Tooth and periodontal disease: a review for the primary-care physician

Dental diseases are widespread and are often underrecognized and treated. Caries and periodontal disease are common dental conditions that cause the majority of tooth loss. Although these conditions are preventable, many persons do not receive regular dental care and have acute problems when seen by their physician. Dental diseases frequently affect patients with multiple systemic disorders, including autoimmune disorders, diabetes, and human immunodeficiency virus (HIV) infection. The presence of dental disease may trigger inflammatory responses and have systemic consequences. Since dental disease affects almost all individuals, physicians should be able to recognize common conditions such as caries, periodontal disease, pulpitis, and dental abscess. In addition to initiating treatment and appropriate dental referrals, physicians should be familiar with the management of antibiotics and medications in the perioperative period. Another important role for physicians is to help reduce the societal and economic impact of these diseases through patient education and prevention.

Filling the gap: strategies for improving oral health

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened, with the Children's Dental Health Project (CDHP), a select group of grantmakers and national experts who have made a major commitment to improving oral health. This Issue Dialogue - held on May 16,2001, in Washington, DC - explored current challenges related to oral health in the United States, and highlighted public and private sector initiatives to overcome these challenges. The roundtable also illustrated current activities and future opportunities for foundations in the area of oral health. This Issue Brief synthesizes key points from the day's discussion with a background paper previously prepared for Issue Dialogue participants. It includes quantitative and qualitative information on oral health as well as profiles of public sector, private sector, and grantmaker strategies for promoting improvements.

Report on the development of a new dental curriculum at Helsinki

A review of the dental curriculum was undertaken in Helsinki in the mid 90s. The objectives of the new curriculum were to reinforce the links between basic biomedical and dental sciences in order to give more emphasis to oral medicine and comprehensive dental care. Furthermore, the curriculum needed to promote an interdisciplinary approach and encourage students to understand dental diseases in relation to the community at large. A two-year, topic-based, preclinical curriculum, fully integrated with medical students, was started. For didactic teaching in the clinical phase, new learning entities were established to promote an inter-disciplinary approach. For the first time in Finland, objectives were formulated for attitudes and interpersonal skills. Clinical training was conducted in a comprehensive clinic, based on the team concept, where emphasis was given to proven competency instead of to the number of procedures performed. The time spent in the clinic was kept the same as previously (1440 h). Students' learning process was assessed with a portfolio. The majority of students welcomed the comprehensive care clinic, especially its team concept and treatment planning seminars. However, feedback seminars after treatment of the patient were not in favour. As part of the evaluation process, a DENTED visitation took place in Helsinki in March 1999. The results obtained in the student questionnaire were consistent with the aims of the undergraduate training and with the present patient treatment range. In conclusion, the curriculum change enabled the school to broaden the biomedical aspects by increasing the period of preclinical studies. Although the extent of these studies was greater than in the past, and meant postponement of clinical skills courses by one semester, it did not jeopardise the competency in clinical dentistry, owing to the effective integration of the clinical phase teaching.

Prevalence and nature of orofacial and dental problems in family medicine

OBJECTIVE

To determine the prevalence and nature of orofacial and dental problems in 2 family medicine practices.

DESIGN

Prospective, cross-sectional analysis of consecutive patient visits.

SETTING

Urban and rural family medicine practices.

PATIENTS AND PARTICIPANTS

Four hundred seventy-two patients between age 10 and 86 years.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Prevalence and nature of patient visits to family medicine practices that were either initiated by problems in the region of the oral cavity or that involved questions raised by the patient concerning oral or perioral sites.

RESULTS

Twenty-one patients (4.5%) of 472 met the inclusion criteria, 16 (76%) of whom had an oral problem as the primary or secondary reason for their visit. Perioral pain and mucosal ulcerations were the most common problems, and gingival tissue was the most common location. Almost two thirds of these patients had bacterial, fungal, or viral infections. Regarding treatment, 13 (62%) of these patients received advice, 10 (48%) received prescriptions, and 3 (15%) were referred to a dentist or another medical specialist.

CONCLUSIONS

Oral and perioral problems are common in the practice of family medicine, which suggests the desirability for specific oral medicine topics in the training and continuing education of primary care physicians. Arch Fam Med. 2000;9:1009-1012

Biocultural analysis of sex differences in mortality profiles and stress levels in the late medieval population from Nova Raca, Croatia

Human skeletal remains of 104 individuals from the late medieval (14th-18th century) Nova Raca cemetery, in continental Croatia, are described. Historic data from the parish Book of the Dead, relevant to a period in the early 19th century, suggest that females may have been under greater stress than males. To test this hypothesis, the skeletal material is analyzed for the presence and distribution of enamel hypoplasias and cribra orbitalia. Observations are also made on the presence and pattern of dental disease, skeletal infection, trauma, osteoarthritis, vertebral degenerative changes, and Schmorl's depression frequencies. The mortuary sample, consisting of 36 subadults and 68 adults, exhibits underrepresentation of subadults, and differential adult male/female mortality profiles. Peak female mortality is between 21-25 years, compared to peak male mortality between 31-35 years. Average adult female age at death is 29.9 years, compared to 34.1 years in adult males. Significant sex differences are present in the frequencies of enamel hypoplasia. Adult females have higher frequencies of hypoplastic teeth, and a larger number of defects in the teeth affected than in males. Subadults in the series also exhibit higher frequencies of hypoplastic teeth, and a larger number of defects in the teeth affected than in adults, documenting a relationship between enamel hypoplasia-causing stress events and reduced life expectancy. Significant sex differences are also present in dental pathology frequencies, possibly reflecting differences in resource access. Sex differences in vertebral osteoarthritis and Schmorl's depression frequencies may reflect differential activity patterns.

