[Surface analysis of 2 composite filling materials after various methods of finishing and sealing]. The surface quality of 2 composite filling materials (Adaptic with coarse hard quartz fillers and Cosmic with fine softer glass fillers) was evaluated using profilometry, scanning electron microscopy and light reflectometry after finishing with experimental diamond discs, 3M discs, corundum discs, polishing paste and also after sealing. Plaque formation on standardized surfaces of both composites was photographically recorded in 20 subjects. The sealed surfaces and the surfaces finished by the matrix alone were approximately 10 times less rough than after finishing procedures. Under in vivo conditions they reflected the most light, for both composites. The sealer failed to cover the whole composite surface. The unfinished and sealed surfaces lost their shine 3-7 days after placement in the mouth. Decrease in reflectance was independent of mechanical oral hygiene procedures. There were no significant differences in the roughness produced by the various discs on Adaptic surfaces. Diamond discs with particle size 1-3 micrometer resulted in least surface roughness and were the only instruments not destroying the filler particles of either composite. 3M discs and the rough corundum discs caused significantly more surface roughness of the Cosmic surface. Reflectometry showed that the finishing methods unfavourably affected composite surface smoothness. Among all finishing methods polishing paste produced the highest reflection value on the Cosmic surface. Adaptic surfaces were always associated with more plaque formation than Cosmic surface after all finishing methods.


[Adpatation and marginal fit of thixotropic composites and syringe system composites. In vitro findings]. In a dye penetration test and a scanning electron microscopic evaluation MOD-restorations made of a thixotropic material (ZKP-A-5(2)) and of two syringe system composites (Concise-Capsule-Composite3, Compocap-S4) were investigated with respect to microleakage and marginal adaptation. These materials did not reveal better marginal micromorphology than a comparable two-paste composite system (Concise3); Compocap-S showed markedly less microleakage. The quality of marginal adaptation, however, was improved to 52% when a low viscosity sealant (ZKP-A-2(2), Concise Enamel Bond3) was applied before insertion of the restorative. A sealant pretreatment is therefore compulsory in thixotropic and syringe packed composites as well. The perfection reached with these composite brands is equal to that of adhesive restorations made of Concise or Adaptic5 [6,7]. Restorations performed with new, complete composite systems (Nimetic6, GC's Epolite 100/Epobond7) revealed moderate results when compared to standard materials like Concise or Adaptic [6,7].


[Evaluation of 16 months old variously fashioned incisor fillings]. The influence of the cavity preparation form, enamel conditioning, and application of a low viscosity sealer upon marginal adaptation and microleakage of anterior teeth proximal composite restorations was investigated in vivo. Restorations inserted using the principles of Adhesive Restoration showed the best results. Experimental adhesive fillings placed into minimally prepared saucer-shaped cavities with no macroscopic dentin retention demonstrated likewise satisfactory results because of their small volume. Definitely inferior marginal adaptation and increased microleakage were obtained with other restorative techniques. Trace areas of etched enamel could be observed after 16 months in those cases where enamel conditioning was not followed by a sealer application. The utilization of a sealer, therefore, improves not only the marginal adaptation of the composite material but in addition offers a protective seal to the previously conditioned enamel surface. Once the adhesive restoration is completed, it is recommended that a fluoride solution be applied to all enamel surfaces in the operational field. This fluoride treatment results in the formation of extremely high concentrations of fluorapatite in enamel areas which might have been inadvertently exposed to etching solutions during the procedure and not sealed or covered by composite material.


[Core build-ups from composites--evaluation of the technics of application]. The advantages and disadvantages of composite materials when used in direct core restoration of endodontically treated teeth is discussed. With the aid of dye penetration tests and scanning electron microscopy, in vitro fabrication of gold and amalgam cores were compared to those of 3 different composite core techniques. A compression technique used in the application of composite to the Radix -anchor post was judged successful. Neither modification of preparation nor application of a sealer before composite insertion improved margin adaptation or reduced microleakage of restoration margins. Acid etching of dentin definitely decreased marginal quality; therefore, for core construction using composites, the acid etch technique is not indicated. The proper use of composites is superior to gold and comparable to amalgam in core fabrication of endodontically treated teeth, when evaluating marginal adaptation and the reduction of microleakage at the composite-dentin interface.


[Effect of the shape of the cavity and the sealant system on the adaptive quality of the proximal anterior filling margins]. The influence of different cavity preparation and the use of a low viscosity sealant on the marginal adaptation and microleakage of class III composite restorations was investigated in a dye penetration and a SEM-study in vivo. In 9 subjects with 4 restorations each, different forms of dentin cavities and enamel preparations were performed. In 3 out of 4 cavity types a low viscosity sealant was applied prior to the insertion of the composite material. Replicas of the restorations after 30 min, 15 and 120 days were examined by SEM (magnification 400X). Marginal areas 1 h, 15 and 120 days after restoration placement were coated with a fluorescent permeating dye, flushed with water, dried and photographed under UV-light. The micromorphological and in vivo permeation investigations have demonstrated that restorations with no marginal leakage and with perfect marginal adaptation could be achieved when using a sealant composite system with a new cavity design, the "adhesive preparation". Furthermore the retentive strength of the "adhesive restoration" which has no macroscopic dentinal retention was largely sufficient.


[In vitro evaluation of the adaptation and quality of the margins in various composite systems]. Microleakage and marginal adaptation of different composite brands (Epoxydent, Restodent, Cosmic) in conventional and adhesive MOD-cavities have been investigated in an in vitro dye-penetration and scanning electron microscope study. The results were compared to those of a standard composite brand (Adaptic). Unrelated to the type of cavity and enamel etching procedures Epoxydent and Restodent revealed moderate results only. When the use of a sealant was omitted prior to bulk placement Cosmic showed the best adaptation. Priming (Cosmic Bond) was found to impede microleakage but not to influence marginal adaptation. The superiority of the adhesive restorations that had been performed with the Adaptic and the Concise system [4] is a result of the combination of these composite materials with a sealant and the new cavity design.


[Therapy of periodontal diseases].

[Therapy of periodontal diseases]. An analysis of general periodontal treatment carried out in the Departement of Cardiology, Periodontology and Preventive Dental Medicine of the University of Zurich, Dental Institute was undertaken with the aid of 50 randomly selected patient case histories. Immediately following therapy, it was found that a normal marginal periodontium had been established in all cases. A prerequisite for this success was effective patient oral hygiene. The duration of total treatment depended upon diagnosis and treatment plan and ranged from 18 to 62 h. Documentation of each phase of treatment was responsible for a significant part of the total therapy time. In view of the relatively large amount of time necessary to treat periodontal disease, future emphasis should be placed upon the refinement and propagation of preventive measures.


[Cariogenic antitussive agents].

[Cariogenic antitussive agents]. Nine cough mixtures available on the Swiss market and randomly chosen were tested telemetrically. With the exception of Sinecod all syrups effected immediate and long-lasting pH-depressions in interdental plaque. Patients should be informed on the pronounced caries-promoting potential of these medications.


The antiplaque effects of a nonflavored and a flavored chlorhexidine gluconate rinsing solution. A flavored chlorhexidine gluconate rinsing solution was compared with a nonflavored solution. Both solutions inhibited plaque growth significantly (60% PlI, 40% SPI). The differences between the flavored and the nonflavored solution were not significant.


Gingivitis in Zurich schoolchildren. A reexamination after 20 years. In 1957 the periodontal health of 1350 Zurich schoolchildren was assessed. The same investigator (M.Z.) examined 1217 children in the same school district 18 years later. 909 children were considered for statistical analysis. Only 9.1% were found to be free from gingival inflammation. 32% of the papillary and marginal gingival areas showed inflammatory signs. Prevalence of gingivitis was similar in different socioeconomic groups and in children treated by general practitioners and school dental clinics respectively. Gingivitis prevalence was remarkably similar in 1957 and 1975. An increase in the intensity of inflammation was, however, statistically significant. Reconsideration and modification of the existing measures in preventive periodontology are indicated.


