The relationship between periodontal disease and systemic conditions.

In this year's report of the United States Surgeon General on oral health in America, two major themes evolved: 1) oral health means much more than healthy teeth, and 2) oral health is integral to general health. This article describes how oral diseases, in particular periodontal diseases, are associated with other health problems, including cardiovascular disease, diabetes mellitus, complications of pregnancies, and osteoporosis.

Women's oral health issues.

Hormonal fluctuations affect more than a woman's reproductive system. They have a surprisingly strong influence on the oral cavity. Puberty, menses, pregnancy, and menopause all influence women's oral health and the way in which a dentist should approach their treatment. This paper will review aspects of a woman's life when hormonal fluctuations may affect oral tissues.

Depressive response to physostigmine challenge in borderline personality disorder patients.

The purpose of this study was to examine the relationship between mood and hormonal responses to cholinergic challenge with physostigmine in order to assess cholinergic system responsiveness in borderline personality disorder (BPD) patients, other non-BPD personality disorder patients, and normal controls. Thirty-four personality disorder patients, 10 of whom met criteria for BPD and 24 of whom met criteria for other, non-borderline, personality disorders, and 11 normal controls participated in a double blind, placebo controlled physostigmine challenge paradigm. The Profile of Mood States depression subscale (POMS-D) self report measure was obtained at baseline and following the physostigmine or placebo infusions. A repeated measures ANOVA of POMS-D scores in placebo and drug conditions indicated a significantly greater depressive response in the total cohort of personality disorder patients than in the normal comparison group (p < 0.05). However, the depressive response to physostigmine was significantly greater in BPD patients, but not other personality disorder patients, compared to normal controls (p < 0.05). There was a correlation between the peak placebo-corrected depressive response to physostigmine and a group of BPD traits related to affective instability but not a group of BPD traits related to impulsivity. There was no correlation in any group between mood response to physostigmine and changes in plasma cortisol, prolactin, or growth hormone, or to nausea or other side effects following physostigmine infusion. These data suggest that there is an association between BPD and acute depressive responses to physostigmine challenge, and that the cholinergic system may be involved in the regulation of affect in Axis II disorders.

Treatment of transverse maxillary deficiency with emphasis on surgically assisted-rapid maxillary expansion.

In this article we discussed the work-up necessary to evaluate a patient for maxillary transverse deficiency, and the three treatments for maxillary transverse deficiency-SDE, RME, and SA-AME. Slow dentoalveolar expansion is used mostly in the primary and early mixed dentition. Rapid maxillary expansion is indicated most often in the mixed dentition and can be attempted in the early adult dentition. Surgically assisted-rapid maxillary expansion is applicable almost exclusively in the adult dentition. The treatment of choice will depend on the age and skeletal maturity of the patient. Surgically assisted-rapid maxillary expansion, the technique that is used at The Medical College of Pennsylvania, combines all aspects of the previously mentioned osteotomies. The maxilla is separated at the midpalatal, the maxillary buttress, and the pterygomaxillary sutures. We have experienced good outcomes and stability with this technique. The reviewed literature shows good results with SA-RME for the treatment of maxillary transverse deficiency in the adult patient. It would be beneficial to study relapse and the periodontal ramifications of maxillary expansion further to better define the indications for SDE, RME, and SA-RME.

The etiology, treatment, and prevention of nursing caries.

Despite the decline in the dental caries rate over the last 20 years, one particular segment of the population does not seem to have benefited significantly. This group is composed of infants and children afflicted with widespread caries destruction of deciduous teeth, most commonly referred to as nursing caries. Untreated cases of the disease have resulted in pain, loss of function, premature tooth loss, delays in development, hearing and speech difficulties, and psychosocial disturbances. Among these children are some of the most paramount problems that dentistry has had to face. This article specifically discusses the epidemiology, clinical characteristics, etiology, risk factors, treatment, and prevention of nursing caries, to serve as an up-to-date reference for the general dentist who treats this patient population.

Caries prevention: a team approach to oral health.

Caries is a result of a multifactorial process. In this article, several of these contributing factors are examined and their interrelationships are discussed. These factors must be addressed by the dental team and the family unit to achieve the successful prevention of this destructive and common phenomenon.

Successful periodontal treatment for the elderly.

The demographic reality of a rapidly growing elderly population segment presents the practicing dentist with certain imperatives and challenges. Familiarity with the healthy aging process and common medical conditions of the aged is becoming increasingly essential. Customized treatment plans and modifications in techniques and home care aids require flexibility and creativity. In addition, it should not be overlooked that this demographic reality also presents the practicing dentist with new opportunities for practice-building as well as personal and professional satisfaction.

