Screening for prediabetes and type 2 diabetes in dental offices

Objectives

Most Americans see dentists at least once a year. Chair‐side screening and referral may improve diagnosis of prediabetes and diabetes. In this study, we developed a multivariate model to screen for dysglycemia (prediabetes and diabetes defined as HbA1c ≥5.7 percent) using information readily available to dentists and assessed the prevalence of dysglycemia in general dental practices.

Methods

We recruited 1,033 adults ≥30 years of age without histories of diabetes from 13 general dental practices. A sample of 181 participants selected on the basis of random capillary glucose levels and periodontal status underwent definitive diagnostic testing with hemoglobin A1c. Logistic models were fit to identify risk factors for dysglycemia, and sample weights were applied to estimate the prevalence of dysglycemia in the population ≥30 years of age.

Results

Individuals at high risk for dysglycemia could be identified using a questionnaire that assessed sex, history of hypertension, history of dyslipidemia, history of lost teeth, and either self‐reported body mass index ≥35 kg/m² (severe obesity) or random capillary glucose ≥110 mg/dl. We estimate that 30 percent of patients ≥30 years of age seen in these general dental practices had dysglycemia.

Conclusions

There is a substantial burden of dysglycemia in patients seen in general dental practices. Simple chair‐side screening for dysglycemia that includes or does not include fingerstick random capillary glucose testing can be used to rapidly identify high‐risk patients.

Practical implications

Further studies are needed to demonstrate the acceptability, feasibility, effectiveness, and cost‐effectiveness of chair‐side screening.

Is dentistry going to get into the salivary diagnostics game or watch from the sidelines?

What is salivary diagnostics and why should you care? Most of us dentists try to avoid or control saliva as it interferes with access, or chemical interactions in dental materials or impression materials, or when it is simply a nuisance. Periodically, we may note reduced flow or encounter a patient with xerostomia. Correspondingly, we then manage the many of today's existing commercialized oral-based tests were yesterday's proposed ideas or concepts, captured in the 1993 New York Academy of Sciences Conference on oral based diagnostics. When coupled with the emerging point-of-care technology, the potential of salivary diagnostics is even more compelling. In this section, I hope to elucidate for the reader the potential of salivary diagnostics for the dental profession and So what is the value proposition? How could this disruptive technology serve the dentist and the patients they treat? What must occur to facilitate the ongoing development and introduction of salivary diagnostics into the marketplace?

Is dentistry going to get into the salivary diagnostics game or watch from the sidelines?

What is salivary diagnostics and why should you care? Most of us dentists try to avoid or control saliva as it interferes with access, or chemical interactions in dental materials, or impression materials, or when it is simply a nuisance. Periodically, we may note reduced flow or encounter a patient with xerostomia. Correspondingly, we then manage the reduced flow in an attempt to maintain homeostasis. However, with the discovery of salivary biomarkers, saliva is taking on a new role.

The cost burden of oral, oral pharyngeal, and salivary gland cancers in three groups: commercial insurance, Medicare, and Medicaid

Background

Head and neck cancers are of particular interest to health care providers, their patients, and those paying for health care services, because they have a high morbidity, they are extremely expensive to treat, and of the survivors only 48% return to work. Consequently the economic burden of oral cavity, oral pharyngeal, and salivary gland cancer (OC/OP/SG) must be understood. The cost of these cancers in the U.S. has not been investigated.

Methods

A retrospective analysis of administrative claims data for 6,812 OC/OP/SG cancer patients was undertaken. Total annual health care spending for OC/OP/SG cancer patients was compared to similar patients without OC/OP/SG cancer using propensity score matching for enrollees in commercial insurance, Medicare, and Medicaid. Indirect costs, as measured by short term disability days were compared for employed patients.

Results

Total annual health care spending for OC/OP/SG patients during the year after the index diagnosis was $79,151 for the Commercial population. Health care costs were higher for OC/OP/SG cancer patients with Commercial Insurance ($71,732, n = 3,918), Medicare ($35,890, n = 2,303) and Medicaid ($44,541, n = 585) than the comparison group (all p < 0.01). Commercially-insured employees with cancer (n = 281) had 44.9 more short-term disability days than comparison employees (p < 0.01). Multimodality treatment was twice the cost of single modality therapy. Those patients receiving all three treatments (surgery, radiation, and chemotherapy) had the highest costs of cost of care, from $96,520 in the Medicare population to $153,892 in the Commercial population.

