Dentistry's role in the recognition and reporting of domestic violence, abuse, and neglect.

Domestic violence is epidemic in western society. Child abuse, intimate partner abuse, and elder abuse victims often have signs of injury that are readily visible to dentists. Dentists have a moral and legal obligation to recognize and report suspected abuse. This article offers information and illustrations to assist in diagnosing abuse. Reporting guidelines and legal obligation information sources for every state in the United States are included.

Clinical evaluation of anorganic bovine bone xenograft with a bioabsorbable collagen barrier in the treatment of molar furcation defects.

The purpose of this study was to compare Bio-Oss (BO), an anorganic bovine bone xenograft, in combination with Bio-Gide (BG), a bioabsorbable collagen barrier, to open-flap debridement (OFD) surgery in human mandibular Class II furcation defects. A total of 31 furcations (18 treatment, 13 control) in 21 patients were treated. There was a statistically significant improvement in most clinical indices for the BO/BG group, with minimal improvement noted for the OFD group. Vertical probing depth reduction of 2.0 mm and horizontal probing depth reduction of 2.2 mm were noted for the BO/BG group, with 0.3 mm and 0.2 mm reductions, respectively, noted for OFD. Hard tissue measurements showed 2.0 mm of vertical furcation bone fill for BO/BG and 0.5 mm for OFD. The BO/BG group had 3.0 mm of horizontal furcation bone fill, and the OFD group had 0.9 mm. The BO/BG group had a defect resolution of 82.7%; 42.5% was noted for the OFD group. There was a statistically significant difference between BO/BG and OFD in all soft and hard tissue measurements with the exception of attachment level, recession, and alveolar crest resorption.

Short-term changes of condylar position after sagittal split osteotomy for mandibular advancement.

OBJECTIVE: The goal of this study was to quantify condylar position changes after mandibular advancement surgery with rigid fixation (screws). Radiographic changes in condylar position were determined in all planes (X, Y, and Z). Computed tomography with image reconstruction was used. STUDY DESIGN: A consecutive population of patients who elected to have rigid fixation for surgical stabilization method were studied (n = 21). Computed tomography data were acquired in the axial plane through use of abutting 1.5-mm-thick slices. Data acquisition occurred 1 week preoperatively and 8 weeks postoperatively. Measurements were made from 2-dimensional reconstructions. RESULTS: The averages were as follows: lateral displacement from midline, 1.2 mm (55% of patients); medial displacement from midline, 1.5 mm (45% of patients; range, 3.2 mm); condyle angle increase from coronal plane, 3.5 degrees (60% of patients); condyle angle decrease from coronal, 4.3 degrees (40% of patients; range, 8.5 degrees); superior rotation of proximal segment, 3.2 degrees (39% of patients); inferior rotation of proximal segment, 8.6 degrees (61% of patients; range, 15.6 degrees); superior displacement, 1.2 mm (60% of patients); inferior displacement, 1.0 mm (40% of patients; range, 2.5 mm); anterior displacement, 1.6 mm (33% of patients); posterior displacement, 1.6 mm (67% of patients; range, 2.8 mm). CONCLUSIONS: Changes occurred in all planes, but the most common postoperative condyle position was more lateral; with increased angle, the coronoid process was higher and the condyle was more superior and posterior in the fossa.

Changes in the fracture toughness of bone may not be reflected in its mineral density, porosity, and tensile properties.

Age-related changes in the skeleton often lead to an increase in the susceptibility of bone to fracture. Such changes most likely occur in the constituents of bone, namely, the mineral and organic phases, and in their spatial arrangement manifested as orientation and microstructure. In the past, however, bone loss or decline in bone mineral density has been considered to be the major contributing factor for the increased risk of bone fractures, and elastic modulus and ultimate strength have been commonly used to assess bone quality and strength. However, whether these properties provide sufficient information regarding the likelihood of bone to fracture remains debatable. Using a novel fracture toughness test, which measures the energy or stress intensity required to propagate a crack within a material, the objective of this study was to investigate if the mineral density and mechanical properties of bone can accurately predict bone fragility as measured by fracture toughness. Changes in fracture toughness (K(IC)), bone mineral density (BMD), elastic modulus (E), yield and ultimate strength (sigma y and sigma s), porosity (P0), and microhardness (Hv) of bone were examined as a function of age in a baboon model. With increasing age, the fracture toughness of bone decreased, and its microhardness increased. However, no significant changes were found in BMD, E, P0, sigma y, and sigma s as a function of age. In addition, simple regression analyses revealed no significant correlation between bone fracture toughness and the other parameters, except for microhardness of bone. The results of this study indicate that changes in bone fracture toughness may not be necessarily reflected in its mineral density, porosity, elastic modulus, yield strength, and ultimate strength.

Long-term assessment of early alveolar bone grafts using three-dimensional computer-assisted tomography: a pilot study.

