Prevalence and etiology of erythema migrans among children in northeast Ohio.

OBJECTIVE: To determine the prevalence of erythema migrans (EM) in northeast Ohio; to identify demographic, health, and dental characteristics associated with this condition in patients aged 1 to 15 years; and to investigate the possibility that EM is a marker for children with multiple medications and certain systemic conditions. METHOD AND MATERIALS: In this retrospective chart review study, 1,900 charts were reviewed at 2 separate offices. One thousand were analyzed at a hospital dental clinic in Cleveland, Ohio, and 900 at a private pediatric dental office in a Cleveland suburb. Data were collected from each chart by 1 investigator and recorded in a database to be statistically analyzed. Nonparametric measures of association and logistic regression were used to determine differences between the presence of EM and the study variables and odds for EM. Significance level was set at P = .05. RESULTS: Seventy-two subjects (3.8%) were found to have EM. The more medications patients were taking, either prescription or over-the-counter, the greater the likelihood of EM (P <.001). Similarly, there was increased likelihood of EM with increasing numbers of medical diagnoses. Gender, oral hygiene, and behavioral status were not found to be statistically significant in the presence of EM. CONCLUSION: Erythema migrans was found in the records of 3.8% of children in 2 clinical facilities in the Midwest. Also, increased prevalence was found among patients with multiple health conditions in conjunction with multiple medication use.

Dental caries and ear infections in preschool-aged children.

PURPOSE: The purpose of this case-control study was to assess the association between ear infection and dental caries. MATERIALS AND METHODS: The sample consisted of 126 children (range: two to five years) with no major medical problems or craniofacial anomalies. Ear infection history, demographic, dental, health and diet history of each child was determined using a questionnaire administered to the parent/guardian of the child. Dental charts were used to abstract dmft (decayed, missing and filled teeth) scores for children with dental caries (DC: dmft > or = 1) and without caries (NDC: dmft = 0), and oral hygiene index (OHI) scores. RESULTS: Chi-square analysis indicated no differences in ear infection history between the 71 DC and 55 NDC (past year: 35% vs. 40%; lifetime: 30% vs. 31%) children. However, there was a trend (p = 0.07) for the mean number of ear infections to be higher in DC versus the NDC group. Baby bottle use was highest among those who had both ear infection and caries. Multivariate regression model revealed that OHI scores, reason for dental visit, and frequency of visits were the best predictors of dmft scores. CONCLUSION: An association between dental caries and ear infection was not observed in this sample. Future investigations should explore common risk factors in increasing the risk of both diseases simultaneously.

Reexamining educational philosophy: the issue of professional responsibility, "Cleveland First".

This paper proposes a shift of emphasis in the dental curriculum from measures to protect and improve the oral health of individuals to measures to protect and improve the oral health of the community or society. This shift represents a fundamental change in educational philosophy of the dental school. To illustrate this shift in emphasis, this paper describes a demonstration project to test the feasibility of this approach involving all seventy first-year students in the Case Western Reserve University School of Dentistry in a four-week experience placing dental sealants in erupting molars of second and sixth graders in fifty schools of the Cleveland City School System. In future years, the program is expected to reach all second and sixth graders in the Cleveland School System. The experience is a required integral component of the curriculum, involving every student in the class, and is designed to make a demonstrable difference in oral health in the City of Cleveland. The experience is reinforced with course material on professional responsibility. The school is developing additional intensive experiences for second-, third-, and fourth-year classes involving smoking prevention for adolescents, oral health maintenance for nursing home residents, and dental care delivery in the inner city. The initial year of the program has had effects on students' responses to other elements of the first-year curriculum that go beyond the experience of placing sealants in children's teeth. The focused efforts of dental students every year are expected to have a measurable effect on the disparities in oral health found in the City of Cleveland as well as a measurable effect on dental students' and dentists' attitudes concerning professional responsibility.