Conclusions

In the U.S., the cost of OC/OP/SG cancer is significant and may be the most costly cancer to treat in the U.S. The results of this analysis provide useful information to health care providers and decision makers in understanding the economic burden of head and neck cancer. Additionally, this cost information will greatly assist in determining the cost-effectiveness of new technologies and early detection systems. Earlier identification of cancers by patients and providers may potentially decrease health care costs, morbidity and mortality.

Clinical reduction of S. mutans in pre-school children using a novel liquorice root extract lollipop: a pilot study

AIM

To determine the clinical effect of a simple herbal caries-prevention protocol aimed at reduction of Streptococcus mutans (SM) in young children in a pre-school setting.

STUDY DESIGN

Proof-of-principle pilot study.

METHODS

To prove the concept this pilot study delivered a clinical intervention using sugar-free lollipops containing liquorice root extract. Regimen: Supervised herbal lollipops, twice daily for 3 weeks. Species-specific monoclonal antibody testing of saliva provided SM counts. Children were grouped in high, medium and low caries-risk using baseline SM-levels as risk-indicator. Bacterial numbers at baseline, during intervention, and for 9 weeks post-intervention were compared.

STATISTICS

SM levels were analysed using GEE modelling.

RESULTS

High-risk children showed the steepest early decrease in mean log-SM (P<.001). At end of a follow-up period, the log-SM decrease moved the high-risk group down to moderate-risk level. High-risk children showed a decrease in fitted mean SM% not seen in other groups (P<.001). The decrease reached a nadir around 22-days post-intervention. Twice-daily use of herbal lollipop significantly reduced both number and relative percent of SM in high-risk children. SM numbers were reduced for 22 days after the last lollipop, stabilized and then began to rebound.

CONCLUSION

A potential for simple effective caries-prevention for high-risk children has been demonstrated. Encouraging results warrant randomised clinical trials (RCT) of liquorice root in herbal lollipops or alternative modes of delivery.

Hepatitis B prevalence and infection control among dental health care workers in a community in South Korea

OBJECTIVES

The objectives of this study were to investigate the prevalence of hepatitis B vaccine and use of infection control procedures by dental health care workers in Taegu, South Korea.

METHODS

Information was obtained with a mailed questionnaire sent to 300 private dental practices. Surveys were received from 177 dentists, 104 dental hygienists, and 46 dental assistants. All dental health care workers were asked to donate a blood sample for analysis of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs).

RESULTS

Vaccination against hepatitis B virus was reported by 63 percent of the respondents. About 40 percent of all participants answered that they were anti-HBs positive, while another 43 percent did not know their status. About 89 percent of dentists reported that they wore a mask with all patients, while hygienists (13.6%) and assistants (13.0%) were less likely to do so. Reported use of gloves (4.5%) and protective eyewear (14%) with all patients was extremely low in every group. Among the 56 dentists who were tested for HBV markers, 23 did not receive the vaccine against hepatitis B, and 13 percent (3 of 23) were positive for HBsAg as carriers.

CONCLUSIONS

About 37 percent (120 of 327) of dental health care workers surveyed in this study in Korea did not receive the vaccine against HBV infection. Basic barrier techniques to prevent cross-contamination were not being used consistently. Nationwide guidelines for barrier techniques and hepatitis vaccinations should be developed and disseminated to dental personnel.

Unstimulated salivary flow rates of young children

OBJECTIVE

Studies on salivary flow rates in human beings have mainly been carried out with adults. The purpose of this study was to determine the unstimulated salivary flow rates of children 4 to 7 years old. In addition, the relative contributions of the variables age, gender, race, height, body weight, dentition status, use of prescription medication, and health status (information obtained from parents) to the unstimulated salivary flow rates of children were also studied.

