Large brachial artery diameter is associated with angiographic coronary artery disease in women

BACKGROUND

Noninvasive methods are needed for the identification of women at highest risk for coronary artery disease (CAD) who might benefit most from aggressive preventive therapy. Identification of brachial artery atherosclerosis, which correlates with coronary artery atherosclerosis, may be useful to estimate or stratify CAD risk. Because atherosclerosis disrupts the arterial architecture that regulates vessel size, we hypothesized that noninvasively measured large brachial artery diameter is a manifestation of atherosclerosis that is associated with angiographic CAD in women with chest pain.

METHODS

We examined 376 women (mean age, 57.1 years) with chest pain in the National Heart, Lung, and Blood Institute's Women's Ischemia Syndrome Evaluation study who underwent B-mode ultrasound scan measurement of brachial artery diameter at rest and during hyperemic stress (to quantify flow-mediated dilation), quantitative coronary angiography, and risk factor assessment.

RESULTS

Large resting brachial artery diameter was associated with significant angiographic CAD (3.90 +/- 0.79 mm vs 3.52 +/- 0.59 mm in women with CAD vs no CAD; P <.001). Impaired flow-mediated dilation, which correlated with resting diameter (r = -0.17; P =.001), was weakly associated with significant CAD (2.74% +/- 7.11% vs 4.48% +/- 9.52% in CAD vs no CAD; P =.046). After adjustment for age, body size, and CAD risk factors, women with large resting brachial artery diameters (>4.1 mm) had 3.6-fold increased odds (95% confidence interval, 1.8 to 7.1; P <.001) of significant angiographic CAD compared with those with small brachial arteries (</=3.6 mm).

CONCLUSION

Large resting brachial artery diameter is an independent predictor of significant CAD in women with chest pain. Therefore, a simple ultrasonographic technique may be useful in the identification of women with chest pain who are at increased risk for CAD.

Assessment of women with suspected myocardial ischemia: review of findings of the Women's Ischemia Syndrome Evaluation (WISE) Study

Coronary artery disease (CAD) is the most common cause of death in women. In general, noninvasive testing in women is less reliable compared with testing in men, and most major clinical trials in CAD have included only a minority of female subjects. The Women's Ischemia Syndrome Evaluation (WISE) Study--sponsored by the National Heart, Lung, and Blood Institute--was initiated to improve diagnostic testing in women. The study consisted of four centers that tested existing methodologies as well as innovative techniques to improve diagnostic testing in women. The WISE study also aimed to clarify physiologic determinants of myocardial ischemia and determine whether angiographically normal coronary arteries are associated with myocardial ischemia. The following discussion provides an overview of the WISE study and reviews the reported and published data from the study.

Effectiveness of early treatment of Class II malocclusion

The purpose of this study was to examine and report the effectiveness of early treatment with the headgear/biteplate and the bionator in patients with Class II malocclusion regardless of the mechanism of correction and to compare early-treatment results with changes over a similar time period in an observation group. The role of factors such as compliance was examined to determine their contribution to effective treatment. The experimental design was a prospective, longitudinal, randomized controlled trial. At the end of the early-treatment period, all 3 groups differed significantly (overall, P = .001) in percentage of treatment goal achieved, with median values of 83% for the bionator group, 100% for the headgear group, and 14% for the observation group. In both treated and observation subjects, the percentages of goal achieved varied by initial molar class severity (treated, P =.0205; observation, P = .0040) and race (treated, P = .0314; observation, P = .0416). Significant correlations in the treated subjects were identified between percentage of goal achieved and bone age (13 bones) (r = 0.16; P = .037), bone age (20 bones) (r = 0.16; P = .043), compliance (r = 0.26; P = .0005), and initial overjet (r = -0.26; P = .0095). Significant correlations were not detected in the observation group. Sex, treatment group, age, mandibular plane angle, pretreatment, and retention did not significantly affect percentage of goal achieved among the treated and the observation subjects. Correlation between normalized compliance scores and percentage of goal achieved was high for both bionator (r = 0.50) and headgear subjects (r = 0.49) at the end of treatment. Multivariate analysis suggested that headgear may be superior to bionator/biteplane in achieving a Class II correction during early treatment.

