The prevalence of hypertension in a dental school patient population.

OBJECTIVE: A study of the prevalence of hypertension in the patient population was conducted at the University of Mississippi, School of Dentistry. METHOD AND MATERIALS: The 3,665 records reviewed represented patients treated by undergraduate dental students from 1993 through 1997. Inclusion criteria were diagnosis of hypertension by a physician or presentation with a systolic reading of greater than 140 mm Hg or a diastolic reading of greater than 90 mm Hg. RESULTS: Of the 1,021 subjects who met the criteria, 609 were previously diagnosed with hypertension and 412 exhibited elevated blood pressure. The prevalence of diagnosed hypertension in the study population was 16.6%. When the 412 subjects who exhibited elevated blood pressure were included, the prevalence of hypertension was 27.9%. At the initial screening, 32.2% of diagnosed adults and 27.0% of undiagnosed adults exhibited a systolic reading of 160 mm Hg or greater or a diastolic reading of 100 mm Hg or greater. For all age groups, there were no statistically significant differences in race, sex, educational level, or occupation between the diagnosed and undiagnosed groups. CONCLUSION: The prevalence of hypertension, often undiagnosed or uncontrolled, justifies routine blood pressure screening of dental patients.

Evaluation of blood pressure in children and adolescents: a review.

Hypertension in children has received minimal attention in the dental literature; this may be the result of comparatively low interest in the subject by the medical community. It is now believed that the processes causing cardiovascular disease morbidity and mortality begin early in life. The implication for prevention is that screening and intervention should commence in childhood. Although the prevalence is lower than in adults, elevated blood pressure during childhood is not uncommon. Dentists may be uniquely positioned to screen children for hypertension. Children from poor families may not use medical services except in emergencies, but may visit a dentist as part of Head Start or through other state or federal programs. By incorporating blood pressure screening for children as well as for adults and with appropriate referral, dentists may contribute to the reduction of cardiovascular disease. This review presents a discussion of blood pressure in children and adolescents, the epidemiology and etiology of elevated blood pressure, the problems associated with hypertension, and recommended procedures for measuring blood pressure in children and young adult patients.

A method for determining patient oral care skills: The University of Mississippi Oral Hygiene Index.

The plaque control record (O'Leary index) appears to be a commonly used oral hygiene index for assessing oral health skills. This index provides sufficient information for patient education; however, the time involved in data collection reduces its value. Most other indices limit the number of teeth and surfaces and function well for researchers, but are limited for patient education. A new oral hygiene index was developed based on the concepts of the Periodontal Screening and Recording (PSR). The highest score obtained in each buccal and lingual sextant is recorded. In addition, proximal and gingival plaque are noted separately. This study assesses the index for inter- and intrarater reliability and validity. Two calibrated hygienists examined 47 patients 3 times. The University of Mississippi Oral Hygiene Index (UM-OHI) was recorded for times 1 and 3, the O'Leary for time 2. There was a strong positive correlation between scores obtained for both hygienists for each method and repetition. The intrarater reliability was high for the 2 methods and also over time for the UM-OHI. Pearson's correlation coefficients ranged from 0.79 to 0.92. Paired t-tests used to compare scores for the 2 hygienists over time showed significant differences. Despite observer bias, these data seem to indicate that the UM-OHI has sufficient reliability and validity to be used as a health education teaching tool.

[Porphyria cutanea tarda in a 4-year-old child with uroporphyrinogen decarboxylase deficiency]. / Porphyrie cutanée "tardive" chez une enfant de 4 ans avec déficit en uroporphyrinogène décarboxylase.

A 4 years old girl presents a typical case of patent form of cutaneous late porphyria with a reduced activity of the erythrocyte, uroporphyrinogen decarboxylase (UROD) genetically transmitted over 3 generations; a multifactor inheritance (HLA A3, a normal phenotype of alpha 1 antitrypsin, exogenous toxins, or viral infections) is discussed.