STUDY DESIGN

Data were obtained from children (n = 447) at 2 sites in the United States (site 1, southeast Michigan; site 2, northern Michigan) and at 5 sites in Brazil (site 3, Porto Alegre; site 4, São Paulo; site 5, Belém; and sites 6 and 7, sites in Rio de Janeiro). In northern Michigan (site 2) the participants were cognitively or developmentally disabled, or both. In Rio de Janeiro (site 7), a group of 8- to 12-year-olds served as a control group. Saliva samples were collected for 3 minutes between 9 AM and noon in the spring or summer, and the saliva rate was determined gravimetrically. Data were analyzed by analysis of variance, bivariate analysis, and regression analysis.

RESULTS

The secretion rates at the 7 sites were (in milliliters per minute) 0.19 +/- 0.15, 0.23 +/- 0.28, 0.34 +/- 0.23, 0.48 +/- 0.37, 0.25 +/- 0.27, 0.37 +/- 0.28, and 0.61 +/- 0.34, respectively. There were significant differences among sites (P <.0001). The older group (site 7) had flow rates that were significantly higher than the flow rates of any other group. In addition, children from Michigan (sites 1 and 2) had significantly lower rates than most groups of children in Brazil. Girls had lower unstimulated salivary flow rates than boys did at all the sites, but the differences were not statistically significant. Race was shown not to affect the flow rates. The use of any prescription medication by children in the previous 3 months was associated with lower salivary flow rates than were found in children not using prescription medication. Children who were in good health and who had no previous medical conditions had higher flow rates--but not significantly so. Higher flow rates occurred in children with mixed dentition than in children with primary dentition, although again the differences were not statistically significant. Regression analysis revealed weight to be of significance in explaining the variability of the unstimulated salivary flow rates at 2 sites, height at 1 site, the use of prescription medication at 2 sites, and age at 1 site.

CONCLUSIONS

The unstimulated salivary flow rates in children in the northern United States are comparable with those reported for Japanese children, whereas the flow rates of children in Brazil are comparable with those reported for North American and European adults. In addition, none of the demographic variables/parameters tested contributed consistently to the variability of the unstimulated salivary flow rates in children at the 7 sites assessed in this study.

The relationships among fluoride, cariogenic oral flora, and salivary flow rate during radiation therapy

Changes in the quantity of Streptococcus mutans, Lactobacillus species, and yeast Candida species were assessed in a cancer population undergoing head and neck radiation. The purpose of this study was to evaluate the effectiveness of a custom vinyl tray-applied fluoride gel to control cariogenic bacteria in a group experiencing hyposalivation because of radiation treatment. Twenty-two subjects participated in the study and served as their own controls. Whole resting and whole stimulated saliva were collected at weekly appointments beginning 1 week before and concluding 4 weeks after radiation therapy. Colony-forming units per mL of Streptococcus mutans and Lactobacillus species and semiquantitative counts of Candida species (0 = none; 1 = light; 2 = moderate; 3 = heavy) were determined from collected saliva. All patients were provided with custom vinyl vacuform mouthguards to be used daily with neutral fluoride gel (1.1% sodium fluoride). Whole stimulated and resting saliva productions decreased by 36.67% and 47.9%, respectively, by the end of 1 week of radiation therapy, and they remained low. No significant changes in cariogenic oral flora were seen during and early after radiation therapy, despite xerostomia. However, colonization by Candida albicans increased during radiation therapy for oropharyngeal cancers. Findings from this study suggest that changes in cariogenic flora may be suppressed through the use of daily topical neutral sodium fluoride gels and that colonization by Candida albicans increase during radiation therapy.

Therapeutic efficacy and bone mineral density response during and following a three-month re-treatment of endometriosis with nafarelin (Synarel)

OBJECTIVE

Our goal was to determine the effects of a repeated course of the gonadotropin-releasing hormone agonist nafarelin on symptoms and signs of endometriosis and lumbar and distal radius bone mineral density.

STUDY DESIGN

Forty-five women previously treated for 6 months with nafarelin, who had recurrent symptoms and signs of endometriosis, received 400 mcg/day of nafarelin intranasally for 3 months. Efficacy was evaluated by changes in severity of symptoms and signs. Lumbar bone mineral density was measured by dual-energy x-ray absorptiometry and distal radius bone mineral density by single-photon absorptiometry. Bone mineral density was also measured in 10 control volunteers.

