettes were 9.7 and 36%, respectively. No significant differences were noted in the response patterns of GDs and PDs. Decisions to report child maltreatment described in the vignettes were associated with perceptions of 1) the seriousness of the incident, 2) the incident being defined as neglect or abuse, and 3) a requirement to report. The possibility that a maltreatment report would have a negative impact on the child was associated with a decision not to report. The perception that a report would have a negative impact on the family was common among likely reporters and nonreporters.

Demographic, educational, and experiential factors associated with dentists' decisions to report hypothetical cases of child maltreatment.

The purpose of this study was to examine demographic factors associated with dentists' decisions to report hypothetical cases suggestive of child maltreatment. Surveys were mailed to 500 general dentists (GDs) in Georgia and all 200 pediatric dentists (PDs) in Georgia and Florida. The general dentists were chosen from a pool of 1500 by a stratified randomization scheme. Each survey contained two brief vignettes suggestive of, but not conclusive for, child neglect and abuse. Respondents were asked about their likelihood of reporting each vignette. General demographic questions were asked about the population served by the dentist, the year of dental degree and speciality certificate acquisition, and gender of the respondent. Further questions were asked about the individual's exposure to continuing education in child maltreatment, knowledge of legal requirements to report and the agency to which reports should be directed, and experience with suspected and filed cases. Responses were received from 185 GDs (37%) and 103 PDs (51.5%), a total of 288 (41.4%). PDs had more practitioners in larger communities and had more female respondents. PDs were more likely to answer yes to the questions about education/experience with child maltreatment. Factors associated with likely reporting of neglect were: 1) serving communities with populations < or = 100,000; 2) PDs acquiring specialty certificates after 1980; 3) being female; 4) exposure to continuing education; 5) having suspected cases in practice; and 6) having filed a maltreatment report. Factors associated with likely reporting of abuse were: 1) PDs acquiring specialty certification after 1980 and 2) self-reported recognition of the legal obligation to report.

Preanesthesia transfusion and sickle cell anemia patients: case report and controversies.

Preoperative transfusion of sickle cell anemia (SCA) patients prior to general anesthesia is considered a routine procedure to ensure adequate levels of normal adult hemoglobin A to prevent a sickle cell crisis. Blood transfusion risks have led some clinicians to question this procedure. A case report is presented in which a SCA patient developed a delayed hemolytic reaction from a transfusion given prior to dental treatment under general anesthesia. The controversy of transfusion in this patient group is presented.

Clinical and radiographic evaluation of juvenile rheumatoid arthritis: report of a case.

Rheumatoid arthritis (RA) is an inflammatory disease of the synovium which may lead to proliferative and degenerative changes in the body's joints, including the temporomandibular joint (TM Joint). Although the exact etiology of rheumatoid arthritis remains unknown, it is suspected that the disease is often initiated by an infectious organism, or by genetic and/or environmental factors. Juvenile rheumatoid arthritis (JRA) is a chronic disease of childhood with a spectrum of joint involvement and associated systemic and other organ involvement. Five percent of all rheumatoid arthritis patients are children. In the United States, approximately 150,000 children are affected by JRA. With upper limb involvement, routine oral hygiene procedures become difficult. Dental evaluations/screenings may not be included in the initial team assessment of these patients until the TM Joint is affected; however, prior to this time, the patient may have had years of poor oral hygiene which could contribute to severe decay and early tooth loss. This case report describes the oral health status of a child with polyarticular juvenile rheumatoid arthritis and the specific recommendations for dental management.

Gingival effects of prescription medications among adult dental patients.

The relationship between self-reported medication use (exposure to one or more drugs with anticipated gingival effect--antidepressants, diuretics, antihypertensives, hormones) and four measures of gingival conditions (plaque index, gingival index, calculus index, maximum CPITN score) was examined among 594 patients in 35 dental practices in two North Carolina counties. Patients with long-term medication use were compared to patients without long-term use on four measures of gingival condition. When controlling for sex and age within age group, medication use was a significant predictor (P less than 0.05) for elevated gingival and plaque index scores among the white less than 65 group. For the white 65+ group (N = 90), medication use was not a significant predictor for any index score.