Treatment of periodontal pockets with tricalcium phosphate in man. A preliminary report. After oral hygiene instruction 29 infrabony pockets in 9 patients were treated with deep scaling and flap surgery. The pockets were filled with a biodegradable tricalcium phosphate implant paste. 6 months postoperatively the average reduction of clinical pockets was 2.6 mm and the radiographically detectable attachment was 1.1 mm more coronal than preoperatively. 10% of the pockets remained deeper than 3 mm. Easy handling and simple storage are the predominant advantages of the described implantation material. Before recommending it for general use, however, some technical problems will have to be solved.


Endosteal oral implantology: two-year results of mobility and hysteresis measurements; A human study. Clinical experience with tooth mobility measurements for assessment of periodontal health was employed in evaluating endosteal implant status. Mobility and hysteresis measurements of 14 implants in 11 patients were carried out regularly during a 2-year period. Immediate postsurgical implant post displacement was 5 hundreths of a millimeter (5.10(-2) mm). After 1, 6, and 24 months, mobility had increased to 13, 21, and 54.10(-2) mm respectively. Viscoelastic recoil patterns were recognized as diagnostic indicators of profound changes in the biophysical properties of periimplant environment.


Dental caries 12 years after introduction of a preventive program-preliminary report from seven communities. Supervised toothbrushing with fluoride preparations and information on prevention of dental disease was introduced in 1963/64 for the majority of schools in the canton of Zurich. From 1963 to 1975, DMFT levels decreased by 47 to 54 percent, DMFS levels by 59 to 64 percent. Caries on surfaces of anterior teeth and on smooth surfaces of molars was reduced by 90 percent. The number of sound deciduous teeth increased substantially from 1963 to 1975.


[Which strata of the population are poorly provided with dental care? A socioeconomic study]. The survey tried to reveal the strata of population which are badly provided with dental care, in the city of Berne and surroundings of 25 km. In a house-to-house query questions were asked on 3 parameters: dental hygiene, removable dentures, and number of remaining teeth. Socioeconomic criteria such as age, residence (urban or rural), presence or absence of a dentist in the region and social status were used. The results showed that the 3 examined parameters were in close relationship to the socio-economic factors. People over 50 and people from lower social level had inferior dental treatment and a 5 times higher percentage of full dentures. This applied particularly to regions without dentist.


[The Michigan splint, a diagnostic and therapeutic aid for patients with disorders of the masticatory system. I. Construction on an articulator and fitted in the patient's mouth]. The Michigan splint is an occlusal appliance for patients with functional disturbances of the gnathic system. It helps to stabilize, reposition and to equilibrate and is a means of diagnosis and therapy. Form and function of the splint are described along with its construction. Special attention is given to the incorporation and the checking appointments with the patient. The splint helps to relax the masticatory musculature. Thereby the madibular recording is facilitated. It helps to make a correct functional analysis and to induce a proper occlusal therapy.


[Biopsies, how and when?].

[Biopsies, how and when?]. The subject is technique and indication for biopsies in the dental office. Should the dentist take biopsies at all? The literature on the subject is controversial. The author warns against the practice of biopsies in the presence of large tumors or when malignancies are suspected. Biopsies should remain part of the main treatment in the respective special clinic. On the other hand, a dentist may make small excision biopsies on small and harmless tissue changes of the mucosa in order to send them in for histological checking.


[Gingival injuries from toothbrush bristles]. The ability of two different toothbrush bristle ends to produce traumatic gingival abrasion was assessed in a double blind study on 15 male and 15 female young adults. Brushing was performed in a circular fashion using a modified Bass technique. An apparatus allowing continuous visual feedback of the average brushing force permitted a degree of standardisation of the system. The upper left canine and bicuspid area had to be brushed for 30 seconds with cut toothbrush bristles (CP) and with round ended toothbrush bristles (RP) respectively. A two-week interval separated the two brushing sessions. Traumatic lesions of the attached gingiva were stained with a disclosing solution, photographed and evaluated planimetrically. The "cut bristles" caused gingival abrasions 30% greater in extent than the round end bristles. The difference was not due to single brushing strokes accidentally greater for the "cut bristles". The size of the lesions was not sex-dependent.


[The effect of bioceramics (calcium phosphate ceramics) on cultured rabbit fibroblasts]. Cell compatibility of biodegradable calciumphosphate ceramic material was tested in rabbit fibroblasts cultivated on cover slips. Culture growth was in no way inhibited during 12 days of cultivation in the presence of ceramics. The fibroblasts showed phagocytosis of ceramic particles and were able to undergo mitosis as long as the cytoplasm was not overloaded with particles. After incorporation of ceramics, impairment of cytoplasmic division could lead to the formation of polyploid and polynuclear cells. Death of overloaded cells was observed only in the cell-and ceramic-dense center of the cultures from the 10th day on, and may be considered as natural decay of aged cells. The cell- and tissue-compatibility of bioceramic material observed in experimental surgery is thus confirmed.


[The suitability of Cr-Co casting investments for use with precious metal casting]. Extensive practical experience, experimental studies and theoretical considerations lead to the result that the investment compounds "Modellgusseinbettmasse LAW" and "Silikan" may be recommended not only for casting chromium-cobalt alloys but also for casting precious metal alloys.


[Experimental studies with radionuclides on the functional behavior of the blood circulation system in the dental pulp]. Using a special semiconductor detector probe and the radiopharmacon DF32P, the author measured the blood supply in the dental pulp. To test the sensitivity of the measuring system, adrenaline was injected for the purpose of vasoconstriction. The resulting change in blood volume is demonstrated by measuring the decrease of the pulse rates during a given period of time.


[Mühlberg's. Bräuninger's and Weiskopf's Leipzig index as a sliding disk--an auxiliary tool for optimal model analysis]. Not all the orthodontists of our country make use of the advantages offered by the index inaugurated by Mühlberg, Bräuninger and Weiskopf for model analysis. Their adherence to the currently used index of Pont is explained. A sliding disk is intended for propagating the "Leipzig index". This disk has been elaborated by Schubert with reference to the Orthometer designed by Korkhaus.


[Comparative studies on the setting time of various phosphate cements and on the effect of differentiated powder-fluid ratios and air humidity on the setting time]. A comparative experimental study served to determine the standard consistency and setting time of various phosphate cements (according to DIN 13903). One of the products under investigation did not comply with standard specifications; therefore, from the viewpoint of setting behaviour, it cannot be recommended for cementing fixed tooth-restorations. It was shown that variations in the powder-liquid ratio affected the setting time, whereas variations in air humidity in the range from 50 to 100% exerted no signficant effects, which might lead to a simplication of material testing and quality control.


[Evaluation of epithetic restoration].

[Evaluation of epithetic restoration]. Starting from an analysis of facial prostheses applied during the years 1967-1977, the authors report of the therapeutical success. The evaluation involved not only objective criteria but also psychical problems of the face-injured patients. Priorities of stomatological efficacy are established with regard to insertion, adaptation and the postadaptive phase.


[The methodological position of frontal feedbacks during work with large groups of dental students]. Single-channel feedback installations without revertive communication to the single work place and without possibility for evaluating the student's performance may be used with success in lectures and diagnostic exercises for large groups of dental students. Dispensing deliberately with the evaluation of performance permits to carry on a dialogue with the student, which offers the possibility of acting rapidly on the learning process during the very same teaching event. This control procedure allows to activate and motivate the students considerably. The methodical approach is explained.


