Cephalometric errors: A comparison between repeat measurements and retaken radiographs

This study compares landmark location errors in cephalometric radiography (when re-measuring radiographs) and radiographic errors (when retaking the radiograph). The samples comprised 32 remeasured and re-digitized radiographs and a further series of 22 retaken radiographs drawn from the same overall sample of 12-year-old Chinese children in Hong Kong. All radiographs were recorded in natural head posture with the lips in light contact. The relative size of the errors were assessed by calculating the 'error percentage' for both selected dento-skeletal and soft tissue profile measures. It is suggested that this index is clinically more meaningful than the usually used 'method error'. It expresses the variance of the method error (me2) as a percentage of the variance of the measurement under study (standard deviation2). This error percentage was found to be doubled, on average, for measurements on the retaken radiographs. In general, measures with most landmarks in the mid-sagittal plane showed the least increase in percentage error. The results suggest that errors arising from retaking cephalometric radiographs may effectively be greater than those usually reported. The Frankfort plane, the functional occlusal plane and the incisor long axes displayed poor reproducibility. For the soft tissues the lips served as poor angular landmarks and relatively acute angles with short 'arms' also displayed large errors.     

Knowledge and practice of behavioral management principles among dentists treating adults with learning disabilities

This study investigated U.K. dentists’ knowledge and practice of behavioral management principles (BMPs) as applied to adults with learning disabilities (AWLD). A postal questionnaire enquired into the dentists’ experience in managing AWLD, utilization of behavioral management techniques, and knowledge of BMPs. The response rate was 41% (N = 53). Two groups were investigated: specialists (dentists registered on the Special Care Dentistry specialists’ list, n = 37) and nonspecialists (dentists not on the list, n = 16). Although specialists treated more AWLD than nonspecialists, both groups of dentists reported they felt highly confident in managing AWLD. However, all dentists’ knowledge of the principles of nonpharmacological BMPs was low. Specialists had a tendency to use a greater range of nonpharmacological behavioral management techniques compared to non‐specialists. These results suggest that dental team members need more training in the theory and practice of BMPs, which might lead to less reliance on costly pharmacological interventions and a clinical experience that is more respectful of the dignity and independence of AWLD.     

Knowledge, opinions, and practices related to oral cancer: Results of three elderly racial groups

A study of 204 inner-city, senior center participants (ages ranged from 41–96 years) was conducted to assess their knowledge, opinions, and practices related to oral cancer. Participants were either White, African-American, or of Korean descent. The interview/questionnaire revealed this cohort to lack correct knowledge of the signs, symptoms, and risk factors of oral cancer, and to have had risk behaviors associated with oral cancer. Given that oral cancer is most frequently diagnosed in those aged 65 years and older, and that this cohort tends not to obtain routine preventive oral health care, it is imperative that these seniors be educated about the risks associated with oral cancer and their need for routine oral examinations.     

Oral health status and treatment needs of Canadian adults aged 85 years and over

In an oral health survey, 1375 adults aged 85 and older were examined in North York, Canada. Only 31% of dentate nursing home residents and 47% of dentate independently living subjects had received dental care in the year previous to examination. The overall prevalence of edentulism was 66%, and about 80% of subjects wore at least one denture. Of the dentate subjects, over 60% had untreated decay, and 47% of nursing home residents had untreated root decay. Regarding clinically defined treatment needs, high levels of unmet need were identified in subjects from both types of residences. Among nursing home residents, about 45% of dentate subjects required tooth extraction, and 56% required prosthodontic treatment. Although only 27% of dentate independently living residents required tooth extraction, over 60% needed restorative treatment. Higher prevalence of both untreated decay and unmet treatment needs was associated with lower utilization of dental care for dentate subjects. For edentulous subjects, prosthetic treatment was required by 70% of nursing home residents and by 51% of independently living subjects. These results indicate that, for both nursing home and independently living residents, dental diseases and treatment needs continue throughout the lifespan.     

Prevalence of HIV-associated Periodontitis and Chronic Periodontitis in a Southeastern US Study Group

OBJECTIVES: This study estimates factors associated with the prevalence of HIV-associated periodontal diseases (HIV-P) and the severity and extent of periodontitis in HIV-infected adults from North Carolina (NC). METHODS: Data are derived from a cross-sectional study of HIV-infected adults (total n = 326, dentate n = 316) treated at the University of North Carolina Hospitals. Outcomes were a diagnosis of HIV-P and measures of probing pocket depth (PPD), recession (REC), and clinical attachment level (CAL). Immunosuppression was measured by peripheral blood CD4+ cells/mm3. RESULTS: In addition to persons with HIV (non-AIDS), this study included 10 percent of the AIDS cases in North Carolina. Median age was 37 years (range = 19-67); 78 percent were male and 60 percent were black. Sixty-two percent of persons had a probing pocket depth > or = 5 mm; 46% had recession > or = 3 mm, and 66 percent had attachment level > or = 5 mm in one or more sites. Cases of HIV-P (n = 15) were rare. Persons taking HIV-antiretroviral medication were one-fifth (OR = 0.20; 95% CI = 0.07, 0.63) as likely to have HIV-P as those not taking those medications, controlling for CD4+ cell counts. CONCLUSIONS: HIV-infected persons in this study group from North Carolina exhibited severe and extensive measures of adult periodontitis. A small proportion experienced a severe form of HIV-P, which was attenuated by antiretroviral therapy.     

