Reprint of “Hip arthroplasty”

Total hip arthroplasty is a cost-effective surgical procedure undertaken to relieve pain and restore function to the arthritic hip joint. More than 1 million arthroplasties are done every year worldwide, and this number is projected to double within the next two decades. Symptomatic osteoarthritis is the indication for surgery in more than 90% of patients, and its incidence is increasing because of an ageing population and the obesity epidemic. Excellent functional outcomes are reported; however, careful patient selection is needed to achieve best possible results. The present economic situation in many developed countries will place increased pressure on containment of costs. Future demand for hip arthroplasty, especially in patients younger than 65 years, emphasises the need for objective outcome measures and joint registries that can track lifetime implant survivorship. New generations of bearing surfaces such as metal-on-metal, ceramic-on-ceramic, and metal-on-ceramic, and techniques such as resurfacing arthroplasty have the potential to improve outcomes and survivorship, but findings from prospective trials are needed to show efficacy. With the recall of some metal-on-metal bearings, new bearing surfaces have to be monitored carefully before they can be assumed to be better than traditional bearings.     

Global aspects of the AIDS epidemic.

The Global Programme on AIDS monitors this epidemic in all countries that report cases of acquired immunodeficiency syndrome to the World Health Organization. The present trends show a dramatic increase in the heterosexual distribution in Africa, Thailand, and some Latin American countries. According to the World Health Organization's prediction, about 4 million infants will have been born to HIV-infected women by the year 2000. Because many HIV-infected patients will have oral manifestations, there is a great challenge to the dental profession.     

Metamorphosis of dentistry. Update on alternative delivery systems

In 1985, Americans spent $27.8 billion for dental care. Patients paid $18 billion out-of-pocket, while private health insurance paid about $9.2 billion. Public programs paid approximately $600 million primarily through Medicaid. Commercial insurance carriers have increased their market share to more than 80 million subscribers, or more than 70 per cent of the total market. Dental service corporations and Blue Cross/Blue Shield plans cover more than 30 million subscribers, while independent plans have policies with more than 6 million customers. Dentistry today is a big business, and Big Business wants to make it their business. What makes health care vastly different from the manufacture and sale of microwaves, furniture and clothing, or the production and serving of fast foods is that the provider is in a unique relationship with the consumer/patient and will always have a large measure of control for this reason. Receiving dental care is not the same as purchasing a new pair of tennis shoes, but good business practices from other business arenas can make it possible for greater numbers of people to have greater access to it. Over the past 25 years a metamorphosis of dentistry has been generated by a rather constant interplay between the various involved parties to obtain a position of least financial risk. Insurance carriers and/or administrative intermediaries want the risk placed on the dentist, employers want the administrators to take it, and dentists want employers, administrators, or patients to assume it. The future will see the gradual evolvement of equitable plans dividing the risk among the four principle parties. Plans are being put in place today that already reflect this. A viable alternative delivery system means: Dental care providers who have the knowledge and incentive to perform quality care; administrators willing to share some of the risk; and employers and consumers who are sophisticated and realistic in their demands in today's marketplace. All these factions are currently interacting to create the new dental picture we see today--and will see in the future.     

A diagnosis of AIDS: understanding the psychosocial impact

Acquired immunodeficiency syndrome (AIDS) was discovered in 1981. It is now estimated that 1.5 million persons have become infected and that, by the year 1991, there will be 270,000 cases of the disease and 179,000 associated deaths. An extraordinary aspect of the AIDS epidemic is the high level of fear manifested by large numbers of people, in a manner disproportionate to the objective threat. AIDS has been referred to in the press as the greatest public health problem in America today. While dental journals are replete with studies enumerating the oral manifestations, and appropriate infection control guidelines, the psychosocial aspects of AIDS have generally been confined to media reports. Appropriate dental management of patients at high risk for the development of AIDS/AIDS-related complex requires a complete understanding of the psychosocial environment confronting these persons.     

