COVID-19 Vaccination: To Lead by Example or an Opportunity Lost

Coronavirus disease 2019 (COVID-19) has created a global health emergency. Vaccine hesitancy and tremendous misinformation about the actual science are leaving the public with significant confusion. However, sound epidemiologic science is guiding us to a clear path toward mitigating this modern-day scourge. It is remarkable how putting an end to current COVID-19 outbreaks has such a simple solution-convincing the public to accept getting vaccinated. The dental research, dental education, and dental practice communities have a unique opportunity to act as trusted public exemplars as well as trusted interpreters of the science for the public.

Releasing the brakes: a case report of pulmonary arterial hypertension induced by immune checkpoint inhibitor therapy

Immune checkpoint inhibitors successfully treat various malignancies by inducing an immune response to tumor cells. However, their use has been associated with a variety of autoimmune disorders, such as diabetes, hepatitis, and pneumonitis. Pulmonary arterial hypertension due to checkpoint inhibitor use has not yet been described. We present a novel case of pulmonary arterial hypertension associated with systemic lupus erythematosus and Sjogren's syndrome overlap that was induced by therapy with the checkpoint inhibitor durvalumab.

Recent Developments In Fluoro-containing Polyamideimides

The synthesis, characterization and development of a new generation of fluoro-containing polyamideimide (PAI) polymers are described in this paper. The polymers are generally prepared by forming the polycondensation product of an aromatic diamine, a trifunctional aromatic anhydride acid chloride and an aromatic dianhydride containing trifluoromethyl moieties. These new materials possess high glass transition temperatures, useful mechanical properties and outstanding thermoplastic flow behavior which render them readily melt processable into fibers, films, sheets and other molded articles. The as-precipitated fluoro-containing PAI materials are soluble in many organic solvents and are thus amenable to solution casting techniques. They also show excellent resistance towards thermooxidative degradation at temperatures to 450°F and have low moisture uptake. In addition, compatible blends with polybenzimidazole (PBI) resin have yield synergistic effects on the mechanical properties of the resulting polymer.

Tuberculosis misclassification among resettled refugees in Buffalo, New York, USA

BACKGROUND

Discordance in the classification of tuberculosis (TB) disease overseas compared to classification in the United States has been observed among immigrant populations.

OBJECTIVE

To examine TB misclassification among recently resettled refugees in Buffalo, NY, between 2005 and 2012.

METHODS

Retrospective study of refugees resettled to Buffalo from 2005 to 2012 and evaluated at a refugee/community health center. Centers for Disease Control and Prevention (CDC) Division of Global Migration and Quarantine (DGMQ) Class B1-B3 and American Thoracic Society (ATS) Class 2 (LTBI) cases were abstracted. Independent variables were demographics, countries of origin and refugee camp internment, year of resettlement, purified protein derivative induration, and chest X-ray findings, while CDC DGMQ and ATS classification were dependent variables. Independent samples t-test and analysis of variance were performed.

RESULTS

Of 284 charts reviewed, 233 (81.2%) were misclassified. Among 101 cases of LTBI (B1/B2) diagnosed outside the United States, 51 (50.5%) were overdiagnosed. Underdiagnoses occurred among 181/182 refugees (99.5%) originally classified as normal overseas.

CONCLUSION

These findings suggest that TB misclassification among recent immigrants remains widespread. Screening procedures both before and after resettlement should be better synchronized. Public health implications range from morbidity and costs of unnecessary treatment to the spread of a highly communicable disease.

The antitumor agent 3-bromopyruvate has a short half-life at physiological conditions

Clinical research is currently exploring the validity of the anti-tumor candidate 3-bromopyruvate (3-BP) as a novel treatment for several types of cancer. However, recent publications have overlooked rarely-cited earlier work about the instability of 3-BP and its decay to 3-hydroxypyruvate (3-HP) which have obvious implications for its mechanism of action against tumors, how it is administered, and for precautions when preparing solutions of 3-BP. This study found the first-order decay rate of 3-BP at physiological temperature and pH has a half-life of only 77 min. Lower buffer pH decreases the decay rate, while choice of buffer and concentration do not affect it. A method for preparing more stable solutions is also reported.

