Hyperaeration of the sphenoid sinus: cause for concern?

A case of exuberant pneumatization of the left sphenoid sinus into the pterygoid process and floor of the middle cranial fossa is presented. The fact that pneumatization of the sphenoid sinus is frequently atypical is of clinical import because there is an intimate relationship between the contents of a hyperaerated sinus and adjacent vital facial and cranial structures. It is imperative that clinicians determine the location and extent of the walls of the sphenoid sinus and its relationship to adjacent vital structures whenever endoscopic sinus surgery is contemplated to avoid morbid consequences during surgery.     

The relation between toothpaste usage and fluorosis: a cause for concern?

Fluoride-containing toothpaste is by far the most widespread source of fluoride in the world and after fluoridated water the most cost-effective at reducing dental caries. Of the seven current issues in the development of fluoride-containing toothpaste described by Holt & Murray (1997), five are either directly or indirectly related to the risk of developing fluorosis, a phenomenon which is on the increase in the industrialised world. The purpose of this study was to evaluate fluoride-containing toothpaste available to the South African public regarding the issues described by Holt & Murray (1997) and to relate the results to the possible development of fluorosis. The amount of fluoride ingested from toothpaste was calculated using the total fluoride concentration present in toothpaste, quantity of toothpaste used per brushing, mean percentage of toothpaste ingested and the 90th percentile of body weight. Results indicate that the "threshold" level of fluoride intake of 0.05 to 0.07 mg F/kg body weight/day beyond which dental fluorosis might occur (Burt, 1992), is exceeded when a ribbon of toothpaste was placed on a child's toothbrush at ages 2-3 years. 'Threshold' levels were ingested when placing a ribbon of toothpaste on the brush at ages 4 and 5 for all toothpaste as well as for a children's formulation containing 1000 microg F/g. Of all pastes studied, 41.9% of the packaging has information for the prevention of swallowing of paste and/or the supervision of children by adults when brushing. The dental profession, manufacturers of toothpaste and government all have a role to play in the prevention of fluorosis in the toothbrushing population of South Africa.     

Dental implants in frail elderly adults: a benefit or a liability?

If an implant-borne fixed prosthesis cannot be maintained by effective home oral health care, it could be modified to a removable prosthesis/overdenture.     

Is the fluoride level in drinking water a gold standard for the control of dental caries?

AIM: To obtain baseline knowledge of levels of dental caries in 12-year-old children residing in areas with varying levels of fluoride in drinking water in Pakistan; and to observe a dose-response relationship between the prevalence of dental caries at different concentrations of fluoride in drinking water. METHOD: Clinical examination of children and analysis of samples of drinking water. RESULTS: The maximum reduction of caries in relation to fluoride levels in Pakistan was witnessed between the fluoride concentrations of 0.00-0.33ppm. CONCLUSIONS: There are no gold standards for setting up a universal optimal level of fluoride in drinking water and each country needs to determine the concentration of fluoride in their drinking water in accordance with its socio-economic and climatic conditions, dietary and oral hygiene habits of its population, and local research to determine how much fluoride is beneficial in the control of caries.     

Dental care use: does dental insurance truly make a difference in the US?

OBJECTIVE: Having medical insurance with or without coverage for dental care has been shown to be associated with an increase in dental use. The purpose of this study is to provide information that will help describe this behavior. METHOD: We isolate the independent effect of health insurance on the likelihood of a dental visit by analyzing Medical Expenditure Panel Survey (MEPS) data. RESULTS: Data show that persons with private medical coverage, controlling for dental coverage and other socioeconomic and demographic factors, are more likely to have a dental visit than persons without private medical coverage. Having medical insurance with or without coverage for dental care is associated with an increased likelihood of having a dental visit. These data suggest a more complex role for dental insurance beyond that of traditional insurance motivation. CONCLUSIONS: These data suggest that programmes designed to improve dental access with added dental coverage may not be sufficient to remedy access deficiencies and may offer only modest extra incentives to use dental services over and above medical insurance.     

Perceptions of D.M.D. student readiness for basic science courses in the United States: Can online review modules help?

There can be a disconnect between the level of content covered in undergraduate coursework and the expectations of professional‐level faculty of their incoming students. Some basic science faculty members may assume that students have a good knowledge base in the material and neglect to appropriately review, whilst others may spend too much class time reviewing basic material. It was hypothesised that the replacement of introductory didactic physiology lectures with interactive online modules could improve student preparedness prior to lectures. These modules would also allow faculty members to analyse incoming student abilities and save valuable face‐to‐face class time for alternative teaching strategies. Results indicated that the performance levels of incoming U.S. students were poor (57% average on a pre‐test), and students often under‐predicted their abilities (by 13% on average). Faculty expectations varied greatly between the different content areas and did not appear to correlate with the actual student performance. Three review modules were created which produced a statistically significant increase in post‐test scores (46% increase, P < 0.0001, n = 114–115). The positive results of this study suggest a need to incorporate online review units in the basic science dental school courses and revise introductory material tailored to students’ strengths and needs.     

Determinants of oral cancer at the national level: just a question of smoking and alcohol drinking prevalence?

