Dentists' attitudes and behaviors regarding domestic violence. The need for an effective response

BACKGROUND: The authors examined the attitudes and behaviors of a national sample of dentists regarding domestic violence and the barriers dentists face in intervening to help victims. METHODS: The authors surveyed a national random sample of 321 dentists by mail from November 1997 to March 1998 about their attitudes and clinical practice behaviors related to domestic violence. Survey items were developed based on the domestic violence and health care literature. The authors used the Total Design Method to maximize the response rate and analyzed data to determine differences between dentists who had received domestic violence education and those who had not. RESULTS: Eighty-seven percent of responding dentists never screened for domestic violence; 18 percent never screened even when patients had visible signs of trauma on their heads or necks. Overall, respondents intervened only minimally to help patients whom they had identified as victims. Respondents reported that the major barriers to screening were the presence of a partner or children (77 percent), lack of training (68 percent), concern about offending patients (66 percent) and their own embarrassment about bringing up the topic of abuse (51 percent). Respondents who had received domestic violence education were significantly more likely to screen for domestic violence and to intervene. CONCLUSIONS: Dentists face many barriers to identifying and helping patients who are abuse victims, yet these data suggest that education about domestic violence could help them overcome some of these barriers. CLINICAL IMPLICATIONS: We suggest that dentists follow the AVDR model when approaching abused patients in their practice: Ask about abuse, provide Validating messages, Document presenting signs and Refer victims to domestic violence specialists.     

The effectiveness of a counter-rotary action powered toothbrush and conventional toothbrush on plaque removal and gingival bleeding. A short term study

Initial investigations have demonstrated the effectiveness of a new contra-rotary powered electric toothbrush in removing plaque supragingivally, subgingivally, and interproximally following a single use. The purpose of this study was to evaluate the effectiveness of a counter-rotary toothbrush following 1) one time instruction, 2) reinstruction and 1 week practice; and 3) a third instruction and 3 weeks of practice and home use. Twenty-four patients were studied; 12 using the counter-rotary toothbrush and 12 using a conventional toothbrush. Using O'Leary and Turesky plaque indices, both brushes significantly reduced supragingival plaque from baseline at all intervals. The counter-rotary brush, however, was more efficient than the conventional brush at all intervals (P less than 0.01). Using a Surface Area Plaque Index, both brushes significantly reduced supragingival plaque from baseline at all intervals but there were no significant differences between brushes. A timed bleeding index showed significant reduction in gingival bleeding following 28 days of brushing with both brushes. Again, the counter-rotary toothbrush was superior to the conventional toothbrush (P less than 0.01).     

EBV and HSV infections in a patient who had undergone bone marrow transplantation: oral manifestations and diagnosis by in situ nucleic acid hybridization

The course of infections with herpes simplex virus and Epstein-Barr virus in an immunosuppressed patient who had undergone bone marrow transplantation and had tested seronegative for human immunodeficiency virus is described. The clinical oral manifestations were unusual, as they included hairy leukoplakia-like lesions and extensive mucosal ulceration. Histologic examination disclosed unique features consisting of both lichenoid and viral cytopathic changes. The association of the lesions with both Epstein-Barr virus and herpes simplex virus was confirmed by in situ hybridization histochemistry. The importance of recognition of the symptoms, specific diagnosis by DNA hybridization, and implications for antiviral prophylaxis and therapy are emphasized.     

The significance of perineural spread in adenoid cystic carcinoma of the major and minor salivary glands

Patient survival, local recurrence and distant metastasis were studied in relation to the pathological finding of perineural spread in 37 patients with adenoid cystic carcinoma of the major and minor salivary glands. All patients underwent a combined surgical and radiotherapeutical treatment. The overall incidence of perineural invasion in primary resection specimens was 52.6%. The 5-year actuarial survival rate for patients with perineural invasion was significantly lower (p less than 0.001) than for those without (36.9% versus 93.8%). In 26 patients with resection margins free of tumour, recurrences developed in 9/11 (81.8%) of the patients with perineural invasion as opposed to 4/15 (26.7%) of the patients without perineural invasion (p = 0.005). In the same group with resection margins free of tumour, distant metastasis developed after the primary treatment in 4/10 (40.0%) of the patients with perineural invasion, while none of the 14 patients without perineural invasion experienced distant metastasis (p less than 0.0002). The incidence of perineural invasion increased with a higher stage of the primary tumour.     

Preventive dental health practices of non-institutionalized Down syndrome children: a controlled study.

Although Down syndrome children are known to be greatly predisposed to periodontal disease when compared with normal children, the preventive dental health practices of non-institutionalized Down syndrome children have not been well reported. This questionnaire study of 25 Down syndrome children aged 1-14 years compared with 25 normal control children showed that Down syndrome children have poorer dental health practices compared with normal children. Significantly greater numbers of Down syndrome children were weaned from the bottle at greater than 18 months of age (56% vs 24%, p less than 0.05) or had taken a bottle to bed (40% vs 12%, p less than 0.05), indicating their increased risk for the development of nursing bottle caries. In addition, Down syndrome children were receiving less help during tooth brushing (60% vs 84%, p less than 0.05), were older when they first visited the dentist, and less likely to be taking regular fluoride supplements. These results indicate that Down syndrome children are further disadvantaged by poor preventive dental health practices and should be targeted for increased preventive dental care.     