Orthodontists' perceptions of the impact of phase 1 treatment for Class II malocclusion on phase 2 needs

The most appropriate timing for the treatment of Class II malocclusions is controversial. Some clinicians advocate starting a first phase in the mixed dentition, followed by a phase 2 in the permanent dentition. Others see no clear advantage to that approach and recommend that the entire treatment be done in the late mixed or early permanent dentition. This study examines how orthodontists, blinded to treatment approach, perceive the impact of phase 1 treatment on phase 2 needs. The sample consisted of 242 Class II subjects, aged 10 to 15, who had completed phase 1 or observation in a randomized clinical trial (RCT). For each subject, video orthodontic records, a questionnaire, a fact sheet, and a cephalometric tracing were sent to five randomly selected reviewing orthodontists blinded to subject group and study purpose. Reviewing orthodontists were asked to assess treatment need, general approach, need for extractions, priority, difficulty, and determinants. Orthodontists agreed highly on treatment need (95%) and moderately on treatment approach (84%) and extraction need (80%). They did not perceive differences in need, approach, or extractions between treated and control groups. Treated subjects were judged as less difficult (p = 0.0001) and to have a lower treatment priority (p = 0.0001) than controls. In ranking problems that affect treatment decisions, the orthodontists ranked dental Class II (p = 0.005) and skeletal relationships (p = 0.004) more highly in control than in treated patients. These data indicate that orthodontists do not perceive phase 1 treatment for Class II as preventing the need for a second phase or as offering any particular advantage with respect to preventing the need for extractions or other skeletal treatments in that second phase. They do view early Class II treatment as an effective means of reducing the difficulty of and priority for phase 2.

Evaluation of orthodontists' perception of treatment need and the peer assessment rating (PAR) index

This paper examines the relationship between orthodontists' subjective assessment of treatment need and objective measurements obtained during standardized intra- and extraoral examinations. Logistic regression modeling was used to develop predictive models of treatment need. Data were obtained from 1155 eighth-grade students by four orthodontists who used standardized examination forms to assess demographics, trauma, skeletal relationships, morphologic malocclusion traits, and mandibular function. At the conclusion of the examination, the orthodontist rated the subjective treatment need as none, elective, recommended, soon, or immediate. For some analyses, the categories were collapsed to represent no need and need. The peer assessment rating (PAR) index (American validated version) was computed from the clinical exam findings and scoring of dental models; PAR scores were used to document malocclusion severity and treatment difficulty. Spearman rank correlation coefficients quantified the relationship between PAR scores and need categories. Logistic regression analysis modeled treatment need using components of the PAR index as well as other variables. The components of these models, as well as sensitivity and specificity, were compared with malocclusion severity/treatment difficulty scores obtained from malocclusion assessments using the PAR index. The five subjective treatment need categories and the PAR index scores were significantly correlated (rho = 0.62, p<0.001). Significant differences were detected between the need and no need groups for all PAR components (p<0.001). PAR index scores and predicted probabilities from logistic regression models performed equally well for classification purposes (no need, need). The data suggest that the PAR index is highly correlated with orthodontists' subjective assessment of treatment need when that assessment is made in the absence of financial considerations and patient desires.

Prevalence of orthodontic asymmetries

Epidemiological studies of the occlusal status of the US population do not include the prevalence of orthodontic asymmetries. To estimate the magnitude of dental and facial asymmetries in adolescents with no history of orthodontic treatment, data were analyzed from two mass orthodontic screenings that had been conducted on public schoolchildren in Florida. An analysis of orthodontic records of patients in treatment at the Virginia Commonwealth University graduate orthodontic clinic provided prevalence data on dental and facial asymmetries in a population of orthodontic patients. In the Florida studies, the two screenings yielded 5,817 untreated children (mean age, 9.3 +/- 0.8 years) and 861 untreated children (mean age, 14.4 +/- 0.5 years). Sagittal molar asymmetry was found in 30% of the children in the first screening and in 23% in the second screening. Additional asymmetry assessments in the second screening showed 12% facial asymmetry and 21% noncoincidence of dental midlines. Among orthodontic patients, the most common asymmetry trait was mandibular midline deviation from the facial midline. This occurred in 62% of patients, followed, in descending order of frequency, by lack of dental midline coincidence (46%), maxillary midline deviation from the facial midline (39%), molar classification asymmetry (22%), maxillary occlusal asymmetry (20%), mandibular occlusal asymmetry (18%), facial asymmetry (6%), chin deviation (4%), and nose deviation (3%).