In addition to individual-based prevention strategies, the burden of oral cancer could be decreased by controlling its national level determinants. Population-based studies have found smoking, drinking, and wealth to be associated with oral cancer incidence and mortality rates. However, these studies merely reported trends, or did not account for confounders or for intercorrelation between predictor variables. This ecologic study sought to investigate oral cancer determinants at the country level. The male, age-standardized mortality rate was the dependent variable. The explanatory variables, obtained from reliable international agencies, were life expectancy, frequency of physicians, gross national product (GNP), expenditure on health, literacy rate, human immunodeficiency virus (HIV) prevalence, smoking prevalence, alcohol drinking prevalence, drinking modality, average daily calorie consumption, and average calorie intake from fruit and vegetables. Common factor analysis was used to generate a new dimension that incorporated all of the strongly intercorrelated variables. These were life expectancy, physician frequency, GNP, expenditure on health, literacy rate, calorie consumption, smoking prevalence, and drinking modality. According to this dimension, arbitrarily called the country development level (CDL), countries were split into quartiles. The ecologic risk for high mortality from oral cancer, estimated using logistic regression analysis, was three to five times higher among the second, third, and fourth CDL quartiles than among the first CDL quartile, which included the highest-income countries. HIV, drinking prevalence, and fruit and vegetable intake did not affect significantly mortality. These results suggest that it might be possible to improve oral cancer mortality by modifying country-based determinants related to aberrant lifestyles (not only smoking and drinking prevalence) and improving healthcare system efficiency, approximately estimated by CDL, as well as general socioeconomic and cultural conditions.     

The political culture of healthcare: why substantial dental care in Canada is covered by government insurance only in Québec - lessons for the United States?

This opinion paper explains the unique and favourable terms of dental health insurance coverage available to residents (both permanent and temporary) of the Province of Québec, Canada. In comparison, the United States and British Canada are the poor stepchildren of government-mediated provision of dental health coverage. The differences in dental healthcare provision between these regions are a question of culture - more specifically, of differing socio-political cultures and different perspectives on the importance of dental care. Lawmakers in the United States can learn from this policy of government-administered dental insurance that appears to work well in Québec.     

Does Medicaid improve utilization of medical and dental services and health outcomes for Medicaid‐eligible children in the United States?

BACKGROUND: Data are lacking to support the contention that Medicaid services improve utilization of healthcare services and result in better health. OBJECTIVE: To compare sociodemographic, utilization of healthcare services and health status characteristics among Medicaid-eligible children. METHODS: The third National Health and Nutrition Examination Survey included 2821 children 2-16 years of age eligible for Medicaid. The main outcome measures are annual physician visit, annual dentist visit, general health status, oral health status, asthma (second most common childhood disease), dental caries (most common childhood disease), asthma treatment needs, and dental treatment needs. We quantified the association of these outcome measures with Medicaid insurance status and sociodemographic status using multiple logistic regression modeling, taking into account the complex survey design and sample weights. RESULTS: Among Medicaid-eligible children, 27% were uninsured. Among uninsured Medicaid-eligible children, 62% had an annual physician visit, 32% had an annual dentist visit, 10% needed asthma treatment, and 57% needed dental treatment. Among insured Medicaid-eligible children, 81% had an annual physician visit, 39% had an annual dentist visit, 13% needed asthma treatment, and 42% needed dental treatment. After simultaneously taking into account other characteristics, uninsured Medicaid-eligible children were more likely to not have an annual physician visit (OR(NoMDvisit) = 2.21; 1.26-3.90), and to need dental treatment (OR(DentalNeed) = 1.57; 1.13-2.18). CONCLUSIONS: This USA population-based study found disparities exist within Medicaid's services between utilization of dental and medical services. Medicaid insurance improved utilization of medical services, but did not improve the utilization of dental services. This suggests that Medicaid insurance does not improve access to dental services for poor children.     

Rapid palatal expansion in the young adult: time for a paradigm shift?

A 19-year-old man presented for correction of a malocclusion that included a transverse maxillary deficiency. The patient was informed that he required orthognathic surgery to expand his upper jaw and correct his malocclusion, but he refused surgical expansion. Recent evidence indicates that rapid palatal expansion can be used without surgery in young adults; the decision was therefore made to treat the patient nonsurgically. Rapid palatal expansion of the maxillary arch was accomplished by means of a Hyrax appliance, with post-treatment radiographs revealing an opening of the midpalatal suture. The belief still persists among some clinicians that young adult patients require orthognathic surgery for palatal expansion, despite recent evidence supporting a nonsurgical approach after closure of the midpalatal suture.     

Air gun pellet remaining in the maxillary sinus for 50 years: a relevant risk factor for the patient?

The authors report the case of a 62-year-old man referred to the department of oral and maxillofacial surgery because of a clinical suspicion of palate carcinoma. Incidentally, diagnostic radiology showed a metallic foreign body in the left maxillary sinus. Anamnestic data revealed that a shot from an air gun accidentally hit the patient's left cheek in 1957. The lead-containing air gun pellet was removed by endoscopic antrostomy and the diagnosis of squamous cell carcinoma was confirmed by histopathological examination. 50 years after the pellet's impact, toxicological blood analysis showed no increased blood lead level. It remains unclear whether the air gun pellet has a potential toxicological effect or is related to the development of the patient's oral carcinoma. In this context the article reviews the literature and discusses the necessity of removing metal-containing foreign bodies, the role of lead in chronic toxicity and its possible carcinogenic effect in humans.