Perioperative management of the geriatric patient. Part I: respiratory system

The population of the United States is aging. It is expected that the population age 65 and older will increase to nearly 60 million by the year 2030 and those age 85 and over to nearly 11 million. Patients over age 65 are more than twice as likely to undergo surgical procedures than patients 40 to 65. Structural and physiologic changes associated with advancing age, combined with the increased likelihood of major disability or disease, significantly increase the risk of perioperative complications. These articles review the major age-related changes and the effect they have on the perioperative management of these patients.     

Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994

BACKGROUND: The aim of this study was to assess the prevalence and extent of gingival recession, gingival bleeding, and dental calculus in United States adults, using data collected in the third National Health and Nutrition Examination Survey (NHANES III). METHODS: The study group consisted of 9,689 persons 30 to 90 years of age obtained by a stratified, multi-stage probability sampling method in 1988 to 1994. The weighted sample is representative of U.S. adults 30 years or older and represents approximately 105.8 million civilian, non-institutionalized Americans. Gingival recession, gingival bleeding, and dental calculus were assessed at the mesio-buccal and mid-buccal surfaces in 2 randomly selected quadrants, one maxillary and one mandibular. Data analysis accounted for the complex sampling design used. RESULTS: We estimate that 23.8 million persons have one or more tooth surfaces with > or = 3 mm gingival recession; 53.2 million have gingival bleeding; 97.1 million have calculus; and 58.3 million have subgingival calculus; and the corresponding percentages are 22.5%, 50.3%, 91.8%, and 55.1% of persons, respectively. The prevalence, extent, and severity of gingival recession increased with age, as did the prevalence of subgingival calculus and the extent of teeth with calculus and gingival bleeding. Males had significantly more gingival recession, gingival bleeding, subgingival calculus, and more teeth with total calculus than females. Of the 3 race/ethnic groups studied, non-Hispanic blacks had the highest prevalence and extent of gingival recession and dental calculus, whereas Mexican Americans had the highest prevalence and extent of gingival bleeding. Mexican Americans had similar prevalence and extent of gingival recession compared with non-Hispanic whites. Gingival recession was much more prevalent and also more severe at the buccal than the mesial surfaces of teeth. Gingival bleeding also was more prevalent at the buccal than mesial surfaces, whereas calculus was most often present at the mesial than buccal surfaces. CONCLUSIONS: Dental calculus, gingival bleeding, and gingival recession are common in the U.S. adult population. In addition to their unfavorable effect on esthetics and self-esteem, these conditions also are associated with destructive periodontal diseases and root caries. Appropriate measures to prevent or control these conditions are desirable, and this may also be effective in improving the oral health of the U.S. adult population.     

The global changing pattern of the oral manifestations of HIV

The significance of the oral manifestations of HIV has been widely recognised since the start of the epidemic. It is estimated that more than 38 million people are living with HIV currently, with more than a third presenting with oral manifestations. Access to optimum clinical management and effective treatment in resource‐rich countries has led to a remarkable decrease in some of the oral manifestations in the HIV population but this is not mirrored in developing countries, where most HIV‐positive patients reside. In this paper, a review of the literature since the start of the HIV infection in different parts of the world is presented to highlight the current significance of the oral conditions in this population. Oral candidiasis was repeatedly reported as the most encountered oral manifestation of HIV in different countries, including in studies on groups on anti‐retroviral therapy. Over time salivary gland disease was reported less in developed countries but was encountered more in developing countries. There is evidence to show that the prevalence of oral warts increased with the establishment of anti‐retroviral therapy. A review of the worldwide prevalence of HIV‐related oral conditions indicates that except for oral hairy leucoplakia, the prevalence of all other nine commonly reported oral conditions remained the same or increased over time. Oral opportunistic infections in HIV‐infected patients are an ongoing clinical burden mainly in developing countries. Maintaining research in the subject and improving access to HIV treatment will help address the oral health inequalities around the world.     