[Renal manifestations of severe human aphthous diseases (author's transl)]. / Manifestations rénales au cours de la grande aphtose.

Renal manifestations of severe human aphthous diseases are seldom mentionned in the literature. The authors report on a case of Behçet disease associated with microscopic haematuria and intermittent proteinuria. Renal biopsy showed circumscribed "necrotizing" vascular lesions. In the absence of any other detectable lesions. In the absence of any other detectable aetiology, the likelihood of the renal symptoms being due to the aphthous disease is to be considered.

[Shulman's syndrome: eosinophilic fasciitis (author's transl)]. / Syndrome de Shulman: fasciite avec éosinophilie.

A detailed report is made of the clinical, histological, biological manifestations of eosinophilic fasciitis, i. e. the Shulman's syndrome, about a 53-year-old man. An extreme induration of sub-cutaneous tissues from arms, legs and trunk, without involvement of the face and extremities, was associated with severe thickening of deep peri-muscular fascias. Raynaud's phenomenon was absent, as were morpheas and visceral involvement. Results of biopsies studied by standard, electron and I. F. microscopy, revealed sclerosis and cellular infiltrates (lymphocytes, plasma cells, histiocytes and eosinophils) in fascia and muscular septa; no changes were seen in epidermis, dermis or sub-cutaneous fat tissue. An elevated ESR, eosinophilia and hyperimmunoglobulinaemia with high levels of circulating immune complexes were the only biological abnormalities. A good response to systemic corticosteroid therapy was observed. These features were similar to those seen in other cases of eosinophilic fasciitis. The etiology and pathogenesis of the Shulman's syndrome remain unclear. A critical review of the literature suggests that eosinophilic fasciitis should be separated from scleroderma and pseudoscleroderma, although this opinion has been discussed.

Defective leukocytotaxia and recurrent staphylococcal infecion: deficiency of leukocytotaxia and abnormal granulocytes associated with increase serum IgE levels in an adult with recurrent staphylococcal infection.

A man who was suffering from recurrent staphylococcal infection had antecedent symptoms of severe pruritus. Laboratory investigations showed leukocytosis with eosinophilia, hyperimmunoglobulinemia of all fractions, but particularly of IgE, and a deficiency of cell-mediated immunity on in vivo testing. Phagocytosis and bactericidal activity of polymorphonuclear leukocytes were normal, but a cellular and serum-associated defect in leukocytotaxia was present. Ultrastructural changes were observed in polymorphonuclear leukocytes. Association of impaired leukocytotaxia and elevated levels of IgE is not uncommon. Recurrent bacterial infections in the patient described are probably related to defective chemotaxis.

[Arteriographic study of the hand in 52 cases of Raynaud's phenomenon of varying aetiology (author's transl)]. / Etude artériographique de la main au cours de 52 phénomènes de Raynaud d'étiologie diverse.

Digital occlusive arterial disease was demonstrated in all cases in which there was a precise aetiology and in many cases in which an aetiology could be suspected. However, the arteriogram was most often normal in cases of Raynaud's disease. Whilst the arterial lesions seen were not specific to a precise aetiology, their presence in a patient with Raynaud's phenomenon should lead to a search for a systemic disease, first and foremost scleroderma in view of the fact that it is the most common condition.

[Cutaneous symptoms of ulcero-haemorragic rectocolitis and of Crohn's disease (author's transl)]. / Manifestations cutanées de la rectocolite ulcéro-hémorragique et de la maladie de Crohn.

The association between ulcerative colitis, Crohn's disease and various abnormalities of the skin is reviewed. Erythema nodosum and pyoderma gangrenosum are the most specific external manifestations and thereby the ones of greatest diagnostic value. Erythema multiforme is probably a manifestation of drug hypersensitivity. Many other dermatosis have been observed in association with these gastrointestinal disorders. However, these associations are not statistically significant. A specific "aphtous colitis" may be observed in the course of Behçet's disease.