RESULTS

Repeated 3-month treatment significantly alleviated recurrent symptoms and signs of endometriosis. Lumbar bone mineral density decreased significantly by a mean of 2% at the end of treatment; this loss was restored within 3 to 6 months after treatment completion. No bone mineral density decline occurred in the radius. Bone mineral density changes in the control group were statistically insignificant.

CONCLUSIONS

A repeated 3-month course of nafarelin treatment significantly relieved recurrent endometriotic symptoms and signs without sustained loss of bone mineral density.

Need and Demand for Oral Medicine Services in 1996. A report prepared by the Subcommittee on Need and Demand for Oral Medicine Services, a subcommittee of the Specialty Recognition Committee, American Academy of Oral Medicine

The need and demand for oral medicine services in the United States and Canada was determined by a prospective survey of American Academy of Oral Medicine practitioners who attended the Academy's 1996 annual meeting. Of the 50 surveys returned from 149 eligible registrants, it was determined that, on the average, oral medicine practitioner respondents practiced 2.3 days per week and treated 8.7 patients per day; this amounts to more than 40,000 patient-care visits per year. Almost 90% of patients were treated because of medically compromising conditions, oral mucocutaneous disease, or chronic orofacial pain. Most of the care (52%) was provided in non-university settings. Most treatment involved the comprehensive evaluation of complex oral problems (36.7%), the prescription of medications (24.2%), or comprehensive dental treatment (21.8%) for patients with severe and life-threatening medical conditions. These results suggest that oral medicine services are needed and that demand for these services is high.

Oral staphylococcus in older subjects with rheumatoid arthritis

OBJECTIVE

To determine if Staphylococcus aureus and Staphylococcus epidermidis, etiologic bacterial agents to late prosthetic joint infections (LPJI), are more prevalent in the oral flora of older individuals with rheumatoid arthritis (RA) than in an age and gender-matched nonarthritic control population (NA).

DESIGN

Cultures were obtained from the nares, oropharynx, saliva, tongue, and gingival crevice, and the results were compared between older patients with RA and controls.

SETTING

University of Michigan Medical Center, Ann Arbor, VA Medical Center, and University of Michigan School of Dentistry.

PARTICIPANTS

A total of 111 community-dwelling subjects with a diagnosis of RA and 83 gender-matched control subjects.

MEASUREMENTS

Colistin nalidixic acid agar plates with 5% sheep's blood were inoculated and incubated. Isolates were speciated using the API Staph Trac micro method and catalase and coagulase tests.

MAIN RESULTS

Individuals with RA had a higher prevalence of S. aureus isolated from the oral cavity. However, only the oropharynx and tongue revealed higher rates; all other sites were insignificant. The presence of oral S. aureus was associated with xerostomia. Staphylococcus epidermidis was not detected from any of the oral sites sampled. Sixty-two percent (10/16) of the S. aureus isolates from the RA subjects were resistant to penicillin and ampicillin, whereas none were resistant to a cephalosporin.

CONCLUSIONS

These findings suggest that rheumatoid arthritis may be a risk factor for LPJI in older prosthetic joint patients undergoing invasive dental procedure in the posterior oral cavity. This increased risk is caused, in part, by a higher prevalence of S. aureus in the posterior oral cavity. The prevalence and the antibiotic resistance of S. aureus must be considered when determining the need for chemoprophylaxis.

Prophylaxis of candidiasis in patients with leukemia and bone marrow transplants

OBJECTIVES

The increased risk for systemic fungal infection and the potential fatal consequences of disseminated candidiasis in bone marrow transplant patients has prompted study of prophylaxis and early treatment of candida colonization and infection.

STUDY DESIGN

Patients with leukemia who received fluconazole prophylaxis were compared with a concurrent group of patients not given prophylaxis for fungal organisms.

RESULTS

A trend to reduction of oropharyngeal colonization by Candida albicans was seen (p = 0.07) although no significant differences in systemic candidiasis were seen. In patients with documented systemic candidiasis, oral colonization was present and systemic infection was identified after the development of ulcerative oral mucositis.

