Relationship of degenerative changes of the temporomandibular joint (TMJ) with the angle of eminentia.

The purposes of this study were threefold: (i) to assess the degenerative changes of the temporomandibular joint [TMJ (condyles and articular eminence of the glenoid fossa)], (ii) to determine whether the TMJ degeneration levels differ by ethnic group and gender and (iii) to assess the association between the angles of eminentia and TMJ degeneration, while controlling for gender, ethnicity, age and number of teeth. The sample included 245 20th century dry skulls: 130 African-American (82 male and 48 female) and 115 European-American (75 male and 40 female), with a mean age of 46.4 +/- 19.9 years. The angles of eminentia were measured in a sagittal plane. The medial, central and lateral portions of the articular slope and anterior portion of the condyle were assessed for degenerative changes. Degeneration scores were calculated for the eminentia and condyles. Statistical analyses included two-way anovas, Pearson's correlation coefficients and linear regression models. There were differences in the degree of TMJ degeneration of the African-American and European-American males and females. European-American females retained fewer teeth, had the highest TMJ degeneration scores and exhibited significant relationships between the eminentia angles and degeneration. When the independent variables were entered into the regression model, only the degeneration of the eminentia was significantly associated with the angles of eminentia. Although the degeneration of the eminentia explained some of the variation of the eminentia angles, it is clear that the inclusion of multiple factors is essential to study the remodelling of the glenoid fossa.

Asymmetry of the articular eminence in dentate and partially edentulous populations.

The purpose of this study was to assess the degree of right-left asymmetry of the glenoid fossa. The specific aims were (1) to determine whether there were relationships between age, number of teeth, slope of the articular eminence, fossa depth, and the degree of right-left asymmetry, and (2) to compare the right-left asymmetry of two populations, one characterized by an acceptable occlusion (A-Occ), the other by an unacceptable occlusion (partially edentulous; Un-Occ). A-Occ was defined as possessing a minimum of 28 teeth that would allow for hand articulation of the mandibular teeth to the maxillary teeth. Un-Occ had fewer than 17 teeth, which would make it impossible to articulate the mandible with the maxilla. The sample included 20th century dry skulls: 70 African-American (44 male, 26 female) and 64 European-American (49 male, 15 female), ranging in age from 21-105 (mean 47.1 +/- 19.9). The medial (M), central (C), and lateral (Lat) aspects of the right (R) and left (L) slopes of the articular eminence were measured in a sagittal plane. The R and L fossa depth also were measured. The raw absolute differences IR-LI and relative differences [IR-LI/IR+Llx100] of the articular slope angles (M, C, and Lat) and fossa depths were computed. Statistical analysis included paired t-tests, independent t-tests, and Pearson's correlation coefficients, significance at p < or = 0.05. Ninety percent (90%) of the population exhibited right-left asymmetry of the glenoid fossa. The right articular slopes (M, C, and Lat) were significantly steeper than the left articular slopes; the right fossa depths were significantly deeper than the left. There generally were no differences in the articular slope steepness or fossa depths between the partially dentate and the dentate, nor were there statistical differences between the two groups in the raw absolute differences or relative differences of the M, C, and Lat slopes or fossa depths. No significant relationships were found between right-left asymmetry, age, or number of teeth. With only 10% of the subjects exhibiting symmetry of the glenoid fossa depths or articular slope angles, clinicians should consider bilateral asymmetry the norm and not an anomaly.

US drinking water: fluoridation knowledge level of water plant operators.

OBJECTIVES: We determined the knowledge level of water plant operators who fluoridate drinking water, and we compared small and large water plants. METHODS: A pretested survey was sent to 2,381 water plant operators in 12 states that adjust the fluoride concentration of drinking water. A z-test for proportion was used to test for statistical difference between small and large plants at alpha = 0.05. Small water plants were those treating less than 1 million gallons of water daily. RESULTS: Eight hundred small and 480 large water plant operators responded, resulting in a response rate of 54 percent. Two-thirds of water plant operators correctly identified the optimal fluoride level, but more than 20 percent used a poor source for choosing the optimal level. Only one-fourth of operators were able to maintain the fluoride concentration to within 0.1 mg/L of the optimal concentration. A significantly greater proportion of operators at large water plants than at small water plants reported that they were able to maintain a fluoride concentration to within 0.1 mg/L of the optimal concentration (33.5% vs 21.3%, z = 4.74, P < .05). CONCLUSIONS: Although most operators correctly identified the optimal fluoride level, small water plant operators were less likely to use accurate reasoning for choosing that level and in maintaining fluoride concentrations within 0.1 mg/L of that level than large water plant operators.

