Patient and parent preferences for orthodontic practices

This study was designed to identify who chooses an orthodontic office and what factors might induce the attraction. Patients and parents from the lists provided by suburban orthodontic offices were contacted. A mail-out survey instrument was used to gather the data. Results revealed that the reputation of the practitioner was most important along with the level of caring attitude the office projected. It was also important that the office is located near home, interestingly, the mother is the most significant decision-maker in the family in choosing an orthodontic office. Moreover, not the cost of treatment but the payment plan was the critical element in the decision process. The higher income families with three or less children were attracted to office characteristics such as excellence of the orthodontist, attention, and convenience. A marketing strategy based on these elements might provide the best return on the investment.

Randomized phase II study of the neurokinin 1 receptor antagonist CJ-11,974 in the control of cisplatin-induced emesis

PURPOSE

To determine the efficacy and safety of the neurokinin type 1 receptor antagonist CJ-11,974 for the control of high-dose cisplatin-induced emesis.

PATIENTS AND METHODS

A double-blind, randomized, phase II design with a group sequential stopping rule was used in this study. Sixty-one patients with cancer who were receiving cisplatin at a dose of at least 100 mg/m2 for the first time were enrolled. All patients received granisetron 10 microg/kg and dexamethasone 20 mg intravenously 30 minutes before they were given cisplatin. Patients were randomly assigned to two groups: group 1 received CJ-11,974 100 mg, and group 2 received placebo orally 30 minutes before and 12 hours after cisplatin and then twice daily on days 2 through 5 after cisplatin. The primary end point was the percentage of patients who developed delayed emesis (emesis on the second to fifth days after cisplatin).

RESULTS

Thirty patients were enrolled in group 1, and 31 patients were enrolled in group 2. Fifty-eight patients were assessable for efficacy. Complete control of emesis (expressed as the percentage of patients who had no emesis) was as follows: day 1, 85.7% (group 1) and 66.7% (group 2) (P = .090); days 2 through 5, 67.8% (group 1) and 36.6% (group 2) (P = .0425, adjusted); days 1 through 5, 64.3% (group 1) and 30% (group 2) (P = .009). Patients in group 1 experienced significantly less nausea than patients in group 2 on day 1 (P = .024). Treatment was well tolerated in both groups.

CONCLUSION

We conclude from this exploratory phase II trial that CJ-11,974 is superior to placebo in controlling cisplatin-induced delayed emesis and may provide additive benefit in acute emesis and nausea control when combined with a 5-hydroxytryptamine-3 receptor antagonist and dexamethasone. Additional larger trials are indicated to confirm the clinical value of CJ-11,974.

Sending a policy signal: state legislatures, medical schools, and primary care mandates

In the past few years, eleven states have directed medical schools in their states to produce more primary care practitioners or to change the training of physicians to make careers in primary care more attractive to medical students. This article outlines the progress and politics of the states' desire to hold medical schools accountable for producing more primary care practitioners. It analyzes the coerciveness and scope of the laws, including the provisions for implementation and accountability. Interviews with legislative staff, legislators, and university and medical school lobbyists provide information on the measures' political rationale and expectations. Most striking was the signaling nature of the provisions. The laws were not strident or especially onerous; they contained many loopholes and no real sanctions. They were important, however, in the message they conveyed. In state after state, legislatures sent a message to the medical schools that they were part of the solution to distributional problems of health care delivery and must be responsive to legislative desires for action. State legislators sent a policy signal, and most medical schools apparently understood its significance.

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.

The effect of tenidap on cytokines, acute-phase proteins, and virus load in human immunodeficiency virus (HIV)-infected patients: correlation between plasma HIV-1 RNA and proinflammatory cytokine levels

Proinflammatory cytokines may be important in the pathogenesis of human immunodeficiency virus type 1 (HIV-1) disease. Tenidap decreases interleukin (IL)-6, IL-1, and tumor necrosis factor (TNF) production by peripheral blood mononuclear cells and decreases IL-6 plasma levels in rheumatoid arthritis patients. In this randomized double-blind study, 43 HIV-1-infected patients received tenidap (120 mg) or placebo daily for 6 weeks and then crossed over to the alternative therapy for an additional 6 weeks. Mean entry CD4 cell count was 140/microL. Analyses were performed on cytokines, acute-phase proteins, virus load, and CD4 cell counts. With the exception of small differences in plasma TNF levels, tenidap had no significant effect on these indices. Significant correlations of plasma IL-6 and TNF levels with HIV-1 RNA were noted. Six patients discontinued tenidap due to rash. The effects of tenidap in HIV-1 infection contrast to results in arthritis patients, in whom tenidap decreased plasma levels of IL-6 and acute-phase proteins.

