Dental Exam Research Articles

Enhancing the Value of Operative Dentistry

A recurring topic for editorials in this journal is concern for the status and future of operative dentistry in dental education and as a distinct clinical discipline. In 1996, Mjor and Wilson pro- posed that operative dentistry has been compro- mised by the evolution of dental specialties with the subsequent loss of expertise to those fields, along with narrowly focused definitions and textbooks limiting the scope and curricula of the discipline 1 . In response to this compromised status (or devalu- ation) they recommended that the ''aims and objec- tives. . .must be global, and as a consequence, broad- based.'' Further, they suggested that ''the preserva- tion and further evolution of operative dentistry cannot be considered to be vested in as ingle organization.'' 1 In 1972, Grainger wrote, ''Operative Dentistry must look at its fundamentals in the light of the future. Operative Dentistry must accept the chal- lenge of a restorative and biologic multispecial- ty. . .The discipline of Operative Dentistry must shrug off its apathy, recognize its worth and dominate once more the direction that dentistry must take. . . We are skilled in producing skeptics, but not very good at producing individuals who can create their own framework for values. The first step towards the reconstruction of professional values is the rediscovery of values in one's own tradition.'' 2 In light of these concerns and others, it seems appropriate to assess operative dentistry's current status and role in dental education and as an essential multi-specialty discipline. This assessment will be made from the following perspectives: the dental school academic unit, the dental curriculum, dental licensing exams, affiliations with the academ- ic dental community, and national/international associations. My purpose is to highlight the consid- erable values operative dentistry already possesses and those which it has to offer other educational disciplines and recognize current and potential partners for its future growth and development. Academic Unit A review of the websites of US dental schools reveals that the term ''Operative Dentistry'' exists as a formally designated part of the schools' organiza- tional structure in 16/59 or 27% of all schools. 3 Some new schools were not included in this review due to insufficient data on their websites. In five of the 16 schools (8% of the total) operative dentistry appears as a primary academic unit (eg, department), while in the other 11 schools, it appears as a division or section under another higher level unit. The other units that serve as the departmental location of the operative dentistry function in the schools' organi- zational structures are variations of ''Restorative Dentistry'' (35 schools), ''General Dentistry'' (8), ''Clinical Dentistry/Sciences'' (3), ''Comprehensive Care'' (3), ''Oral Rehabilitation'' (2), and three others including ''Adult Dentistry,'' ''Reconstructive Scienc- es,'' and ''Oral Health Practice.''

School screening and parental reminders in increasing dental care for children in need: a retrospective cohort study.

The objective of this study is to assess follow-up dental care received by children given baseline screening and referrals as part of an ongoing clinical trial. A retrospective study with two cohorts of kindergarten children who had baseline and follow-up (9 months later) dental exams was used. The parents/caregivers of children with routine restorative or urgent needs at baseline received a referral letter and telephone reminders to seek care for their child. Children with referrals were evaluated at follow-up exam for the receipt of care. A baseline caregiver questionnaire provided information on the individual and family characteristics of the children. A total of 303 children had dental exams at both time periods. At baseline, 42 percent (126/303) received referrals and among the referred group19 percent (24/126) received follow-up care. A greater proportion with urgent referrals (10/30, 33 percent) received care than those with routine referrals (14/96, 15 percent). Baseline dmft decayed, missing, filled primary teeth and DMFT decayed, missing, filled permanent teeth was similar between children who did/did not receive follow-up care (P = 0.178 and 0.491, respectively). Children receiving referrals had caregivers with less education, higher Medicaid participation, fewer routine care visits, poorer self-rating of teeth, and a higher proportion of children reporting tooth pain. Children without receipt of follow-up care had caregivers who were more likely to report not visiting a dentist within the last 5 years and a greater number of missed days from work because of tooth problems. The rate of dental utilization was low even with school screening, referral and parental reminders among poor, largely minority inner-city kindergarten children.

Daily Deals: A Good Marketing Tactic for SLPs and Audiologists—or Not?

