Cervical lymphadenopathy in the dental patient: a review of clinical approach.

Lymph node enlargement may be an incidental finding on examination, or may be associated with a patient complaint. It is likely that over half of all patients examined each day may have enlarged lymph nodes in the head and neck region. There are no written guidelines specifying when further evaluation of lymphadenopathy is necessary. With such a high frequency of occurrence, oral health care providers need to be able to determine when lymphadenopathy should be investigated further. Although most cervical lymphadenopathy is the result of a benign infectious etiology, clinicians should search for a precipitating cause and examine other nodal locations to exclude generalized lymphadenopathy. Lymph nodes larger than 1 cm in diameter are generally considered abnormal. Malignancy should be considered when palpable lymph nodes are identified in the supraclavicular region, or when nodes are rock hard, rubbery, or fixed in consistency. Patients with unexplained localized cervical lymphadenopathy presenting with a benign clinical picture should be observed for a 2- to 4-week period. Generalized lymphadenopathy should prompt further clinical investigation. This article reviews common causes of lymphadenopathy, and presents a methodical clinical approach to a patient with cervical lymphadenopathy.     

The social behavior of autistic children with younger and same-age nonhandicapped peers

Results of a study observing autistic children's interactions with nonhandicapped and autistic peers are reported. Six 8- to 12-year-old autistic children played in dyads with younger, normally developing kindergarten children and with nonhandicapped peers matched on chronological age for 10 15-minute sessions spaced over 3 weeks and then with a playmate of the alternate age for another 10 sessions. After intervention, all subjects showed gains in proximity, orientation, and responsiveness when playing with nonhandicapped peers and with autistic classmates. Same-age nonhandicapped playmates initiated more frequently than did younger nonhandicapped playmates and were better able to modify their initiations in ways that increased the likelihood of response from the autistic children.     

Differences in blood pregnenolone and dehydroepiandrosterone levels between schizophrenia patients and healthy subjects.

BACKGROUND AND OBJECTIVE: Contradictory and confusing reports on serum dehydroepiandrosterone (DHEA) levels in schizophrenia led us to compare the serum concentration of its precursor, pregnenolone (PREG), between medicated schizophrenia patients and healthy subjects. The neurosteroid levels were monitored for two months and the relationship of these neurosteroids with schizophrenic symptomatology, emotional distress, and anxiety was examined. METHOD: We determined blood levels of PREG, and DHEA in 15 schizophrenia patients and 12 healthy controls at four time points: at the start of the study, after 2, 4 and 8 weeks. Analysis of covariance and canonical correlations across four time points were applied. RESULTS: Controlling for age, serum concentrations of PREG were lower, while the DHEA level and the molar ratio values of DHEA/PREG were higher in schizophrenia patients compared to healthy controls. Both levels of PREG and DHEA and their molar ratio did not change significantly during the study's period either among schizophrenia patients or healthy controls. The blood levels of PREG appear to be associated with trait-anxiety scores in the schizophrenia patients, while associations of clinical symptoms with two neurosteroids did not reach a significant level when the confounding effect of emotional distress, and anxiety scores was controlled. CONCLUSION: Low serum pregnenolone concentrations in schizophrenia appear to be associated with trait-anxiety scores independent of symptoms. Further research into the role of pregnenolone in schizophrenia is warranted.     

Dental Arch and Cephalometric Changes Following Treatment for Class III Malocclusion by Means of the Function Regulator (FR-3) Appliance

AIM: The aim of this retrospective clinical study was to evaluate dental arch, skeletal, dentoalveolar, and soft tissue profile changes following treatment of Class III malocclusion by means of the Function Regulator (FR-3) appliance. SUBJECTS AND METHODS: The study sample consisted of 14 growing patients (seven boys and seven girls) with a mean age of 9.7 +/- 1.1 years presenting Class III malocclusion. They were treated with an FR-3 appliance exclusively for a period of 2.4 +/- 0.6 years. Dental casts and lateral cephalometric radiographs were obtained immediately before initiation and after completion of treatment with the FR-3 appliance. Thirteen variables were used for the dental cast analysis and 61 variables for the cephalometric analysis. The paired t-test was utilized to evaluate the presence of significant changes (p < 0.05). RESULTS: The evaluation of the dental casts revealed that there was a significant increase in intermolar, interpremolar, and intercanine width of the maxilla and of palatal height after treatment. Concerning the mandible, an increase in intermolar and intercanine width and a decrease in lower arch depth were observed. Cephalometric evaluation revealed a significant decrease in SNB angle and an increase in ANB angle, overjet, facial convexity, nose prominence, and lower soft tissue face height. There was an increase in upper lip thickness and a decrease in lower lip convexity observed after treatment. CONCLUSIONS: The results of this study confirm a favorable functional and esthetic maxillary and mandibular position following treatment by means of the function regulator (FR-3) appliance.     

Utility of the coefficient of determination (r2) in assessing the accuracy of interspecies allometric predictions: illumination or illusion?

The appropriateness of relying on the coefficient of determination (r(2)) as a statistical metric for judging the predictability of human clearance (CL) based on interspecies animal data was assessed. An explicit mathematical expression was derived for r(2) as a function of species body weight and the corresponding measured value of CL. The derived mathematical function demonstrated that r(2) is numerically large in most instances. Simulations using random CL generated from a common combination of species of mouse, rat, and monkey resulted in an r(2) of 0.75 as the minimum, and 0.95 and 0.98 at 50th and 75th percentiles, respectively, given that total CL values increase with increasing species body weight. Analysis of literature data also indicated that the prediction accuracy of human CL was not correlated with values of r(2). Therefore, it is concluded that r(2) is a limited statistical measure when assessing allometric scaling for the purpose of predicting human CL.     

Predictors of oral health quality of life in older adults

There is limited information regarding oral health status and other predictors of oral health‐related quality of life. An association between oral health status and perceived oral health‐related quality of life (OHQOL) might help clinicians motivate patients to prevent oral diseases and improve the outcome of some dental public health programs. This study evaluated the relationship between older persons' OHQOL and their functional dentition, caries, periodontal status, chronic diseases, and some demographic characteristics. A group of 733 low‐income elders (mean age 72.7 ISD=4.71, 55.6% women, 55.1% members of ethnic minority groups in the U.S. and Canada) enrolled in the TEETH clinical trial were interviewed and examined as part of their fifth annual visit for the trial. OHQOL was measured by the Geriatric Oral Health Assessment Index (GOHAI); oral health and occlusal status by clinical exams and the Eichner Index; and demographics via interviews. Elders who completed the four‐year assessment had an average of 21.5 teeth (SD=6.9). with 8.5 occluding pairs (SD=4.6), and 32% with occlusal contacts in all four occluding zones. Stepwise multiple regressions were conducted to predict total GOHAI and its subscores (Physical, Social, and Worry). Functional dentition was a less significant predictor than ethnicity and being foreign‐bom. These variables, together with gender, years since immigrating, number of carious roots, and periodontal status, could predict 32% of the variance in total GOHAI, 24% in Physical, 27% in Social, and 21 % in the Worry subscales. These findings suggest that functional dentition and caries influence older adults' OHQOL, but that ethnicity and immigrant status play a larger role.