Tenidap inhibits replication of the human immunodeficiency virus-1 in cultured cells

Interleukin-6 (IL-6) may be important in the pathogenesis of HIV-1 because of its ability to induce HIV-1 expression in infected cells in vitro. Tenidap, a structurally and functionally novel antirheumatic drug affecting diverse biologic processes, has been shown to reduce IL-6 production by peripheral blood mononuclear cells stimulated with lipopolysaccharide. Tenidap also inhibits the activity of chloride-bicarbonate exchangers and causes acidification of the cytoplasmic compartment that is similar to the effect of the anion transport inhibitor UK5099. Furthermore, tenidap inhibits the cyclooxygenase-mediated pathway of arachidonic acid metabolism as do the nonsteroidal antiinflammatory drugs (NSAIDs). Here we show that tenidap decreased HIV-1 replication as measured by p24 core antigen in the acutely infected CD4+ T-lymphocyte lines H9 and Jurkat, in the acutely infected monocyte line U937, and in its chronically infected subclone U1.8/HIV. These effects were seen at concentrations in the range of 3 to 15 microM, well below those toxic to cells. The antiviral effects of tenidap may be independent of its ability to reduce IL-6 production based on the observations that these effects were as prominent in IL-6 nonresponsive lines as in IL-6 responsive lines and that the inhibition of p24 production was not reversed by exogenous IL-6.

Infection control knowledge, practice, and attitudes of Mississippi dental hygienists

PURPOSE

The purpose of this study was to assess Mississippi dental hygienists' knowledge and use of infection control techniques, attitudes pertaining to universal precautions and the risk of clinician/patient cross-infection, and attitudes toward treatment of patients with infectious diseases.

METHODS

A 41-item questionnaire was mailed to all 508 licensed dental hygienists in Mississippi. Inactive, retired, and out-of-state hygienists (n = 59) were deleted from this study. The data were tested for significant associations using Chi-square.

RESULTS

After adjusting for the 59 unusable returns, the response rate for analysis was 58% (n = 297). Dental hygienists reported using infection control techniques including sterilization or disposal of common items such as prophylaxis angles, suction tips, and air/water syringe tips. Although 98% of the respondents believed that barrier techniques were effective, some believed patients infected with HIV/AIDS (43%), hepatitis B (31%), or tuberculosis (40%) are best treated in public clinics rather than in private settings and that these clients pose a threat to dental hygiene practitioners. Further, a majority of the respondents believed that all oral healthcare workers and patients should be tested for HIV/AIDS.

CONCLUSIONS

The incongruity between perceived knowledge, reported practice, and attitudes suggests the need for continuing education courses designed to allow dental hygienists to explore the affective domain regarding the care of patients with infectious diseases. In addition, courses on working with patients with HIV/AIDS should be offered in smaller cities for greater accessibility.

How dentists perceive the effects of orthodontic extraction on facial appearance

In recent years, orthodontic treatment, particularly that involving premolar extractions, has been alleged to cause flat facial profiles. Those who make such assertions also claim to be able to instantly identify from a distance faces of patients who have received orthodontic treatment. These are strong claims that could profoundly affect the public's perception of dentistry and its specialties. This study examined whether dentists could distinguish between profiles of treated and untreated patients as well as between patients who had undergone extraction and those who had not.

Infection control in Mississippi dental practices: a comparison of Mississippi Dental Association members and non-members

In conclusion, the results of the survey were reassuring in many ways. The data indicate that the dental profession in Mississippi seems to have taken advantage of continuing education opportunities, paid increased attention to infection control, and in general, were using appropriate techniques before the OSHA mandate of 1992. Furthermore, members of the MDA not only demonstrated a greater understanding of infections diseases, but were also 20 percent more likely to report behavior known to reduce the risk of cross infection. It will be important to continue to identify the "gaps" and provide information, additional training, and encouragement to the dental profession and to dental auxiliaries to improve infection control procedures where improvement appears to be needed.