You have accessThe ASHA LeaderMake it Work1 Jun 2011Daily Deals: A Good Marketing Tactic for SLPs and Audiologists—or Not? Maggie McGary Maggie McGary Google Scholar More articles by this author https://doi.org/10.1044/leader.MIW.16062011.np SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In http://www.asha.org/Publications/leader/2011/110517/Daily-Deals--A-Good-Marketing-Tactic-for-SLPs-and-Audiologists-or-Not.htm Heard of Groupon or LivingSocial? Chances are, if you haven't heard about these “daily deal” websites or others like them, you probably will soon. As restaurants and other businesses have reaped the benefits of daily deals, other kinds of businesses have started to show interest in the concept for marketing their services—notably, medical services like dental exams and cosmetic surgical procedures. It's only a matter of time until daily-deal sites begin promoting their services to other kinds of medical providers, including speech-language pathologists and audiologists. According to a recent Harris Interactive survey, approximately 23 million Americans purchased deals from daily-deal sites in 2010. U.S. consumer spending on daily-deal sites is expected to reach $1.25 billion this year, up from $873 million in 2010. That's a lot of sales and a high volume of potential repeat business, for little or no up-front investment. There is typically no up-front cost to businesses advertising on deal sites—usually the deal site takes 50% of the purchase price for all deals sold. For instance, in the case of a typical restaurant deal offering a $50 gift certificate for which the consumer pays $25, the deal site keeps 50% and the restaurant earns 50%. Luke Barber (homespeechhome.com) is a speech-language pathologist who also is involved with a family business that happens to be a daily-deal site. As Barber sees it, daily-deal sites could be a great way for SLPs or audiologists to market their practices or services—or a potentially risky marketing tactic. “From an SLP or audiologist's point of view, group deals could be fantastic because of the potential for repeat business. For a private-practice clinician to offer, for instance, a speech-language evaluation for half off is brilliant because of the potential for future business.” Barber elaborated that another potential area for daily-deal marketing could be telepractice—such deals could be great on national sites because they're not limited by geographical area and could potentially draw clients from many areas. There are many different deal sites, each with different target audiences—for instance, Plumdistrict and Mamapedia are two sites that target parents. There also are many local deal sites, which Barber said would work best for on-premise treatment. Alexandra Costlow, a second-year audiology doctoral student at the University of Maryland, pointed out that daily deal sites also could potentially be a good way to raise awareness about audiologists among younger people (68% of Groupon's subscribers are 18–34 years old). Group deals also could be a way audiologists could promote special deals or events during Better Hearing and Speech Month. But just as there are possible benefits to daily deals as a marketing tool for SLPs and audiologists, both Costlow and Barber point out some significant drawbacks. The ethical quicksand around discounting speech or hearing services is notable—ranging from current clients complaining that they're paying more for the same services being advertised at a discounted rate to potential health insurance or anti-kickback law issues. If one of the main benefits of group deals is garnering new clients who you hope will become repeat clients, clinicians should know that the conversion rate from one-time daily-deal customer to repeat customer is low—the current estimate for conversions is around 19%. With repeat business already a known issue, will new clients reeled in by a group deal expect to pay that discounted rate for future visits? Also, even the best-case scenario of group deals could be troublesome for solo practitioners inundated with clients who purchase a deal, a common complaint of small businesses that have offered mass discounts through daily-deal sites. Although daily deals make sense for restaurants and other entertainment venues or products, the risks involved in using them as a marketing tactic for SLPs or audiologists are considerable. Clinicians are cautioned to think carefully about the implications of offering discounted services, especially as it relates to contracts with private or public insurers if contracts include stipulations about providing the best price for services. Author Notes online ASHA community and social media manager, can be reached at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 16Issue 6June 2011 Get Permissions Add to your Mendeley library History Published in print: Jun 1, 2011 Metrics Downloaded 88 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2011 American Speech-Language-Hearing AssociationLoading ...

Phase II trial of bevacizumab (A), lenalidomide (R), docetaxel (D), and prednisone (P) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC).

