Five-year incidence rates and intraoral distribution of root caries among community-dwelling older adults

The 5-year incidence and intraoral distribution of decayed and filled root surfaces were evaluated in 379 black and 323 white residents of North Carolina aged 65 and older. During the period of study, approximately 39% of blacks developed at least one root DFS compared with 52% for whites (Wald X(2) test, p = 0.062). When the results were calculated using the net root DFS increment, blacks did not have significantly higher rates than whites over the 5-year study period (0.52 surfaces/person versus 0.42 surfaces/person, Survey Regression, n = 363, p = 0.708). However, for blacks, the 5-year incidence density rate of root DFS was 0.26 per 60 surface-months at risk, and for whites the rate was 0.19 new root DFS per 60 surface-months (incidence density ratio = 1.33, 95% CI = 1.01-1.76, p = 0.047). Intraoral distribution patterns for root caries incidence revealed that the approximal surfaces of the anterior teeth were involved most frequently, particularly in the mandible and maxilla in whites, followed in decreasing order by the buccal surfaces of the lower anteriors and the mesial surfaces of the upper anteriors in blacks. Although root caries incidence rates were obviously low, there were significant differences in the occurrence of caries between blacks and whites. The pattern of occurrence was similar for both races with root surface disease being concentrated in the approximal surfaces of the anterior teeth in a small proportion of affected individuals, with whites presenting more filled root increments than blacks. These findings suggest a need for more caries treatment in blacks and increased monitoring of this population since they are at a higher risk for root caries.

Differences between racial groups in the impact of oral disorders among older adults in North Carolina

OBJECTIVES

This study investigated variations in impact of oral disorders between older black adults and older white adults living in North Carolina.

METHODS

Using the Oral Health Impact Profile (OHIP) questionnaire, 440 participants aged 70 and older provided data on their perceptions of the impact of oral disease on aspects of their lives during the previous 12 months.

RESULTS

For 22 of the 49 items queried in the OHIP questionnaire, older blacks reported more frequent impact than older whites (P < .05). For none of the OHIP items did whites report more frequent impact. The impacts reported were diverse and included items reflecting pain, physical disability, psychological disability, and social disability. When the number of items occurring fairly often or very often were summed for dentate participants, blacks reported more items than did whites (3.7 vs 1.1, P < .0001). This difference decreased to 2.7 vs 2.0 (P < .346) after controlling statistically for greater mean periodontal pocket depth, more unreplaced missing teeth, and more episodic dental visits among blacks.

CONCLUSIONS

Older dentate blacks reported more impact from oral problems than older dentate whites. The differences in reported impact likely are linked to differences in oral status and dental visit history between these two racial groups in North Carolina.

Unilateral choanal atresia in a foal

A 4-month-old Thoroughbred foal was examined because of a history of exercise intolerance and lack of airflow from the right nostril since birth. Endoscopy of the airways revealed complete membranous obstruction of the right nasal passage at the level of the nasopharynx and marked narrowing of the caudal aspect of the right ventral meatus. Unilateral choanal atresia was diagnosed. Laser ablation of the obstructing tissues was attempted through a videoendoscope. Scar tissue occluded the right nasal passage at follow-up examination 7 weeks later. Intranasal resection, using laparoscopic instruments, was then performed, and a nasal stent was maintained for 2 weeks after surgery. At 1 year of age, the foal was reported to have decreased airflow from the right nares and excessive respiratory noise during exercise. Atresia of the choanae in horses usually is bilateral and, therefore, life-threatening and detectable at birth. Unilateral choanal atresia may not be suspected until later, but should be considered in horses with decreased or no airflow from 1 naris.

Physicochemical properties, pharmacokinetics, and biodistribution of gadoteridol injection in rats and dogs

RATIONALE AND OBJECTIVES

The physicochemical properties of gadoteridol, a macrocyclic nonionic gadolinium complex, were studied together with its pharmacokinetics and biodistribution in rats and dogs.

METHODS

Studies in rats were conducted after single intravenous injections at 0.1 or 0.35 mmol/kg using 153Gd-labeled gadoteridol or with seven daily doses of 0.1 mmol/kg to examine the levels of residual gadolinium in organs. Nonradioactive biodistribution and excretion studies were performed in dogs following injection at 0.1 mmol/kg.

RESULTS

After injection, the dose was rapidly cleared from rat blood and excreted such that more than 90% of the dose appeared in the urine within 4 hr of injection. At 7 and 14 days postinjection, only extremely low levels of gadolinium were observed in liver and bone; these levels were two to eight times lower than the levels reported after the injection of gadopentetate dimeglumine.