Saliva, Diagnostics, and Dentistry

Saliva, a scientific and clinical entity familiar to every oral health researcher and dental practitioner, has emerged as a translational and clinical commodity that has reached national visibility at the National Institutes of Health and the President’s Office of Science and Technology. “Detecting dozens of diseases in a sample of saliva” was issued by President Obama as one of the 14 Grand Challenges for biomedical research in the 21st Century ( National Economic Council, 2010 ). In addition, NIH’s 2011 Government Performance Report Act (GPRA) listed 10 initiatives in the high-risk long-term category ( Collins, 2011 ). The mandate is to determine the efficacy of using salivary diagnostics to monitor health and diagnose at least one systemic disease by 2013. The stage is set for the scientific community to capture these national and global opportunities to advance and substantiate the scientific foundation of salivary diagnostics to meet these goals. A specific calling is to the oral, dental, and craniofacial health community. Three areas will be highlighted in this paper: the concept of high-impact diagnostics, the role of dentists in diagnostics, and, finally, an infrastructure currently being developed in the United Kingdom—The UK Biobank—which will have an impact on the translational and clinical utilizations of saliva.

Global Oral Health Inequalities

Four oral mucosal infections were identified as Global Oral Health Priorities: (a) HIV and associated viral, bacterial, and fungal infections; (b) tuberculosis; (c) NOMA; and (d) sexually transmitted diseases. Huge global inequalities exist in all four. HIV-associated infections constitute the major challenge. Oral manifestations of AIDS can be specifically diagnostic, indicating a significant role for dentists within health teams. The World Workshops in Oral Health & Disease in AIDS have identified a research program, elements of which are being implemented. Data on oral mucosal involvement in tuberculosis, syphilis, and gonorrhea are incomplete in developed countries and virtually non-existent in low- and middle-income countries, indicating the need for further epidemiological studies. Oral manifestations of tuberculosis and sexually transmitted diseases are largely associated with general health, so action programs should be integrated with agencies treating the systemic diseases. NOMA is very much in the oral health domain. It is a preventable disease associated with malnutrition and unidentified bacterial factors. Prevalence is probably grossly overestimated at present; but nevertheless it constitutes a challenge to the profession, especially in the NOMA belt. Current treatment is surgical, but plans for its eradication should be achievable. The global oral health community, especially the IADR, has a major role to play.

HIV transmission in the dental setting and the HIV-infected oral health care professional: workshop 1C

This workshop addressed two important issues: first, the global evidence of HIV transmission from health care provider to patient and from patient to health care provider in the general health care environment and the dental practice setting; second, in the era of highly active antiretroviral therapy, whether oral health care professionals living with HIV pose a risk of transmission to their patients and whether standard infection control is adequate to protect both the patient and the oral health care professional in dental practice. The workshop culminated in a general discussion and the formulation of a consensus statement from the participating delegates, representing more than 30 countries, on the criteria under which an HIV-infected oral health care professional might practice dentistry without putting patients at risk. This consensus statement, the Beijing Declaration, was agreed nem con.

Social aspects of HIV and their relationship to craniofacial problems: workshop 4C

The oral research community needs an understanding of the social causes, consequences, and costs of disease in relation to oral health. This workshop concluded that HIV infection constitutes a special dental need requiring specific arrangements to facilitate oral care for infected persons. Oral manifestations of HIV infection affect everyday life, but more evidence is needed on the effects of interventions to alleviate these impacts. Other oral health habits add to the burden of HIV/AIDS-associated oral diseases and compete with them for resources. These problems are most acute where the prevalence of HIV is high and resources are scarce. Effective health promotion is therefore important in these areas. Without data on the utility of oral health care in developing countries, practical approaches are guided by societal and multidisciplinary principles. There are also important ethical considerations.