4574 Background: Angiogenesis may play a critical role in the progression of mCRPC. Previously we have shown the potent anti-tumor activity of the combination of D, Thalidomide (T), A, and P in mCRPC (Ning JCO 2010). We hypothesized that combining R, an analogue of T, with A, D and P would have a more favorable efficacy/toxicity profile. Methods: All pts had chemotherapy-naïve progressive mCRPC. 6 pts were treated with R at 15 and 20 mg prior to doses at 25 mg. Treatment is 75 mg/m2 D, 15 mg/kg A every 21 days as one cycle (C), plus 25 mg R for 14 days with daily 10 mg P and enoxaparin. After grade 3 neutropenia was seen in > 80% of pts in all cohorts, the protocol was amended to include prophylactic pegfilgrastim. PSA is tested each C with imaging after C2 and then every 3C. Dental exams with mandible CTs are at baseline, after C5, and then every 6C or earlier if needed. Results: 32 of the planned 51 patients have been enrolled. Characteristics were: median age 66 [51-82], Gleason score 8 [68.8% 8-10, 31.2% 6-7], on-study PSA 136 ng/ml [9.2-3520], and pre-study PSA doubling time 1.43 months [0.52-4.07]. Median treatment Cs was 11 [2-26] as of this analysis. 3/32 patients came off study due to clinical and radiographic progression. 29 patients remain on study; 29/32 (90.6%) and 24/32 (75%) patients who have completed ≥2 cycles had PSA declines of ≥50% and ≥75%, respectively. Of 17 patients with measurable disease there were 1 CR, 13 PR, and 3 SDs (82.4% overall RR). Grade ≥ 3 toxicities included neutropenia (16/32), anemia (6/32), thrombocytopenia (3/32), weight loss (1/32), hypertension (1/32), and infection (4/32). 1/32 pts had febrile neutropenia. 2/32 pts had perianal fistula. 10/32 pts (31.3%) had grade 2 osteonecrosis of the jaw (ONJ), defined as bone death on dental exam; 6/10 pts had concomitant and 3/10 pts had a history of bisphosphonate use. Conclusions: Combined therapy with anti-angiogenic agents A and R, plus D and P is associated with high response rates, 90.6% in PSA and 82.4% in measurable disease in mCRPC, with manageable toxicities. Further study is underway to characterize the activity and to explore the high incidence of ONJ, including the possibility of ascertainment bias.

Phase II trial of bevacizumab (A), lenalidomide (R), docetaxel (D), and prednisone (P) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC).

138 Background: Angiogenesis appears to play critical role in the progression of mCRPC. Previously we have shown anti-tumor activity in mCRPC with the combination of D, thalidomide (T), A and P (Ning JCO 2010). We hypothesized that combining R, an analogue of T, with A, D and P would have a more favorable toxicity profile and similar anti-tumor activity. Methods: All pts had chemotherapy-naïve progressive mCRPC. 6 pts were treated with R at 15 and 20 mg prior to doses at 25 mg. Treatment is 75 mg/m2 D, 15 mg/kg A every 21 days as one cycle (C), plus 25 mg R for 14 days with daily 10 mg P and enoxaparin. After grade 3 neutropenia was seen in > 80% of pts in all cohorts, the protocol was amended to include prophylactic pegfilgrastim. PSA is tested each C with imaging after C2 and then every 3C. Dental exams with mandible CT's are at baseline, after C5, and then every 6C or earlier if needed. Results: 28 of a planned 51 pts have been enrolled. Pt characteristics include: median age 65.5 [51-78], Gleason score 8 [67.9% 8-10, 32.1% 6-7], on-study PSA 94.3 ng/mL [9.2-3520], and pre-study PSA doubling time 1.43 months [0.52-4.07]. Median C number was 8 [1-21]. 2/28 pts were off study due to clinical or radiographic progression. 26 pts remain on study. 22/24 (91.7%) and 20/24 (83.3%) pts who have completed ≥ 4C had PSA- decline of ≥ 50% and ≥ 75%, respectively. 14 pts with measurable disease were evaluable with 2 CRs (1 unconfirmed), 9 PRs (2 unconfirmed), and 3 SDs (a 78.6% overall RR). Grade ≥ 3 toxicities include neutropenia (16/28), anemia (6/28), thrombocytopenia (3/28), hypertension (1/28), and infection (2/28). 1/28 pts had febrile neutropenia. 8/28 pts (28.6%) developed grade 2 osteonecrosis of the jaw (ONJ), defined as bone death on dental exam, higher than 18.3% as reported by Ning. 5/8 had concomitant and 2/8 pts had history of bisphosphonate use. Conclusions: Combined therapy with anti-angiogenic agents R and A, plus D and P is associated with high response rates, 91.7% in PSA and 78.6% in measurable disease in mCRPC pts, with manageable toxicities. Further study is underway to characterize the activity and to explore the high incidence of ONJ, including the possibility of ascertainment bias. No significant financial relationships to disclose.