Patient evaluation.

This article has focused on the various aspects of patient evaluation that is a vital component in the total care of the dental patient. It must be emphasized that dentists are ultimately responsible for the overall management of the patients that they are treating, and only by careful selection and treatment plan can the practitioner maximize the benefits while minimizing the dangers inherent in outpatient anesthesia.

Ability of the xid gene to prevent autoimmunity in (NZB X NZW)F1 mice during the course of their natural history, after polyclonal stimulation, or following immunization with DNA.

F1 hybrid offspring of New Zealand Black mothers and New Zealand White fathers [(NZB X NZW)F1] female mice develop antibodies to single-stranded (ss) and native DNA, immune complex glomerulonephritis, massive proteinuria, and premature death with renal failure. By a series of matings, congenic (NZB X NZW)F1 . xid/xid mice were prepared. These mice were different from (NZB X NZW)F1 mice in having the X chromosome-linked immune deficiency gene, xid, in homozygous form. Such congenic (NZB X NZW)F1 . xid/xid females failed to develop antibodies to single-stranded or native DNA. They also failed to develop fatal renal disease as measured by proteinuria, glomerular histology, glomerular immunofluorescence, and survival. To control for unknown genetic factors, studies were performed with littermates that were derived by mating NZB . xid/+ females with NZW . xid/Y males such that the resulting offspring were either (NZB X NZW)F1 . xid/xid (and therefore "defective") or (NZB X NZW)F1 . xid/+ [phenotypically like (NZB X NZW)F1]. In these and in additional studies, mice were housed in the same cages and identified by ear tagging so as to avoid possible environmental variations from cage to cage. In these studies, xid/xid mice failed to develop the characteristic signs of autoimmunity, whereas the controls did. Similar results were also obtained with (NZW X NZB)F1 xid/xid mice compared with (NZW X NZB)F1 xid/+ mice. The effect of xid/xid upon (NZB X NZW)F1 mice was further investigated by assessing responses to immunization and polyclonal B cell activation in vivo. The xid/xid mice failed to produce anti-ssDNA following immunization with ssDNA complexed to a protein carrier in fluid form or even emulsified in adjuvant. Finally, the xid/xid mice failed to produce antiDNA in response to multiple injections of the polyclonal activator, bacterial lipopolysaccharide (LPS), or the polyclonal activator, polyribose inosinic acid . polyribose cytidylic acid. However, the xid/xid mice were neither generally hyporesponsive nor unable to recognize LPS because they made normal antibody responses following immunization with LPS to which multiple trinitrophenyl groups were chemically attached. We conclude from these studies that xid/xid, which is known to cause the deletion of a B cell subset, has a profound affect upon (NZB X NZW)F1 mice, rendering them insusceptible to the naturally occurring autoimmune disease characteristic of (NZB X NZW)F1 mice, and preventing them from producing antibodies to DNA despite purposeful immunization and polyclonal B cell activation. These results force a reevaluation of previous concepts regarding the mechanisms by which xid/xid might interfere with the development of autoimmunity, and a consideration of therapeutic implications.

Studies of immune abnormalities in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) in humans and in mice appears to be a syndrome with different cellular bases. In individuals, the illness is influenced by a variety of factors, including genetic, hormonal, immune, and environmental. In mice, SLE can be induced with polyclonal B-cell activators and thymectomy. Retardation of disease occurs with the gene xid on an NZB background. Tolerance studies indicate that tolerance depends upon a normal thymus. In addition, females can be nontolerant with a single immune defect, whereas males can become tolerant with only one defect; they become nontolerant with two immune defects. These studied may help to explain the prevalence of SLE in females and the protective effects of androgens. Human SLE is characterized by excessive B cell activity and impaired T cell activity, especially in active disease. A scheme by which the disease becomes activated is put forth. The details of cell-cell dialogue are becoming clearer with study of the autologous mixed lymphocyte reaction. T 4+ cells provide helper signals for T 8+ cells. Macrophages and T cells combine to regulate the AMLR. The AMLR itself gives rise to a variety of functional cells and serves as an amplification system. This system is defective in active SLE. Preliminary attempts have been made to separate human SLE into subgroups on the basis of the ratio of helper to suppressor cells (RT). A low RT is associated with renal disease, whereas a high RT characterizes patients with a multisystem illness with less important kidney involvement.