CONCLUSION

The extracellular distribution and rapid urinary excretion of gadoteridol is in agreement with data obtained with other gadolinium-containing chelates used as intravascular magnetic resonance imaging contrast agents. Differences observed in the long-term retention of gadolinium between gadoteridol and gadopentetate dimeglumine were consistent with the reported greater in vivo resistance to transmetallation of gadolinium macrocycles compared with the linear gadolinium chelate molecules.

Risk factors for dental fluorosis in pediatric dental patients

OBJECTIVES

Concerns have been raised recently about whether a substantial amount of dental fluorosis is resulting from the increased use of fluoride from various sources. The purposes of this study were to determine the prevalence and severity of dental fluorosis in a sample of pediatric patients seeking dental treatment in a university pediatric dental clinic and to evaluate sources of fluoride as risk factors for dental fluorosis.

METHODS

A convenience sample of 157 children aged 8 to 17 years were examined for dental fluorosis using the Tooth Surface Index of Fluorosis (TSIF). Fluoride history questionnaires assessing previous exposure to fluoride during the first eight years of life were completed by the children's parents. Fluoride exposures were compared among 54 cases and 54 matched controls using a case-control retrospective design.

RESULTS

Fluorosis was found in 72 percent of the children, but was generally quite mild. The risk of fluorosis was significantly greater for children who had greater exposure to fluoridated water and who used larger amounts of fluoridated toothpaste up to age eight.

CONCLUSIONS

This study provided evidence that increased use of fluoride toothpaste may be a risk factor for dental fluorosis. The results suggest prudent use of dentifrice by young children to minimize the risk of fluorosis.

Eighteen-month incidence of tooth loss among older adults in North Carolina

This study investigated tooth loss in North Carolina adults 65 years of age or older. A random sample of 335 Blacks and 284 Whites participated in dental examinations and interviews at baseline and again after 18 months. Blacks were more likely than Whites to lose at least one tooth (36% vs 19%), and they lost more teeth on average (1.0 vs 0.4). Several oral disease conditions and symptoms were related to tooth loss, but many other hypothesized factors were not. Risk models were inconclusive in the identification of factors related to risk of tooth loss.

Three-year root caries incidence and risk modeling in older adults in North Carolina

OBJECTIVES

The purposes of this study were to describe the incidence of root caries and to identify its risk factors in a representative sample of older adults.

METHODS

Root caries incidence was estimated and multivariate risk assessment models were developed to identify predictors for root caries in a three-year follow-up study of 234 black and 218 white noninstitutionalized adults aged 65 and older residing in North Carolina.

RESULTS

During the observation period, 29 percent of blacks developed root caries, compared to 39 percent of whites (P < .05). The mean net DFS increment per person was 0.55 +/- 0.13 root surfaces for blacks vs 0.80 +/- 0.21 for whites (P > .32). Multivariate logistic regression analysis indicated that blacks wearing a partial denture, having some root fragments, having an average gingival recession > or = 2 mm, and being free of P. intermedia were at greater risk for developing new root caries. The model for whites showed that retired people with their most severe gingival recession > or = 4 mm, an average probing pocket depth > or = 2 mm, and taking antihistamines were more likely to develop new lesions.

CONCLUSIONS

These findings suggest that older blacks had less risk of root caries than whites, and in both groups indicators of poor periodontal status increased the risk of root caries.

Intraperitoneal use of sodium carboxymethylcellulose in horses undergoing exploratory celiotomy

The effect of intraperitoneal sodium carboxymethylcellulose (SCMC) administration on clinical outcome and survival was evaluated in horses undergoing exploratory celiotomy for acute gastrointestinal disease. Comparison of variables was made retrospectively between 44 horses that had SCMC and 92 horses (controls) not treated with SCMC. Mean age, body weight, heart rate, packed cell volume and plasma total protein of horses at admission, and convalescent period were not significantly different between control and SCMC groups. No significant differences were noted between control horses and SCMC horses with respect to incisional infection, hernia formation, recurrent episodes of colic, clinical outcome, and long-term survival (> 6 months). Seventy-six (83%) control horses and 34 (77%) SCMC horses survived long-term. Seventy (76%) control horses and 30 (68%) SCMC horses survived without complications and returned to their previous use. These results suggest that intraperitoneal use of SCMC does not adversely affect abdominal incisional wound healing, clinical outcome or long-term survival, however, the efficacy of SCMC in prevention of postoperative intestinal adhesions in horses requires further investigation.