CONCLUSIONS

Our results support the potential of fluconazole to reduce oropharyngeal colonization by Candida albicans, however, we did not show prophylaxis of oral candidiasis or systemic candidiasis. These findings and reports of fluconazole-resistant candidal species and a rising number of cases of infection as a result of Candida krusei indicate the need for further studies of prophylaxis of candidal infection in patients who are anticipated to develop profound neutropenia.

Energy levels and probe placement in contact transscleral semiconductor diode laser cyclophotocoagulation in human cadaver eyes

We investigated the effects of semiconductor diode laser contact transscleral cyclophotocoagulation in human cadaver eyes by gross examination, light microscopy, and scanning electron microscopy to determine optimum clinical treatment parameters. Irradiation was performed using a continuous-wave semiconductor diode laser with a fiber-optic probe. At 1.0 to 1.25 mm posterior to the limbus, spots were centered on the pars plicata by gross examination. Exposures of less than 2 J produced no visible damage. A 2- to 3-J exposure produced mild whitening of the ciliary processes, while 4- to 5-J exposures created more intense whitening of the pars plicata. Energies higher than 5 J frequently produced explosive tissue damage. Light microscopy of tissue treated with 1.8 to 6 J at 1.0 to 1.25 mm posterior to the limbus revealed coagulation necrosis of the nonpigmented and pigmented epithelium, with evidence of thermal coagulation of the ciliary stroma and stromal vasculature. Coagulation necrosis was more intense with longer exposure times. We found the optimum parameters for contact transscleral diode laser cyclophotocoagulation in cadaver eyes to be 3 to 4.5 J of energy delivered with the anterior edge of the probe 1.0 to 1.25 mm posterior to the limbus.

Chemoprophylaxis of prosthetic joint patients during dental treatment: a decision-utility analysis

A decision-analytic model and a cost effectiveness analysis was performed on 1 million hypothetic prosthetic joint patients undergoing dental treatment, to determine the most cost-effective strategy to prevent late prosthetic joint infections. The cost per quality-adjusted life-year saved (QALY) was determined for three preventive strategies: no prophylaxis, oral penicillin, and oral cephalexin. The UCLA Pain-Walking-Function-Activity Scale was used to obtain quality-of-life adjustments (utility assessment) for the study population. Costs were derived from 70 patients hospitalized between July 1, 1982, and June 30, 1986, at the UCLA Center for Health Sciences. The most cost-effective preventive strategy was the no prophylaxis alternative ($196,500/QALY). However, by recommending a 1-day strategy of oral cephalexin only to those dental patients at high risk for late prosthetic joint infections rather than a 3-day regimen to all patients, the cost effectiveness improved from $1.1 million/QALY to $446,100/QALY while maintaining a low risk of death (0.38 deaths per 10(6) dental visits).

Semiconductor diode laser photocoagulation in retinal vascular disease

The authors successfully performed clinical transpupillary retinal photocoagulation in 30 eyes of 26 patients with retinal vascular disease using a gallium-aluminium-arsenide (GaAlAs) diode laser emitting at 805 nm. Retinal photocoagulation was performed at treatment powers of 300 to 1300 mW and exposure durations of 0.2 to 0.5 seconds with a 200-microns diameter treatment spot. Patients treated with both diode and argon green lasers required 4.5 +/- 1.8 times greater mean laser energy with diode compared with argon to create ophthalmoscopically similar lesions. Parallel experimental retinal photocoagulation in Chinchilla rabbits required 3.1 +/- 0.9 times more power to create ophthalmoscopically similar lesions with the diode laser than with the argon laser. Intraoperative subretinal hemorrhage occurred rarely in patients with an incidence of 4 (0.44%) of 9021 treatment spots. Patients complained of moderate-to-marked pain in 10 (43%) of 23 treatments initiated under topical anesthesia. A transpupillary diode laser may be used clinically to perform therapeutic retinal photocoagulation.