Immunohistochemical localization of CEA,EMA and keratin in salivary mucoepidermal carcinoma]

Localizations of CEA,EMA and keration in 19 cases of mucoepidermal carcinomas were investigated using the indirect immunoperoxidase technique.The results showed CEA was negative in normal salivary glands and showed faint reaction in glands near carcinoma tissue.Keratin and EMA were localized in some myoepithelial cells.The positive rates in carcinoma tissue were 78.9%,89.5% and 84.2%,respectively.The positive rates and staining intensity of CEA and EMA in carcinoma tissue gradually decreased with the decline of tumor differentitation,but that of keratin showed no variation.the author consider that CEA and EMA could become good indices in clinically diagnosing mucoepithelial carcinoma and determining tumor differentiation type cell in mucoepidermal carcinoma and have a potential to multiply express the tumor elements of epithelium and/or mesenchyma.     

Osseous anatomy of unilateral coronal synostosis

High resolution, thin slice computerized tomography (CT) scans with paraxial and three-dimensional surface reconstructions were utilized to document the endocranial, exocranial, and orbital anatomy of non-syndromal unicoronal synostosis (UCS). Eighteen patients with UCS were evaluated qualitatively and quantitatively. Of these, 10 were studied both preoperatively and 1 year postoperatively. The endocranial base in UCS is characterized by a 9 degree angulation toward the synostosis of the anterior cranial base with respect to the posterior cranial base. The exocranial base has a 7 degree angulation toward the synostosis between the midpalatal suture and the posterior cranial base. The locus of angulation appears to be posterior to the anterior clinoids endocranially, and between the maxillopalatopterygoid articulations and the mandibular condyle exocranially. The orbital rim height is greater ipsilateral to the synostosis than contralaterally. The analysis documents the normalizing effect of one of two different surgical procedures upon orbital height. Application of computer assisted medical imaging to the study of UCS has allowed in vivo quantitation of cranial base and orbital dysmorphology for both preoperative assessment and postoperative evaluation.     

Medial pterygoid muscle activity during chewing and clenching

Specific activity of the human medial pterygoid muscle in relation to jaw movements and occlusion during mastication and clenching tasks is unclear. EMG activity of the medial pterygoid, masseter, anterior, and posterior temporal muscles was recorded simultaneously with three dimensional incisor point movement of the mandible. Data were sampled and analyzed by an on-line computer system. Patterns of medial pterygoid muscle activity were consistent for ipsilateral chewing and demonstrated activity of the muscle on the chewing side that peaked near the onset of intercuspation. The muscle on the contralateral side was active at the onset of intercuspation for subjects with a chopping stroke and inactive for those with a more lateral stroke guided into intercuspation on cuspal inclines. Activity in the early part of the closing phase was associated with a marked jaw movement toward the chewing side. There was generally less activity in protrusive than intercuspal clenching when occlusion was normal but more activity if marked incisal wear was present or multiple tooth contacts could be attained on protrusion. Intercuspal clenching initiated less activity when force was directed posteriorly and more activity when directed anteriorly than vertical intercuspal clenching.     

Enhanced fluoride uptake from mouthrinses

It has been shown in laboratory and animal studies that tooth enamel becomes considerably more reactive toward low levels of fluoride after receiving pre-treatment which forms dicalcium phosphate dihydrate (DCPD) in the enamel as an intermediate. This in vitro study was undertaken to determine the effect on human enamel fluoride uptake of incorporating DCPD-forming rinses into a conventional fluoride rinsing program. In one group, enamel samples received a one-minute rinse with 0.2% NaF each day for 20 days. Samples in the second group were treated identically, except that they were also given a one-minute DCPD-forming rinse prior to the first, sixth, eleventh, and sixteenth fluoride rinses. At the end of the rinsing program, all samples were washed in 1 M KOH to remove labile fluorides. The enamel biopsy data showed that the fluoride uptake resulting from 0.2% NaF alone was not statistically significant, whereas uptake produced by the DCPD-forming plus NaF rinses was significant. The results suggest that the DCPD-forming rinse may improve the efficacy of fluoride rinse programs.     

Early maxillary orthopedics in CLP cases: guidelines for surgery.

Two samples of complete cleft cases between five and seven years of age are compared (11 UCLP + 9 BCLP versus 21 UCLP + 12 BCLP). The same early orthopedic procedures were applied to all cases, but surgical management differed for the two groups: "classical" surgery (lip 3 months, palate 2--2 1/2 years) versus delayed conservative surgery (lip 6 months, soft palate 18 months, hard palate 6--8 years). It is evident that early maxillary orthopedic treatment is of little consequence for long-term development unless concomitant surgery complies with growth and functional requirements. In contrast to "classical" surgery, palatal closure in two steps is more favourable to skeletal growth and does not interfere to any relevant degree with speech development.