Likelihood-based inference for the genetic relative risk based on affected-sibling-pair marker data

Using genetic marker data from affected sibling pairs, we study likelihood-based linkage analysis under quasi-recessive, quasi-dominant, and general single-locus models. We use an epidemiologic parameterization under a model where the marker locus is closely linked to the putative disease susceptibility gene. This model and parameterization allow inferences about the relative risk associated with the susceptible genotype. We base inferences on approximate likelihoods that focus on the affected siblings in the sibship and, using these likelihoods, we derive closed-form maximum likelihood estimators for model parameters and closed-form likelihood ratio statistics for tests that the relative risk associated with the susceptible genotype is one. Under the general single-locus model, our likelihood ratio test is the same as the iteratively computed triangle test proposed by Holmans (1993, American Journal of Human Genetics 52, 362-374) for the case where marker identity-by-descent is known; our derivation gives a closed form for the test statistic. We present quartiles of the distribution of parameter estimates and critical values for the exact null distribution of our likelihood ratio test statistics; we also give large-sample approximations to their null distributions. We show that the powers of our likelihood ratio tests exceed the powers of more commonly used nonparametric affected-sibling-pair tests when the data meet the inheritance model assumptions used to derive the test; we also show that our tests' powers are robust to violation of model assumptions. We conclude that our model-based inferences provide a practical alternative to more common affected-sibling-pair tests when investigators have some knowledge about the mode of inheritance of a disease and that our methods may sometimes be useful for comparing the genetic relative risk with environmental relative risks.

Occlusal traits and perception of orthodontic need in eighth grade students

In 1994, 1155 eight-grade students in Alachua County, Fla., were asked about self-perception of and level of concern for their occlusal status. Clinical assessments of orthodontic parameters were also recorded. Twenty-five percent of the students had a history of orthodontic treatment. Of the remaining students who had no history of orthodontic treatment, 74% reported satisfaction with the way their teeth looked, 64% expressed no perceived need for braces, and 57% were judged clinically to have optional or no orthodontic needs. Sex, soft tissue profile, overjet, anterior crowding, and molar classification were significantly associated with the perception of need for braces while race and overbite were not. Clinical judgment of orthodontic need differed significantly among levels of satisfaction with teeth. Eighth graders with no history of orthodontic treatment were generally satisfied with the appearance of their teeth and perceived less need for braces than clinicians.

Anteroposterior skeletal and dental changes after early Class II treatment with bionators and headgear

In this study we examined anteroposterior cephalometric changes in children enrolled in a randomized controlled trial of early treatment for Class II malocclusion. Children, aged 9.6 +/- 0.8 years at the start of study, were randomly assigned to control (n = 81), bionator (n = 78), and headgear/biteplane (n = 90) treatments. Cephalograms were obtained initially, after Class I molars were obtained or 2 years had elapsed, after an additional 6 months during which treated subjects were randomized to retention or no retention and after a final 6 months without appliances. Calibrated examiners, blinded to group, used Johnston's analysis to measure anteroposterior cephalometric changes. Statistical analysis was used to determine annual skeletal and dental changes during treatment, retention, and follow-up, and overall. Our data reveal that both bionator and head-gear treatments corrected Class II molar relationships, reduced overjets and apical base discrepancies, and caused posterior maxillary tooth movement. The skeletal changes, largely attributable to enhanced mandibular growth in both headgear and bionator subjects, were stable a year after the end of treatment, but dental movements relapsed.

Tobacco control activities in U.S. dental practices

The authors surveyed general dentists, periodontists, pediatric dentists and dental hygienists in three U.S. geographical regions to estimate the percentage who practiced tobacco use cessation activities in their dental offices. A total of 1,746 dentists and 723 dental hygienists completed either a long or short version of a mailed survey or telephone interview. The authors found that tobacco cessation activities are not a routine part of dental practice and that tobacco control activities and training vary by dentist type and geographical region.

Intraoperative autologous transfusion during elective infrarenal aortic reconstruction: a decision analysis model

PURPOSE

The use of intraoperative autologous transfusion devices expanded during the last decade as a result of the increased awareness of transfusion-associated complications. This study was designed to determine whether routine use of an intraoperative autologous transfusion device (Haemonetics Cell Saver [CS]) during elective infrarenal aortic reconstructions is cost-effective ($50,000/QALYs threshold).