Antibiotic prophylaxis for dental patients with joint prostheses? A decision analysis

A decision analysis was performed to assess the risks, costs, and effects of no prophylaxis, oral penicillin, and cephalexin regimens currently being debated for dental patients at risk for late prosthetic joint infection (LPJI). The analysis suggests that there is a very small risk of LPJI (29.3 cases per 10(6) dental visits), which is outweighed by a greater risk of death with an oral penicillin strategy than with a "no prophylaxis" strategy (2.31:1.93). An oral cephalosporin appears to spare life and limb but does so at an extremely high cost. Over $500,000 must be spent to spare one year of life, while $480,000 needs to be spent to prevent one case of LPJI. Some individual dental patients may still be at a much greater risk for LPJI than others. However, from the evidence to date, routine predental antibiotic prophylaxis for all prosthetic joint patients is a very expensive preventive strategy and is not cost-effective. However, clinical experience suggests that antibiotic prophylaxis may be appropriate in some situations.

Experimental use of semiconductor diode laser in contact transscleral cyclophotocoagulation in rabbits

Acute and long-term effects of contact transscleral semiconductor diode laser cyclophotocoagulation were studied in rabbits. Immediately following cyclophotocoagulation, light microscopy revealed coagulation necrosis of the ciliary pigmented and nonpigmented epithelia and stroma; destruction increased in relation to power. There was architectural disruption with higher energy levels. The findings with diode and continuous-wave contact neodymium-YAG lasers were similar. In rabbits treated and followed up for 6 weeks there was a decrease in intraocular pressure during the observation period (P less than .05, paired Student's t test). The gross and light microscopic examination revealed focal atrophy and fibrosis of the ciliary processes, with pigment-laden macrophages on the ciliary processes and in the outflow pathways. Higher energy levels caused lens capsule damage and vitritis. The diode laser produced ciliary destruction similar to the continuous-wave contact neodymium-YAG laser in rabbits, with significant intraocular pressure lowering during the 6-week follow-up.

Characterization of the mycoflora from oral mucosal surfaces of some HIV-infected patients

Oral mucosal surfaces from 54 patients seropositive for human immunodeficiency virus (HIV) were assayed for the presence of cultivable yeasts. Oral colonization with Candida albicans, represented by 6 biotypes, was evident in 35 persons. The closely related variant, Candida stellatoidea, was found in 3 patients. Single isolates of Candida parapsilosis, Candida glabrata, Candida tropicalis, and Candida paratropicalis were also identified. One patient harbored a population of Saccharomyces cerevisiae. The susceptibilities of these 43 isolates to clotrimazole and nystatin were compared by the disk diffusion technique.

Acceptance of hepatitis B vaccine among dental health care workers

Participation in hepatitis B vaccination programs by dental health care workers (DHCWs) has been low. Following a vaccination program at the University of Michigan School of Dentistry, a survey was conducted to determine the relation of sociodemographic status, health beliefs, amount of patient contact, and perceived barriers to participation or nonparticipation in the program by 618 students, faculty, and staff. Stepwise logistic regression revealed that a respondent's age, perceptions about susceptibility to hepatitis B, amount of patient contact, and perceptions about the cost of the vaccine were significant determinants of participation. Findings from this study suggest that a highly structured program format is necessary to lower barriers and facilitate access to vaccination, while also cueing the DHCW to appropriate preventive behavior. knowledge appears to be but one factor that may affect decisions regarding acceptance of hepatitis B vaccine; health beliefs, motivational factors, barriers, and program organization all have a significant impact on the DHCW's decision.

A comparison of potential treatment costs for group capitation versus voluntary individual enrollment plans

As competition among insurance companies for increased market share intensifies, dental plans designed for new markets have begun to appear. One such plan is marketed to individuals not eligible for group plans. The purpose of this study was to determine if differences in potential treatment costs exist between patients enrolling in individual-targeted plans and those in group-based plans. The cost of treatment plans to eliminate dental disease and replace missing teeth whenever possible and/or practical was calculated for 119 patient pairs from both types of plans. Individually targeted patients had significantly higher levels of potential treatment costs, which were due primarily to significantly greater needs for operative, periodontal surgery, and endodontic services. These findings are important to insurance companies in designing plans that are both equitable and attractive to consumers and potential providers of care, who must weigh their costs of providing care against anticipated revenues.

