Costs of school-based mouthrinsing in 14 demonstration programs in USA

The purpose of this study was to determine the economic costs of school-based mouthrinsing in the demonstration programs. Costs for two complete years were expressed in 1978 dollars, and divided into explicit and implicit categories. Costs per participant were found to vary among programs (ranges of average total costs - period I: $2.35-$8.05, period II: $1.46-$7.94), and a tendency for some average costs to increase with size was identified. That costs were higher than the conventionally reported $0.50-$1.00 reflects 1) the organization of these federally funded programs and, 2) the use of an accounting method which describes the real economic costs of public programs.

Inhibition of experimental dental caries using an intraoral fluoride-releasing device

An intraoral fluoride releasing device designed to provide continual topical fluoride therapy for the prevention of dental caries was found to be effective in inhibiting caries in the rat model. Animals fitted with an intraoral device that released approximately 0.15 mg of fluoride per day developed 63% fewer carious enamel areas than animals receiving no treatment. Fluoridated drinking water (10 ppm) produced a 25% reduction in carious enamel areas. The fluoride-releasing device was more effective than ad libitum fluoridated drinking water in inhibiting caries on the approximal and sulcal surfaces. These results agree with the hypothesis that the continual presence of fluoride in oral fluids enhances the cariostatic effect of fluoride and, when combined with the results of earlier primate and human trials of the intraoral fluoride-releasing device, suggest that this fluoride delivery system can be developed into an effective anticaries agent.

Clinical evaluation of an intraoral device for the controlled release of fluoride

An intraoral-releasing device designed to release 0.5 mg of fluoride per day was evaluated in a one-month trial. The results showed that the 11 men who wore the fluoride-releasing device on their maxillary first molars had significantly elevated levels of fluoride in their saliva and plaque compared with baseline levels. No significant changes were observed in mean serum or urine fluoride levels or in the gingival or plaque indexes during the study. The prevalence of S mutans in whole saliva did not change during the study and the relative proportion of S. mutans, S. sanguis, and A viscosus and A naeslundii in plaque also remained relatively stable. The elevated fluoride levels in saliva and plaque are presumptive evidence that the intraoral fluoride-releasing device could exert a cariostatic effect in humans. However, long-term clinical trials are needed to determine the cariostatic potential of this fluoride releasing system.

Evaluation of the retention of two types of pit and fissure sealants

The aim of this study was to statistically compare the retention of a chemically polymerized sealant (Delton, Johnson & Johnson Co., East Windsor, N.J.) with a widely tested UV-polymerized system (Nuva-Seal, L.D. Caulk Co., Milford, Del.) Two hundred children aged 5-16 years who resided in Fairfax County, Virginia (a fluoridated community) and who had one or more pairs of homologous permanent posterior teeth free of decay or fillings were admitted to the study. Posterior teeth on one side of the mouth of each subject were randomly assigned to receive Nuva-Seal; teeth on the other side were treated with Delton. Treated teeth were examined for sealant loss approximately every 6 months for a period of 2 years. Scores for complete retention of Nuva-Seal were 86% after 6 months and 78% at the end of 2 years. The corresponding values for Delton-treated teeth were 96% and 92%. For both sealants, scores of total retention were highest in mandibular first premolars and lowest in mandibular second molars. The greatest rate of sealant loss occurred within the first 6 months after placement. A comparison of overall retention scores (net gain) for Delton and Nuva-Seal revealed that Delton scores were significantly higher than Nuva-Seal at each semi-annual examination. The McNemar test was used to compare the retention of the two sealants for each tooth type. The test showed that the retention scores for Delton were significantly higher than those for Nuva-Seal only on maxillary and mandibular first molars.

A program self-administered fluorides in a rural school system

In 1972, a self-administered fluoride program was initiated in Nelson County, VA, a fluoride-deficient area. Children in elementary school (grades K-6) ingest daily a 1-mg fluoride tablet, rinse weekly with 0.2% NaF solution and receive fluoride dentifrice for home use. In 1978, dental examinations of elementary schoolchildren (ages 6-12) who had continuously participated in the program for 1 to 6 years showed a prevalence of 2.70 DMFS, 45% lower than the score of 4.89 DMFS for their cohorts at the baseline. The preventive program inhibited dental caries effectively in all types of surfaces, but the reduction in proximal surfaces of 85% is particularly striking. Findings of high school children (ages 13-17) in 1978, who had not participated in the elementary school program for 1-5 years, showed evidence of strong post-treatment effects. At each succeeding follow-up survey, benefits have continued to improve. For elementary school participants, benefits were 17.7% after 2 years, 35.3% after 4 years and 44.8% after 6 years. Weekly fluoride mouthrinsing and daily ingestion of a fluoride tablet are feasible school-based procedures for the prevention of dental caries. Combined with the use of a fluoride dentifrice at home, these procedures have a pronounced cariostatic effect.

A randomized comparative trial of adriamycin versus methotrexate in combination drug therapy

A prospective randomized trial was conducted comparing the clinical response of 78 previously untreated patients with advanced metastatic breast cancer to a combination of cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) or to a combination of cyclophosphamide, adriamycin, and 5-fluorouracil (CAF). Sixty-two percent of the patients receiving CMF responded to treatment compared to an 82% response rate for the patients receiving CAF. Although within acceptable limits, hematologic and GI toxicity was greater with CAF. There was no significant difference in the duration of response to the two regimens. Therefore, the therapeutic difference between the two therapies is a higher initial response rate to the adriamycin containing regimen.

Prognostic factors in patients undergoing lymphadenectomy for malignant melanoma

Review of a 19 year experience in melanoma patients undergoinglymphadenectomy at the National Cancer Institute revealedthat the preoperative assessment of the status of theregional lymph nodes was accurate 91% of the time when thesurgeon felt the nodes were clinically positive, and accurate79% of the time when the nodes were judged clinically negative. The 10-year survival in patients with one to three histologicallypositive nodes or no positive nodes was 50-55%, compared to a25% 8-year survival in patients with four or more histologicallypositive nodes. Stepwise multivariate evaluation of prognosticfactors indicated that the most important factor for predictingprognosis is the number of nodes histologically involved. Nodepalpability was the second most important factor because of itshigh correlation with number of nodes histologically involved. Site of melanoma was the third most important factor, aspatients with extremity (upper or lower) melanoma had a bettersurvival (P = 0.002) than patients with axial melanoma (trunkor head and neck). Five years following lymphadenectomythere appeared to be substantial differences in survivalaccording to differences in the level of invasion of the primarylesion, however, these differences were not nearly aspronounced 10 years following node dissection.B The division of melanoma thicknesses into <1.50 mm and>1.50 mm provided some prognostic discrimination at fiveyears but again the differences were not pronounced 10 yearsfollowing node dissection. The thickness measurements wereeasier to determine than the level of invasion, and more reproduceableon resubmission to the same pathologist. Fourpatients with melanoma less than 0.76 mm had subsequentmetastases, but these may represent inadequate sampling of theprimary melanoma both in our series and in the four similarpatients previously reported with such thin metastasizingmelanomas.