Prevalence and risk factors of hand problems and carpal tunnel syndrome among dental hygienists.

PURPOSE: Recent research indicates a growing presence of hand problems and carpal tunnel syndrome (CTS) in dental professionals, especially among dental hygienists. This study was designed to determine the prevalence of hand problems and CTS among dental hygienists and identify risk factors for these conditions. METHODS: As part of a study that surveyed more than 5,000 army dental personnel, 177 dental hygienists were analyzed in great detail. Because of the magnitude of the overall study, which included all types of dental professionals, it was not only possible to identify the prevalence and risk factors of hand problems and CTS affecting dental hygienists, but also the prevalence rates as compared to other dental personnel. RESULTS: While the overall response rate for all dental personnel was 81%, dental hygienists responded at nearly 92%. Seventy-five percent of dental hygienists reported having hand problems, and 56% exhibited probable or classic symptoms of CTS. By logistic regression, the data revealed that dental hygienists whose practice comprised a majority (> 50%) of patients with heavy calculus were 2.3 times more likely to develop hand problems than those treating fewer patients with heavy calculus. Those who had practiced more than 10 years were also 1.9 times more likely to manifest symptoms associated with CTS than those with fewer years in the profession. CONCLUSION: The prevalence of hand problems and CTS among dental hygienists was the highest among army dental personnel, with the exception of dental therapy assistants. Risk factors for both hand problems and CTS are multifactorial, and dental hygienists should be particularly aware of those factors that can be prevented.

Musculoskeletal pain: prevalence, prevention, and differences among dental office personnel.

Data regarding the presence and specific region of musculoskeletal pain were collected as part of a study that surveyed more than 5,000 dental personnel, dentists, and dental auxiliaries. The magnitude of the overall study, which included all types of dental professionals, made possible identification of the prevalence of musculoskeletal pain and comparison of regions of pain among the different dental professionals.

Carpal tunnel syndrome: effect on Army dental personnel.

The purpose of this study was 2-fold: (1) to determine the prevalence of hand problems, in particular carpal tunnel syndrome (CTS), among Army dental personnel; and (2) to identify dental professionals at risk. A 12-page survey was mailed to all U.S. Army military and civilian dental personnel. Of the 6,320 surveys mailed, 80.9% were returned completed. An analysis was performed identifying the prevalence of hand problems and CTS and noting differences between civilian and military dental personnel. Of the 5,115 surveys analyzed, 44.8% indicated hand problems and 25.4% were determined to indicate a high probability of CTS. Of the 18 dental job specialties, dental therapy assistants and dental hygienists had the highest prevalence of CTS, 73% and 57%, respectively. Army dental personnel are at greater risk of developing CTS than the general public, especially civilian dental personnel, who were female, older, and employed longer.

Fluoride and bacterial content of bottled water vs tap water.