METHODS

A decision analysis tree was constructed to model all of the complications that are associated with red blood cell replacement during aortic reconstructions for both abdominal aortic aneurysm (AAA) and aortoiliac occlusive disease (AIOD). It was assumed that a unit of CS return (CSR; 250 ml/unit) equaled a unit of packed red blood cells (PRBCs) and that all CS transfusions were necessary. Transfusion requirements (AAA:PRBC = 2.8 +/- 3.2 units, CSB = 3.7 +/- 3.2 units; AIOD:PRBC = 3.1 +/- 3.0 units, CSR = 2.1 +/- 1.7 units) were determined from retrospective review of all elective aortic reconstructions (AAA, N = 63; AIOD, N = 75) from Jan. 1991 to June 1995 in which the CS was used (82.1% of all reconstructions). Risk of allogenic transfusion-related complications (transfusion reaction, hepatitis B, hepatitis C, human immunodeficiency virus, human T-cell lymphotropic virus types I and II) and their associated treatment costs (expressed in dollars and quality-adjusted life years (QALYs) were obtained from the medical literature, institutional audit, and a consensus of physicians.

RESULTS

Routine use of the CS during elective infrarenal aortic reconstructions was not cost-effective in our practice. Use during reconstructions for AAA repairs cost $263.75 but added only 0.00218 QALYs, for a rate of $120,794/QALY. Use during reconstructions for AIOD was even more costly at $356.68 and provided even less benefit at 0.00062 QALYs, for a rate of $578,275/QALY. The sensitivity analyses determined that the routine use of the CS would be cost-effective in our practice only for AAA repairs if the incidence of hepatitis C were tenfold greater than the baseline assumption. The model determined that CS was cost-effective if the CSR exceed 5 units during reconstructions for AAA and 6 units during reconstructions for AIOD.

CONCLUSIONS

The routine use of the CS during elective infrarenal aortic reconstructions is not cost-effective. The use of the device should be reserved for a select group of aortic reconstructions, including those in which cost-effective salvage volumes are anticipated. Alternatively, the CS should be used as a reservoir and activated as a salvage device if significant bleeding is encountered.

Dental, visual, auditory and olfactory complications in Paget's disease of bone

OBJECTIVE

To determine the prevalence of dental problems in Paget's patients and in a control population without Paget's disease. The relationship of localization of bony involvement of Paget's disease with the prevalence of dental, auditory, visual, and smell changes is examined.

DESIGN

Cross-sectional national survey.

PARTICIPANTS

Four hundred ninety-eight subjects with Paget's disease were generated randomly from the mailing list of the Paget Foundation.

INTERVENTION

Each subject was sent a cover letter, two questionnaires, and a stamped, addressed return envelope. One questionnaire contained questions specific for the individual with Paget's disease. Subjects were asked to give the other questionnaire, which contained the same questions except for those asking about the specifics of Paget's disease, to an unaffected spouse or a similar aged friend.

MEASUREMENTS

All subjects were asked about their age, gender, race, educational level, income, living situation, chronic medical conditions, self-rating of their general physical and dental health, the number of teeth present, and the presence of dental, auditory, visual, and olfactory problems. Paget's subjects were also asked to indicate which bones were affected.

RESULTS

Paget's disease subjects assessed their oral health to be poorer than the controls. Paget's subjects were more likely to report pain when opening the mouth and were more likely to have had dental extractions. A significantly higher percentage of Paget's individuals with facial or maxillomandibular involvement reported having heart trouble. Paget's individuals with skull, facial or maxillo-mandibular involvement were more likely to report a change in their hearing, sight, and smell than Paget's subjects without involvement of the craniofacial complex. Dental problems were reported by 93% of those Paget's subjects with maxillomandibular involvement, compared with only 10% for those with skull involvement only or involvement at sites distant to the craniofacial complex.

CONCLUSIONS

Patients with Paget's disease of bone involving facial or maxillo-mandibular parts of the skeleton have a higher prevalence of change in hearing, sight, smell, and dental problems. We also have found an association of heart disease in patients who have involvement of facial or maxillo-mandibular bones.

Orthodontic treatment demand and need in third and fourth grade schoolchildren

There have been few reports worldwide addressing orthodontic need and demand in children and no recent reports in the United States. The purpose of this study was to examine the orthodontic need and demand in third and fourth grade children (n = 3696). Data including age, sex, race, orthodontic status, socioeconomic status, availability of specialist treatment services, as well as thorough occlusal data, were collected. Orthodontic demand was significantly higher in girls (9.5%) than boys (6.8%), whereas need had the inverse relationship (41.8%, 44.2%, respectively). There were no meaningful differences in age among the demand, need, and no need groups. Demand was greater in white than in black children (11.8% versus 1.2%); however, need was observed to be less in black (35.3%) than in white children (47.2%). Demand was greater in the urban schools (8.9%) than in the rural schools (6.3%), whereas need was found to be similar. There was more demand in the higher socioeconomic groups (11.7%) than in the lower groups (1.8%), whereas need was similar in all the groups. The demand group had a significantly greater number of orthodontists within a radius of up to 5 miles of the school than the need and no need groups. Logistic regression models to examine factors that distinguish the groups show that when demand versus need/no need groups are compared, those students with an increased "risk" of previous treatment are more likely to have more orthodontists nearby, to be in higher socioeconomic groups, and to be female students.

