Trends in urban violence: a comparison of accident department and police records.

Police crime statistics and crime survey data are known to be poor indicators of levels of violence in society. Longitudinal investigations of assault injury have not been carried out in accident and emergency departments hitherto, but may provide an accurate perspective of trends in violence. The attendance of assault patients at a city centre accident and emergency department was compared with 'wounding against the person' recorded by the police between 1973 and 1990. Woundings recorded by the police increased consistently throughout the study period whereas the number of assault patients did not increase between 1977 and 1987. From 1975 to 1990, police statistics showed a 9-fold and accident and emergency data a 6-fold increase. Both data sets showed substantial overall increases in violence after 1987, and a decrease in 1979. Further epidemiological studies of violence are necessary.

A study of the comparative efficacy of four common analgesics in the control of postsurgical dental pain.

Four common oral analgesics were tested in a single-blind trial to determine their relative efficacy in the management of postsurgical pain in 103 patients who had their impacted third molars surgically removed under general anesthesia. The analgesics tested were acetylsalicylic acid (26 patients), ibuprofen (26 patients), a paracetamol/codeine/caffeine combination (Solpadeine) (25 patients), and dihydrocodeine (26 patients). The paracetamol/codeine/caffeine combination, ibuprofen, and acetylsalicylic acid preparations produced equally effective analgesia. Dihydrocodeine was found to be a poor analgesic in this pain model. There were no adverse reactions to any of the preparations.

Roots of urban violence.

Alcohol consumption and dependence, employment status, social and family history and history of previous violence in 49 patients injured in city-centre violence were compared with that in 49 paired, age and sex matched control individuals in a major accident and emergency department. All control individuals had been in the same locations as the patients at the time of injury. Alcohol consumption was recorded in units and dependence was assessed by means of the CAGE questionnaire. Patients had consumed significantly more alcohol in the 6 h before injury (mean consumption: 9 units/controls 7.1 units) and had been involved in more previous violence (mean number of incidents in previous 5 years: 4.3/controls: 1.5 incidents). In comparison with controls, male patients tended to be single rather than married (P = 0.051), to have lost a parent (P = 0.058) and to feel guilty about their alcohol consumption (P = 0.068). These results indicate that in relation to young adults, injury in urban violence was associated with excessive binge-alcohol consumption, but not with alcohol dependence, unemployment at the time of violence or socio-economic group.

Simulation of natural enamel caries in vitro with methylcellulose acid gels: effect of addition of calcium and phosphate ions.

A modified acid gel technique for producing caries-like lesions in dental enamel has been developed. The decalcifying medium consists of a 10% (w/v) methylcellulose gel acidified with 0.1 M lactic acid-sodium lactate at pH 4.5 and having a hydroxyapatite content of 0.05% (w/v). This medium can produce caries-like lesions in vitro at a slow rate, which are indistinguishable from natural enamel caries when examined by polarised light microscopy and contact microradiography.

Careers of dentists undertaking a medical qualification.

The careers of doubly-qualified dentists have been re-examined, 12 years after the report by Henderson, Liversedge and James (1977). Three groups of medically qualified dentists were analysed. (a) those qualifying before 1960; (b) those qualifying between 1960 and 1975; (c) those qualifying since 1975. An increased proportion of those embarking on a medical qualification fail to return to a dental career, despite a stated intention to do so. There appears to be a 'wastage' to dentistry of approximately 40% of those dentists who subsequently obtain a medical qualification. Of those who do return, most practice hospital specialties at consultant level.

Antimicrobial prophylaxis of infective endocarditis: effect of BSAC recommendations on compliance in general practice.

General dental practitioners in the South West Region of the U.K. were surveyed to assess compliance with the recently published recommendations of the British Society for Antimicrobial Chemotherapy on the antimicrobial prophylaxis of infective endocarditis. For the majority of dental patients, the level of prophylaxis had improved compared with previous reports: 75% of practitioners organized the prophylaxis themselves, 80% gave oral amoxycillin to penicillin non-allergic patients, and 86% gave erythromycin to penicillin-allergic patients. Some 51% complied to an acceptable level with recommended amoxycillin schedules but only 2% complied with erythromycin schedules. The BSAC recommended prophylactic regimens have certainly improved compliance although they are not yet universally accepted.

Clinical evaluation of benzydamine, chlorhexidine, and placebo mouthwashes in the management of recurrent aphthous stomatitis.