A longitudinal study of dental students' personality type preferences

The Myers-Briggs Type Indicator was administered to five classes of students at the beginning and end of their dental education. The 161 students who completed both tests were categorized according to personality type. The Spearman rank-order correlation of the two sets of data was calculated and tested. Changes in personality type between the tests were noted using two different standards. The first standard defined change as any alteration in the four-letter MBTI designation and thus was a measure of change in type. The second standard defined change utilizing the 95 percent confidence interval of the continuous score of each of the four MBTI scales and thus was a measure of change in the underlying construct, personality. The first standard indicated 75.8 percent of students change type; the second indicated 11.2 percent changed personality. These data are consistent with previously reported studies, but raise questions regarding what is being measured and how the data are being analyzed.

Prevalence of primary canine hypoplasia of the mandibular teeth

The purpose of this study was to determine the prevalence of an uncommon lesion of the primary mandibular canines (primary canine hypoplasia), and its association with age, race, gender, dental caries, fluoridation status of the drinking water, breast-feeding, and geographic location. The study population comprised 2686 randomly selected children, black and white, 4 and 8 years old, who were enrolled in accredited private and public preschools and elementary schools in Mississippi. There were 1318 males and 1368 females, 1289 white children and 1397 black children, 1353 4-year-olds and 1333 8-year-olds. Results indicate that an association exists for race (P = 0.0001), gender (P = 0.01), and dental caries (P = 0.0001), but not for age (P = 0.07), geographic location (P = 0.73), fluoridation status of the water supply (P = 0.145), or breast-feeding (P = 0.392). The prevalence rate of primary canine hypoplasia was 33.2% for black children and 17.2% for white children. These data indicate that this lesion is significantly more prevalent in blacks than whites, and that teeth with this lesion have a greater probability of developing dental caries.

The interaction of CD4 with HIV-1 gp120

CD4 is an integral cell surface glycoprotein that is able to enhance T cell specific antigen responses when it interacts with its physiological ligand, class II major histocompatibility (MHC) molecules. In addition, CD4 is a specific cell-surface receptor for the human immunodeficiency virus-1 (HIV-1). Infection by HIV-1 is initiated by the binding of the envelope glycoprotein, gp120, to the first domain of CD4. The binding of CD4 to class II MHC is inhibited by gp120, one possible mechanism for immunosuppression in AIDS patients. In addition, the CD4/gp120 interaction may directly inhibit T cell function. Recently we have synthesized small molecules (CPFs) that specifically inhibit this interaction. CPFs bind to gp120 and prevent the binding of gp120 to CD4, and also inhibit the infectivity of HIV-1.

A simplified hypoplasia index

A simplified hypoplasia index for deciduous teeth has been developed. The index utilizes a two-digit system to signify the type and severity of the hypoplastic lesion. The types of lesions recorded are primary canine hypoplasia (PCH) and linear enamel hypoplasia (LEH). The severity ranges from minimal to severe and accounts for the presence of dental caries, dental restorations, and recurrent caries. To determine the reliability of the index, two tests were conducted. The first measure was a repeat reliability coefficient (test-retest) to calculate the stability of the instrument. This measure was calculated for two populations by two examiners under the same examination conditions and exams were conducted seven weeks apart. The second measure calculated the interrater reliability (standardization). Test results were analyzed by employing the Pearson product moment correlation. The repeat reliability coefficients were .75 (P less than or equal to .0001) and .74 (P less than or equal to .0001). The interrater reliability coefficient was .87 (P less than or equal to .0001). These data seem to indicate that the index is reliable over time and between examiners.

Dental caries assessment of Mississippi Head Start children

This study assessed the dental caries status and treatment needs of Mississippi Head Start children during the 1987-88 school year. The 2,393 children examined, representing a 10 percent random sample of all Mississippi Head Start children, were three to six years old with a majority being four to five years old. The mean deft ranged from 1.34 for three-year-olds to 4.32 for six-year-olds; the mean defs ranged from 2.33 to 9.99. More than 50 percent of primary teeth of three-year-olds with dental caries experience required treatment, whereas less than one-quarter of similarly affected teeth of six-year-olds were in need of treatment.