PIP: Researchers analyzed 2 sets of data, 1 year apart, on 653 adult dental patients from 35 general practices in 2 counties in North Carolina to examine the association between self reported medication use and 4 measures of gingivitis. They were only concerned about drugs that possible had a gingival effect--diuretics, antidepressants, oral contraceptive and other hormones, and antihypertensives. Only 33% of the 65 year old sample were males basically because 22 female used hormones while no males used hormones. For patients 65 years old, after the researchers controlled for sex and age, medication significantly affected the plaque index and gingival inflammation index scores (p.05). On the other hand, medication did not have an periodontal effects on patients 65 years old. Specifically the adjusted mean score for the plaque index was .38 for those taking medications compared to .29 for those not taking medications. In fact, in preliminary analyses, antidepressant use significantly increased plaque among those 65 years old. The researchers suggested that antidepressants may actually identify people who are not motivated to practice good oral hygiene. The adjusted mean score for gingival inflammation stood at .58 and .47 respectively. Nevertheless the differences in index scores between drug effect categories were slight. Further virtually ever model exhibited larger adjusted score differences by age and gender within age groups. Therefore the researchers concluded tat medication affects the gingiva rather infrequently in adult, ambulatory, regular dental patients regardless of age.

Reasons for changing employment positions among practicing North Carolina dental hygienists.

This study sought to identify factors associated with dental hygienists' decisions to leave one dental office and commence practice in another. Although dental hygienists' decisions to leave the profession have been examined in some detail, this more common phenomenon of changing positions has not been carefully examined. All currently practicing dental hygienists in North Carolina were surveyed in 1990, as a part of a cooperative project addressing retention of dental office team members. The survey collected information concerning the 976 respondents' (51% response rate) employment experience, reasons associated with leaving past positions, current job and career satisfaction, and personal characteristics. These data were analyzed to determine factors associated with both reported position changes and respondents' predictions of their professional activity status five years hence. No one reason or group of related reasons predominated among respondents' indicated reasons for leaving past positions. Approximately 25% of all changes were related to family responsibilities or spouse relocation. A larger proportion of changes was associated with a variety of job-related factors. Length of time in current position was not strongly related to job or career satisfaction, or to specific employment arrangements. The satisfaction measures were strongly associated with respondents' predictions of future activity status, while the employment arrangements were not. The results indicate that position changes occur for a variety of reasons, most, but not all, of which represent problems amenable to resolution through interventions designed to improve aspects of management within the practice.

The development of leadership skills in clinical practice.

Leadership is often seen as the province of the manager. However, as the NHS changes and responsibility is increasingly devolved, practitioners at all levels are expected to lead change and innovation. In this paper the author describes how attending the Leadership in Nursing for the Community (LINC) programme has influenced her practice. As a result of the programme she has an increased awareness of her own leadership role and of the political and professional climate in which she works.

DNA methylation analysis of the autistic brain reveals multiple dysregulated biological pathways.

Autism spectrum disorders (ASD) are a group of neurodevelopmental conditions characterized by dysfunction in social interaction, communication and stereotypic behavior. Genetic and environmental factors have been implicated in the development of ASD, but the molecular mechanisms underlying their interaction are not clear. Epigenetic modifications have been suggested as molecular mechanism that can mediate the interaction between the environment and the genome to produce adaptive or maladaptive behaviors. Here, using the Illumina 450 K methylation array we have determined the existence of many dysregulated CpGs in two cortical regions, Brodmann area 10 (BA10) and Brodmann area 24 (BA24), of individuals who had ASD. In BA10 we found a very significant enrichment for genomic areas responsible for immune functions among the hypomethylated CpGs, whereas genes related to synaptic membrane were enriched among hypermethylated CpGs. By comparing our methylome data with previously published transcriptome data, and by performing real-time PCR on selected genes that were dysregulated in our study, we show that hypomethylated genes are often overexpressed, and that there is an inverse correlation between gene expression and DNA methylation within the individuals. Among these genes there were C1Q, C3, ITGB2 (C3R), TNF-α, IRF8 and SPI1, which have recently been implicated in synaptic pruning and microglial cell specification. Finally, we determined the epigenetic dysregulation of the gene HDAC4, and we confirm that the locus encompassing C11orf21/TSPAN32 has multiple hypomethylated CpGs in the autistic brain, as previously demonstrated. Our data suggest a possible role for epigenetic processes in the etiology of ASD.