HIV diagnosis and testing: what every healthcare professional can do (and why they should)

Over the last thirty years, the human immunodeficiency virus (HIV) epidemic has matured. In the United States, HIV has changed from an explosive outbreak to an endemic disease; currently, an estimated 1.1 million people are infected with HIV, including a substantial number who are unaware of their status. With recent findings demonstrating the high transmissibility of HIV early in infection, and the potential benefit of early initiation of treatment, it is essential to identify as many infected individuals as possible. The Centers for Disease Control and Prevention (CDC) has expanded HIV testing to include any healthcare setting, including dental offices. Testing advances, including oral testing, have reduced the window period of HIV infection. Dental care represents a key, reliable, independent, and confidential link between the healthcare system and the general population that has been under‐utilized in the effort to control the HIV epidemic. HIV testing is straightforward, and knowledge of the types of testing will afford dentists an important opportunity to help advance and preserve the health of their patients and to promote the public health of their community. Here, we review the basics of HIV testing and discuss new changes in the approach to HIV diagnostics.     

Scientific approaches to AIDS prevention and control in China

The HIV epidemic in China started among intravenous drug users in the late 1980s. The second wave of the epidemic was caused by an outbreak in the paid plasma donors in central China in the mid-1990s. Sexually transmitted HIV cases have steadily increased and comprised more than half the reported HIV/AIDS infections since 2007. In the last 5 years, there has been a sharp increase of HIV infection in men who have sex with men. The HIV epidemic in China has expanded from high-risk groups to the general population and from rural regions to urban areas. This brief article discusses the history of HIV epidemics in China and the challenges facing the current AIDS control efforts in the country. It explains that only scientific approaches can sustain the national AIDS control programs and introduce the type of research needed to address those challenges. The selected research areas include molecular epidemiology, drug resistance surveillance, and the Chinese HIV vaccine research.     

Massachusetts fluoridation update 2006

Massachusetts has a long history of activity with community water fluoridation. Although the state has 3.8 million people living in 137 fluoridated communities, there are more than 2 million people who do not have these benefits. The Bay State is ranked 35th in the country regarding the percent of people on public water supplies with fluoridation. We can do better than that. We have more than 60 years of experience receiving the health and economic benefits of fluoridation in our country; however, there is still a lot of misinformation about fluoridation, and the unreliable nature of information posted on the Internet exacerbates much of this misinformation. Dental professionals, their patients, and decision-makers must be continuously educated about the safety, health, and economic benefits of community water fluoridation. Patients from 6 months to 16 years of age living in nonfluoridated communities should be prescribed supplemental fluoride. Dental professionals in nonfluoridated communities should assist them to become fluoridated. All dental professionals need to become more involved in the leadership of their communities.     

Immigrant families changing the face of America and delivery of health care services

15.7 million U.S. children, including more than 1.5 million New York State children, live in immigrant families. These newest arrivals are becoming a critical component of the changing demographics of the state's--and nation's--evolving population. A complex set of economic, social and cultural factors affect these youngsters and their families, which, in turn, can have an impact on the delivery of health services.     

Economic aspects of alveolitis

In 1680 cases of alveolitis ("dry socket") the national economic-loss is more than 339,693.-marks. Nearly 3 million teeth will be extracted in one year in the DDR. By a valuation of nearly 3% of the alveolitis 90,000 patients have this complication. That will be a economic-loss of 18.1 million marks in one year. The prophylaxis of this complication is therefore a most important problem.     

Penicillin concentration in the compact bone of the mandible.

During surgical removal of impacted third molars, the concentration of Penicillin G was determined in the compact bone of the mandible. Fifteen patients received 5 million IU and 15 received 10 million IU of Penicillin G intravenously as a single dose before surgery began. In both groups concentrations of penicillin with a bactericidal effect on most pathogenically relevant oral bacteria were detected during osteotomy. Taking into account the considerable interindividual variation, the one-shot application of 10 million IU of Penicillin G was more effective in certain cases than the 5 million IU dose. The factors influencing the decision on the high single-dose application include expected length of operation, body weight, kidney function, and infusion period. Assuming that in intraoral osteotomies the bone becomes contaminated with bacteria that are highly sensitive to penicillins, the results indicate that preoperative infusion of Penicillin G could be an effective method of preventing wound infection.     