The aid of electron microscopy in the diagnosis of osteosarcoma of the bone (case report). Osteogenic sarcoma with marked cellular anaplasia and little or no osteoid formation may present major problems in histologic identification. The application of electron microscopy is demonstrated in a case of a poorly differentiated osteosarcoma of the tibia. Unequivocal electron microscopic diagnostic findings are described in relation to light microscopic data.


[On the growth characteristics of human osseous sarcoma metastases: mathematical calculations and clinical consequences (author's transl)]. Metastases of osteosarcomas do not grow according to a simple exponential function, but rather according to a type of Gompertz' function where flattening with a tendency toward plateau formation sets in after a certain time. This deviation from an exponential growth type corresponds to a substantial increase in the initial tumor size--doubling time. The metastasis doubles in the period after its transfer faster than when it first becomes visible in an x-ray. Another important conclusion resulting from the use of the Gompertz model is the assumption of a tumor-specific maximum volume which cannot be exceeded over a period of infinite growth. For lung metastases of osteosarcoma this volume amounts to approximately 120 cm3. The critical volume which kills the host is, at 70 to 80 cm3, relatively close to this theoretical growth limit (only approximately one cell division below this limit). If a metastasis develops from a single cell, the number of divisions up to this point is approximately 46. Of these, 38 lie within the growth zone which is not visible via x-ray. Since cell-cycle specific agents (for example Vincristin and Methotrexate) have the greatest effect against rapidly proliferating tumors, these drugs (for example alkylantic drugs) are especially effective in the case of slowly proliferating neoplasms. Therefore, use of these drugs should be favored when the metastasis is visible in the x-ray. Since occasionally, particular when the primary tumor is still relatively small, metastasization may not necessarily have already taken place, radical operation of the primary tumor should be carried out as soon as possible. A preliminary irradiation of the primary tumor cannot prevent metastasization with certainty. Therefore delayed amputation should be avoided.


The incidence and significance of intracytoplasmic calcifications in nipple aspirate specimens. Intracytoplasmic deposits demonstrated to be calcifications have been identified in nipple aspirates from 3.6 per cent of breasts with satisfactory cytology. The deposits occurred almost exclusively in epithelial groups, and their structure ranged from dust-like particles and spiculated forms to psammoma bodies; all exhibited characteristic density, refractility and well-defined, irregular borders. Nipple aspirates containing calcifications were typically characterized by the presence of numerous epithelial groups, frequently of papillary type. This association was supported histologically by the fact that 11 of the 14 available tissue specimens contained papillary lesions in the duct system, including three with papillary carcinoma in situ. Cytologic abnormality was significantly associated with the presence of calcifications, and marked cellular changes were found four times as often in this group as in the total population with satisfactory cytology. Calcific deposits were found in six of the fourteen available tissue specimens, four of which contained breast carcinoma. Calcifications were noted in only 23 per cent of 97 available mammograms, but further investigation has revealed other significant radiologic findings. Cytologic calcifications were found most frequently in aspirates from women between the ages of 41 and 60 and were often associated with clinical findings of breast disease. Preliminary findings indicate an increased prevalence of breast carcinoma in patients with cytologic calcifications and suggest that such patients may require closer than normal follow-up.


Ferruginous bodies in sputa of former asbestos workers. Routine cytopathologic examinations were performed at six-month intervals on sputum specimens from 628 former asbestos workers and 138 control patients. The occurrence of ferruginous bodies in sputa is found to increase as a logarithmic function of the length of occupational exposure to asbestos in workdays. No significant association is found between the occurrence of ferruginous bodies and the worker's age, smoking history, degree of cellular epithelial atypia, or time since last exposure. We conclude that the presence of ferruginous bodies in sputa is evidence of probable significant occupational exposure to asbestos dust. Their absence does not indicate lack of exposure. We can also conclude that routine cytopathology procedures are sufficient for the detection of ferruginous bodies in sputa.


Development of osteosarcoma in rats after irradiation. The rat femur diaphysis was exposed to local continuous irradiation with various constant dose-rates for different periods of time and examined after different observation times. The incidence of osteogenic sarcomas per cm2 appeared to be comparable to that reported for animals exposed to internal irradiation by bone-seeking isotopes which involves systemic effects. The site of origin in 5 rats was found to be in or near the endosteum. Malignant proliferation started after at least 180 days of irradiation. Tumour development was dependent upon continued irradiation of an endosteum which contained a thin layer of fibroblasts and a few apparently inactive osteoblasts and osteoclasts. No increased cellular activity and no indication of new bone, cartilage or fibrosis were evident before the tumours began to develop.


The numerical composition of cellular samples from the female reproductive tract IV. Carcinoma in situ cases exhibiting other than normal vaginal flora. The numerical composition of vaginal, ectocervical and endocervical (VCE) cell samples from patients with carcinoma in situ of the uterine cervix exhibiting other than normal vaginal flora is described. The comparative results of cell counts in patients with carcinoma in situ with normal and other than normal vaginal flora are presented.


Trichinosis in an immunosuppressed human host. The clinical presentation and autopsy findings in the case of a patient with acute myelomonocytic leukemia and trichinosis are described. Cellular immunity is an important host defense against nematode infections such as strongyloidiasis. It is therefore probable that the severe trichinosis seen in this immunosuppressed patient was more than coincidental. Due to concomitant failure of humoral immunity, serodiagnosis of trichinosis would have been impossible. The only means of making the diagnosis antemortem would have been muscle biopsy.


Chromosomes and causation of human cancer and leukemia: XXVIII. Value of detailed chromosome studies on large numbers of cells in CML. Comparison of the chromosome findings obtained on routine examination (10-50 cells) of the marrows from patients with Ph1-positive CML with those based on a large number (110-500 cells) of metaphases in six of these patients, in whom appropriate material was available, revealed the presence of small percentages of aneuploid cells in the marrow during the chronic phase of the disease and not seen with the routine procedure. These aneuploid cells may ultimately constitute the dominant clone during the blastic phase of the chronic myelocytic leukemia (CML). Furthermore, karyotypically abnormal cells, in addition those observed on routine study, were detected in the blastic phase when a large number of cells was examined. The value and implications of these observations are discussed.


The value of reverse banding in detecting bone marrow chromosomal abnormalities: translocation between chromosomes 1, 9, and 22 in a case of chronic myelogenous leukemia (CML). A case of chronic myelogenous leukemia (CML) with complex chromosomal abnormalities is reported. Conventional staining techniques indicated incorrectly that the Ph1 chromosome was not present. These studies showed a 46,XY,-1,+C karyotype in all bone marrow cells. Employing RFA (R bands by fluorescence using acridine orange) technique it was clear that the part of the long arm of chromosome 1 (1q23 leads to qter) was missing the tip of the long arm chromosome 22 (band q22) was translocated to it. The missing long arm of chromosome 1 was translocated to the long arm of chromosome 9. Furthermore, there was a break at band 9q22 and the whole terminal part was lost. The value of RFA technique is discussed.


Therapeutic considerations in acute lymphocytic leukemia. Evidence that the first human neoplasm systematically explored with chemotherapeutic treatments has apparently been cured in a palpable segment of affected patients evokes optimism for other types of cancer. The application of similar effort, similar logic, and quantitative experimental therapeutic approaches to the common cancers augurs well for cancer research and clinical medicine.


[Measurements of cuff pressure of different low pressure cuffed endotracheal tubes under mechanical ventilation (author's transl)]. Three different low pressure cuffed endotracheal tubes (Lanz, Portex soft-seal, Kamen-Wilkinson) were studied in cadaver tracheas and patients in our intensive care unit during ventilation. In the air filled low pressure cuffs without controlled pressure system the cuff pressure and the ventilation pressure are almost identical. Rises of intrathoracic pressure during mechanical ventilation are reflected by increased cuff pressure. Tubes with controlled pressure system or foam-filled cuffs have lower peak cuff pressures, especially during sighing, coughing and suctioning.


