Do occlusal contact detection products alter the occlusion?

Clinicians rely on occlusal contact detection products to identify high contacts and to equilibrate occlusions. Concerns about these products have stimulated numerous investigations into marking reproducibility, accuracy and interpretation, but none have looked at their effects on the occlusion itself. The aim of this study was to assess whether these products alter the occlusion that they purport to measure by determining whether there are differences in the forces and moments experienced by occluding teeth with and without their presence. A matched pair of IPN Portrait 33° molar denture teeth was placed into occlusion with the mandibular tooth supported by a load sensor and the maxillary tooth mounted onto a vertically sliding assembly with a total weight of 15·1N. The three-dimensional force and moment components on the mandibular tooth were measured when the teeth were in direct crown-crown contact (control) and with the products in place. All six products, (Accufilm I, Accufilm II, Hanel Articulating Silk, Rudischhauser Thick and Thin, and T-scan) showed significant (P<0·05) differences in forces and moments from control.

Implications of population growth on prevalence of diabetes. A look at the future.

The purpose of this study was to present projections of the future population of diabetes patients, to discuss policy implications of these projections, and to suggest ways that these projections might be made more useful to medical professionals. Under the assumption that the incidence of diabetes in four age-groups will remain constant in future years, previous estimates of the incidence of diabetes will be applied to Bureau of the Census population projections to project the number of new cases of diabetes that can be expected in future years in each of these age-groups. The prevalence of diabetes will remain relatively constant at approximately 1 million patients in younger populations (less than 45 yr old) through the middle of the next century. As the post-World War II baby boom ages, the number of older diabetes patients (45 and older) will almost double from 6.5 million in 1987 to an estimated 11.6 million in the year 2030. Although there is little doubt that the aging of the population will increase the number of diabetes patients, the assumption of constant incidence rates is a very limiting one. These projections would be more useful for the planning of research and training if the incidence of diabetes could be estimated for more refined categories of demographic and medical characteristics.

PIP: A 1987 US study cited the prevalence of diabetes as 26.8 patients/1000 population. Using the Census Bureau's population projections of these same age groups until the year 2050 based on their middle mortality assumptions, projections of the number of diabetes patients by age-group are obtained by multiplying with the prevalence rates. These projections indicate that the number of diabetes patients 25 years of age will remain almost constant in the next 1/2 century, whereas the number between 25 and 45 will decline from a high of 983,000 in 1995 to a low of 870,000 in 2040. The number of patients in the 45-64 age group is projected to rise from 2.4 million in 1990 to 4.1 million in 2015, i.e., about 69,000 additional patients/year for the next 25 years. Those aged or= 65 years with the highest prevalence are projected to increase by an average of 55,000 new patients/year. For the following period of 2015-35 this oldest group of patients is projected to increase by an average of 120,000 patients/year. This is under the overly pessimistic assumption that there will be no scientific or medical discoveries to reduce the prevalence of diabetes. There are some implications for the diabetes community if the population of patients increases by over 1 million in the next decade and by over 3.7 million by 2020. Although the number of diabetes patients 65 will grow steadily for the next 20 years, the highest growth rates will be in the 45-64 age group. This implies that the number of qualified professionals may have to be increased and more emphasis directed to initial diagnosis and treatment. After the year 2010, the rate of growth of diabetes patients age 65 or older can be expected to accelerate compared with other age groups. These projections stress the importance of prevention and education. The requisite change in life style, exercise, or nutrition habits will be more difficult than if a drug is developed for treatment.

Future issues in health economics: one view from Washington.

These are comments about how policy issues at the federal level may create a demand for research in several areas of health economics. As background, there is a discussion of the current federal budget situation and the cost-containment pressures this puts on public health programs. The longer-term problem of financing of the Medicare trust fund is also discussed. Four areas where new research may affect future health policy are identified: the market for physician's services, medical technology, competition in health care, and the market for health insurance.

What is today's price for health?

As medical technology gets better and better, healthcare costs get higher and higher. How can costs be controlled without compromising the quality of healthcare delivery? The problem is a financial one, not a technological one, and the Reagan administration believes that the solution lies in restoring incentives for cost control to the patient and the provider. It is time to take a stand against a creeping antitechnology bias and encourage the private sector to begin to shoulder the burden of its own problem.