Intraoral Radiographic Findings in Acne Calcification: A Case Report

The authors present a case report of a 52-year-old Hispanic female who presented for a routine dental exam at the Arthur A. Dugoni School of Dentistry in San Francisco. Incidental findings of multiple, calcified acne vulgaris lesions were noted in the soft tissues of the cheek that were viewed in the periapical radiographs. The findings were confirmed by a clinical evaluation of the patient's skin and past history.

N-3 Fatty Acids and Periodontitis in US Adults

Background Periodontitis is a common, chronic inflammatory disease. Although n-3 fatty acids have anti-inflammatory properties, it is unclear whether n-3 fatty acids can treat or prevent periodontitis. Method We studied 9,182 adults aged 20 years and older who participated in the National Health and Nutrition Examination Survey between 1999 and 2004. Periodontitis was assessed by dental exam and was defined as >4 mm pocket depth and >3 mm attachment loss in any one tooth. Intake of n-3 fatty acids was assessed by 24-hour dietary recall. We used multivariable logistic regression to estimate the associations between periodontitis and intakes of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and linolenic acid (LNA). Results The weighted prevalence and 95% confidence interval (CI) of periodontitis was 8.2% (95% CI 7.0 to 9.4). Compared with the lowest tertiles, the adjusted odds ratios for periodontitis associated with the highest tertiles of dietary n-3 intake were 0.78 (95% CI 0.61 to 1.00; P=0.009) for DHA, 0.85 (95% CI 0.67 to 1.08; P=0.10) for EPA, and 0.86 (95% CI 0.60 to 1.23; P=0.28) for LNA. The associations were little changed by multivariable adjustment or exclusion of individuals reporting use of dietary supplements containing DHA, EPA, or LNA. Conclusions In this nationally representative sample, higher dietary intakes of DHA and, to a lesser degree, EPA, were associated with lower prevalence of periodontitis. Interventional studies are needed to confirm the potential protective effects of n-3 fatty acids on periodontitis.

Methemoglobinemia secondary to over-the-counter Anbesol

Methemoglobinemia is a potentially lethal condition which may result from exposure to benzocaine. It must be treated promptly, because it may cause a significant decrease in oxygen delivery to tissues and organs. A 39-year-old caucasian man presented to the emergency department (ED) with dental pain. After a review of systems and a dental exam, an oxygen saturation of 90% was noted. The patient reported no previous cardiac or pulmonary pathology, but did report using a large amount of over-the-counter Anbesol. A second oxygen saturation measurement had fallen to 87%. An arterial blood gas sample was taken, and the patient was found to have high levels of methemoglobin. He was transferred to the critical care ED and treated with 2 mg/kg intravenous methylene blue. Dentists must be aware of the possible lethal effects of benzocaine toxicity, including methemoglobinemia. It is important to recognize the signs and symptoms and act in a judicious manner.

Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach.

BackgroundDespite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level.ObjectivesTo assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics.MethodsThe study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed.ResultsDental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics.ConclusionsGirls, students whose parents have low schooling, those with low per capita income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.