The need for orthodontic treatment.

The need for orthodontic treatment. Basic problems of the need and demand for orthodontic treatment have been discussed and new areas of research have been identified. Discrepancies have been described between the views of the dental profession and the potential patients on malocclusion and the need for treatment. For malocclusions with or without impairment of the function the self perception of the patient may be different from and of more relevance than the professional judgment of the orthodontist. Before going into orthodontic treatment, the social sufficiency of the patient should be evaluated.


A radiographic study of tongue posture at rest and during the phonation of /s/ in class III malocclusion. In this investigation a group of individuals with Angle Class III malocclusions were studied radiographically to determine their tongue posture at rest and during phonation of /s/. Their speech and hearing was also evaluated. All of the subjects had normal hearing, while eleven of the twelve in the group showed some degree of sibilant distortion. At rest, these Class III subjects demonstrated a tongue posture that was lower than normal and more retruded. During the phonation of /s/ these individuals also demonstrated retrusion of the tongue in an apparent attempt to achieve a normal relationship of the tongue tip to the maxillary anterior teeth, an increased amount of mandibular depression, and a greater than normal distance between the tongue tip and the mandibular anterior teeth. Despite the compensatory movements exhibited by these individuals with Class III malocclusions, normal /s/ production was found in only one of the twelve subjects studied. This is in contrast to the successful compensations that result in normal /s/ production seen in a great number of individuals with a Class III, Division 1 malocclusion, as demonstrated by Subtelny, Mestre and Subtelny.


A new approach to cephalometric analysis of the dental base relationship. 1. The Reference line, connecting the centres of area of the projected skull outline, the cranium and the face, is relatively easy to locate and forms a more stable base from which to measure changes in the face in profile including the dental base relationship, than are the sella-nasion, maxillary or mandibular planes. 2. The Reference-Profile angle is a reliable assessor of a bimaxillary prognathism or retrognathism. Its mean value is 44 degrees. Angles above this value are associated with a bimaxillary retrognathism, and angles below this value with a bimaxillary prognathism. 3. The Reference-Dental Base angle is the most consistent for assessing the anterior jaw relationship between the maxilla and mandible. Its mean value of 50 degrees indicates a Class I relationship. Angles of 53 degrees and above indicate clinical Class II cases and angles of 48 degrees and below indicate clinical Class III cases. 4. These two angles are potentially valuable diagnostic indices for use in orthodontic clinical assessment.


Hyoid changes following orthopedic treatment of mandibular prognathism. In this study 30 patients exhibiting mandibular prognathism were treated by the orthopedic chin-cup appliance for a three-year period. The patients began treatment at the age of six years and completed treatment at the age of nine years. As previously reported, chin-cup treatment resulted in a "clockwise" facial rotation with the mandible moving relatively posteriorly and inferiorly. Hyoid position measured in this study also tended to move slightly posteriorly but was primarily displaced in an inferior direction. The positional alteration exceeded in amount what might have been expected by growth alone. The inferior direction of change in hyoid and associated structures and the resultant lack of encroachment on the vital pharyngeal passageways suggests that stability and patency of the pharyngeal airway is a primary factor in hyoid positioning. The duration and "growth guidance" aspects of treatment allowed for functional as well as morphologic adaption to the altered hyoid position.


The effect of image quality on the identification of cephalometric landmarks. The effect of rare-earth phosphor intensifying screens on diagnostic image quality was examined. Five observers were asked to identify ten landmarks on each of fifteen cephalometric images having varying screen-film-kvp combinations. The most sensitive screens were found to significantly affect diagnostic image quality and thereby the reliability of landmarks identification. This finding was, however, only established for those landmarks having the lowest standard deviations and the clinical significance is thus questionable. There would appear to be other more important factors than physical image quality involved in the reliability of landmark identification. High intensifying screens are, therefore, recommended for use in cephalometric analyses since they help to reduce patient dose and do not appear to sacrifice diagnostic image quality to the extent that the reliability of cephalometric measurements is significantly affected.


Upper headgear versus lower headgear, yokes, and class III elastics. The use of a lower headgear-yoke-Class II mechanism on an average works faster than a maxillary headgear. The distal tipping of the molars is greater with HGY-II which may be the result of the quicker tooth movement. The speed of distalization is probably due to the effect of the constant force of the Class II elastics. An orthopedic change on the maxilla could be seen if one can draw any conclusions from a change of only 1 degrees. A reduction of the SNA angle and a slight clockwise rotation of the palatal plane was noticed. These results agree with earlier investigations about cephalometric changes with headgear therapy. We have come to the conclusion that both methods are indicated. We use the upper headgear especially at a time when a complete therapy is not possible because of noneruption of the permanent teeth. The HGY-II mechanism is indicated when most permanent teeth are available and thus the therapy can be completed in one treatment period.


Prediction of breadth of permanent canines and premolars in the mixed dentition. Multiple stepwise regression was used in the selection of mixed dentition variables capable of predicting the total breadth of the unerupted permanent canine and premolars. The material consisted of 77 children. Stone casts were made before and after eruption of the canine and premolars. At the first examination when the children were, on the average, 10 years old, intraoral roentgenograms were obtained of the canine and the premolars. To predict the total breadth of the upper canine and premolars the buccolingual breadth of the upper first permanent molar and measurements on roentgenograms of the breadths of the upper canine and premolars proved most useful. In the prediction of the total breadth of the lower canine and premolars the best results were obtained with measurement of the breadths of the teeth in the roentgenograms. The breadth of the incisors proved less useful as a predictor of the breadths of unerupted canines and premolars.


The mandibular dental arch: part II. Effects of lower incisor position on the soft tissue profile. It has been demonstrated that there are reliable methods of predicting the ultimate position of the lower incisor and the soft tissue. However, the concept of treating this tooth to any one number for every individual was not supported by the evidence. An optimum system would allow the clinician to select and combine factors from all methods and arrive at a balance of esthetics, function, and stability, obtaining a suitable compromise for his individual patient. This is undoubtedly attempted intuitively by many experienced clinicians.


Digital image enhancement of cephalograms. Quantification of cephalometric X-rays requires the use of hand tracings of the structures to delineate points, lines, and angles. The structures, especially soft tissue, are often obscure and are therefore approximated. Recent biomedical application of image enhancement by digital computer promises a method whereby landmarks in the cranium are more clearly defined. Development of this technique will enable a more extensive and accurate utilization of cephalometric radiographs for diagnostic and research purposes.


Is partial anodontia a syndrome of Black Americans? A study was designed to test the prevalence of congenitally missing permanent teeth in two Black American samples of children, ages 3-18. When combined, male with female, and compared with the Caucasian sample, the incidence of congenital absence is 2.57% and 5.15% for Caucasians.


Chronic, multiple tics of Gilles de la Tourette's disease. CSF acid monoamine metabolites after probenecid administration. Central nervous system metabolism in six children and one adult with the syndrome of chronic multiple tics was studied by measuring the accumulation of acid metabolites of dopamine and serotonin (homovanillic acid [HVA] and 5-hydroxyindole-acetic acid [5-HIAA], respectively) in the CSF following probenecid administration. The accumulation of 5-HIAA was reduced in patients with multiple tics in contrast with other pediatric patients (N = 27). The degree of reduction in 5-HIAA relative to HVA appeared to be associated with the severity of the tic disorder. With dextroamphetamine, tic symptoms worsened, CSF HVA level decreased, and CSF 5-HIAA concentration increased. These findings suggest an association in Gilles de la Tourette's disease of reduced functioning of inhibitory serotonergic mechanisms and functional dopaminergic overactivity.