Polyimide Copolymers Containing Various Levels Of The 6F Moiety For High Temperature And Microelectronic Applications

Trifluoromethyl group-containing polyimides not only show extraordinary electrical properties, but they also exhibit excellent long-term thermo-oxidative stability. Among the most thermomechanically stable structural polyimides are those from 6F dianhydride (6FDA) and 6F diamines. The effects of substituting non-fluorine containing monomers such as BTDA, mPDA and 4,4′-DADPS for the hexafluoroisopropylidene monomers on the dielectric, thermo-oxidative, thermal and mechanical properties of the copolymers were studied.

(A2) Oral health and general health

The interactions between oral and systemic health are bi-directional and complex, involving many pathways. Regarding health as not merely the absence of disease, but as a state of total well-being, these interactions profoundly influence the progress of many diseases, and the quality of life and economic performance of HIV-infected individuals and populations. The evidence base for specific interactions is currently weak, partly because few good-quality studies have been published, partly because of the naïveté of the instruments currently available for recording these interactions and their inherent complexity. Recording quality of life should be a fundamental aspect of all future studies. The most significant conclusion of this Workshop is the need for all involved in oral health research and oral health care to be seen as, and to act as, essential partners in comprehensive care for whole patients and communities.

Recurrent intraoral pyogenic granuloma with satellitosis treated with corticosteroids

The development of recurrent pyogenic granulomas as multiple satellite lesions has not been reported in the oral cavity. This report describes an unusual case of intraoral pyogenic granuloma recurring multiple times after surgical excisions with the formation of satellite lesions. Due to failure of surgical management, an alternative approach was taken. We illustrate how the lesions were successfully treated with a series of intralesional corticosteroid injections.

Consensus guidelines on quantifying HIV-related oral mucosal disease

The workshop agreed that the development of consensus quantification protocols was desirable, but that this whole field was underdeveloped, to date. The working goals were therefore redefined (vide infra). Three possible protocols were presented and discussed relating to oral hairy leukoplakia, oral ulceration (NOS) and oral candidiasis. There was agreement that different data-set protocols would have to be developed for specific HIV-related mucosal diseases. Furthermore, the data set should be consistent, standardized and disaggregated. In this way, with everyone working to the same standards of outcome, data from geographically, nationally, socially or culturally different areas could be readily compared. A future meeting to generate the disease-specific protocols would, most likely, be needed.

Use of intralesional interferon-alpha for the treatment of recalcitrant oral warts in patients with AIDS: a report of 4 cases

Four human immunodeficiency virus-positive homosexual men with 2- to 4.5-year histories of recurrent oral warts that had failed to respond to conventional surgical and other treatment modalities were offered treatment with interferon-alpha. All had multiple or large oral warts, 3 had skin warts, 2 had a history of anal warts, and 1 had penile lesions. All 4 patients were treated with a combination of intralesional and subcutaneous interferon-alpha. Adverse side effects were dose-related, mild, and transient; they included flulike symptoms (3 patients), hair loss and tachycardia (1 patient), and transient changes in the white blood cell count. All patients responded to therapy and remained free of disease up to 42 months. Intralesional injection with interferon-alpha appears to provide excellent clinical control for recurrent, multiple, and extensive oral warts in the human immunodeficiency virus-positive population, and is a useful adjunct to initial surgical removal of oral warts.

The dental patient with asthma. An update and oral health considerations

OVERVIEW

Asthma is a serious global health problem that has steadily increased in prevalence during the past two decades. New classification and treatment guidelines have been published, and dental providers need to be aware of these changes.

LITERATURE REVIEWED

The authors searched textbooks and MEDLINE, looking for the most updated medical information on asthma, as well as for previous publications on treatment of asthmatic patients in a dental setting.

RESULTS

More than 9,000 articles on asthma were published in English between 1997 and 2000. From 1960 until 2000, approximately 40 articles specifically addressed asthma and dental care. The authors reviewed more than 300 articles from the medical literature and all articles after 1980 that directly focused on oral health issues for importance and relevance.

