Oral health status of a long-term-care, veteran population.

The Department of Veterans Affairs (VA) operates the largest, integrated health care system in the United States of America. The projected need for long-term-care in the VA health care system parallels an expected increase in need for care in the United States, but precedes the need for care in the general population by 25-30 yr. The VA's Office of Dentistry, in an effort to estimate the resource requirements of this swelling group of veterans, initiated in 1986-7 an oral health survey of long-term care patients. The overall goals were to describe the oral health status of VA nursing home care units (NHCU) residents and to develop a methodology for estimating future dental health services utilization. This study describes the oral health status of the study population. Demographic and oral health data were collected for 650 long-term care residents of six VA NHCUs between October 1986 and July 1987. Data were collected on sociodemographic status, medical history, dental caries, periodontal diseases, oral soft tissue pathology, and the presence of dental prostheses. Caries and periodontal disease were evaluated using the United States National Institute of Dental Research Survey of Employed Adults and Seniors protocols. The oral health status of the population is described using DMF and ESI indices, the prevalence of oral lesions, levels of tooth loss, oral hygiene scores, and the status of existing dentures. Findings show moderate levels of untreated dental caries and periodontal disease and significant tooth loss which increased with age. A need for preventive therapy, restorative dentistry, conservative periodontal therapy, and prosthodontic care was evident.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of cost-productivity of hospital-based general practice residency programs.

This study evaluated the 1985 cost-productivity of staff dentists and general practice residents at 11 dental clinics with general practice residency (GPR) programs and five nonteaching dental clinics in Veterans Administration hospitals. The results indicate that on the basis of dental service production, GPR facilities are or should be as cost-efficient as nonteaching facilities. It was also found that GP residents can repay a major part of their training costs.

Multiple, painful oral ulcerations in a patient with Hodgkin's disease.

The frequent occurrence of the oral lesions of histoplasmosis in combination with disseminated infection necessitates prompt recognition and diagnosis. The possibility of such an infection occurring in an immunocompromised patient should be considered high on the list of differential diagnoses, and treatment should be planned accordingly. The varied clinical presentations of histoplasmosis, ranging from shallow ulcers to nodular or vegetative masses, can be confusing and may lead to inaccurate diagnosis with resultant delay in treatment or inappropriate treatment. Submission of adequate tissue sections for microbiological and histopathological assessments is crucial.

Dental health status of an aging VA population: implications for a preventive dental health care program.

The purpose of this study was to describe the sociodemographic characteristics and dental health status of the largest eligible class of veterans (Class IV) within the Greater Miami catchment area. Only 43 percent of 4,882 Class IV patients within this area have sought VA dental care. Sociodemographic data were obtained from a randomized sample of both the VA-treated and non-VA-treated groups. The prevalence and incidence of dental diseases and actual dental treatment procedures completed for the VA-treated sample were determined from clinical records. Results indicated that periodontal disease and dental caries are substantial problems; small groups of patients account for the majority of treatment needs and associated costs; 71 percent of these patients are over 55 years of age; and the "average" Class IV patient is lower middle-class and retired. Study implications suggest that the best strategy for developing an effective VA dental health program would be one in which each patient would have a preventive regimen tailored to meet his needs and the ability to comply with the preventive program. The VA needs to determine the cost-effectiveness and dental health advantages of providing preventive dental health care services to eligible veterans.

Painless, irregularly shaped erythematous area on the middorsum of the tongue.

Regardless of what name is used to identify the lesion and its nature of origin, clinicians should be aware of the clinical features and biologic activity of this relatively common oral abnormality and be prepared to reassure patients of the innocuous nature of the lesion.

Lingual cortical mandibular defects: a radiographic incidence study.

Two thousand six hundred ninety-three oral panoramic radiographs were reviewed, and thirteen (0.48 percent) displayed changes characteristic of lingual cortical defects of the mandible. The abnormalities were almost equally distributed on the right and left sides, and none occurred bilaterally. All of the patients with the defects were adult males, and none of the areas was symptomatic. In one patient the defect was determined to have been present for 7 years with no discernible radiographic change.

Irregular papular lesions of the hard palate.

Dental practitioners should be familiar with Darier's disease because oral lesions of the disease may resemble other diseases. Differential diagnosis should include papillary hyperplasia of the palate, acanthosis nigricans, Cowden's disease, nicotine stomatitis, and condyloma acuminatum. Careful observation of the oral and skin lesions and consideration of the medical and family history should assist in diagnosis. Vitamin A, given in high doses, has been used with variable success in the treatment of Darier's disease. Systemic corticosteroids have been used with good results, but these require prolonged use as they are not curative. Secondary infection is a common complication for which topical corticosteroids are helpful.

Asymptomatic multilocular radiolucent lesion of the mandible.

The odontogenic keratocyst is an established pathologic entity. Dentists must be aware of its existence and understand its clinical characteristics. Because it is impossible to radiographically and clinically differentiate the keratocyst from more innocuous odontogenic cysts, all cystic lesions removed from patients should be submitted for histopathologic examination and diagnosis.

Acute episodic inflammatory lesions of the mucous membrane and skin.

The first consideration in the treatment of erythema multiforme is to search for and eliminate a possible underlying cause. Mild cases require little treatment. Severe forms of the disease must receive prompt, active therapeutic measures. Fluid and electrolyte imbalance must be corrected, secondary bacterial infections must be combated with topical or systemic antibiotics, and large doses of systemic corticosteroids are used for short periods. Without treatment, lesions can persist for many weeks. Mild forms of the disease, which constitute most of the cases, usually subside in a few days to two to three weeks without sequelae. Severe forms persist for three to six weeks longer; sequelae include neurologic changes, corneal opacities, blindness, conjunctival, vaginal, or preputial synechiae, and esophageal strictures. Mortality of all forms has been reported as less than 0.5% but severe cases, at approximately 10%. Recurrences are likely in approximately 25% of the cases; the pattern is variable, chronic, and episodic.

Mineralization of the stylohyoid-stylomandibular ligament complex. A radiographic incidence study.

In this Veterans Administration-based study, 1,771 oral panoramic radiographs were reviewed to detect abnormalities in the styloid process, stylohyoid-stylomandibular ligament complex. Three hundred twenty-three (18.2 percent) of the radiographs revealed mineralization in these areas which varied from an apparent elongation of the styloid process to extensive involvement of the entire ligament complex with segmentation, nodularity, and the development of jointlike structures. Mineralization was unilateral in 12.4 percent of patients and was observed more commonly in patients 50 to 59 years of age. No relationship could be established between the extent of mineralization and increasing patient age. This study suggests that mineralization of the stylohyoid complex is not uncommon and probably only rarely causes symptoms.