Three-year tooth loss among black and white older adults in North Carolina

The distribution and determinants of tooth loss in older adults are poorly defined, especially in Blacks, who have been underrepresented in previous studies. This study investigated, epidemiologically, the distribution and predictors of tooth loss in elder Blacks and Whites by following a random sample of older adults in North Carolina for three years. It was hypothesized that Blacks would be at greater risk of tooth loss and would have different risk factors for tooth loss. Data from 263 Blacks and 228 Whites were collected by dental examinations and interviews conducted in the participants' homes. During the three-year follow-up, 53% of Blacks and 29% of Whites lost at least one tooth. Blacks lost 13% of their remaining teeth compared with 4% for Whites. Logistic regression models showed that factors related to tooth loss for Blacks were: more S. mutans in stimulated saliva, deeper periodontal pockets, more P. intermedia in subgingival plaque, high blood pressure, limited help from others, and few symptoms of depression. For Whites, significant factors were: more lactobacilli in stimulated saliva, history of current oral pain at baseline, more alcohol consumption, no history of past use of calcium or xerostomic medications, higher income, lower occupational prestige, and increased numbers of negative life events. This study showed that older Blacks were at greater risk of tooth loss than older Whites. For both races, factors such as oral bacteria, periodontal conditions, oral symptoms, and psychosocial and economic factors are related to increased risk of tooth loss.

Distribution of primary tooth caries in first-grade children from two nonfluoridated US communities

In a prospective longitudinal study, 1099 first grade children from Aiken, South Carolina, and 1086 children from Portland, Maine, were examined annually for 3 years. Caries prevalence and dmfs incidence were determined. The mean dmfs in Portland children was 2.9. In Aiken, white children had a mean dmfs of 8.4, and black children had a mean dmfs of 10.2. The mean 3-year primary tooth caries increment was 1.5 surfaces in the Portland cohort 3.3 surfaces in the Aiken white cohort and 2.8 surfaces in the Aiken black cohort. These increments were divided evenly between interproximal and fissure surfaces. Twenty percent of the children in Portland had 75% of the caries; in Aiken, 20% of the children had 60% of the caries. This distribution suggests a high-risk group that could be targeted for aggressive caries prevention efforts if risk factors can be identified.

Repair of fractures of the distal aspect of the radius in two horses

Fractures of the distal radius in two horses were repaired by open reduction and interfragmentary compression using screws placed in a lag fashion. One horse had a complete oblique fracture of the medial aspect of the epiphysis of the distal radius and was sound for riding 32 months after surgery. The other horse had an open spiral comminuted fracture with medial displacement of the distal radial fragment. Laminitis developed in the contralateral limb and this horse was euthanatized 5 weeks after surgery.

Effects of acetylpromazine, xylazine, and vertical load on digital arterial blood flow in horses

Palmar digital arterial blood flow was measured in 6 conscious, standing horses, using surgically placed perivascular ultrasonic flow probes. The effects of 2 dosages of xylazine (0.55 and 1.1 mg/kg of body weight) and of 3 dosages of acetylpromazine (0.01, 0.02, and 0.04 mg/kg), as well as the effect of vertical load, on digital blood flow were evaluated. Intravenous administration of xylazine induced a significant (P < 0.05), transient decrease in digital blood flow. Intravenous administration of acetylpromazine induced a significant (P < 0.05), prolonged increase in digital blood flow. Correlation between vertical load and digital blood flow was found. The results of this study indicate that use of acetylpromazine may be beneficial in clinical treatment of horses with reduced digital blood flow. Xylazine, on the other hand, may exacerbate ischemic conditions of the digit and should be used with caution.

Eighteen-month coronal caries incidence in North Carolina older adults

In this longitudinal study of a random sample of North Carolinians over the age of 65 and living in their homes, 325 blacks and 280 whites were examined and interviewed 18 months after baseline examinations. Coronal caries incidence was greater among whites than blacks. The increment due to teeth becoming root fragments were similar for both races; however, there were more newly crowned teeth among whites. Newly crowned surfaces were not used as part of the caries increment in logistic regression models to investigate potential risk predictors. For blacks, caries development over the 18-month period was associated with a higher lactobacillus score and more coronal caries at baseline, more previously filled coronal surfaces, and lack of active membership in clubs or other groups. For whites, having no self-reported tooth sensitivity, having a lower socioeconomic index score, taking antihistamine medications at baseline, and having the perception of more problems after the age of 40 than before were all associated with the development of coronal caries.

Conservative management of femoral diaphyseal fractures in four foals

Femoral fractures in young horses can occur as a result of severe trauma and generally have a poor prognosis despite treatment. Four young horses with femoral diaphyseal fractures were managed with conservative treatment consisting of prolonged rest, analgesics, hind limb support, and corrective farriery. A favorable outcome in the form of pasture soundness with potential for limited athletic usefulness was obtained in 3 out of the 4 cases. This report supports the use of conservative treatment of selected diaphyseal femoral fractures in young horses.