Endo- and exoglycosidases in an experimental rat osteosarcoma. Glycosidases capable of degrading intercellular matrix components were investigated in a 32P induced rat osteosarcoma. Homogenates of ossifying tumour were shown to readily degrade hyaluronic acid, chondroitin sulphates 4 and 6 but not dermatan sulphate. High levels of the exoglycosidases, beta-glucuronidase and beta-N-acetylglucosaminidase were found in tumour homogenates, and it was demonstrated that these enzymes contribute to the degradation of high molecular weight hyaluronic acid. The levels of these enzymes were compared with activities found in homogenates of neonatal bone and muscle surrounding tumours. Exoglycosidases, but not hyaluronidase, were found to be produced by cultures of osteosarcoma in vitro.


Analgesic abuse, renal parenchymal disease and carcinoma of the kidney or ureter. In a consecutive series of 88 cases of carcinoma of the kidney and upper urinary tract seen at one hospital, 31 had malignant urothelial tumours of the renal pelvis or ureter. Forty-two per cent of these transitional-cell carcinomas occurred in patients with renal papillary necrosis following upon prolonged and heavy analgesic ingestion. Other possible aetiological factors were heavy cigarette smoking (61% of cases), long standing urinary obstruction or infection (23%) and possible occupational exposure (6%); in only four cases (13%) was there no identifiable aetiological factor. Those cases with analgesic nephropathy were characterised by renal functional impairment, hypertension and interstitial nephritis, but there was no difference in the clinical behaviour or pathological appearances of the tumours in the two groups. The clinical and experimental evidence that certain metabolites of phenacetin are carcinogenic is reviewed.


Cigarette smoking in a cohort of Sydney schoolchildren: 1971--1974. Cigarette smoking habits of a cohort of Sydney schoolchildren aged 12--13 years in 1971 have been recorded for four years. Smoking prevalence increases steadily over those years, 2.3% of boys and 0.5% of girls smoking 20 or more cigarettes a week at age 12.7 years in 1971, rising to 23.6% of boys and 17.6% of girls by age 15.6 years in 1974. A substantial increase in smoking prevalence in children aged 15.6 years was found in 1974 compared with a similarly aged group studied by the National Health and Medical Research Council (Australia) Subcommittee on Smoking in 1968. Quite a few children changed their smoking habits during the study. Children who changed or left schools smoked more than children who remained at the one school. Attacks of asthma or bronchitis were not related to smoking except that girls who were very heavy smokers reported more of these illnesses in 1974. No changes in lung function could be attributed to smoking by age 14.6 years. New approaches to smoking need to be evaluated in view of its rising prevalence, especially among older schoolchildren.


The effect of ethyl alcohol on striated muscle: some clinical and pathological observations. Electrophysiological and pathological studies have been performed on three patients with recurrent focal swelling of the calf muscles simulating deep venous thrombosis, and in a patient with both cardiomyopathy and skeletal muscle disease. In all patients there were elevated CPK levels, histological evidence of an acute myopathy, heavy alcohol intake prior to the development of symptoms, and improvement in hospital with the cessation of alcohol consumption. These patients illustrate a form of alcoholic muscle disease which may be more common than generally realised.


Electromyographic (EMG) study in thyrotoxic periodic paralysis. Thyrotoxic periodic paralysis (TPP) is produced by a different metabolic disorder than familial periodic paralysis. In the familial disorder, a myopathic cause is well known, but although electromyography can be used to demonstrate the site of the lesion in TPP, such studies are rare in the medical literature and the results are conflicting. In this report, EMG studies were carried out on eight Chinese patients with thyrotoxic periodic paralysis during the attack and the results compared with studies repeated during a remission. Most cases showed a myopathic pattern during an attack of paralysis which disappeared during remission. The myopathic changes noted were a decrease in duration of muscle action potentials, an increase in polyphasic potentials, a satisfactory interference pattern with reduced amplitude and a reduced amplitude of the evoked muscle action potential on nerve stimulation. Peripheral nerve function was normal in the cases studied. It is concluded that the weakness in TPP is myopathic and that the peripheral nerve function during paralysis is normal.


Demonstration of surgical portasystemic venous shunts by scintisplenoportography. Scintisplenoportography (SSP) was used to assess shunt patency in 15 patients with surgically created portasystemic venous shunts and proved to be a simple, safe and accurate technique for demonstrating the patency of both mesocaval "H" grafts and distal lienorenal shunts. SSP was as accurate as angiography in confirming shunt patency but was simpler to perform and resulted in less radiation exposure to the patient. The direction and distribution of blood flow within the splanchnic venous system was different to that obtained by angiography. It is postulated that SSP may well reflect portal haemodynamics more accurately than angiography. In patients with patent mesocaval "H" grafts SSP demonstrated the complete diversion of splanchnic venous blood through the shunt into the systemic venous circulation. This suggests that the mesocaval "H" graft is haemodynamically similar to other side to side portacaval shunts.


Jejuno-gastric intussusception---gastroscopic diagnosis. A case of actue jejuno-gastric intussusception diagnosed at gastroscopy is described. The patient had undergone a Polya gastrectomy eight years previously. Other reported cases have been discovered by radiology or at surgery. Endoscopy is the method of choice to diagnose this uncommon, but important condition.


Peripheral vascular disease as a mode of presentation of pseudoxanthoma elasticum. Two men presenting with premature peripheral vascular disease and minimal risk for atherosclerosis were found to have pseudoxanthoma elasticum (PXE). Fluorescein angiography was found to be of potential value in the early recognition of angioid streaks and pseudoxanthoma elasticum. There was evidence of disruption of arterial elastic tissue which may contribute to atherogenesis in PXE. Management is presently limited largely to minimizing risk factors for atherosclerotic vascular disease.


The significance of the Philadelphia chromosome in acute lymphoblastic leukaemia: a report of two cases. Two cases of Philadelphia chromosome (Ph1) positive acute lymphoblastic leukaemia are reported, both of which lost the Philadelphia chromosome during remission. In one patient remission of the acute lymphoblastic leukaemia continued but classical Ph1 positive chronic granulocytic leukaemia developed. In the other patient relapse of the acute lymphoblastic leukaemia occurred associated with the return of the Ph1 chromosome. The evidence suggests that the chromosome aberration occurred in a pluripotential stem cell, which in one case proliferated along both a lymphoid cell line and a myeloid cell line. Both cases responded well to conventional therapy for acute lymphoblastic leukaemia.


Serum enzymes profile in human acute myeloblastic leukaemia: preliminary results. Serum enzymatic activities in 18 human acute myeloblastic leukaemias were tested using a semiquantitative micromethod: the activities of 5 enzymes were observed to be changed.


Monitoring normal and malignant human white blood cells by the use of linear programmed thermal degradation mass spectrometry. A new methodology has been applied to the analysis of human white blood cells obtained both from donors with normal white cells and from donors having one of several cytologically identified leukemias. The analytical process makes use of evolution patterns of molecular fragments generated during the well controlled degradation of the cells. The process has been shown to be effective both in grouping together malignant cells that originate from the same diseases and in distinguishing between malignant cells originating from different diseases. The reproducibility of the method has been demonstrated.


Intermittent combination chemotherapy with adriamycin for childhood acute lymphoblastic leukemia: clinical results. One hundred thirty-seven children with previously untreated acute lymphoblastic leukemia were entered into a new program that included intermittent combination chemotherapy featuring Adriamycin. Remission induction was initially randomized to vincristine and prednisone with or without an anthracycline. All children received asparaginase consolidation and central nervous system prophylaxis with cranial irradiation and intrathecal methotrexate. There were no primary failures of CNS prophylaxis. Complications were primarily infectious. Clinical evidence of cardiotoxicity and leukoencephalopathy were not observed. The time to enter complete remission and the presence of an anterior mediastinal mass at diagnosis were found to be statistically significant adverse prognostic factors, whereas presenting age and white blood count were not. With a median follow-up of 26 mo, and using life plot analysis, 65% of the children have remianed in continuous complete remission.