Unrecognized Odontogenic Maxillary Sinusitis: A Cause of Endoscopic Sinus Surgery Failure

Endoscopic sinus surgery (ESS) is reported to improve symptoms in approximately 85% of patients. Reasons for failure include misdiagnosis, technical inadequacies, underlying severe hyperplastic disease, biofilm, and immunodeficiency. Only one previous case of unrecognized odontogenic maxillary sinusitis has been cited in the literature as a reason for failure to improve with sinus surgery. This study was designed to characterize clinical and radiographic findings in patients who fail to improve with ESS because of an unrecognized dental etiology. Five patients, with odontogenic maxillary sinusitis with prior unsuccessful ESS, were prospectively enrolled. Demographics and clinical aspects including duration of illness, prior sinus surgeries and therapies, and radiographic data were assessed. Five adults underwent an average of 2.8 sinus surgeries with persistence of disease and symptoms until their dental infection was treated. Duration of symptoms ranged from 3 to 15 years. In four of five patients, the periapical abscess was not noted on the original CT report but could be seen in retrospect. Three of five patients had been seen by their dentists and told they had no dental pathology. All five patients underwent dental extractions and one patient underwent an additional ESS after dental extraction. These procedures led to a resolution of sinusitis symptoms in all five patients. Unrecognized periapical abscess is a cause of ESS failure and the radiological report frequently will fail to note the periapical infection. Dentists are unable to recognize periapical abscesses reliably with dental x-rays and exam. In patients with maxillary sinus disease, the teeth should be specifically examined as part of the radiological workup.

Estimation of horse age based on dental exam

Estimation of horse age based on the teeth exam is a work seldom applied and limited by the Medical Veterinaries, due perhaps to ignorance of the established parameters in the equine dental chronology. However, it is the best-suited form to know or to verify the horse’s age, although they have or not established records. In the present work a revision of relevant aspects in the denture of the specimens in order to know and to establish the horses age is made. A detailed description of the tooth structure is realized, as well as of the dental formula and its evolution in time.

Differences in exposure and biological markers of fluoride among White and African American children

To determine differences in self-reported fluoride exposure and fluoride exposure biomarkers between two racial groups. Questionnaires regarding fluoride exposure, urine and water collection kits were distributed to African American and White 7-14-year-old children. Children received a dental exam for fluorosis. Water, urine, and saliva were analyzed for fluoride content. Questionnaire responses and results of sample analyses were compared and observed differences were analyzed. 83 African American and 109 White children completed the study. Dental fluorosis was observed in 62.5 percent White and 80.1 percent African American children. Significant differences were found for fluorosis prevalence and severity between the groups (P < 0.05). Less African American children reported having used fluoride supplements in the past. White children began brushing their teeth at an earlier age. More White children visited a dentist for the first time before age 3. African American children reported currently using larger amounts of toothpaste. More Whites than African Americans had received topical fluoride treatments over the previous year. All of these differences were significant. Multivariate models showed that supplement use and amount of toothpaste used for brushing had significant associations to a child's fluorosis scores. Fluoride concentration of water and saliva was not different for the two groups; however, the fluoride content in urine was significantly higher in African Americans than in Whites [P < 0.05; 1.40 +/- standard deviation (SD) 0.65 ppm versus 1.08 +/- SD 0.28 ppm]. Differences in fluoride exposure between two racial groups were observed. These differences are complex and need to be better defined.

Characteristics of Applicants Who Obtain Interviews at Orthodontic Postgraduate Programs

To evaluate applicant credentials that are associated with receiving interviews to postgraduate orthodontic programs. Twenty-two variables incorporating academic, work, and personal characteristics of 68 applicants were analyzed using a mailed questionnaire survey and data from application files. Applicants were grouped into categories based on the number of interviews reported. Statistically significant associations were identified between interview category and: age, number of programs applied to, grade in orthodontic course, grade point average, scores from part 1 of the national dental board exam, academic honors, research, recommendation letter from orthodontic faculty, general practice residency, work experience, and community service. Programs are interested in rounded, well-balanced individuals who excel at more than one thing. Cumulative grade point average and orthodontic work experience were the most significant.