CONCLUSIONS

Recent information regarding the etiology, pathogenesis and treatment of asthma had not been adequately addressed in the dental literature. Dental care of asthmatic patients may necessitate considerations beyond what has previously been published in the dental literature.

CLINICAL IMPLICATIONS

In the treatment of asthma, as with treatment of most medical conditions, oral health care providers play a role that is important in terms of both the patient's overall health and the systemic condition's effect on oral health. This article provides dentists with a timely update on asthma and the relationship between asthma and oral health, and it offers suggestions for safe and appropriate dental care.

Prevalence of HIV-1 and oral lesions in pregnant women in rural Malawi

OBJECTIVE

Whether oral lesions were associated with human immunodeficiency virus-type 1 (HIV-1) status in a cohort of pregnant Malawian women was studied.

STUDY DESIGN

Six hundred thirty-eight women participated in a randomized prospective study at 3 prenatal clinics in a rural area of southern Malawi. Oral examinations, followed by collection of oral fluid specimens with an HIV-1 oral specimen collection device, were performed. The specimens were tested for antibodies against HIV-1.

RESULTS

Sixty-one oral lesions were found in 60 participants. While traditional HIV-1 associated lesions were rare, benign migratory glossitis was unexpectedly common (6%). Oral hairy leukoplakia was significantly more common among women who were HIV-1 positive than among women who were HIV-1 negative. An HIV-1 prevalence rate of 21.8% was estimated among the women, with the highest rate of HIV-1 infection (34.1%) among women aged 25 to 29 years.

CONCLUSION

Stratifying lesions showed a small number of oral hairy leukoplakia to be markers for HIV-1. A high seroprevalence was found in this rural cohort, but there were unexpectedly few oral lesions. The relatively few oral lesions diagnosed may indicate a recent infection with HIV.

A novel energy-based stochastic method for positioning polar protons in protein structures from X-rays

A novel automated method for the optimal placement of polar hydrogens in a protein structure is presented. The algorithm adds initially, to a protein data bank file of the protein, nonrotatable hydrogens such as peptide backbone hydrogens according to geometric considerations. Then, water protons and polar side chain protons of lysine, serine, threonine, tyrosine, aspartic acid, glutamic acid, and the C and N termini of a protein are added according to energy considerations. A unique stochastic approach has been developed to overcome a combinatorial explosion in the search for the lowest energy structure. First, the system is divided into ensembles. Each ensemble is treated separately: N conformations are sampled at random, their energies computed, whereas common components of high-energy combinations are gathered on one hand, and low-energy combinations on the other. Components that yield only high-energy conformations and do not contribute to any low energies are excluded. This is reiterated while the total amount of combinations is decreased along the iterative process. When the total number of combinations is lower than a user defined threshold, all remaining combinations are evaluated by exhaustive search. Energy evaluations use nonbonding energy expressions alone. The program was tested on five high-resolution crystal structures: bovine pancreatic trypsin inhibitor (Brookhaven Protein Data Bank file 5PTI), RNase-A (5RSA), trypsin (1NTP), and carbon monoxymyoglobin (2MB5), for which neutron diffraction structures are available, as well as phosphate binding protein (1IXH) for which very high resolution X-ray crystallography was used. The low RMS values prove the efficiency of this algorithm as a tool for positioning protons in proteins. It may be used for other biological structures.

Viral and fungal infections of the oral cavity in immunocompetent patients

Oral lesions are easily visualized and often are signs of systemic diseases. Clinical diagnosis of viral and fungal infections can sometimes be confusing because many lesions will have similar clinical presentations. This article reviews the more common viral- and fungal-associated lesions found in the oral cavity in immunocompetent individuals. Differential diagnoses for the oral lesions are discussed and treatment options are proposed.