Fifteen patients with complete unilateral cleft lip and palate who had primary alveolar bone grafting were studied with computer-assisted tomography at a mean age of 12 years. Keeping the maxillary alveolar crest parallel to the plane of the scan, 1.5-mm cuts of the maxilla were made from the infraorbital rim to the gingival third of the crowns of the teeth. A single operator reformatted the data into three-dimensional images using the Maxiview 3200 computer workstation. This allowed examination of the position, size, and spatial relationship of the grafted area and quantification of the amount of bone coverage of root surface and bone height of the alveolus in or adjacent to the graft site. Ten patients showed a lateral incisor in the line of the cleft. The average bony coverage of these tooth roots was 76.5 percent. In the five patients in whom there was lateral incisor agenesis, the canine root had average bony coverage of 82.6 percent. The average height of bone at the lateral incisor was 8.7 mm; at the canine, 14.1 mm. In two patients in whom there was only 42 percent tooth root coverage, the teeth were still viable, stable, and without mobility. Computed tomographic (CT) scans of the 15 patients demonstrated good graft survival with adequate volume. The functional and aesthetic status of the dentition in the area of the cleft also was demonstrated.

Comparison of 2-D calculations from periapical and occlusal radiographs versus 3-D calculations from CAT scans in determining bone support for cleft-adjacent teeth following early alveolar bone grafts.

OBJECTIVE: This investigation was conducted to determine the agreement between three-dimensional (3-D) calculations from CAT scans and two-dimensional (2-D) calculations from standard dental radiographs in evaluating bone support for cleft-adjacent teeth after primary bone grafting. DESIGN: This retrospective study utilized CAT scans and dental radiographs taken of the alveolar cleft in patients an average of 11 years after primary bone grafting. SETTING: The subjects were patients treated by the Cleft Palate Team at Children's Memorial Hospital and Loyola University Medical Center, Chicago, Illinois. PATIENTS: Fourteen UCLP patients (9 males, 5 females) agreed to participate in this study by undergoing CAT scan assessment of their alveolar cleft sites. They also had to have periapical or occlusal radiographs of the grafted cleft site taken within 6 months of the CAT scan. INTERVENTIONS: All patients underwent primary lip repair, placement of a passive palatal plate, primary alveolar bone grafting (mean age 6.4 months), and palatoplasty before 1 year of age. Major tooth movement through final orthodontics was completed by the time of the radiographic assessment. MAIN OUTCOME MEASURES: CAT scan sections were reformatted and reconstructed to three-dimensionally calculate the percentage of root covered by bone support for the 15 teeth adjacent to the graft cleft sites. Dental radiographs of the same teeth were also traced and digitized. Percentages of root supported by bone were also established using the dental radiographs by dividing the amount of root covered by bone, by the anatomic root length. RESULTS: A paired, two-sample t test revealed no significant differences between the two methods of assessment, while linear regression showed a statistically significant correlation between the CAT scan assessment and the percentages found on the radiographs. CONCLUSIONS: Routine dental radiographs were able to estimate the total 3-D bone support for the roots of cleft adjacent teeth as determined by CAT scan to a statistically significant degree when groups where compared. The clinical significance for evaluation of individual cases was less impressive with a wide range of variability and a level of agreement that required acceptance of differences up to 25%.

Advanced imaging methods.

Recent developments in imaging sciences have enabled dental researchers to visualize structural and biophysical changes effectively. New approaches for intra-oral radiography allow investigators to conduct densitometric assessments of dento-alveolar structures. Longitudinal changes in alveolar bone can be studied by computer-assisted image analysis programs. These techniques have been applied to dimensional analysis of the alveolar crest, detection of gain or loss of alveolar bone density, peri-implant bone healing, and caries detection. Dental applications of computed tomography (CT) include the detailed radiologic anatomy of alveolar processes, orofacial soft tissues and air spaces, and developmental defects. Image analysis software permits bone mass mineralization to be quantified by means of CT data. CT has also been used to study salivary gland disease, injuries of the facial skeleton, and dental implant treatment planning. Magnetic resonance imaging (MRI) has been used extensively in retrospective and prospective studies of internal derangements of the temporomandibular joint. Assessments based on MRI imaging of the salivary glands, paranasal sinuses, and cerebrovascular disease have also been reported. Magnetic resonance spectroscopy (MRS) has been applied to the study of skeletal muscle, tumors, and to monitor the healing of grafts. Nuclear imaging provides a sensitive technique for early detection of physiological changes in soft tissue and bone. It has been used in studies of periodontitis, osteomyelitis, oral and maxillofacial tumors, stress fractures, bone healing, temporomandibular joint, and blood flow. This article includes brief descriptions of the technical principles of each imaging modality, reviews their previous uses in oral biology research, and discusses potential future applications in research protocols.

Regional comparisons of child abuse and related variables in the United States.