CONTEXT: Bottled water has become a status symbol and is frequently used in place of tap water. While both waters are considered safe to drink, is either more beneficial in preventing tooth decay and is there a difference in purity? OBJECTIVE: To determine the fluoride level and bacterial content of commercially bottled waters municipal tap water and to compare the results. DESIGN: Comparative study. SETTING: Cleveland, Ohio. SAMPLE: Fifty-seven samples of 5 categories of bottled waters were purchased from local stores. Samples of tap water were collected in sterile containers from the 4 local water processing plants. Fluoride levels were determined by an ion-selective electrode method. Water was cultured quantitatively and levels of bacteria were calculated as colony-forming units (CFUs) per milliliter. MAIN OUTCOME MEASURE: Fluoride levels and bacterial counts. RESULTS: Fluoride levels within the range recommended for drinking water by the Ohio Environmental Protection Agency, Cincinnati, 0.80 to 1.30 mg/L, were found in only 3 samples of bottled water tested. The fluoride levels of tap water samples were within 0.04 mg/L of the optimal fluoride level of 1.00 mg/L. The bacterial counts in the bottled water samples ranged from less than 0.01 CFU/mL to 4900 CFUs/mL, including 6 samples with levels substantially above 1000 CFUs/mL. In contrast, bacterial counts in samples of tap water ranged from 0.2 to 2.7 CFUs/mL. CONCLUSIONS: Five percent of the bottled water purchased in Cleveland fell within the required fluoride range recommended by the state, compared with 100% of the tap water samples, all of which were also within 0.04 mg/L of the optimal fluoride level of 1.00 mg/L. Use of bottled water based on the assumption of purity can be misguided. Recently, the Environmental Protection Agency, Washington, DC, published a final ruling that requires community water systems to regularly report to the public on the quality of local tap water; there are no similar proposals to determine the quality of bottled water through labeling.

Prevalence of elevated blood pressure in students attending a college oral health program.

Physical evaluation of dental patients prior to treatment can reveal signs and symptoms of diagnosed and undiagnosed disease. This cross-sectional study examined the prevalence of elevated blood pressure readings in a group of college students attending an annual oral health program. The data were collected at the annual session on one day in three consecutive years. While the risk of hypertension increases with age, unless the blood pressure is recorded in all adult patients, a significant number of occult high blood pressure readings may go undetected. Since untreated hypertension can cause morbidity and mortality in some patients, the recording of the blood pressure for all adult patients is indicated. The results of this study revealed that 56 of 416 (13.4%) college students with recorded blood pressure values had elevated blood pressure readings within the ranges of mild to severe elevations. Male gender was associated with elevated readings (x2 = 18.57, p < 0.001). Self-reported high blood pressure was associated with age differences, current care by a physician, and medication use. Routine recording of blood pressure is essential for the comprehensive evaluation of adult dental patients, regardless of age. Inconsistent application of physical evaluation principles based on age and disease-related abnormalities may exclude younger individuals at risk for occult disease and associated morbidity. Screening for blood pressure elevation, even in younger adult groups not usually associated with hypertensive disease, can Identify individuals needing further medical evaluation.

Public perception of DDS versus DMD degrees.

There are currently two degrees awarded to dental graduates from U.S. dental schools. The aim of this study was two-fold: (1) to determine the level of confusion among lay personnel concerning these degrees and (2) to identify and explore any basis for any public opinion. Five hundred and twenty-four lay persons were interviewed in Cleveland and the surrounding area. Chi-square analyses were employed to determine the effects of gender, frequency of dental visits, types of dental insurance, education level, age, income, and race on public perception of the DDS and DMD degrees. Fewer than 20% of those interviewed knew that a DDS and DMD received the same level of training. Of those who indicated there was a difference in training, 69% felt that DMDs had more training than DDSs. Since the majority of lay persons were confused about the two degrees, the establishment of one unified dental degree may contribute to a better public understanding of the education and capabilities of dentists.

Prevalence and implications of accessory retromolar foramina in clinical dentistry.

The occurrence of retromolar foramina (RMF) was examined in a sample of dry skulls (African American n = 249; Causcasian n = 226) to consider the potential clinical impact. A prevalence rate of 7.8% of RMF was found. There were no statistical differences based on race or gender. The prevalence may contribute to the explanation of a portion of inferior alveolar nerve block failures and provide insight into potential implications of surgery in the posterior mandible.

Parents' satisfaction with children's tooth color: fluorosis as a contributing factor.

The authors surveyed parents of 708 patients in a pediatric dental practice about their satisfaction with the color of their children's teeth and factors associated with their level of satisfaction. Overall, 43 percent of parents were dissatisfied with their children's tooth color, and 78 percent of children had a Tooth Surface Index of Fluorosis, or TSIF, score greater than 0. The worst TSIF score was the only factor associated with parent satisfaction.

The average daily dose of fluoride: a model based on fluid consumption.