The effect of dentition on feeding development in piglets and on their growth and behavior after weaning

The objectives of this study were to determine the effects of dentition on feed-oriented behavior and feed consumption before weaning at 28 d, and whether premolar eruption or occlusion at the time of weaning influenced postweaning growth or behavior. Over 3 trials, 24 litters of Yorkshire piglets (n = 233) were provided with creep feed marked with 1% chromic oxide on d 5. Dental exams were performed on d 2, 6, 9, 13, 16, 20, 23, and 27. Fecal samples were visually assessed for feed consumption (via fecal color) on the same day as dental exams, beginning on d 6. The duration of time spent at, and frequency of visits to, the creep feeder were determined from continuous video recordings on d 7, 10, 14, 17, 21, and 24 for 6 h/d (0700 to 1000 h, 1300 to 1600 h). After weaning, behavior was recorded every 5 min for three 2-h time periods (0600 to 0800 h, 1100 to 1300 h, and 1600 to 1800 h) on d 2, 4, 6, 8, 10, and 12. Piglets younger than 17 d with their premolars erupted and occluded spent less time at the creep feeder and visited it less often than piglets without their premolars erupted and occluded [duration: p(3) (premolar position 3 on maxilla), d 7 (P = 0.005); p(4) (premolar position 4 on mandible), d 7 (P < 0.0001), d 10 (P = 0.003); p(4 )(premolar position 4 on maxilla), d 17 (P = 0.012); occlusion, d 7 (P < 0.0001), d 10 (P = 0.0004); visits: p(3), d 7 (P < 0.0001); p(4), d 7 (P < 0.0001), d 10 (P = 0.001); p(3 )(premolar position 3 on mandible), d 14 (P = 0.037); p(4), d 17 (P = 0.024); occlusion, d 7 (P < 0.0001), d 10 (P = 0.003)]. By d 21 of age, this trend reversed such that piglets with premolars erupted and occluded spent more time at the feeder and visited it more frequently [duration: p(3), d 24 (P = 0.025); p(4), d 24 (P = 0.0005); occlusion, d 21 (P = 0.001), d 24 (P = 0.0001); visits: p(3), d 21 (P = 0.0002), d 24 (P < 0.0001); p(4), d 24 (P = 0.0002); occlusion, d 21 (P < 0.0001), d 24 (P < 0.0001)]. The percentages of piglets with positive fecal scores were 0, 1.4, 4.6, 8.0, 29.0, 44.9, and 60.6% on d 7, 10, 14, 17, 21, 24, and 27, respectively (P < 0.0001 between each day). No associations were found between the eruption or occlusion of premolars and feed consumption before weaning (P > 0.05), and no dental measures influenced growth rates (P > 0.10) or behavior (P > 0.10) after weaning. A more precise method may be necessary for detecting associations between dental eruption and feed consumption. However, the behavioral results indicate that, before weaning at 28 d, younger piglets are inhibited from feeding when their premolars first erupt, whereas older piglets with a more advanced dentition are more attracted to feed.

The Preventive Health Behaviors of Long-Term Survivors of Cancer and Hematopoietic Stem Cell Transplantation Compared with Matched Controls

Little is known about the health promotion, prevention, and disease screening behaviors of cancer survivors treated with hematopoietic cell transplantation (HCT), who undergo arduous treatment and may be at particular risk for late effects and secondary malignancies. The purposes of this study were to examine the current health and secondary prevention behaviors of long-term HCT survivors compared with matched controls without cancer, and to identify sociodemographic and clinical factors associated with appropriate preventive practices. HCT survivors (n = 662) were drawn from 40 North American transplantation centers. Peer-nominated acquaintances of survivors matched on sex, age, education, and marital status served as controls (n = 158). Data were collected a mean of 6.7 years post-HCT (range, 1.8-22.6 years). Despite a greater frequency of physical exams, the HCT survivors had similar health and screening behaviors as the matched controls. Sociodemographic factors were associated with health prevention behaviors in expected ways. Some differences between disease group and type of transplant were found, with survivors of acute leukemia less likely to report regular exercise, autologous transplant survivors more likely than allogeneic transplant survivors to report screenings for breast and cervical cancer, and allogeneic transplant survivors more likely than autologous transplant survivors to report undergoing a skin exam in the previous year. Despite higher levels of engagement with health care providers, HCT survivors had similar health behaviors as matched controls and comparable to those reported by cancer survivors who did not undergo HCT. There remains considerable room for improvement. These findings support the need for further education of both HCT survivors and health practitioners.