The distribution and interrelationship of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and BANA scores among older adults

In a random sample of subgingival dental plaque samples from 375 blacks and 300 whites aged 65 and older, immunofluorescence assays for 3 target pathogens including Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia, and BANA enzyme analysis were carried out. Blacks had significantly greater proportions of P. gingivalis and P. intermedia in their subgingival plaque and had significantly higher BANA scores. These assay results were investigated for concordance with each other and with 2 cariogenic salivary bacteria, Streptococcus mutans and lactobacilli. In general for both races, the periodontal pathogens were more likely to occur in combination with each other than with either S. mutans or lactobacilli. P. gingivalis and P. intermedia were more frequently associated with each other than with A. actinomycetemcomitans. There was a significant negative concordance between BANA and A. actinomycetemcomitans in whites and a significant positive concordance between BANA and P. intermedia in blacks.

Understanding the value of teeth to older adults: influences on the quality of life

Understanding the value of teeth to older adults is important in marketing dental services and motivating patients to care for their teeth. The authors surveyed more than 1,000 older adults in North Carolina to determine how teeth affect the quality of their lives.

A retrospective evaluation of laminitis in horses

Case records of 202 horses treated for laminitis were reviewed with the intent of determining the long-term outcome and correlating this with digital radiographic findings and with the degree of pain associated with the laminitis. At long-term follow-up 57 horses had returned to athletic soundness (Group 1), 20 horses were intermittently lame (Group 2), 19 horses had permanent severe lameness (Group 3), 97 were dead (Group 4), and 9 were lost to follow up. Using simple regression analysis, functional outcome did not correlate with the degree of rotation (R2 = 0.004) or the presence of distal displacement (R2 = 0.139). Functional outcome did correlate with the clinical grade of laminitis (R2 = 0.504). Horses in Group 1 had significantly less distal phalangeal rotation (5.89 +/- 6.48 degrees) than did horses in Group 2 (11.10 +/- 8.19) and Group 3 (14.50 +/- 10.80), but were not significantly different from Group 4 horses (7.49 +/- 6.57). Of 96 surviving horses, 23 had evidence of distal displacement compared with 54 of 97 non-survivors. Based on these results, horses that develop distal displacement of the distal phalanx are more likely to die than are horses without distal displacement; however, the presence or absence of distal phalangeal displacement and the degree of distal phalangeal rotation cannot be used to predict the outcome of a horse with laminitis. Clinical assessment is a more reliable means of determining the final outcome and should be given precedence over radiographic findings.

Assessing dental practice quality by evaluating radiology items

The DEMCAD dental office assessment instrument was developed to evaluate practice quality using Donebedian's quality assessment model of structure, process, and outcome. This previously validated instrument takes about six hours to complete. Subsequent analysis was undertaken to determine whether an abbreviated office assessment based on the evaluation of radiology items was sufficiently sensitive, specific, and practical to be used as a screening instrument for identifying dental offices with very low evaluation scores. Data for this analysis were obtained from 300 volunteer general dental practices evaluated in the field testing of the DEMCAD instrument. The nine radiology structure items predicted very poorly the overall structure scores. However, 13 radiology process items predicted overall process scores quite accurately. Four of the 13 radiology process items (periodontal diagnoses recorded, interdental bone shown on x-rays, caries diagnoses recorded, and current x-rays mounted) produced a combined R2 of .58. These four radiology variables predicted the 10 percent of the dental practices with the lowest overall process score with 87 percent sensitivity and 93 percent specificity. This analysis showed that an abbreviated dental practice process quality assessment using oral radiology items in an audit of patients' records may be feasible as a screening test for dental office assessment.

Streptococcus mutans, lactobacilli, and caries experience in older adults

This study investigated salivary levels of Streptococcus mutans, lactobacilli, and caries experience in a random sample of 448 black and 362 white older dentate adults living in North Carolina. Significant proportions of the participants had stimulated salivary flow rates less than 1.0 mL/min, salivary buffering capacity less than 4.0, S. mutans levels of 10(5) cfu/mL or more in stimulated whole saliva, or lactobacilli levels of 10(5) cfu/mL or more. Each of these factor levels could be considered, on a clinical basis, to increase caries risk. In general, people with higher levels of S. mutans or lactobacilli had more untreated coronal and root caries, but not greater total caries experience.