Conversion of polycythemia vera to refractory anemia with hyperplastic bone marrow. Clinical and morphologic findings in the conversion of treated polycythemia vera to pancytopenia with hyperplastic bone marrow (refractory anemia or pancytopenia with hyperplastic bone marrow) are described in light of our own observation. The nomenclature associated with this condition (pancytopenia, chronic erythroleukemia, preleukemia) is not uniform, whereas the morphologic findings are virtually identical. Some patients subsequently develop acute leukemia. The prognosis in cases of refractory anemia with hyperplastic bone marrow following polycythemia vera is, independent of the subsequent acute leukemia, invariably terminal.


Hallucinogenic N-methylated indolealkylamines in the cerebrospinal fluid of psychiatric and control populations. The incidence and quantities of dimethyltryptamine and O-methylbufotenine were studied in the cerebrospinal fluid of patients suffering acute schizophrenic illnesses and in surgical and neurological control groups. Some schizophrenic patients have higher levels of both amines than do controls, though the differences in distribution did not reach statistical significance in the sample studied. The gas-chromatographic technique used is sensitive at the low picogram level.


Giant-cell pneumonia caused by measles and methotrexate in childhood leukaemia in remission. Four children who had acurate lymphoblastic leukaemia in remission and developed pneumonia were studied. Investigations including electron microscopy and immunofluorescence of lung biopsy material disclosed measles, although there was no clinical evidence of the disease. Despite an identical presentation, two types of illness developed: two children died of giant-cell pneumonia, while the other two developed pneumonia indistinguishable from that associated with methotrexate treatment, recovering when treated with steroids and gammaglobulin. Measles infection is easily overlooked in the absence of rash. The diagnosis may be suggested by clinical and radiological features and confirmed by specific immunofluorescence staining of lung biopsy tissue.


Testicular disease in acute lymphoblastic leukaemia in childhood. Report on behalf of the Medical Research Council's Working Party on leukaemia in childhood. In three trials conducted by the Medical Research Council on acute lymphoblastic leukaemia in childhood the incidence of testicular infiltration in relation to presenting features and treatment was analysed. Initial severe thrombocytopenia was associated with an increased incidence. Testicular infiltration was occasionally found during treatment in patients with high blood leucocyte counts at diagnosis but the main incidence in patients with all types of disease occurred within one year of stopping treatment. The incidence may be increased when "second-line" drugs, especially cyclophosphamide, have been used. A reappraisal of the value of additional drugs in maintenance treatment of patients with good prognosis is needed.


Analysis of treatment in childhood leukemia. IV. The critical association between dose fractionation and immunosuppression induced by cranial irradiation. The degree of long term lymphopenia induced by cranial irradiation is shown to be dependent upon the number of fractions into which the standard cranial dose of 2400 rads is divided. The mean lymphocyte count of patients three months after receiving this dose in five fractions was 1.84 X 10(9)/1; in twelve fractions it was 1.12 X 10(9)/1 and in twenty fractions it was 0.64 X 10(9)/1. An explanation for this finding is offered which is based upon marked radiosensitivity of certain lymphocytes and the pattern of recirculation and redistribution of these cells.


Chromosomes and causation of human cancer and leukemia. XXIX. Further studies on karyotypic progression in CML. Fifty-seven Ph1-positive cases of chronic myelocytic leukemia (CML) were analyzed with chromosomal banding techniques and their karyotypic progression followed. These cases included 1 without evidence of a Ph1-translocation and 1 new patient with a complex Ph1-translocation involving chromosomes No. 9, No. 17 and No. 22. Of the 57 patients, 28 had the Ph1 as the only karyotypic anomaly, whereas the remaining 29 cases developed and/or were associated with chromosomal changes usually of a hyperdiploid nature, particularly in the blastic phase, in addition to the Ph1. Even though the additional karyotypic changes frequently included chromosomes No. 8, No. 17, No. 19 and No. 21, a large number of others was also involved, although less often. The series included 3 cases with different types of translocations unrelated to the Ph1. The cytogenetic observations have been correlated with some of the clinical parameters. The survival of the patients was evaluated in relation to the karyotypic findings, indicating that the chromosomal changes may not play as important a role in the prognostic and progressive aspects of Ph1-positive CML as that of other as yet undetermined factors.


Anaphylactoid type reactions in two patients receiving high dose intravenous methotrexate. Two patients recieving intravenous high dose methotrexate (MTX) and intracutaneous BCG injections as adjuvant treatment for osteogenic sarcoma suffered sudden cardiovascular collapse within minutes of infusion of MTX. These cases demonstrate that anaphylactic or idiosyncratic reactions to MTX and/or contaminants in these preparations do occur and that careful patient monitoring is required.


Biochemical and pharmacological basis for the lateral hypothalamic syndrome. The lateral hypothalamic (LH) syndrome characterized by impairment of the ability to regulate food and water intake has been reported to occur after injections of 6-hydroxydopamine (6-OHDA) into this region. In the present experiment the fluorescence histochemical technique was used to assess monoamine depletion of noradrenaline and dopamine containing neurons following intrahypothalamic injection of 6-OHDA. Results show that the intensity and area of monoamine accumulation in axons served by 6-OHDA is correlated with the severity of behavioral deficits but that actual catecholamine depletion of either the corpus striatum or the hypothalamus is unrelated to the syndrome. Possible mechanisms of action of this accumulation in producing behavioral deficits are discussed.


Changes in DNA associated with induction of erythroid differentiation by dimethyl sulfoxide in murine erythroleukemia cells. The Friend virus-infected murine erythroleukemia cell can be induced to differentiate along erythroid cells in culture with various compounds, including dimethyl sulfoxide. DNA from murine erythroleukemia cells cultured with dimethyl sulfoxide shows a decrease in sedimentation rate in alkaline sucrose gradients after alkali lysis of the cells. These changes can be detected as early as 27 hr after the beginning of culture. Similar results are observed with DNA of the cells cultured with other inducers, butyric acid and dimethylacetamide, but not with DNA from a variant cell line resistant to induction with dimethyl sulfoxide. Ultraviolet irradiation, which is known to cause similar changes in the sedimentation rate of DNA in alkaline sucrose gradients, induces differentiation of the murine erythroleukemia cells. These studies suggest that alterations in DNA may be related to events involved in the induction of differentiation of murine erythroleukemia cells by dimethyl sulfoxide.


Objectives and criteria for the management of cleft lip and palate and the delivery of management services. This is a report of the proceedings of a conference convened for the purpose of identifying objectives of cleft lip and palate treatment and criteria for systems by which the treatment is delivered. A major feature of the report is the consideration of the interdisciplinary approach which is required for effective treatment of the problem.


Differences in the size of the palatal processes in mouse embryos with cleft palate induced in two critical periods. Using planimetric measurements of projections of the space between the palatal processes of ICR-Velaz mouse embryos, we indirectly demonstrated that the pre-horizontalization size of the palatal processes after the i.m. administration of 7.5 mg cortsone acetate on the 12th day of gestation was smaller than in the controls. After horizontalization, the inadequate palatal processes were unable to meet in the midline as they do in the majority of normal embryos. The administration of 0.5 mg 6-amino-nicotinamide on the 14th day of gestation did not significantly affect the size of the palatal processes.


An assessment of informative-counseling procedures for cleft palate children. 32 children with cleft palate and their mothers were interviewed for the purpose of learning what information they had about cleft and cleft management. Their responses were compared with standards specified by eight cleft palate specialists from four disciplines. The findings indicate that the specialists were somewhat inconsistent in what they expected the families to know about clefts and in their routine counseling procedures to provide the information. In general, the mothers had appropriate knowledge about clefts but predicted that their children knew more about clefts and cleft management than was actually the case. The children had less than adequate information about the general impact of a cleft, the etiology of clefts, the rationale for cleft management they had received, and future management of their problem. The results of the study indicate the need or more systematic procedures for providing information to the child with a cleft. The results also suggest the need for additional research about the general counseling process.