Rheumatoid arthritis: a review and suggested dental care considerations

BACKGROUND

Rheumatoid arthritis, or RA, is a chronic multisystem disease of presumed autoimmune etiology. It is estimated that arthritis and other rheumatic conditions affect 42.7 million Americans. Medical complications due to RA and its treatment may affect the provision of oral health care.

METHODS

The authors undertook an extensive review of the English literature relating to RA and dental care. They used primarily MEDLINE searches, which included such key words as "rheumatoid arthritis" and "dental care" and subsequent appropriate subheadings. While the MEDLINE search spanned the years from 1975 to the present, the most recent literature was prioritized. Appropriate medical and dental textbooks were also used. The authors extrapolated information from selected texts based on its relevance to dentistry, oral health and the role of the dental provider in the overall treatment of RA patients.

RESULTS

The authors reviewed nearly 200 articles and seven textbooks. Their determination of the texts' relevance to oral health care was based on content, significance, quality, journal in which articles were published and year of publication. Major features of RA--including its diagnosis, pathophysiology, clinical features and medical treatment--were identified, as well as complications due to treatment modalities and various related oral manifestations and conditions.

CONCLUSIONS

Medical complications due to RA and its treatment can affect oral health care. Oral health care providers need to recognize and identify modifications of dental care based on the medical status of patients with RA. Furthermore, oral health care providers play an important role in the overall care of these patients as it release to early recognition, as well as control of the disease.

CLINICAL IMPLICATIONS

In most patients with RA, the condition will necessitate few or no changes in routine dental care. However, considerations include the patient's ability to maintain adequate oral hygiene, xerostomia and its related complications, the patient's susceptibility to infections, impaired hemostasis, and untoward drug actions and interactions. Patients with RA may require antibiotic prophylaxis owing to joint replacement and/or immune suppression, glucocorticosteroid replacement therapy and modifications in oral hygiene procedures. Intra- and extraoral conditions such as ulcerations, gingival overgrowth, disease-associated periodontitis and temporomandibular pathology also need to be recognized.

Know thy hepatitis: A through TT

Several viruses have been identified as causative agents of hepatitis in humans. Other hepatotropic viruses have been implicated as potentially disease-causing. This article reviews hepatitis A virus through the newly discovered hepatitis TT virus and their implication for the profession of dentistry.

New guidelines for prevention, detection, evaluation and treatment of high blood pressure

New guidelines for the management of patients at risk of developing hypertension and associated conditions have recently been published. These guidelines include a new risk stratification and blood pressure classification, as well as an altered approach to drug therapy. This article describes the major changes from previous recommendations, highlights the role of oral health care providers and emphasizes the dental implications of caring for patients with blood pressure conditions.

Oral health care issues in HIV disease: developing a core curriculum for primary care physicians

BACKGROUND

Given the high occurrence of oral manifestations in patients infected with human immunodeficiency virus (HIV), the relative ease in recognizing these manifestations on physical examination, and their potential impact on the health care and quality of life in these patients, it is critical to provide adequate training for primary care physicians in this area.

METHODS

Based on a review of the published literature and the consensus of a national panel of primary care physicians and dentists with clinical and research expertise in this area, a core curriculum was developed for primary care physicians regarding oral health care issues in HIV disease.

RESULTS AND CONCLUSIONS

We describe the process of developing the core curriculum of knowledge, skills, and attitudes regarding oral health care issues in HIV disease. The final curriculum is in a format that allows for easy accessibility and is organized in a manner that is clinically relevant for primary care physicians.

Dietary cardiovascular risk factors and serum cholesterol in an Old Order Mennonite community

OBJECTIVES

Dietary and coronary heart disease risk factors in Old Order Mennonite men and women were examined.

METHODS

A food frequency questionnaire was mailed to 250 Mennonites who had participated in a previous study of coronary heart disease risk factors.

RESULTS

Mennonites consumed a diet high in total fat, saturated fats, and cholesterol. Men had lower average serum cholesterol levels (174 mg/dL) than women (191 mg/dL).