The prevalence of neurologic dysfunction in children with strabismus who have superior oblique overaction

BACKGROUND

Children with certain neurologic diseases (hydrocephalus, meningomyelocele, or cerebral palsy) have been reported to manifest a high frequency of A-pattern strabismus and superior oblique overaction. However, it is not generally recognized whether children with strabismus who have superior oblique overaction are more likely to have concurrent neurologic diseases than those without superior oblique overaction. In this study, the authors examine this issue.

METHODS

The authors retrospectively reviewed the medical records of all patients (n = 168) with overdepression of the downturned eye in adduction, who were examined between October 1989 and March 1992. A randomly selected population of children with strabismus who did not have overdepression of the eye on infraduction and adduction served as controls (n = 98). Patients with simulating or confounding conditions such as pseudo-superior oblique overaction, inferior rectus skew deviation (alternating skew on lateral gaze), and restrictive or paralytic strabismus, and who were older than 20 years of age, were excluded.

RESULTS

One hundred twelve patients with true superior oblique overaction were analyzed. Of these 112 patients, 45 (40.2%) had concurrent neurologic abnormalities, compared with less than one fifth (17.3%) of control subjects (17 of 98) (P < or = 0.001).

CONCLUSIONS

Children with strabismus who have superior oblique overaction were found to have higher prevalence of concurrent neurologic diseases than control subjects. Superior oblique overaction may represent a clinical marker for an associated neurologic dysfunction, possibly representing a form of skew deviation in some cases.

Comparison of the double-plate Molteno drainage implant with the Schocket procedure

A randomized, prospective study was undertaken to compare the results of the double-plate Molteno implant with those of the anterior chamber tube shunt to encircling band (ACTSEB) procedure, described by Schocket, for eyes with complicated glaucoma. One surgeon performed all the procedures. For statistical analysis there were 21 eyes in the ACTSEB group and 19 eyes in the Molteno group, with at least 6 months of follow-up (mean follow-up, 26 months; range, 6 to 49 months). Eyes with aphakia/pseudophakia, uveitis, previous penetrating keratoplasty, previous unsuccessful trabeculectomy, and neovascular glaucoma were evenly distributed between the two groups. Mean preoperative intraocular pressures in the ACTSEB and Molteno groups were 35.2 and 34.6 mm Hg, respectively. With the exclusion of one phthisical eye in each group final mean intraocular pressure in the ACTSEB group was 15.1 mm Hg, with a mean of 0.43 medications, and 14.4 mm Hg, with a mean of 0.95 medications, in the Molteno group. Seven (33%) of 21 eyes and 13 (68%) of 19 eyes in the ACTSEB and Molteno groups, respectively, were receiving additional antiglaucoma medication at the most recent visit (P = .027). Final visual acuity was stable (within one Snellen line of baseline visual acuity) or improved in 10 (48%) of 21 eyes in the ACTSEB group compared with 13 (68%) of 19 eyes in the Molteno group. Complications or inadequate pressure control requiring further surgical intervention were seen in nine (47%) of 19 eyes in the Molteno group and 12 (57%) of 21 eyes in the ACTSEB group.(ABSTRACT TRUNCATED AT 250 WORDS)

The value of barium as a gastrointestinal contrast agent in MR imaging: a comparison study in normal volunteers