Eighteen patients with minor recurrent aphthous stomatitis were given alcoholic benzydamine hydrochloride, aqueous chlorhexidine, or a benzydamine-free placebo mouthwash in random order. Each patient used each preparation for a 3-month period. Ulcer diaries were marked at the same time each week during the 9-month test period. Records were made of the number, size, sites, and pain severity of any ulcers present. Statistical analysis of the results showed no significant differences between any of the treatments tested. Stinging of the oral mucosa was the only consistent side effects noted by nine patients using benzydamine, nine patients using placebo, and three patients using chlorhexidine. Eight patients stated a personal preference for benzydamine because of the transient local anesthetic effect of benzydamine, which gave pain relief.

Sources and patterns of referrals of oral cancer: role of general practitioners.

Referrals of patients with oral squamous cell carcinomas to an oral medicine clinic were assessed with regard to the sources, delays, and pattern of referrals from general medical practitioners and general dental practitioners. Slightly more patients were referred by dental practitioners than by medical practitioners, but general medical practitioners were far more likely to see advanced tumours and to request an urgent second opinion or suggest a diagnosis of malignant disease. The greatest delay overall was caused by the patients in seeking advice from their practitioner, particularly those who attended a general medical practitioner. Both groups of practitioners requested a hospital opinion within roughly a month--a reasonable interval. Subsequent delays were minimal. Delays occur mainly because the patients are slow in seeking professional advice and, in general, do not appear to have been reduced over the decade since a previous British study on referral patterns was carried out. This study emphasises the importance of educating patients about oral cancer since it is they who appear to be mainly responsible for the delays in diagnosis. The results also help to dispel the myth that general medical practitioners might be less competent at diagnosis and referral of patients with oral cancer than are dental practitioners, though we are aware of misdiagnoses from both groups.

A model for the production of artificial caries in the mouth in man.

Sixteen blocks of enamel were sliced from the buccal surfaces of caries-free human premolars and mounted in an appliance worn in the mouth by one individual for 6 months. Eight of the blocks were arranged in pairs with buccal surfaces in contact. The other eight were not in contact but were able to accumulate plaque by being recessed in the appliance. Lesions formed in all specimens, the depths of which were measured in ground sections; around contact surfaces, these formed at only half the rate of those not in contact. Histologically, lesions on contact surfaces were similar to natural lesions, but the shape of the artificially-induced lesions was greatly influenced by the curvature of the buccal enamel.

The amount and distribution of sclerotic human root dentine.

In low-power photomicrographs of ground sections of canine teeth, the amount of sclerosis increased with age linearly and was not markedly affected by the function of the tooth or external stimuli encountered during life. The pattern of distribution was similar in all teeth. Sclerosis started in the apical dentine adjacent to the cementum and extended coronally and towards the root canal, with increasing age. In the plane transverse to the long axis of the root, sclerosis appeared first at the mesial and distal sides so that the sclerotic zones formed a butterfly shape.

The histology of sclerotic human root dentine.

Studies by optical microscopy, microradiography and SEM suggested that sclerosis is the result of occlusion of the dentinal tubules by a mineral substance with a refractive index similar to that of the rest of the dentine. Translucence appeared before the majority of the tubules were completely occluded. The deposition of the occluding mineral took place initially in individual tubules or in groups of tubules. The occluding material and the peritubular dentine were almost indistinguishable under SEM. Both were smooth and densely mineralized. The process of deposition of occluding mineral appeared to be more like that of in-vitro mineralization and thus different from that of peritubular dentine.

Continuous eruption of some adult human teeth of ancient populations.

It has been argued that the teeth maintain a potential for eruption throughout life and that eruption takes place whenever an opportunity occurs. Thus continuous, active eruption would be expected when the occlusal surfaces of the teeth have been affected by severe attrition. Radiographs of teeth and jaws of adult skulls with marked attrition from the Romano-British, Anglo-Saxon and Mediaeval periods were measured using the inferior alveolar canal (IAC) as a reference structure. Statistical analysis of the measurements from 164 of the specimens showed that the worn occlusal surfaces (OS) maintained a more or less constant distance from the IAC with age, and the distance from the IAC to the cemento-enamel junction increased continuously. Likewise, the distance from the IAC to the alveolar bone crest (AC) and the distance OS-AC remained almost constant. In most groups there was a slow, continuous deposition of bone at the lower border of the mandible which could account for the increased face height of older individuals. Hence continuous eruption occurs at least up to about 45 years providing that there is inter-occlusal space available into which the teeth may erupt; furthermore, there is potential for eruption whether or not attrition occurs in all human adults at a similar age.