CONCLUSIONS

The Mennonites' diet was similar to that of the overall US population in saturated fat percentage and higher in cholesterol. Serum cholesterol levels, adiposity, and blood pressure were lower than expected among Mennonite men, perhaps because of their higher levels of physical activity.

Oral ulcerations in individuals infected with human immunodeficiency virus: clinical presentations, diagnosis, management, and relevance to disease progression

Oral ulcerations can be both a localized disease entity and a manifestation of an underlying systemic condition. In individuals infected with the human immunodeficiency virus, oral ulceration may serve as a marker for a specific systemic illness, early immunosuppression, and disease progression. This article reviews clinical manifestations, diagnosis, and management of oral ulcerations in individuals with the human immunodeficiency virus.

Providing care in an infectious disease clinic. Why students volunteer

This qualitative study explores the motivations of dental students who volunteered as care providers for patients identified as carriers of infectious diseases. The study involved 12 students, seven 4th year and five 3rd year students who worked 1-2.5 days per week in an infectious disease clinic in a dental school in the northeastern United States. 4 faculty members who also volunteered their time in the clinic supervised the students. Personal interviews were conducted with each student to determine their reasons for volunteering and to explore the perceived significance of their experiences in the clinic. Internal validity was established through group interviews wherein responses during the personal interviews were discussed with the students. All 12 students were interested in Oral Medicine and all 4th year students had completed a course on HIV-AIDS for their selective requirement. Students expressed willingness to care for patients who are medically compromised in anticipation of an increase of this type of patients in their future practice. Previous exposure to a family member or friend or patients (non-dental) who were terminally ill or to patients with HIV was another common reason. All 12 students preferred to work in the infectious disease clinic more than in other school clinics. They felt that there was more faculty-student interaction and a more stimulating learning atmosphere that the faculty created. The students felt that the patients treated in the clinic were more appreciative. Students also claim they experienced more team spirit among their fellow students and staff and that the clinic atmosphere was more relaxed and less competitive. Students got the most satisfaction from helping patients who were perceived to have had problems in accessing care prior to their visit to the clinic. Results of the study show that the students volunteered to treat patients who are known to have infectious diseases such as HIV/AIDS because they find personal and academic satisfaction from working in a clinic which provides care to individuals with specific medical needs.

Lupus erythematosus: considerations for dentistry

Lupus erythematosus, or LE, is a connective tissue disease that affects a number of organ systems. Patients with this condition can experience several other serious conditions--bleeding, infection, endocarditis, adrenal insufficiency and mucocutaneous disease--that can affect the provision of dental care. The authors describe considerations for managing dental treatment of patients with LE.

The hypertensive dental patient

The dental team plays an integral role in safeguarding the general health of patients. Dental health care workers should be able to recognize risk factors associated with hypertension and counsel patients in an effort to reduce those that are present. In addition, dental professionals should recognize how these risk factors and associated hypertension affect the provision of dental care. This article reviews recent findings and therapies for hypertension, evaluates historically accepted but unsupported anecdotal information on the dental management of hypertensive patients and proposes guidelines for the dental management of these patients.

Dentistry in the operating room

Some special patients are unable to tolerate dental care in outpatient dental offices. Providing dental care under general anesthesia in an operating room setting involves various medical, dental, and hospital issues and procedures that differ from outpatient care. This article reviews pertinent information for the dental management of patients who require general anesthesia.

The professional responsibility for care

Access to dental care is an essential need for all patients, particularly for individuals with complex medical conditions. Consequently, dentists have a moral and professional obligation to provide care for all individuals within the dentist's realm of expertise. However, throughout the HIV epidemic dental professionals have demonstrated an unwillingness to treat infected patients. This article addresses common objections raised by dentists unwilling to provide care, and discusses the professional obligation to treat and the importance of professionalism in reducing discrimination.