Chemoprophylaxis of dental patients with prosthetic joints: a simulation model

A computer simulation model was created to assess the risks and effects of no prophylaxis, oral penicillin, and oral cephalexin regimens for dental patients at risk for late prosthetic joint infection (LPJI). Given the assumptions made, this analysis suggests that there is a very small risk of LPJI (29-68 cases per 10(6) dental visits), which is outweighed by a greater risk of death from a fatal antibiotic reaction. Thus, routine predental antibiotic prophylaxis for all dental patients with prosthetic joints may lead to higher mortality. However, clinical experience suggests that antibiotic prophylaxis may be appropriate in "high risk" patients.

Cost effectiveness of prevaccination screening for hepatitis B antibody

The cost effectiveness of screening for hepatitis B antibodies prior to instituting a vaccination program was investigated. Prevaccination screening tests for anti-HBs were performed on sera from 295 faculty and staff. Anti-HBs positive titers were found for 58 persons, and 43 (14.6 percent) of these had titers high enough to confer immunity. The cost of screening 295 persons was $1,666.64, or $5.65 per participant. By not vaccinating 43 persons, $4,498.23 was saved. A prevaccination screening would be most cost effective if only faculty with patient contact were screened.

Bacteria isolated from late prosthetic joint infections: dental treatment and chemoprophylaxis

The recommended administration of prophylactic antibiotics, before and during dental procedures, to persons with total joint prostheses is not without controversy. Hospital and dental charts of 2,693 patients in whom total prosthetic joints were placed at the Veterans Administration Hospitals of Ann Arbor and Allen Park, Michigan, as well as the University of Michigan Hospital, were analyzed. The identity of the micro-organism associated with the late (6 months after placement) infected prosthetic joint and the sensitivity of the organisms to specific antibiotics were recorded. Of the 30 (1.1%) late prosthetic joint infections, only one (0.04%) could be temporally associated with dental treatment. Fifty-three percent of the isolates were gram-positive staphylococci, the most common isolate being Staphylococcus epidermidis (36%). Pseudomonas aeruginosa was the most frequent gram-negative isolate cultured. Twenty-five of 34 isolates tested were resistant to penicillin, while only 3 of 36 isolates tested were resistant to a cephalosporin and 5 of 21 isolates tested were resistant to methicillin.

Dental treatment and late prosthetic joint infections

Hospital and dental charts of 2,693 patients in whom total prosthetic joints had been placed at the Veterans Administration Hospitals of Ann Arbor and Allen Park, Michigan, as well as at The University of Michigan Hospital, were analyzed. Of the thirty (1.1%) late prosthetic joint infections (greater than 6 months after placement), only one (0.04%) could be temporally associated with dental treatment. A Fisher's exact test of the data reflected that dental treatment in this population did not increase the incidence of late prosthetic joint infections (p value is 0.0005). Nine of the thirty late infections occurred in insulin-dependent diabetic patients and patients on long-term immunosuppressive therapy. An analysis of the organisms isolated from the late infections shows that 54% where Staphylococcus epidermidis and Staphylococcus aureus. These data do not support the practice of prescribing prophylactic antibiotic coverage of prosthetic hip and knee joints prior to all dental therapy. Rather, use of antibiotics during dental treatment appears warranted only if a chronic bacteremia is anticipated or where a predisposing systemic condition may exist.

Probe placement during electric pulp-testing procedures

Electrode placement sites during electric pulp-testing procedures on the crown of a tooth were evaluated in a laboratory setting using thirty-one extracted teeth, an oscilloscope, and a new electric pulp tester (Digital Analytical Pulp Tester). This study showed that the lowest resistance occurred on the occlusal two-thirds electrode sites of the labial or buccal surfaces of maxillary incisors and premolars. More specifically, the middle-third electrode sites of the incisors and the occlusal-third electrode sites of the premolars were shown to have the least resistance. The electrode placement area on the crown where the pulp nerve is first excited to threshold must be identified to avoid false-positive stimulation of surrounding periodontal nerves. This will decrease nerve damage and ensure the patient's cooperation and acceptance.