The objective of this article is to familiarize the health care professional with 1990 national data on child abuse and to review some of the trends reported in the literature. The United States was divided into Northeast, Midwest, South, and West. Data were collected, analyzed, and transformed to calculate the incidence and types of abuse reported by region. Variables of interest were income, marital status, perpetrator, age of victim, and drug use by region. To determine significant differences among regions for each type of abuse and related variable, frequency distributions were calculated and chi-squared tests were used. State data summaries were measured for correlation analysis. The West was highest in reported incidence of child abuse (5.9%) and, specifically, physical abuse (36.7%). California reported 55% of the physical abuse in the West. In all regions, neglect and physical maltreatment were reported more than sexual and emotional abuse. The incidence of neglect in the south (52.8%) was greater than in any other region and did not correlate to income in this region. Early detection of child abuse can aid in preventing fatalities. This information should increase awareness of child abuse and result in an increase in reporting if abuse is suspected.

Clinical usefulness of two-dimensional reformatted and three-dimensionally rendered computerized tomographic images: literature review and a survey of surgeons' opinions.

PURPOSE: This study compares the usefulness of axial computed tomography (CT) with two-dimensional (2D) reformats and three-dimensionally (3D) rendered CT data in the treatment planning and management of patients. PATIENTS AND METHODS: Twenty-nine patients who had been studied with CT were grouped into the following four clinical problems: 1) temporomandibular joint assessment (n = 8), 2) growth and development assessment (n = 4), 3) posttrauma and postoperative assessment (n = 13), 4) "other" (n = 4). The clinicians who treated these patients were surveyed for their opinions of the usefulness of CT with and without 2D/3D reformatting. RESULTS: In a majority of the cases within each of the four clinical groups, the clinicians believed that 2D and/or 3D reformatting of the CT data provided additional useful information for patient management. In most of the cases, 3D imaging provided information in addition to that provided by the axial or reformatted 2D images. CONCLUSION: 2D and 3D CT images can be useful to the clinician in diagnosis and treatment planning. These methods enhance the accuracy of diagnostic decisions and the establishment of appropriate treatment plans.

Magnetic resonance spectroscopy of inflammation associated with the temporomandibular joint.

Noninvasive early recognition and treatment of temporomandibular joint dysfunction remains a diagnostic challenge. This pilot study evaluated the use of phosphorus 31 magnetic resonance spectroscopy with magnetic resonance imaging to measure alterations in pH and high-energy phosphate metabolite ratios of muscle that is adjacent to an inflamed temporomandibular joint. Ten New Zealand white rabbits were used in this study. Two animals were used to develop signal acquisition protocols and to ensure that stable baseline data could be measured. In each of the eight animals used in the experiment, one temporomandibular joint was injected with a suspension of silica particles and the contralateral joint served as a control. Data were collected from control and experimental joints on days 0, 7, 14, 21, and 28, after the injection. At the end of the study, temporomandibular joints were block resected and histologically examined to confirm the presence of an inflammatory response. Results indicated that pH and metabolite ratios could be obtained by 31P-magnetic resonance spectroscopy. Changes in pH and some metabolite ratios in experimental joints showed statistical significance (p < 0.001). Differences were seen on day 2 and day 7 (p = 0.040 and p = 0.008, respectively) in the phosphocreatine/alpha-adenosine triphosphate ratios. This contrasts with phosphocreatine/beta adenosine triphosphate ratios that showed significance that began at day 7 (p = 0.022) and continued to day 14 (p = 0.025). Histologic examination indicated that the tissue response within the joint capsule was less than the granulomatous reaction expected.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental radiology.

Although diagnostic imaging in dental radiology usually involves the dentition and associated supporting structures, the use of the advanced imaging systems is becoming more widespread. The literature reflects interest in advancing the diagnostic yield of oromaxillofacial radiology and at the same time reducing the radiation exposure to the patient population. In the past year, publications concerning radiology of the head and neck regions have focused on the use of advanced systems for endosseous implants. Radiation dose-rates to radiosensitive organs from specific dental radiographic procedures have been updated. Also, methods to reduce dosage to radiosensitive organs are addressed. The requirements of digitization for equal or enhanced diagnostic yield have been studied. Additionally, the implications of dental materials and dental implants as they relate to MR imaging have been addressed.

The temporomandibular joint.

MRI is the procedure of choice for diagnosing most internal derangements. MRI provides images that not only demonstrate bony detail but show excellent representation of soft tissues in both anatomic and semifunctional relationships. MRI does not use ionizing radiation and has no known adverse effects. Multiplanar imaging allows a three-dimensional analysis of the TMJ, providing a more complete assessment of the condyle, articular disc, fossa relationships. Whenever capsular adhesions or disc perforations are suspected and are not demonstrated with MRI, then arthrography should be performed.

Antibiotic therapy of osteomyelitis in outpatients.

The therapy of osteomyelitis utilizing 481 courses of intravenous antibiotics in outpatients was analyzed to identify the types of bone infection most frequently treated by this form of therapy. The efficacy of this form of treatment is also discussed.