A lining vomer flap for palate pushback in unilateral cleft palate repair. A combinaation vomer mucoperiosteal flap and nasal floor mucoperiosteal flap is described which is used to achieve nasal coverage in unilateral cleft palate patients requiring pushbacks. A posteriorly based readily accessible vomer flap is raised on the cleft side and used as nasal lining for the palatal mucoperiosteal flap on the non-cleft side. On  the cleft side, a symmetrically sized nasal floor flap is easily elevated under direct vision and used to cover the nasal aspect of the corresponding mucoperiosteal palatal flap.


Lip adhesion and its effect on the maxillofacial complex in complete unilateral clefts of the lip and palate. The use of a lip adhesion as part of the treatment program for wide complete clefts of the lip and palate is gradually being accepted. Heretofore, little mention has been made as to its actual beneficial effects. Since the introduction of this procedure by our Group in 1966, it has been used routinely by us. Its effects on the maxillofacial complex is discussed in detail.


A rapid method of measuring the palatal surface area of cleft palate infants. A method is described for rapidly measuring the surface area of the palate by adapting a piece of soft plastic to a model of the upper jaw using a vacuum moulding technique. Tests with a hemisphere of known surface area showed the method to be consistent and to have a low degree of systematic error. When measuring models with unrepaired cleft palates, the error was found to be 2.1 per cent (compared with 3 per cent using stereophotogrammetry) but 7.1 percent when measuring intact palates. Because of the consistency of the method, the true palatal area could be calculated from the measured area by the use of a multiplying factor. These findings are described, and the application of the technique to the pretreatment assessment of cleft cases is illustrated by showing that, in a series of 30 cleft palate and 30 normal infants, a tissue deficiency of 16.8 per cent existed in the cleft subjects at birth.


Craniofacial and dental characteristics of cartilage-hair hypoplasia. The cranio-facial and dental features were studied by means of roentgencephalometry and anthropometry in 24 patients with cartilage-hair-hypoplasia. Data pertaining to the cranial base were considered indicative of subnormal growth in some of the cranial synchondroses. The width of the neurocranium was slightly below the values of the controls, whereas neurocranial length and circumference appeared unaffected. Facial height was larger than in the controls and facial index values were high. The chin was receding, but the other values of facial depth were relatively large. No abnormalities were observed in tooth morphology, dental age, or dental occlusion. The neurocranial morphology in CHH and achondroplasia show some similarities; the skull base, however, is clearly less bent in the CHH-syndrome. This, together with the virtually normal face and dentition in CHH-patients, is, perhaps, of differential diagnostic value.


A new syndrome involving cleft palate, cardiac anomalies, typical facies, and learning disabilities: velo-cardio-facial syndrome. This report describes a pattern of similarities among 12 patients which are felt to represent a newly recognized congenital malformation syndrome. The symptoms shown most consistently by the 12 patients were overt or submuscous clefts of the secondary palate, ventricular septal defects, typical facies, and learning disabilities. Other symptoms were noted with varying frequency. The occurrence of velopharyngeal insufficiency in all twelve patients reflected poor motion in the lateral pharyngeal walls, thus necessitating specific forms of treatment. Treatment was often dependent on the extent of cardiac lesions.


Videoendoscopic feedback in training velopharyngeal closure. Each of two adolescents with velopharyngeal closure deficits was taught to position him or herself on an endoscope attached to a television camera and to observe the velopharyngeal port during the production of syllables and other units. The videoendoscope was then used as a training apparatus, and each subject was given practice attempting to increase velopharyngeal closure while producing vowels and syllables. Videorecordings of each subject made without feedback before, during, and after the training period were played to panels of observers who were to rate closure during each utterance, and the data obtained indicated that the subjects more frequently approximated complete closure as the study progressed but improved performance was not established on an automatic level. Suggestions are made for the refinement and further investigation of videoendoscopic closure training.


Cleft uvula: prevalence and genetics.

Cleft uvula: prevalence and genetics. The prevalence of cleft uvula (CU) was determined among 70,359 school children 6-18 years of age; 90 children having the condition were chosen as probands for a family study. Prevalence of CU was 0.44 per cent with no sex differences. The Non-Ashkenazi group had a higher prevalence than the other population groups. The prevalence of CU in parents and siblings was 7.7 per cent and 7.5 per cent respectively. The findings from the family study support the hypothesis of a polygenic mode of inheritance for CU. The prevalence of cleft palate and agenesis of upper lateral incisors in the families studied did not differ from that expected in the general population.


Posterior pillar webbing and palatopharyngeus displacement: possible causes of congenital palatal incompetence. Three cases of congenital palatal incompetence in the absence of the usual stigmata associated with hypernasality are presented. In two instances, mucosal webbing of the posterior pillars was noted and in one case the palatopharyngeus muscle was displaced. Hypernasal voice quality was apparent in each patient. A z-plasty on both sides of the posterior pillars is suggested as the treatment of choice when no other morphologic abnormalities are present.


Early septal surgery in a chimpanzee animal model. Early resection of the proximal one-third of the cartilagenous nasal septum was performed in a chimpanzee. Longitudinal data on facial growth was collected for fourteen months. Growth rates (from regression equations) were shown to be the same for operated and unoperated animals. Implications for cleft palate repair are discussed.


Overview of ethical aspects of clinical studies. Research in human subjects should be conducted only if the rights and welfare of the participants are protected. Prospective study subjects must be given adequate information about all aspects of a study so that they can make a rationally exercised decision about participation; coercive techniques to solicit participants should not be used. Research in humans may be classified in one of three categories: (1) research on treatment of existing conditions; (2) research on preventive measures; and (3) research other than for treatment or prevention. Different concerns and aspects of informed consent assume particular importance in each category. In research on the treatment of existing conditions, untreated or placebo-treated control groups are rarely justified if the condition is irreversible. In research on preventive methods prospective subjects should be informed of the likelihood of receiving an ineffective treatment, if one or more placebo groups are included. A randomized clinical trial is usually the best design for studies of preventive methods. Non-randomized designs, which are feasible and statistically valid, may be employed in order to avoid depriving some subjects from receiving effective preventive methods. In social or behavioral research, confidentiality of collected information and privacy of the subject are essential considerations.


Social sciences research: ethical and policy implications. Ethical issues are raised about the conduct of social research in the dental field particularly with respect to the use of survey methodology and aggregated data. Problems associated with respondent identifiers, open-ended and probing questioning, privacy of subject-matter, community contamination and burden, group stereotyping, knowledge of law violations, mis-use of data banks, re-use of data, effects of disclosure, and referral for treatment are discussed. The natural and the contrived social experiments are reviewed as well as the issue of needed research on the effects of regulation on science and on the protection of privacy.


Behavioral science research: ethical and policy implications. Problems centered about protection of human subjects in behavioral science research are discussed. Difficulties in obtaining truly informed consent are noted. It is concluded that the risks involved to subjects are minimal in this field of research. The use of deception in psychological research is discussed along with the necessity of appropriately debriefing the subject. The use of institutional committees to protect subjects' rights is contrasted with the bureaucratic review processes of the government. It is concluded that, in the absence of evidence to the contrary, the local institutional review process is likely to induce greater cooperation from investigators in protecting subjects' rights.