The changing role of dental auxiliaries: a literature review

A review of the literature on dental auxiliaries and their utilization in the dental workforce is presented, and their future role is examined in the light of broader issues relating to changing disease patterns and service delivery. Legislative factors, productivity, quality assurance and the potential scope for dental auxiliaries in both the public sector and private practice setting are discussed. A strategy for adopting a team approach in the delivery of dental services is suggested, which would necessitate the dentist taking on the role of team leader and maintaining responsibility for overall treatment planning and quality assurance. Dental auxiliaries could provide basic preventive and restorative dental services, allowing dentists to concentrate on providing more complex high-technology treatment. Implications for the future training of dental auxiliaries are presented.

Diagnosis of X-linked hypophosphatemic vitamin D resistant rickets

Recent advances in the pathophysiology and diagnosis of X-linked hypophosphatemic rickets (XLH) are reviewed. The recent discovery of the gene that is responsible for XLH especially enables us to understand the mechanism of hypophosphatemia in XLH. Laboratory and radiological findings are important for the diagnosis. However, dental abnormalities such as spontaneous dental abscess and a defect of dentin maturation are also notable findings.

Obesity and self-perceived health in Sweden

Data on self-perceived health in relation to relative body weight from the nationally representative adult Swedish population (12988 men and 13414 women) obtained from Statistics Sweden were analysed. The results are adjusted for age, socio-economic groups, self-reported chronic disease and marital status. Obesity was associated with 40% higher prevalence of severe pains from several joints in men and women and higher consumption of analgetics (OR = 1.6, 95% CI 1.2-2.2, in men, OR = 1.9, 95% CI 1.6-2.3, in women). Overweight and more often obese subjects reported physical impairment and in particular reduced mobility (OR = 1.9, 95% CI 1.5-2.5 in obese men and OR = 2.4, 95% CI 2.0-2.9 in obese women). Intake of vitamins was 20-40% significantly lower in overweight and obese than in normal weight subjects; the intake of iron pills was 60% lower in obese women. Dental status was worse in overweight and obese subjects. Dentures were found more often in overweight (OR = 1.5, 95% CI 1.3-1.7) and obese women (OR 2.2, 95% CI 1.9-2.7) in comparison to those with normal weight. Underweight was associated with adverse self-perceived health with regard to all these indicators. Our findings suggest that already moderate overweight in particular in women results in reduced mobility and physical impairment.

The neuropathology of Williams syndrome. Report of a 35-year-old man with presenile beta/A4 amyloid plaques and neurofibrillary tangles

OBJECTIVE

To study neuropathologically Williams syndrome in a 35-year-old patient.

METHODS

Sections from multiple regions of the brain were examined with luxol fast blue and hematoxylineosin staining, and selected sections were stained with the silver impregnation technique (Bielschowsky technique) and Congo red. In addition, immunohistochemistry with monoclonal antibodies against glial fibrillary acidic protein, beta/A4 amyloid, paired helical filaments, and phosphorylated tau protein was performed on cortical, hippocampal, amygdaloid, and basal ganglian sections.

RESULTS

No specific macroscopic or microscopic abnormalities were recognized that are specific for Williams syndrome. The histopathologic examination did, however, demonstrate the presence of Alzheimer-type changes, including beta/A4 amyloid-containing senile plaques and scattered neurofibrillary tangles in neocortex and medial temporal lobe structures (entorhinal cortex, CA1 area of the hippocampus, and amygdala). Plaques were most numerous in the amygdala (7/mm2) and in the entorhinal cortex (4/mm2). Neurofibrillary tangles were less numerous (< 1/mm2), except in the hippocampus, where approximately 2/mm2 were found.

CONCLUSIONS

To our knowledge, ours represents the first neuropathologic description of a patient with Williams syndrome. Although Williams syndrome is usually sporadic, familial cases have been reported along with candidate chromosomal loci. If our findings are confirmed in additional patients with Williams syndrome, they may provide clues to other factors that are important in the pathogenesis of senile plaques (with beta/A4 amyloid deposition) and neurofibrillary tangles.

Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The annual review of selected dental literature this year cites 384 published papers and reports. This year's review contains more editorial comment than reviews of years passed. New data on the biological responses to materials is emphasized in several sections. Observations on new compounds able to prevent plaque formation are presented. Clinically relevant advances in knowledge concerning the etching of different tooth structures are reported along with the effect of etching procedures on the dental pulp. Evaluation of periodontal diseases in all age groups is a topic. Limitations of current diagnostic techniques in periodontal disease, temporomandibular disorders, and implant therapy are included. There are new views on the use of dental amalgam. The future use of dental mercury is predicted. Interest in new ceramic systems is indicated as the demand for esthetics continues. Clinical information is emphasized over scientific information throughout this year's review.