Into the Mouth of the Hadrosaur

A dental exam has supplied evidence that Edmontosaurus —one of the most common dinosaurs of the late Cretaceous, some 67 million years ago—chewed unlike any animal alive today. Edmontosaurus belonged to a group of plant-eating dinosaurs called ornithopods. In 1984, researchers studying the sutures between bones in fossil skulls concluded that ornithopods had flexible upper jaws. When the lower jaw clamped shut, they said, the pressure would spread outward from both sides of the upper jaw. The upper rows of teeth would then grind against the lower teeth, rather than slicing as they do in other dinosaurs. Now three paleontologists have acquired the strongest independent evidence yet for this unique jaw motion. Vincent Williams of the University of Leicester in the United Kingdom and colleagues examined microscopic wear patterns on 13 teeth from a 13-meter-long Edmontosaurus found in Wyoming. The dinosaur and its close kin, known as hadrosaurs, had as many as 1000 teeth in multiple rows that moved forward as functional teeth were worn down, says Leicester co-author Mark Purnell. Patterns of tiny scratches on the teeth revealed that the jaws moved just as had been predicted, the team reported last week in the Proceedings of the National Academy of Sciences . “They would have been able to process very tough vegetation,” such as horsetails, says co-author Paul Barrett of the Natural History Museum in London. ![Figure][1] Rows of unerupted teeth in the lower jaw below the chewing surface look like overlapping leaves. CREDIT: VINCE WILLIAMS Paleontologist Lawrence Witmer of Ohio University College of Osteopathic Medicine in Athens calls the study “one of the best microwear papers I've seen.” But he still isn't convinced that the upper jaw could flex. [1]: pending:yes

Decreased occurrence of osteonecrosis of the jaw after implementation of dental preventive measures in solid tumour patients with bone metastases treated with bisphosphonates. The experience of the National Cancer Institute of Milan

Background: Screening of the oral cavity and dental care was suggested as mandatory preventive measures of osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates (BPs). We investigated the occurrence of ONJ before and after implementation of dental preventive measures when starting BP therapy.Patients and methods: Since April 2005, 154 consecutive patients treated with BPs (POST-Group) have undergone a baseline mouth assessment (dental visit ± orthopantomography of the jaws) to detect potential dental conditions and dental care if required. A retrospective review was also conducted of all consecutive cancer patients with bone metastases (PRE-Group) and treated for the first time with BPs from January 1999 to April 2005 in our clinic without receiving any preventive measure. Incidence proportion and incidence rate (IR) were used to estimate the incidence of ONJ.Results: Among the study population (966 patients; male/female = 179/787), 73% had breast cancer. 25% of patients were given zoledronic acid (ZOL), 62% pamidronate (PAM), 8% PAM followed by ZOL and 5% clodronate. ONJ was observed in 28 patients (2.9%); we observed a reduction in the incidence of ONJ from 3.2% to 1.3%, when comparing—pre and post-implementation of preventive measures programme. Considering the patients exposed to ZOL, the performance of a dental examination and the application of preventive measures led to a sustained reduction in ONJ IR (7.8% in the PRE-Group versus 1.7% in the POST-Group; P = 0.016), with an IR ratio of 0.30 (95% confidence interval 0.03–1.26).Conclusions: ONJ is a manageable and preventable condition. Our data confirm that the application of preventive measures can significantly reduce the incidence of ONJ in cancer patients receiving BPs therapy. Dental exams combined to the identification of patients at risk in cooperation with the Dental Team can improve outcomes and increase the number of ONJ-free patients.