Preliminary data suggest that barium sulfate suspension is a potentially useful negative gastrointestinal contrast agent for MR imaging. To evaluate this hypothesis in a controlled fashion, abdominal and pelvic MR studies of 10 normal volunteers were performed before and after both oral (600-900 ml) and rectal (400 ml) administration of barium. Standard spin-echo coronal T1-, axial T1-, proton density-, and T2-weighted images were obtained at 1.5 T. Images obtained were randomized and interpreted by three observers, who evaluated bowel visualization and delineation of normal anatomy. Bowel segments evaluated were stomach, duodenum, proximal small bowel, proximal colon, distal colon, and rectum. Anatomic structures examined were pancreatic head, pancreatic body, pancreatic tail, retroperitoneum, spleen, liver, pelvic side walls, uterus, vagina, bladder, prostate, and seminal vesicles. Data concerning barium tolerance and safety were recorded. Descriptive, percent change, and kappa statistics were analyzed. Pairwise agreement techniques and repeated measures analysis of variance were performed. This statistical assessment showed a significant improvement in both bowel visualization (59-123% improvement, depending on the segment) and delineation of normal anatomy (23-68% improvement, depending on the structure) after barium administration, particularly on T1-weighted images. In addition, barium was a well-tolerated and safe contrast agent that did not produce artifacts. Our results show that barium sulfate is a useful negative gastrointestinal contrast agent for MR because it improves bowel visualization and delineation of abdominal anatomy, particularly on T1-weighted sequences.

Maturation of vaginal and cervical epithelium in women exposed in utero to diethylstilbestrol (DESAD Project)

A total of 452 women with documented exposure in utero to diethylstilbestrol (DES) with epithelial findings present at the time of their initial examination have been evaluated prospectively to determine whether these findings changed over a period of 3 years. The examinations were all performed according to a strict protocol. Findings present at the time of the third annual examination were verified at a fourth examination. A verified decrease in the extent of epithelial findings occurred in 29.2% of these women and a verified increase in 6.6%; 53.1% had no change in the extent of epithelial findings, and 11.1% had a change that could not be verified at the time of the fourth visit. Analysis of many variables failed to identify a strong association between any variable and a decrease in the extent of the findings. It appears that the most important factor in the occurrence of changes in DES-associated findings is the passage of time.

Dysplasia and cytologic findings in 4,589 young women enrolled in diethylstilbestrol-adenosis (DESAD) project

This report presents the cytologic findings and the rates of dysplasia for 4,589 young women enrolled in the National Cooperative Diethylstilbestrol-Adenosis (DESAD) Project. Mucinous columnar cells and/or metaplastic squamous cells with or without mucinous droplets were encountered in 22% of vaginal scrape smears from all diethylstilbestrol (DES)-exposed participants identified by review of prenatal records and in 43% of women in whom vaginal epithelial changes (VEC) were observed by colposcopy or by iodine staining. The frequency of cellular findings in the vaginal scrape smears was closely related to the timing of the administration of the DES to the mother. With increasing age of the daughters, the overall frequencies of both the mucinous and metaplastic cells decreased; relative to each other, an increasing proportion was metaplastic squamous cells. These data suggest that, as the women grow older, vaginal adenosis regresses by the process of squamous metaplasia. Endometrial type cells were found in 2% of vaginal scrape smears. Their cyclical occurrence during the menstrual cycle and lack of correlation with the presence of VEC indicated an origin from the uterine corpus rather than the tuboendometrial type of adenosis. Squamous cell dysplasia of the vagina and cervix was detected by biopsy or scrape smear specimens in 1.8% of DES-exposed women in the record review group. The rate of unexposed women was twice as high. In general, the rates of dysplasia were higher in the cervix than vagina, and the more severe degrees of dysplasia were encountered only in those women who were referred to the DESAD Project or who themselves requested entry. Four patients who were referred or who themselves requested entry were found to have clear cell adenocarcinoma of the vagina. The vaginal smear provided the first clue to the presence of an abnormality in three of them.

Risk factors associated with incisor injury in elementary school children

This study examined risk factors associated with incisor injury in 3396 third and fourth grade school children in Alachua County, Florida. One of six orthodontists completed a standardized examination form for each child to assess severity of incisor injury, gender, age, race, skeletal relationships, morphologic malocclusion, incisor exposure, interlabial gap, TMJ sounds, chin trauma, and history of lower facial trauma. One in five (19.2%) exhibited some degree of incisor injury. This was limited to a single tooth in 73.1% of those with injury, while enamel injury predominated (89.4%). The majority of the injuries (75.4%) were localized in the maxillary arch, with central incisors the most frequently traumatized. Chi-square tests of association indicated that gender, race, school, orthodontist, history of lower facial trauma, chin trauma, profile, and maxillary and mandibular horizontal positions were associated with incisor injury (P < 0.05). Wilcoxon rank sum tests identified differences in age, overjet, time of screening, and interlabial gap between those with and without injury (P < 0.05). Results of logistic regression analyses indicated risk of incisor injury was greater for children who had a prognathic maxilla, a history of trauma, were older, were male, and had greater overjet and mandibular anterior spacing.