Periodontal manifestations of collagen vascular disorders.

Chronic degeneration of connective tissue components can be produced by a variety of autoimmune mechanisms. The designations connective tissue disease and collagen-vascular disease are commonly used to describe such conditions when a patient exhibits chronic, immune-mediated deterioration of connective tissue structures in a systemic distribution. Recognized conditions that fit this definition include rheumatoid arthritis, lupus erythematosus, progressive systemic sclerosis, CREST syndrome, and mixed connective tissue disease. Several characteristic oral manifestations of these conditions are recognized. Xerostomia associated with any of these conditions in addition to dryness of the eyes is the definition of secondary Sjögren's syndrome. Fibrosis of facial skin and the resulting limited jaw opening are diagnostic features of progressive systemic sclerosis. Several periodontal manifestations are associated with these connective tissue disorders. Dramatic periodontal ligament space widening that is associated with some cases of progressive systemic sclerosis has been appreciated for more than five decades. However, it has been more recently reported that the majority of progressive systemic sclerosis patients exhibit at least subtle generalized periodontal ligament widening when intraoral radiographs are carefully evaluated. This finding is, however, of limited periodontal significance because the teeth are typically not mobile. Comparisons of periodontitis indices such as pocket depth between healthy subjects and patients with progressive systemic sclerosis do not reveal significant differences (21). In addition, recent evidence suggests a tendency for more severe or progressive manifestations of periodontitis as a consequence of xerostomia that may result from these diseases.

Differential diagnosis of oral enlargements in children.

The purpose of this article is to review soft tissue and bony enlargements that typically occur in the oral and perioral region of children. In order to organize these lesions into a thorough but comprehensible format, the principles of differential diagnosis must be used. All oral enlargements are broadly classified as soft tissue or bony abnormalities. Determination of the specific lesion category is based primarily on a prominent feature that demonstrates the nature of the lesion, followed by the secondary clinical features and any contributory patient information. Classification of exophytic soft tissue entities includes: papillary surface enlargements, acute inflammatory enlargements, reactive hyperplasias, benign submucosal cysts and neoplasms, and aggressive and malignant neoplasms. Bony enlargements of the maxilla and mandible are divided into three categories: inflammatory lesions, benign cystic and neoplastic lesions, and aggressive and malignant lesions. This extensive topic is summarized on flow charts for easy reference with emphasis on grouping together lesions with common characteristics.

Ethnicity, location, age, and fluoridation factors in baby bottle tooth decay and caries prevalence of Head Start children.

Baby bottle tooth decay (BBTD) is a term applied to a specific form of rampant decay associated with inappropriate bottle or breast feeding of infants and young children. Although the prevalence of BBTD has been studied in individual ethnic groups, comparison studies are rare. Head Start children have frequently served as study subjects for assessing the prevalence of BBTD. The purpose of this study was to compare BBTD and caries prevalence among Head Start children who are members of four ethnic groups in five southwestern States. Age, residence, and fluoridation status were also compared for the total sample and ethnic categories. The sampling process was a stratified random site selection; it was used to obtain data on 1,230 children. This number constituted 3 percent of the children enrolled in Head Start in Public Health Service Region VI (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas) where the study was conducted. The criterion for determining the presence of BBTD was based on the number of carious deciduous maxillary incisors observed. The severity of the condition was reported as two of four and three of four of the target teeth affected. Thus, two levels of severity are reported. BBTD was prevalent in approximately 24 percent and 15 percent of the total sample, depending on the severity criterion used. Native American children had a significantly higher (P less than 0.05) prevalence than Hispanic, white, and black subjects. Rural children had significantly higher (P less than 0.05) prevalence of BBTD than nonrural children for all ethnic groups except whites. The prevalence of decayed and filled (df) surfaces of primary dentition was significantly greater for all rural than for non rural groups (P< 0.05).Children attending centers showed no significant differences based on fluoride status for the total sample or other variables. BBTD and caries prevalence increased with age. Studies are needed to identify predisposing factors among the ethnic groups and residence status in order for more effective preventive regimens to be developed, implemented,and evaluated.

Dental care utilization among dental students.

The purpose of this study was to determine the proportion of needed dental care actually received by dental students during their dental education. This was accomplished by a review of dental records for recent Baylor College of Dentistry graduates. Collected data included restorative, periodontal, endodontic and extraction procedures planned and dental care actually accomplished prior to graduation. Comparisons of these findings were made based on gender, ethnicity and academic standing of the sample subjects. The sample size of 134 included 98 males and 36 females; 111 were Caucasian and 23 Minorities. Fifty-six individuals were in the upper academic third of their class, 37 in the middle third and 41 in the lower third. The treatments required were primarily operative dental restorations (7.28 +/- 7.19 surfaces per student), crowns (0.43 +/- 1.22 units per student) and extractions (0.90 +/- 1.58 per student). Periodontal and endodontic needs were minimal. Students received approximately 60% of the required care during their dental education. Minimal relationships were identified between gender, academic standing and ethnicity and the students' care needs and treatments. The results suggest a relatively low priority for receiving needed dental care among dental students.

Treatment of an oroantral fistula with chronic sinusitis: a case report.

A patient with an oroantral fistula of seventeen years' duration presented clinically complaining of symptoms suggesting recurring episodes of acute maxillary sinusitis. After control of the acute sinusitis, the defect was repaired using a buccal flap procedure and the sinus was enucleated via a Caldwell-Luc approach. The sinus contents included what appeared to be a chicken bone. The patient healed uneventfully. A discussion of the management of chronic oroantral fistulas and a case report are presented.

Identification of lead sources in California children using the stable isotope ratio technique.

Two case studies are presented which apply the lead isotope ratio method to the identification of lead sources in 12 Oakland, California children. One study examined lead sources in 10 children, ages 3 to 15 yr, living together as an extended family in dilapidated housing close to a busy freeway. Eight children had elevated blood lead levels (greater than or equal to 30 micrograms/dl) and 6 children also had elevated erythrocyte protoporphyrin levels (greater than or equal to 50 micrograms/dl). A second case study examined 2-yr-old male twins, both with elevated blood lead and erythrocyte protoporphyrin levels, living in a modest, but well maintained inner city duplex apartment. Paint and surface soil samples collected in and around both households had high lead concentrations. Paint concentrations ranged from 2.9 to 273 mg/g and surface soil concentrations from 0.48 to 7.1 mg/g. The isotopic ratios of lead in the blood of these children were close to the average lead ratios of paints from exterior walls and to the lead ratios of surface soils in adjacent areas where the children played. In both case studies, the data suggest that the lead in the soil was derived mainly from weathering of lead-based exterior paints and that the lead-contaminated soil was a proximate source of lead in the blood of the children.

The identification and elimination of a potential lead hazard in an urban park.

During development of a park in Oakland, California, a potential public helath hazard due to lead in the soil (approximately 1,000 to 100,000 ppm) was identified through cooperative sampling and analysis efforts of the staffs at the county and state health departments. Analysis of samples collected at various locations and depths in the park, coupled with a three-dimensional model of the lead values obtained, indicated steps necessary to eliminate the hazard. The county undertook the abatement program, and with the elimination of the health hazard, the park development has been completed. Concomitant blood lead screening of neighborhood children failed to establish the park as a source of elevated lead in any of the children tested.