Salivary cortisol among American Indians with and without posttraumatic stress disorder (PTSD): Gender and alcohol influences

Disruptions in hypothalamic–pituitary–adrenal regulation and immunity have been associated with posttraumatic stress disorder (PTSD). We examined the association of PTSD with diurnal rhythms in salivary cortisol in a convenience sample from a population-based study of male and female American Indians. Subjects with and without PTSD were identified from American Indians living on/near a Northern Plains reservation as part of a larger study. Over two days diurnal saliva samples were collected by staff at the University of Colorado Denver Clinical Research Center at waking, 30 min after waking, before lunch, and before dinner. Generalized estimating equations linear regression models investigated the influence of PTSD on cortisol over time. The association of a lifetime diagnosis of PTSD with salivary cortisol level was assessed in subjects with complete data (PTSD: n = 27; no PTSD n = 32) for age, gender, and alcohol consumption in the past month. Subject mean age was 44 years, and 71% were women. When stratified by gender, women with a lifetime diagnosis of PTSD had significantly higher mean cortisol levels throughout the day than women without PTSD ( p = 0.01); but there was no significant association between PTSD and cortisol levels in men ( p = 0.36). The cortisol awakening response – the difference in cortisol levels from waking to 30 min after waking – was not associated with PTSD in men or women. A lifetime diagnosis of PTSD may influence diurnal cortisol among American Indian women. These effects were independent of influences of current alcohol use/abuse. The unexpected elevation in cortisol in American Indian women with a lifetime diagnosis of PTSD may reflect acute anxiety associated with experiencing a number of novel tests in a strange location (e.g., cardiac imaging, medical, dental exams, etc.), or concurrent depression.

The Potential Role of Breast‐Feeding and Other Factors in Helping to Reduce Early Childhood Caries

Dental caries is the most common chronic disease in US children. Early childhood caries (ECC) is particularly virulent and can interfere with a child's ability to eat, grow, speak, and communicate. Studies on whether breast-feeding or bottle-feeding are more likely to reduce ECC have proven inconclusive. The study population included 175 children, aged 1 to 5, receiving dental care at the Hughes Spalding Children's Hospital in Atlanta, GA. Participation included a dental exam, chart data abstraction, and a personal interview with the mother. Too few exclusively breast-fed children prevented the adequate study of breast-feeding. However, children exclusively bottle-fed for at least 1.5 years had more decayed or filled tooth surfaces than children breast-fed part of that time but well short of a year. No bottle at night nor juice at irregular times, the mother's brushing of her child's teeth, and adequate dental care in the mother seemed to reduce ECC. Our results suggest measures that might reduce ECC risk. Medical providers must discuss oral health with new mothers and educate them on the important role they play in keeping their babies' teeth healthy

Recruiting and retaining pregnant women from a community health center at the US—Mexico border for the Mothers and Youth Access clinical trial

Recruitment and retention in clinical trials of minorities is low, particularly in rural underserved populations. This has slowed progress in addressing racial/ethnic disparities in oral health. To describe factors associated with successful recruitment, and identify predictors of continued retention of pregnant women attending a community health center into a randomized controlled clinical trial to prevent early childhood caries. The Mothers and Youth Access (MAYA) Trial recruited women in the second trimester of pregnancy. At baseline, consenting women completed an oral health questionnaire and received a dental exam and oral health counseling. Four months postpartum, women returned with their babies for randomization with follow up at 9-, 12-, 18-, 24-, 30-, and 36-month postpartum visits. To assess predictors of retention, data about respondents' demographics, and oral health-related knowledge, attitudes, and behaviors were obtained by questionnaire and analyzed by logistic and discrete time-to-event regression analyses. Of 556 predominantly Mexican-American women recruited at baseline, 195 (35%) were excluded after baseline for not meeting inclusion criteria; 361 (65%) continued to randomization. Factors such as race/ethnicity, annual household income, household composition, oral health-related knowledge and behaviors significantly related to retention until randomization. In multivariable models, women reporting a higher annual household income were less likely to be lost to attrition before randomization (odds ratio = 0.73, 95% confidence interval (CI) 0.60-0.89); while Mexican/Mexican-American women were less likely to be lost beyond randomization (hazard ratio = 0.53, 95% CI 0.26-1.08). Factors not measured at baseline may have been important in predicting attrition. The MAYA Trial is expected to finish by November 2008; therefore, complete results for total retention may differ from those reported here. Recruitment and retention efforts for pregnant Hispanic women should place heavy emphasis on culture as ethnicity remained the only borderline significant predictor in postrandomization retention.