Issues in Financing Dental Care for the Elderly

The elderly make up an increasingly larger segment of the patient population in dental practices. This article reviews recent epidemiologic, demographic, and health services research, and concludes that significant segments of the elderly are at high risk for oral disease and/or limited access to dental treatment, and consequently warrant classification as high-risk groups for policy considerations. It then proposes policy options to the dental community and public decision makers. Oral care can be viewed as having three components. Two basic components are the primary care component--which includes diagnostic, preventive restorative, and periodontal care--and the acute care component--i.e., the treatment of oral pain, trauma, and infection. The third, rehabilitative component, has to do with the restoration of oral function, including prosthodontics and cosmetic dentistry. Viewing dental care in this perspective may help link funding for dental primary care services with that for other primary health services, and link restoration of function and improvement of quality of life with similar health services, like hearing, vision, and social services. In addition, approaching dental care policy makers on several levels--i.e., federal, state, and local--will contribute to our ability as a profession, in the decades ahead, to meet the oral health needs of more elders: including the frail, those at high risk for oral disease, and those with limited access to care.     

质粒介导变形链球菌转化的研究

本研究建立了变形链球菌ＭＴ８１４８转化系统。在本组转化培养条件下，变形链球菌ＭＴ８１４８在对数生长早期出现感受态但维持时间很短，供体ＤＮＡ最适浓度为２５μｇ／ｍｌ，超螺旋闭环质粒与线性质粒均可转化变链ＭＴ８１４８。与变链ＧＳ５相比，变链ＭＴ８１４８的转化率约低１００倍     

螺旋CT测量颅面三维结构矫治变化的方法学研究

目的设计应用螺旋CT的三维重建技术测量颅面牙齿的三维结构变化的方法。方法 以鼻额缝的前上部中点(N点),蝶鞍前壁上后缘中点(S’点),和枕骨大孔前缘下后中点(B点)为基准点建立以S’点为原点的测量三维坐标系。用Unisight软件在MPR相下获得各点原始三维坐标值,通过数学计算得到各测量点在测量三维坐标系下的坐标值。结果经统计学检验,此方法的测量结果重复性好,精确度符合要求。结论此种方法可以用于螺旋CT对于颅面牙齿三维变化的测量研究。     

翼外肌上头与颞下颌关节盘关系的研究

目的探讨翼外肌上头与关节盘的关系。方法对４７侧老年尸体颞下颌关节标本进行了斜矢状面上的解剖学和组织学研究。结果①显微镜下观察翼外肌上头纤维可附着于关节盘、关节囊、关节盘前附着及髁突；②翼外肌上头附着于髁突的纤维平均为５２％，附着于关节盘的纤维为１０％，附着于关节囊的纤维为２４％，附着于下颌前附着的纤维量为４％；③翼外肌上头附着于关节盘的比例与关节盘前移无确切相关性；④翼外肌上头纤维与关节盘纤维的连接方式包括结点连接、肌腱连接和端端连接。结论翼外肌上头主要附着于髁突，附着于关节盘的少量纤维不足以独立地使关节盘发生前移位。     

体外人牙髓细胞的矿化特性

为探讨体外人牙髓细胞的生物学特性，采用体外细胞连续培养、钙质染色、Ｘ射线能谱分析与透射电镜观察等方法，对体外人恒牙牙髓细胞的矿化特性进行了研究并与人牙龈成纤维细胞（ｈｕｍａｎｇｉｎｇｉｖａｆｉｂｒｏｂｌａｓｔｓ，ＨＧＦｓ）进行了比较。结果表明，人牙髓细胞在体外可以复层生长并形成细胞结节，ＨＧＦｓ则无此能力，牙髓细胞的碱性磷酸酶活性亦较ＨＧＦｓ者高；细胞结节钙质染色呈阳性，结节内钙磷含量明显增高；人牙髓细胞有许多与成牙本质细胞相似的超微结构特征，胞间基质中可见致密晶状小体。结果提示，体外连续培养的人牙髓细胞有向成牙本质细胞分化的可能，这可为研究人牙髓细胞的分化和矿化提供有价值的思路。     

Melanotic neuroectodermal tumour of infancy: an immunohistochemical and ultrastructural study

Two cases of melanotic neuro-ectodermal tumour of infancy (MNTI)—a rare neoplasm arising in the first year of life—are reported, with the results of immunohistochemical and ultrastructural examination. The tumours consisted of a biphasic cell population in a fibrous stroma. The small, darkly staining cells comprising the first population stained positively for synaptophysin, showing them to be neuroblasts, and the large epithelioid cells comprising the second cell population stained positively with the antibodies HMB-45 and NKI-Beteb, showing them to be melanocytes. Ultrastructural examination of the second case confirmed the biphasic nature of the tumour cells, with secretory granules and neurofilaments in the neuroblastic population, and melanosomes in the epithelioid population. These results add to the evidence supporting the neural crest origin of MNTI and confirm its formation from two distinct cell lines. Both cases have responded to local excision, with no recurrence more than a year after initial treatment.     

Salivary clearance of sugar before and after insertion of fixed orthodontic appliances

This study was conducted for the purpose of establishing the possible influence of orthodontic therapy with fixed appliances on salivary clearance of sugar. Fifteen consecutive patients between the ages 12 and 17 years took part in the investigation. Unstimulated salivary flow rate, residual volume of saliva in the mouth after swallowing (RESID), and salivary clearance of sugar was determined on two occasions, before treatment commenced and after a minimum of 3 weeks of appliance wear. Analysis of the data showed that both RESID and salivary flow rate exhibited significantly increased levels during orthodontic therapy. The insertion of fixed appliances did not seem to have any effect on the rate of salivary clearance of sugar. It was assumed that this finding could be a consequence of the combined effects of the changes in salivary flow rate and RESID.     

Removal of overhanging amalgam: A comparative study of three instruments

This study compared the effects on tooth surface of three power-driven instruments commonly used to remove overhanging amalgam. Comparisons of methods of instrumentation were made on enamel, cementum, and amalgam. Cavitron, Roto Pro, and EVA system instruments were used. Findings showed significantly more abrasion on all surfaces in EVA groups compared with other groups. All surfaces in Roto Pro groups appeared to be smoother than in other groups. There appeared to be little difference between treated surfaces and control surfaces in the Cavitron group.     

Das Göttinger Fotostatverfahren

Zusammenfassung Methode zur Anfertigung exakt auswertbarer Fotos ohne Zephalostatgerät, auch für enge räumliche Verhältnisse geeignet. Verwendet wird Polizei-Adapter für Planfilm in Verbindung mit Linhof-Technika; die Orientierung erfolgt über eine Mattscheiben-Horizontale nach neuartigen Gesichtsmarkierungen. Es wird empfohlen, gegebenenfalls verschiedene Lippenhaltungen zu dokumentieren.

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Summary A method is described of making clinical photos without any cephalostatic instrument. Police Adapter for flat film together with Linhof-Technika is used; the orientation is given by means of a horizontal focusing screen in accordance with new face markings. It is advisable to document different lip postures.

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Résumé Il s'agit d'une méthode permettant de faire des photographies exactes sans l'aide d'un céphalostat et dans des conditions spatiales réduites. Le Polizei-Adapter pour film plat est utilisé avec la Linhof-Technika. L'orientation est donné par un verre dépoli horizontal en relation avec de nouveaux marquages faciaux. Il est recommandé de noter le cas échéant, différentes postures des lèvres.

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Mit 8 Abbildungen

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Herrn Prof. Dr. Dr. Th. Kirsch zum 60. Geburtstag