新型冠状病毒防控阶段口腔颌面创伤管理策略

新型冠状病毒肺炎（COVID-19）疫情在短期内已扩散至全球30个国家和地区,被世界卫生组织认定为“突发公共卫生事件”。正确的防控措施可以阻断新型冠状病毒在医院内的传播,降低感染发生风险,有效防止疫情的进一步扩散。口腔颅颌面科承担着颌面部创伤急诊的工作,因诊疗操作的特殊性,交叉感染的风险较高,严格的防控措施尤其重要。本文从新型冠状病毒的流行病学特点、患者评估以及门急诊诊疗操作规范、围术期全方位防护管理等方面进行讨论,并提出相应建议。     

The patient with hypertension.

Elevated blood pressure appears to be an affliction that is more common in developed than in developing countries. However, the blood pressure consistently increases with age in most populations in the world, modified only by genetic and environmental factors. In the United States, it is estimated that there may be as many as 58 million people with hypertension; fewer than 5% of these cases have a curable cause. Oral health care providers can expect to be called on to care for patients with this progressively debilitating disease. To provide competent care to patients with hypertension, clinicians must understand the disease, its treatment, and its impact on the patient's ability to undergo and respond to dental care.     

Perioperative management of the diabetic patient

Diabetes mellitus is a significant global public health problem and is a major source of morbidity and mortality in the world today. Type 2 diabetes mellitus is the predominant form of diabetes worldwide and represents approximately 90% of all cases. There is an epidemic of type 2 diabetes mellitus in the world today in both developed and developing countries. Globally, it is expected that the number of people with diabetes will increase from the current 150 million to 220 million by the year 2010 and to 300 million by the year 2025. In addition, there has been an alarming increase in the incidence of type 2 diabetes in children and adolescents. It is therefore increasingly likely that diabetic patients will appear for dental and oral maxillofacial surgical treatment in both the office and ambulatory surgery clinic setting. Surgical stress often produces hyperglycemia in the perioperative period. Hyperglycemia has been shown to cause a significant increase in perioperative morbidity and mortality. It is the general consensus that strict glycemic control is beneficial and should be achieved for diabetic patients in the perioperative period. Preoperative, intraoperative, and postoperative management protocols for improved perioperative glycemic control of both type 1 and type 2 diabetics are presented.     

The future of dental care for the elderly population

The U.S. population is aging, and the elderly are maintaining many of their natural teeth. Studies have shown that if older people have teeth, they tend to utilize dental services to a similar extent as younger cohorts. Geriatric dental care is the diagnosis, treatment, and prevention of dental and oral diseases for all older adults. A functional categorization of the aging population is more useful in dentistry than a chronological one, and 70 percent of this population, or 23.2 million people, is able to visit a dentist in his or her office. The oral health care of older adults has become more challenging because they will no longer accept extraction and dentures as a solution to complex restorative needs. This paper discusses these issues and looks at the future of geriatric dental care.     

Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994

BACKGROUND: Accurate information on the prevalence and extent of periodontal diseases in the United States adult population is lacking. This study estimated the prevalence and extent of periodontal disease in the United States using data from the third National Health and Nutrition Examination Survey (NHANES III). METHODS: A nationally representative sample was obtained during 1988 to 1994 by a stratified, multi-stage probability sampling design. A subsample of 9,689 dentate persons 30 to 90 years old who received a periodontal examination was used in this study, representing approximately 105.8 million civilian, non-institutionalized Americans in 1988 to 1994. Periodontal attachment loss, probing depth, and furcation involvement were assessed in 2 randomly selected quadrants per person. Attachment loss and probing depth were assessed at 2 sites per tooth, the mesiobuccal and mid-buccal surfaces. The periodontal status of each subject was assessed by criteria based on the extent and severity of probing depth and furcation involvement. These assessments were used to classify each subject as having a mild, moderate, or advanced form of the disease. In the analyses, weighted data were used to reflect the complex sampling method. RESULTS: Prevalence of attachment loss > or = 3 mm was 53.1% for the population of dentate U.S. adults 30 to 90 years of age and, on average, 19.6% of teeth per person were affected. The prevalence of probing depth > or = 3 mm was 63.9% and, on average, 19.6% of teeth were affected. Fourteen percent of these persons had furcation involvement in one or more teeth. We estimate that at least 35% of the dentate U.S. adults aged 30 to 90 have periodontitis, with 21.8% having a mild form and 12.6% having a moderate or severe form. The prevalence and extent of attachment loss and the prevalence of periodontitis increase considerably with age. However, the prevalence of moderate and advanced periodontitis decreases in adults 80 years of age and older. This is most likely attributed to a combination of a high prevalence of tooth loss and gingival recession in the oldest age cohorts. Attachment loss and destructive periodontitis were consistently more prevalent in males than females, and more prevalent in blacks and Mexican Americans than whites. We estimate that in persons 30 years and older, there are approximately 56.2 and 67.6 million persons who, on average, have about a third of their remaining teeth affected by > or = 3 mm attachment loss and probing depth, respectively. We also estimate that about 21 million persons have at least one site with > or = 5 mm attachment loss, and 35.7 million persons have periodontitis. These are conservative estimates based on partial-mouth examinations, and the true prevalence and extent of periodontal disease may be significantly higher than what is reported here. CONCLUSIONS: Periodontitis is prevalent in the U.S. adult population. The results show that black and Mexican American males have poorer periodontal health than the rest of the U.S. adult population. Primary and secondary preventive measures should therefore be specifically targeted towards these groups.     

Antibiotic prophylaxis: problems in paradise

The age of antibiotic prophylaxis may be receding into its twilight years because the assumption upon which it was based has not proved generally true. Although antibiotics treat infections, limited benefit has been demonstrated in preventing infections. These are two entirely different biologic entities, a distinction which appears to have gone unappreciated by many for more than 50 years. If the principles of antibiotic prophylaxis established more than 40 years ago had been assiduously followed, many of its abuses could have been avoided. This may not have stopped our legal colleagues, but it would have been worth an effort on behalf of our patients. It is likely that the massive overuse of antibiotics as litigation prevention has contributed to the global epidemic of antibiotic-resistant micro-organisms and an unknown number of serious adverse effects to the antibiotics themselves. Even with this abuse, much money has still flowed from defendant to plaintiff. Substantial data exist that antibiotics do not prevent bacteremias. The absolute risk rate for bacterial endocarditis after dental treatment even in at-risk patients is very low. Antibiotic prophylaxis for surgical infections requires specific dosing schedules (perioperative surgical prophylaxis) to be successful. Hopefully the difficulties presented herein regarding antibiotic prophylaxis will lead to their more enlightened use in the future.     

Dental treatment and socioeconomic status in the period of 1981-1995

Between 1981 and 1995 the number of people in the Netherlands with a complete set of dentures fell by an average of 0.8 per cent per year. This means that the number of Dutch inhabitants with complete dentures dropped from 3.5 million in 1981 to 2.5 million in 1995. In general, relatively more people with a lower than with a higher socio-economic status have complete dentures. These socio-economic differences did not change in the period 1981-1995. In the same period, the number of consultations at which the dentist provided preventive treatment increased by 1 per cent per year. The results do not show any important differences in preventive aid between socio-economic groups. Changes in the reimbursement system for dental treatment, introduced on 1 January 1995, have led to a decrease of the number of dental consultations by people on a low income with non-private health insurance.