Should physicians screen for oral disease? A physical examination study of the oral cavity.

OBJECTIVE: To assess how well primary care clinicians select patients needing early referral to a dentist based on an oral cavity examination. DESIGN: Prospective comparison of the screening oral cavity examinations performed by primary care clinicians with that performed by a dentist. SETTING: General medicine clinic and dental clinic of a Veterans Affairs Medical Center. PATIENTS: A sample of 86 consecutive patients attending regularly scheduled appointments in a primary care medical clinic. MEASURES: Each patient was examined independently by two primary care clinicians and then one dentist. History and physical findings, clinical impression, and plan based on the oral cavity examination were recorded. The reference standard was the examination by a dentist blinded to the patient's history. RESULTS: The prevalences of lesions suspicious for premalignancy, periodontal disease, calculus, and caries were 23%, 37%, 54%, and 18%, respectively. When the primary care clinicians noticed a lesion suspicious for premalignancy, the likelihood that such a lesion was present increased significantly (LR+ = 2.7 to 6.6). However, a normal examination by the primary care clinicians did not significantly lower the likelihood of a premalignant lesion (LR- = 0.7 to 0.8). The primary care clinicians were more efficient at evaluating dental and gingival conditions (LR+ = 2.7 to 5.8, LR- = 0.2 to 0.7). CONCLUSIONS: Screening for oral disease by primary care clinicians is justified but should not replace routine screening by dentists.

Blood-flow mapping of oral tissues by laser Doppler flowmetry.

The purpose of this study was to develop a rapid protocol for noninvasive quantification of blood flow at intraoral sites by laser Doppler flowmetry. For each flow measurement, the lowest flow observed over a 30-s period was recorded. Three flow readings at each site were averaged and recorded. Forehead and dorsal right-hand blood flows measured agreed with previous laser Doppler flow measurements. Flows measured with a hand-held probe were not different from flows measured with a stent-stabilized probe on the attached gingiva and an adhesive-stabilized probe on the dorsal hand. High flows were found in the tongue, buccal mucosa, and buccal vestibule. Medium flows were found in the attached gingivae. The lowest flows were found in the teeth. These results indicate that flow in intraoral tissues varies by site and can be noninvasively quantified with the laser Doppler flowmeter when a rigorous measurement protocol is used.

The chemical degradation of phenylmercuric nitrate by disodium edetate during heat sterilization at pH values commonly encountered in ophthalmic products.

The stability following heat sterilization (121 degrees C for 15 min) of phenylmercuric (PM) nitrate in the presence of disodium edetate at pH values 5-8 has been investigated by both high-performance liquid chromatography (HPLC) and atomic absorption spectroscopy (AAS). A stability-indicating HPLC method involving formation of the diethylamine-dithiocarbamate complexes of phenylmercuric and mercuric ions was found to suffer a pH-dependent interference from disodium edetate. A second method was therefore also employed involving selective extraction into diethylether of the phenylmercuric ion followed by HPLC of the piperidinedithiocarbamate complex with concomitant analysis of the unextracted mercuric ion by AAS using the cold-vapour technique. An HPLC method was also developed for benzene in the degraded mixtures. The application of these methods to autoclaved solutions containing PM nitrate and disodium edetate demonstrates that under the conditions of heat sterilization the phenylmercuric ion is degraded to mercuric ion and benzene to the extent of 15% at pH 8, 80% at pH 7 and completely degraded at pH 5 and 6.

Dental hygienists' knowledge and opinions about fluorides and fluoridation.

This article reports results of a study of 563 practicing Minnesota and Wisconsin dental hygienists' knowledge and opinions about fluorides and water fluoridation. Two independent samples were selected randomly from the populations of licensed dental hygienists residing in the two states. Data were collected using a pretested, 42-item, mailed questionnaire. An 84 percent response was achieved with two followup reminders. These data provide baseline information about the caries prevention knowledge and attitudes of practicing dental hygienists in two states. Respondents from both states held similar levels of knowledge about fluorides and opinions about decision making on fluoridation. Fluoride topics, especially water fluoridation, were not receiving high priority in patient education, although nearly all believed that dental hygienists should promote water fluoridation actively. Two-thirds of respondents from both states believed fluoridation decisions should be made by health authorities, rather than by elected officials or through public vote. Greater attention to patient education about fluoride and community water fluoridation is needed by dental hygienists.

Dental hygienists' knowledge, opinions, and use of pit and fissure sealants: a comparison of two states.

This article reports results of a study of 563 practicing Minnesota and Wisconsin dental hygienists' knowledge, opinions, and use of pit and fissure sealants. The study was carried out six months prior to the 1983 NIH Consensus Development Conference on Dental Sealants in the Prevention of Tooth Decay. It therefore provides baseline information for two states prior to the initiation of widespread public information about the positive value of sealants that occurred as a result of that conference. Such baseline information is relevant for future studies of the diffusion of adoption of this caries-preventive technology by dental hygienists. Two independent samples were selected randomly from the populations of licensed dental hygienists residing in the two states. Data were collected using a 42-item mailed questionnaire, with an 84 percent response. Data were analyzed for both interstate and intrastate comparisons. Respondents were generally knowledgeable and had favorable opinions about sealants, although they had low levels of training in their use. Sealants were being used in 54 percent of the offices in which respondents practiced, with the dentist placing them most often. Among hygienists who applied sealants at all, more than two-thirds did so three or fewer times per week. Eighty-four percent indicated they would like to apply sealants more often. The most frequent reasons given for nonuse were lack of acceptance by the dentist-employer and nondelegation.