Relationship of cytomegalovirus to salivary gland dysfunction in HIV-infected patients

In a previous retrospective study of HIV-infected patients we detected a relationship between xerostomia and the presence of cytomegalovirus in saliva. This prospective study compares 13 patients with HIV and a complaint of xerostomia and low salivary flow rates with a control group of 7 patients with HIV without xerostomia and normal salivary flow rates. Both groups were evaluated for the presence of cytomegalovirus in saliva, peripheral blood mononuclear cells, and labial minor salivary glands. Viral cultures, polymerase chain reaction, and histopathologic examination were used to detect cytomegalovirus. Xerostomia and low salivary flow rates were associated with the presence of CMV in saliva. The virus was detected in 10 of 13 xerostomia patients and 2 of 7 controls (p = 0.05, Fisher's exact test). Cytomegalovirus was detected in the saliva of patients who did not also have it in their blood suggesting a local source of virus replication such as the salivary glands. The minor salivary glands were not a major site of cytomegalovirus. Culture was more sensitive then polymerase chain reaction in detecting salivary cytomegalovirus as a result of the presence of inhibitors to the reaction in saliva. These results suggest a link between cytomegalovirus in saliva and salivary gland dysfunction in HIV-infected patients.

Medical considerations for dental care of patients with alcohol-related liver disease

More than 7 percent of all adults in the United States have met diagnostic criteria for alcohol abuse and alcohol dependence. Many of these people and even occasional users of alcohol may exhibit medical complexities, particularly liver disease, that can adversely affect provision of routine dental care. This article highlights some of the important clinical topics associated with alcoholic liver disease as it relates to dental care and provides guidelines on treatment of affected people.

Dental considerations in asplenic patients

The spleen plays an important role in the body's defense mechanism against microbial infections. However, trauma or diseases sometimes make removal of this important organ necessary, which predisposes patients to certain infections. This increased risk of infection and the underlying reason for the organ's removal both may affect the provision of dental care. This article reviews the structure and function of the spleen, conditions that may require its removal or cause its dysfunction, and provides considerations for dentists who care for asplenic patients.

The role of the dentist in the era of AIDS

Dental care providers are constantly redefining their role in response to new medical challenges. The AIDS era has invoked stimulating discussions on several issues providers need to address as participants in the healthcare dilemmas surrounding this disease. This article considers six major issues on which dental workers can have a major impact regarding the future of this epidemic.

Dental considerations for the patient with renal disease receiving hemodialysis

An increasing number of Americans are living with end-stage renal disease. This disease has many implications for dentistry, in terms of oral manifestations and management of afflicted patients. The authors present pertinent information to help dentists treat patients who exhibit the oral and systemic manifestations of renal disease, from the onset of renal impairment through hemodialysis.

Dental management of patients with diabetes mellitus

It is estimated that a total of 16 million Americans are suffering fro m diabetes mellitus (DM). Dental health-care providers are involved in screening for this disease, as well as treating numerous patients with DM. As do all medically complex patients, individuals with DM pose a challenge for dental providers. This article describes the pathogenesis and physiology of DM and recommends guidelines for dental care.

A review of oral fungal infections and appropriate therapy

Dental health care providers must recognize oral fungal pathogens that often are markers for early signs of immune deterioration. After accurate identification, appropriate therapy can be initiated. Predisposing factors for development of oral fungal infections, identification of oral fungal infections, treatment options and their relative costs are reviewed.

Developmental differences in the symptomatology of psychiatric inpatients with and without mild mental retardation

The symptomatology of psychiatric inpatients with mild mental retardation was compared with that of a matched sample of inpatients without mental retardation. An integration of the developmental position on mental retardation with the developmental approach to adult psychopathology generated the hypotheses that, compared to patients without mental retardation, patients with mild mental retardation would display (a) more symptoms indicative of turning against others and fewer symptoms indicative of turning against the self, (b) more symptoms involving expression in action rather than thought, and (c) psychotic symptom pictures that more frequently involve hallucinations without delusions and infrequently involve delusions alone. All hypotheses were confirmed.