Non-clinical information obtained by dentists during initial examinations of older adult patients

The authors sent a questionnaire to a random sample of general dentists in Ontario, Canada, to assess the types of non‐clinical information (NCI) dentists usually obtain during initial examinations of older patients. From a list of 11 NCI questions, dentists indicated which questions they usually asked during new patient examinations. The adjusted response rate was 34% (n = 672). Respondents most often asked about pain and satisfaction with the appearance of teeth and/or dentures. About half the respondents asked about oral dryness and whether problems with chewing had limited food choices. Respondents were least likely to ask about problems with speaking and avoidance of eating with others because of chewing problems. Traits of those who asked the least common NCI questions typically including continuing education courses in geriatric dentistry, self‐perceived competence in treating elderly adults living in institutional settings. exposure to geriatric outreach settings during dental school and greater dentist involvement in patient history taking.     

Period between Completion of Radiation Therapy and Prosthetic Rehabilitation in Edentulous Patients: A Retrospective Study

PURPOSE: The primary purposes of this study were: (1) to describe the number and types of complications patients had before and after insertion of a removable prosthesis (i.e., denture) following radiation therapy to the head and neck and (2) to investigate whether the time between radiation therapy and denture insertion might contribute to those complications. MATERIALS AND METHODS: This research evaluated edentulous patients and those who were rendered edentulous as a result of their cancer treatment. After obtaining institutional approval following HIPAA regulations, a total of 349 charts were identified: 152 patients from Houston Veterans Administration Medical Center (HVAMC) and 197 patients from M. D. Anderson Cancer Center (MDACC). A total of 190 patients met the inclusion criteria with data available for review. RESULTS: No significant differences were found in any of the comparisons made, except when comparing complications that occurred after the dentures were inserted and the amount of time it took for prosthetic rehabilitation. The majority of patients had no complications. The patients who received their dentures in 180 days or less had the same number of complications when compared with those patients who received their dentures in 181 to 365 days and those who had to wait longer than a year for prosthetic rehabilitation. Patients with more pre-insertion complications tended to have delayed prosthetic rehabilitation. Those patients who had complications both before and after denture insertion tended to have bilateral dosing of their radiation treatment. Patients who had received radiation therapy were 1.7 times more likely to have post-prosthesis insertion complications. The majority of patients who experienced complications before and after denture insertion had greater than 5000 cGy. CONCLUSIONS: The numbers of complications reviewed in this retrospective analysis were considerably fewer than the number expected. There appears to be no difference in the number of pre- and post-insertion complications as a function of the time delay from oral surgical procedure to start of radiation treatment (10 to 21 days vs. 22 days or more).     

The Effects of Abutment Wall Height, Platform Size, and Screw Access Channel Filling Method on Resistance to Dislodgement of Cement-Retained, Implant-Supported Restorations

PURPOSE: Factors affecting the retention of fixed prostheses to natural abutments are well understood. In contrast, little is known concerning factors influencing the retention of fixed prostheses cemented to implant abutments. The purpose of this study was to investigate the effect that varying implant abutment wall height, platform size, and screw access channel filling method has on the retention of castings cemented to implant abutments using TempBond. MATERIALS AND METHODS: Four 15 degrees preangled abutments (Nobel Biocare Replace Select Esthetic) of each platform size--narrow (NP), regular (RP), and wide (WP)--were used. In each group of abutments the screw access axial wall was either unadjusted, one-third removed, two-thirds removed, or completely removed. The screw access channels were either fully or partially filled with Memosil, a vinyl polysiloxane impression material. For each abutment a casting was constructed that incorporated an attachment to allow removal. Castings were cemented to abutments with TempBond. The tensile force required to separate the cemented castings from the abutments was measured using an Instron Universal load-testing machine. RESULTS: The mean peak removal force for comparable abutments was significantly different ( p < 0.05): (1) where the screw access channel was completely filled with Memosil compared with those partially filled with Memosil; (2) with platform sizes--WP > RP > NP; (3) with alteration of axial wall height--1/3 removed > unadjusted = 2/3 removed > total wall removal. CONCLUSIONS: The retention of castings cemented to implant abutments with TempBond is influenced by the wall height, platform size, and the filling modality of the screw access channel.     

Utilization in Alberta''s Universal Dental Plan for the Elderly, 1974-91

Since 1973 the government of Alberta, a Canadian province of 2.4 million people, has funded a dental care plan for all residents over 64 years old and their dependents. It is the only dental plan in North America that covers all seniors and their dependents residing in a state or province. Under this plan, just over 270,000 persons (in 1990-91) are eligible for comprehensive, premium-free dental services provided by dentists and denturists in private practice on a fee-for-service basis. The plan's design, administration, utilization, and costs are reviewed. Utilization increased from 27 percent of eligibles using the plan in 1974-75 to 44 percent in 1990-91, and the mean number of services per user rose from 4.9 to 6.9 during the same time period. Although the cost per eligible person has increased about 200 percent, from Canadian (C) $42 to C $131, these costs only began to exceed the rate of inflation in 1986-87. Even though just 12 percent of the two main providers participating in the plan are denturists, nearly 22 percent of plan patients attended denturists rather than dentists for their complete dentures. Fees paid to dentists by the plan have decreased over time relative to the standard fees for the various services listed annually in the Alberta Dental Association fee guide. The apparent growth of direct additional billing by dentists of plan users to recover the difference between their usual fees and those paid by the plan and the effects of greater plan utilization are discussed, as are future potential difficulties in the plan's administration.