Trends in oral health in the aging population.

Increased survival of the natural dentition, persistence of periodontal disease, deterioration of prior dental restorations, root surface caries, and continued incidence of oral cancer represent a complex of emerging oral health problems of the aged in the United States. Additional data on the epidemiology of oral mucous membrane syndromes will help to characterize the prevalence of these diseases in the aging population as well. Improvement in the utilization and accessibility of dental services by the aging cohorts will contribute to the prevention of oral disease in the future. Combined with the substantial growth in the size of this cohort of the population and alterations in the prevalence of these oral health status indicators, changes in the need for and projected utilization of professional oral health services can continue to be anticipated. Clinical research directed toward assessment of efficacy of treatment modalities for prevention of dental disease and maintenance of dental health are essential for the projection of dental health manpower needs for the future. This should also lead to the development of appropriate academic and training programs to meet the changing needs of the elderly.

Achieving health outcomes through professional dental care: comparing the cost of dental treatment for children in three practice modes.

The search for effective strategies to deal with prevention and treatment of oral disease focuses on children as a natural target population. This article reports data on the comparative costs of delivering dental care to children via (1) a school-based practice using Expanded Function Dental Auxiliaries, (2) a school-based practice without EFDAs, and (3) a group of unrelated private dental practices operating independent of the school system. Utilization of a dentist's services varied significantly between the children assigned to private care and those assigned to the school-based programs, but it cost less per patient to provide dental treatment through the private practitioners. If school-based practices are clearly more effective in reducing dental disease, in the long run the need for manpower and resources in these programs might be lowered to a point where they will become more cost-effective than private practices. If the two delivery modes are equally effective in reducing dental disease, however, results from the study indicate that private practices are more cost-effective and will probably maintain their cost-effective advantage over school-based programs.

Neurophysiological and neuropsychological function in mercury-exposed dentists.

In a study of the relation between cumulative exposure to mercury and chronic health impairment 298 dentists had their mercury levels measured by an X-ray fluorescence technique. Electrodiagnostic and neuropsychological findings in the dentists with more than 20 micrograms/g tissue mercury levels were compared with those of a control group consisting of dentists with no detectable mercury levels. 30% of the 23 high mercury dentists had polyneuropathies. No polyneuropathies were detected in the control group. The high mercury group had mild visuographic dysfunction; they also had more symptom-distress than did the control group. These findings suggest that the use of mercury as a restorative material is a health risk for dentists.

Loss of periodontal attachment in adolescents.

Loss of attachment as measured by a portion of Ramfjord's Index (PDI) was determined in 383, 12-16-year-old schoolchildren in rural Juniata County, PA. Prevalence and distributions were tabulated for sex, last dental visit, and type of treatment received. Dental knowledge test scores, toothbrushing effectiveness periodontal status and oral cleanliness were determined at annual intervals from Spring '75 to Spring'79. Mean scores were contrasted with bone loss measurements. 47.3% had loss of attachment (greater than 1 mm) including 24.5% with 2mm or more of attachment loss per mouth. Females (41.0%) ahd significantly lower prevalence rates than males (52.7%). Students who visited a dentist in the last 6 months and who received scaling had less bone loss, lower GI, PII, PI, and QHI scores. An inverse relationship was found between dental knowledge and the other variables measured. Similar patterns were seen with high, medium and low bone loss groups. Many variables in this study were associated with bone loss, including: plaque, dental knowledge, dental behavior (toothbrushing and visiting a dental clinic), recent treatment received and sex. None appeared more significant than the others.

The inheritance of recurrent aphthous stomatitis. Observations on susceptibility.

In an effort to determine the prevalence of recurrent aphthous stomatitis (RAS), 1,303 children from 530 families were interviewed. While over-all disease prevalence in the children was 39.2 percent, there was a sharp difference in those children younger than 5 years (19.7 percent) and those 5 years of age and older (48.3 percent). Moreover, the prevalence of the disease in the children was significantly affected by whether RAS was present in none, one, or both of the parents. These observations suggest that disease susceptibility may be a complex interaction between host and environment.

Atypical nuclear structures in the buccal mucosal cells of the rhesus monkey.

During evaluation of cytologic buccal samples obtained from nine female rhesus monkeys over a period corresponding to three menstrual cycles, unusual nuclear changes were observed in the exfoliated cells. The changes ranged from small nuclear protrusions to bi-lobed and multi-lobed structures.

Effect of levamisole on the incidence and prevalence of recurrent aphthous stomatitis. A double-blind clinical trial.

Twenty patients with severe recurrent aphthous stomatitis were treated with a new drug, levamisole, to determine its effects upon the incidence and prevalence of recurrent aphthous stomatitis. The trial, conducted in a non-crossover, double-blind fashion, did not demonstrate any statistically significant differences when levamisole and placebo groups were compared over time either in the number of ulcers, number of ulcer-days, mean duration of ulcers, or mean number of ulcers per day. Positive subjective results were experienced by the 10 patients receiving levamisole but these were not of sufficient magnitude to affect group mean differences.

A retrospective study of recurrent herpes labialis (RHL) in a professional population, 1958-1971.

A retrospective 12-year investigation of 1,788 professional school students from the schools of medicine, veterinary medicine, dental medicine, nursing, and dental hygiene was conducted by the mailed distribution of questionnaires requesting information on current and prior disease history of recurrent herpes labialis (RHL). Because of changes in address, death, loss of married names, and unwillingness to participate in the investigation, only 683 proband subjects were available for the follow-up study. The data suggested a trend toward a decrease in the prevalence and severity of RHL during the interval of study: only slightly more than one firth (23.9 per cent) of the proband population of the present study experienced RHL as compared with almost two fifths (39.6 per cent) at the time when they were students.

Inheritance patterns in recurrent aphthous ulcers: twin and pedigree data.

Nineteen sets of twins and 318 individuals from six families were examined and interviewed in order to ascertain whether a genetic component could be established for recurrent aphthous ulcers (RAU). While no specific mode of inheritance could be established, the data strongly support the hypothesis of a genetic factor involved in susceptibility to the disease.

A retrospective study of the prevalence and incidence of recurrent aphthous ulcers in a professional population, 1958-1971.

A 12-year retrospective investigation of 1,788 professional school students from the University of Pennsylvania was conducted. Because of changes in profession, location, marital status, and names, only 651 proband subjected were available for the follow-up investigation. Techniques of subjective evaluation of disease status (mailed schedules describing disease and color photographs) were used in making an assessment of RAU, including both current disease and histories of prior disease. The data presented suggested a trend toward decreased RAU prevalence and severity among physicians, dentists, veterinarians, and nurses as compared with 12 years previously when they were professional school students. The prevalence rate, however, was still very high, indicating that 48.3 per cent of the men and 57.2 per cent of the women had RAU at the time. It has been suggested that the student years may represent the highest levels of RAU and that special features of the life patterns of the student favor disease expression; the data from study support this hypothesis, since reduction in severity was observed in all groups.