Primary canine hypoplasia in Head Start children

Primary canine hypoplasia is an incomplete or defective development of the enamel matrix. The lesion is located on the labial surface and is seen more frequently on mandibular teeth. The purpose of this preliminary study was to determine the prevalence of this lesion among Head Start children. During a dental needs assessment of Mississippi Head Start children, 371 children from 11 centers were examined for this lesion. Of the centers, four were located in optimally fluoridated communities, and six were located in fluoride-deficient communities. Ages ranged from three to five years. There were 206 males and 165 females, 334 black and 37 white children. At ten centers all children were black, while all children at one center were white. Results indicated no significant differences in the black population between fluoridated (38.2%) and fluoride-deficient (36.3%) communities (P = .729) or between males (36.8%) and females (37.6%) (P = .877). When data were collapsed on sex and fluoridation status, the racial differences were highly significant (P = .001). The prevalence rate of dental caries associated with primary canine hypoplasia was 26.0 percent. These preliminary data indicate that the presence of primary canine hypoplasia may result in an increased potential for the tooth becoming carious.

Labial hypoplasia of primary canines in black Head Start children

During routine examinations of 334 black Head Start children in Mississippi, many presented with areas of hypoplasia on the labial surfaces of the mandibular primary canines. Mean prevalence was 38 percent in fluoridated areas and 36 percent in areas without fluoridation. As it appears that hypoplastic defects have a strong potential to become carious, one should expect that the incidence of 25 percent reported here would continue to increase.

Triple teeth: case reports of combined fusion and gemination

The discovery of a rare combination of fusion and gemination in one clinical crown, involving the same primary teeth in two patients, within a short period of time, is described.

Changes in dental students' personal needs and values

Personality characteristics of dental students were studied longitudinally by means of the Allport-Vernon-Lindzey Study of Values and Edwards Personal Preference Schedule. There were no significant differences when 21 scale scores of seniors were compared to the scores obtained from the same students as freshmen. The lack of significant change indicated a minimal effect of dental education on the personal needs, values, and attitudes of students. Thus, it is essential that faculty know as much as possible about applicants' values and needs prior to their admission to dental school. Knowledge of these personality characteristics is also essential for teaching and reinforcing those attitudes and values that are believed to assist students in developing well-integrated personal and professional lives.

Dental students' personality: a Jungian perspective

The Myers-Briggs Type Indicator (MBTI) was employed to measure the nature and strength of dental students' various basic preference in perceiving and making judgments. The MBTI yields four sets of scores--extrovert-introvert (E-l), sensing-intuitive (S-N), thinking-feeling (T-F), and judging-perceptive (J-P)--and represents 16 personality types that define these preferences. The sample consisted of five classes at the University of Mississippi School of Dentistry (n = 217). The data indicated that the largest group (32 students) was ESFJ, while the next largest (30) was ESTJ. The least frequently represented groups were the INTP (3), the INFP (7), the INTP (7), and the ENTP (7). Dental students exhibited characteristics different from those of students in business, engineering, social work, medicine, and other fields. These findings have implications for admissions committee decisions as well as for the organization and curriculum of the dental school.

The use of audiovisual procedures in evaluating oral diagnostic and treatment planning skills of dental students

In the belief that an examination testing the diagnostic and treatment planning capabilities of junior dental students should involve more than the traditional paper and pencil test, a new test was developed at the University of Mississippi School of Dentistry. Interesting and varied stimuli, such as a videotape, visual aids, and relevant dental data were included as part of this exam. The test was administered, and the degree of student anxiety before, during, and after the examination was measured. In general, students performed well; the majority indicated a preference for this type of examination over the usual paper and pencil test. As expected, anxiety levels increased until the examination was completed and then decreased. Student evaluations were not affected by the degree of anxiety. The inclusion of a variety of materials in a test measuring diagnostic and treatment planning skills resulted in a more challenging examination; the use of a videotaped segment simulating a case history provided consistency in the test material.