The quantity of fluoride needed to prevent caries but avoid dental fluorosis is unknown. To estimate the desired daily dose of fluoride, we analyzed fluid consumption data from a stratified random sample of 7,345 children studied during the 1977-78 US Department of Agriculture Nationwide Food Consumption Survey and applied it to Dean's observations of optimally fluoridated communities in the 1940s. The average daily fluoride intake per kilogram body weight from optimally fluoridated tap water was highest (0.080 mg/kg/d) from 7 to 9 months of age, and declined linearly to 0.034 mg/kg/d at 12.5 to 13 years of age. The mean was 0.068 +/- 0.008 mg/kg/d from birth to age 7 years, and 0.042 +/- 0.006 mg/kg/d from age 7 to 13 years. The American Academy of Pediatrics supplementation schedule delivers fluoride dosage rates that are below our findings of the average daily dose of fluoride after the third month of life, although the two curves are within 0.006-0.013 mg/kg/d from 3 months to 16 years of age. While supplementation alone does not exceed the average daily dose of fluoride, the cumulative effects of fluoride from tap water, processed foods, ingested toothpaste, and dental treatments after the third birthday should be evaluated for their role in the increased prevalence of fluorosis.

The prevalence and risk factors of fluorosis among patients in a pediatric dental practice.

Seven hundred eight patients aged 5-19 years in a pediatric practice in North Carolina were selected using a random-start, systematic sampling procedure and enrolled in a case control study to determine risks for fluorosis. Subjects were examined by four trained examiners using the Tooth Surface Index of Fluorosis (TSIF). Information on fluoride exposures and other explanatory variables was obtained through parent interviews and mail questionnaires. Fluoride exposure was confirmed by fluoride assay of community drinking water samples. Bivariate associations for the entire sample were tested using MH chi2 statistic. A secondary analysis controlling for fluoride in drinking water was performed using logistic regression for 233 subjects (116 drinking fluoridated water; 117 drinking fluoride-deficient water) who were lifetime residents at the same address. Nearly 78% of subjects had a TSIF score of > 0; 36.3% > 1; and 18.9% > 2. Twenty-two variables found in bivariate analyses (P < 0.15) to be associated with fluorosis were included in multivariate analyses. For subjects drinking fluoride-deficient water, fluorosis (1 or more positive TSIF scores) was associated with dietary fluoride supplement frequency (OR = 6.5) and age of the child when brushing was initiated (OR = 3.0). For subjects drinking fluoridated water, fluorosis was associated with age of child when brushing was initiated (OR = 3.1).

Treatment needs and treatment time for soldiers in dental fitness class 2.

A systematic random sample of 962 dental records of soldiers in class 2 was reviewed by six general dentists and their estimates of periodontal and non-periodontal treatment time were recorded. The majority (88.9%) required some treatment. Periodontal treatment time ranged from 0 to 18 hours with a median and mode of 0 hours, a mean of 1.18 hours, and a standard deviation of 2.96 hours. Non-periodontal treatment time ranged from 0 to 58 hours with a median of 3 hours, a mode of 0 hours, a mean of 4.51 hours, and a standard deviation of 5.11 hours. When consultation time is included, the total time was 5.89 hours per soldier.

A comparison of dental fitness classification using different class 3 criteria.

Examinations were performed on 585 Army Reserve Component soldiers during their 2-week Annual Training at Fort Pickett, Virginia, from June through September 1991. Of the 585 soldiers examined, 338 (57.8%) were in class 3 using the current DoD criteria, while 272 (46.5%) were in class 3 using the previous criteria. Of 585 paired examinations, there was agreement between the two systems in 531 (90.8%) examinations. Over 96% of the disagreement represented patients put in class 2 under the old system who were put in class 3 under the new system. In the aggregate, there were 19.3% more soldiers put into class 3 under the new system. The major source of this difference was partially erupted or pericoronally involved third molars. The increase in the class 3 proportion is due to the lack of operational criteria in the old system. Data collected under the current system provide more detailed information for administrative epidemiologic purposes. Because of the additional clinical guidelines under the current DoD criteria, the inevitable differences should be considered when pre- and post-DoD instruction dental fitness classification data are compared for a population.