Tension-band wiring and lag screw fixation of a transverse, comminuted fracture of a patella in a horse

A transverse, comminuted fracture of the patella was treated surgically by combining tension-band wiring and lag-screw fixation in a horse. Partial patellectomy or smaller detached fragments of the patella was performed. Satisfactory healing of the fracture was evident 10 weeks after surgery, and there were no complications. Implants were not removed. The horse was sound at a trot 4 months after surgery and was used for pleasure riding 8 months later.

Sutured end-to-end and stapled side-to-side jejunal anastomoses in the horse

Hand sutured end-to-end (EE) and stapled side-to-side (SS) small intestinal anastomoses were performed in 10 healthy adult horses. In five SS anastomoses, staple lines on the blind ends of the jejunum were inverted (SSI) and in five they were not (SSNI). Five EE anastomoses were sutured with polydioxanone and five were sutured with polyglyconate. All horses were euthanatized on day 30. Intra-abdominal adhesions were graded (0-4), and stomal areas were calculated from contrast radiographs made with the bowel distended. Histopathology scores for the anastomoses were based on the degree of inflammation (0-3), fibrosis (0-3), and alignment and healing of intestinal layers (0-3). Mean surgery times +/- standard deviations for EE, SSI, and SSNI techniques were 33.9 +/- 5.4, 36.2 +/- 5.6, and 29.6 +/- 5.9 minutes, respectively. Mean and median stomal areas were 9.4 +/- 5.5 and 8.9 cm2 for EE anastomoses and 17.2 +/- 16.5 and 12.1 cm2 for SS anastomoses. Intra-abdominal adhesions developed in three horses, one of which had clinical signs of colic. Mean histopathology scores for EE and SS anastomoses were 4.8 +/- 2.0 (median = 5) and 4.4 +/- 1.8 (median = 4), respectively. There were no statistically significant differences in surgery times, intra-abdominal adhesion scores, stomal areas, or histopathology scores between small intestinal EE and SS anastomoses in these horses.

Effect of examining half the teeth in a partial periodontal recording of older adults

Limited evidence to date has suggested that half-mouth examinations can be used in epidemiological surveys for accurate estimation of the prevalence of periodontal conditions. This study investigated the accuracy and efficiency of half-mouth periodontal examinations of mesial and buccal sites by comparing whole-mouth findings from those sites with findings that would have been obtained by examining only two randomly selected quadrants of teeth in three older dentate adult populations: 263 whites in Iowa, 309 whites in North Carolina, and 384 blacks in North Carolina. Mean half-mouth scores for gingival recession, pocket depth, attachment loss, and Extent and Severity Index were almost identical to those of mean whole-mouth scores, with correlations between means exceeding 0.93. However, the proportions of the population having selected levels of moderate or severe periodontal disease in mesial and buccal sites were underestimated by as much as 13%. This study showed that half-mouth examinations can be accurate and efficient in estimating mean periodontal measures, but may underestimate the prevalence of periodontal conditions.

Repair of a ruptured calcaneal tendon by transposition of the tendon of the peroneus longus muscle in a goat

Traumatic rupture of the calcaneal tendon was diagnosed in a 3-year-old female goat. Clinical features included tarsal hyperflexion and diffuse swelling in the area of the calcaneal tendon. Surgical repair consisted of debridement of devitalized tissue and transposition of the tendon of the peroneus longus muscle to bridge the calcaneal tendon defect. Adequate postoperative immobilization followed by gradual introduction of tendon loading allowed a favorable outcome.

Intracranial trauma associated with extraction of a temporal ear tooth (dentigerous cyst) in a horse

Heterotopic polyodontia is typically associated with a sinus and a fistulous tract with a secreting membrane which extends to an ectopic tooth attached to the temporal bone. Recommendations for treatment include complete excision of the tract, the dental component, and the lining of the alveolar socket. Iatrogenic cerebral trauma was encountered during surgical extraction of an ectopic tooth. At post-mortem examination a second ectopic tooth was found compressing the right side of the cerebellum.

Five-year incidence of tooth loss in Iowans aged 65 and older

The prevalence of missing teeth has been described for US adults, but little is known about the incidence of tooth loss in any segment of the population. This study investigated the 5-yr incidence of tooth loss in a random sample of Iowans aged 65 yr and older residing in two rural counties. These people had an average of 20 teeth at baseline and approximately 40% lost at least one tooth in the subsequent 5 yr. The incidence of tooth loss was highest for mandibular molars and lowest for mandibular canines. Men were more likely than women to lose teeth. Although we were able to identify a number of statistically significant potential risk factors for tooth loss, the multivariate models that incorporated all these factors were not good predictors of which people were at highest risk for tooth loss.