Dental anxiety and needs in low-income pregnant women

This study utilized the Dental Anxiety Scale (DAS) in examining 128 pregnant women, aged 15--34. The data indicated that 71% had not been to the dentist within the past year, 58% had made their last visit to the dentist because of pain, and 36% had presented to the dentist in pain. These patients had a mean of 7.3 tooth surfaces, or almost two teeth, that needed to be extracted, and 11.3 tooth surfaces, or almost three teeth, that had been extracted previously. Fillings were almost non-existent in this group of women. The moderately high anxiety scores were anticipated due to the inverse association between socioeconomic status and dental anxiety. However, knowing the anxiety level and needs prior to treatment prepared the operator to use caution and tact during each procedure. This brief test is invaluable in dental treatment situations.

Host-derived antibody-dependent cytotoxic cells within murine tumors

Mouse ascites tumor preparations had strong antibody-dependent cell-mediated cytotoxic (ADCC) activity, whereas cultured tumor cells did not. L5178 lymphoma cells reversibly expressed surface Fc receptors in vivo but not in vitro. Cultured lymphoma cells grown in vivo in diffusion chambers expressed Fc receptors but not ADCC activity. These results suggest that an Fc receptor is not sufficient to endow a cell with ADCC activity. The transplanted ascites tumors L5178 and MOT, an ovarian teratoma, contained about 2-5% host-derived cells, which represents a significant increase in the total number of host-derived peritoneal cells compared to the number of cells found in nontumor-bearing mice. These infiltrating host cells were separated from the ascites tumor cells by velocity sedimentation and by lysis with antibody and complement. In both instances, all the ADCC activity was associated with the host cells, whereas cells, such as killer cells and macrophage;, infiltrate ascites tumors and completely account for the potent ADCC activity associated with ascites tumor preparations.

Recurring oral pregnancy tumors

Two cases of recurring "pregnancy tumors" are described. The likelihood of these lesions occurring and recurring following conservative therapy is enhanced by hormonal concentrations in the gingival tissues in conjunction with local factors produced by poor oral hygiene. This condition may pose a clinical problem in the pregnant woman.

Mechanisms of hemopoietic and immunological dysfunction induced by lymphocytic choriomeningitis virus

Sublethal irradiation (500 R) of C3H mice is followed by a gradual replacement of radiosensitive cells in their spleens by surviving stem cells originating in bone marrow. This compensatory hemopoiesis was quantitated by counting the numbers of stem cell-derived colonies appearing on spleen surfaces, as well as those which grew in vitro after marrow cells, suspended in soft agar, were overlaid onto syngenic mouse embryo fibroblast feeder layers. Compensatory colony formation, both in vivo and in vitro, was severely depressed when mice were infected with lymphocytic choriomeningitis virus (LCMV) 1 day before irradiation, although the induction of virus-specific cytotoxic T cells in their spleens was unimpaired. Without irradiation, mice, acutely infected with LCMV, showed a dramatic reduction in the numbers of specific antibody-forming cells generated in their spleens after priming with sheep erythrocytes during week 1 post-infection, yet the ability of their marrow cells to form colonies in vitro remained normal. Therefore, the basis of immunodepression is distinct from that of defective hemopoiesis since the latter is apparent only when LCMV infection is accompanied by irradiation. However, as discussed, both phenomena may be related to alterations induced within the splenic environment by LCMV.

Standardization of value profiles of dental students and dental faculty

This study used the Allport-Vernon, Lindzey1,2 Study of Values to establish standardized norms for dental populations, and examined the relationship among freshmen, seniors, and full-time and part-time faculty. The normative data indicate that there is a similarity in general patterns for all groups. The dental student population sampled have higher scores on aesthetic and social values than their counterparts ten years ago.

Comparison of personal values among freshman and senior dental students and dental faculty

The purpose of this study was to test the effects of dental education on the values of dental students and dental faculty. This was accomplished by testing five hypotheses. The results of the study indicate no significant differences between freshmen and senior students' values; infer no apparent changes in student values during a dental education; indicate no significant differences between part-time faculty and full-time faculty; support a positive association among all groups, i.e., freshmen, seniors, full- and part-time faculty; rank-order the values for all groups from highest to lowest (theoretical, aesthetic, political, economic, social, and religious); and show some significant differences between students as a group and faculty as a group. If a more objective means of choosing dental students is desired, then further research will be needed to determine the characteristics of the type of practitioner that is needed. The presented data help in defining one aspect of the collective personality of dental students and dental faculties.