Community dentistry: developmental discussion approach. In 1960, Blackerby asked the question "Why not a department of social dentistry?". Since that time most of the dental schools in the United States have made some attempt at establishing such a department. Various names were given to these departments, but the one that appears to be in the forefront is the Department of Community Dentistry. Since that time each school with such a department has strived to develop various innovative methods of teaching community dentistry to its students. When the amount of time is taken into consideration, unlike the biological and clinical sciences, time allotted to community dentistry is minimal. However, at The University of Michigan students spend 232 hours in community dentistry, which necessitates development of creative teaching techniques to maintain their interest. This paper discusses one such technique which has proven to be successful over the past 3 years. Emphasis is placed on utilizing a modified method of the developmental discussion approach in teaching a course in community dentistry to 3rd-year dental students.


Betal chewing and caries experience in New Guinea. The prevalence of dental caries and variables relating to the betel-chewing habit were examined in a sample of 301 rural New Guineans aged 12--24 years. Consistent inverse associations were demonstrated between caries experience and the intensity of betel chewing for individuals and aggregates of subjects. The results indicate that betel chewing confers a degree of protection against caries.


Occurrence of dental caries and gingivitis in low, medium and high fluoride areas in Finland. The study was performed on a material of 365 Finnish schoolchildren aged 13--15 years. One-third of the children were from Jyväskylä, with 0.2 parts/10(6) fluoride in the drinking water, one-third from Kuopio, with an artificially corrected 1.0 parts/10(6) fluoride content since 1959, and one-third from Hamina, where the natural fluoride content of the drinking water varies between 2.5 and 5.0 parts/10(6). All the children were scored for the Visible Plaque Index (VPI), the Gingival Bleeding Index (GBI) and for past caries experience (DFS). With increasing fluoride content of the drinking water the DFS scores were found to decrease significantly. No such difference was observed with regard to the VPI scores. The prevalence of gingival bleeding was found to be highest in Hamina (2.5 parts/10(6)). A highly significant positive correlation was found between individual VPI and GBI scores in all three towns. No corresponding correlations were found between the individual VPD and DFS scores. The latter finding is in desagreement with the generally accepted view that oral hygiene is an efficient caries-preventive measure.


An epidemiologic study of dental space anomalies in Icelandic schoolchildren. This study was performed mainly to determine the prevalence of space anomalies with regard to the various stages of dental development in Icelandic schoolchildren. The sample consisted of 1,641 randomly selected children (791 boys and 850 girls), making up 9.5% of the children attending all primary and secondary schools in Reykjavík during the school year 1972--73. In most of the frequencies of the different space anomalies boys showed a higher prevalence than girls. In both sexes there was often a significant difference from one stage of dental development to another. The results were compared with those reported for other ethnic groups.


Etiological factors in oral squamous cell carcinoma. A retrospective survey of 75 patients with oral squamous cell carcinoma (ICD Nos. 143, 144, 145) resident in the County Borough of Stoke-on-Trent, England, and 150 controls has been carried out by interview. The controls were matched for age, sex, occupation and place of residence. There was no difference in the prevalence or duration of denture wearing, although male controls had their dentures remade more frequently. Male patients practised oral hygiene procedures less frequently when they had their own teeth than controls. Habitual beer-drinking was more common and greater quantities were drunk by male patients than controls. Habitual cigarette smoking was less and pipe smoking greater among male patients than controls. Tobacco chewing, which was restricted to miners, was equally common (45%) in the two groups. Among miners, the combined habit of tobacco chewing and pipe smoking was more common among patients (1005) than among controls (25%).


Five years of community preventive dentistry and health education in the county of Sutherland, Scotland. Examination of 11-year-old Scots children who had participated in a 5-year, fortnightly dental health education and preventive dentistry programme showed that, compared with a similar age-matched group, the regimen produced mean DMF and DMFS reductions of 48.6% and 42.1%, respectively. In addition, the plaque and gingival indices differed significantly and 22.5% of test children were caries-free compared with only 7.6% of controls.


Enamel solubility reduction by acidulated phosphate-fluoride (APF) treatment. The enamel solubility reducing (ESR) potential of acidulated phosphate-fluoride (APF) solutions containing varying amounts of F was studied. Commercial APF (1.23% F, pH 3.0) reduced solubility by about 80%. Fivefold dilutions of this APF were made with either phosphoric acid or water without significant effect on ESR potential. Further dilution to 0.12% F significantly decreased effectiveness. Commercially available APF products (1.23%) can be diluted several-fold with distilled water in the dental office without significant loss of ability to reduce the solubility of enamel.


Effect of a field program based on systematic plaque control on caries and gingivitis in schoolchildren after 3 years. The effect of a field program, based on systematic plaque control, on caries and gingivitis was tested during a 3-year period on 1,100 schoolchildren. Once every 3rd week the children were given oral hygiene instructions, professional toothcleaning and fluorides topically delivered by specially trained dental nurses. The children of a control group of approximately the same number of pupils, participated in a preventive program consisting of mouthrinsings once every 2nd week with a 0.2% sodium fluoride solution. The children of the third and fourth grades were, at the start of the experiment, selected as reference groups and then continuously examined once every year. At the end of the trial the mean reduction of surfaces haboring plaque and units with gingival inflammation was 59% and 73%, respectively. The reduction in caries increment was 51%.


Release of fluoride from fluoride-containing chewing gum. The release of fluoride from fluoride-containing chewing gum and the fluoride concentration in whole saliva was measured at different intervals after the start of the chewing procedures. The residual fluoride contents were 78, 32, and 6% of the initial 0.25 mg in the gum after chewing for 2, 5, and 10 min, respectively. When chewing for 10 min, the salivary fluoride increased from 0.05 to 11.7 and 15.3 parts/10(6) after 2 and 5 min, respectively, followed by a fall to 3.9 parts/10(6) after 10 min. Concentrations exceeding the preintake level were still recorded 60 min after the start of the chewing.


Mottled permanent incisors in 15-year-old Lagos children. Mottled permanent incisors were studied in a stratified convenience sample of 206 Lagos schoolchildren aged 15 years. The mouth prevalence of this condition was 32%, and the right-left symmetry of the mottled incisors occurred very approximately in only a third of those persons with mottling. The distribution pattern was similar to that observed in similarly aged children in non-fluoride communities, and also that observed in optimally fluoridated Anglesey, England. The cause of this type of mottling in unknown, but its distribution suggests that endogenous (possibly genetic) factors may be involved.


Effect of professional toothcleansing every third week on gingivitis and dental caries in children. A previous paper reported on the 1-year effect on dental caries and gingivitis of biweekly professional toothcleansing. The purpose of this study was to evaluate the influence of a change from 2 to 3 weeks in the interval between the professional toothcleansings during the 2nd year. The DMFS increment during the 2nd year did not differe significantly between the experimental and control groups. The plaque and gingival indices, although  increased during the 2nd year, were still significantly lower in children subjected to the 3-weekly cleansing than in children in the control group.


Oral conditions and need for dental treatment in an elderly population in northern Norway. Oral conditions and dental treatment needs were investigated in a group of persons aged 65--79. A sample comprising 280 persons was drawn systematically to cover all persons in this age category living in the county of Troms in Norway. 241 persons attended, leaving a participation-rate of 86. The participants were examined mainly in their homes by dentists in graduate training. Sixteen percent of the group were in constant need of assistance or care due to a poor general state of health. In all, 80% were edentulous: 72% of the men and 87% of the women. Ninety-two percent wore removable dentures, 5% had natural teeth only, and 14% had natural teeth combined with a denture. Furthermore, 4% had neither teeth nor dentures, while dentures in both jaws were found in 66%. The "objective" treatment needs were extensive and had mainly accumulated due to neglectec care. Forty percent of the total group needed new complete dentures and 20% a more comprehensive correction of their dentures. By contrast only 30% intended to seek treatment in the near future. There seemd to be a definite need for a dental program to overcome or reduce the economic and other situational barriers.


Vacuolated lymphocytes in type II glycogenosis--a diagnostic approach? Using electron microscopy, glycogen-filled lysosomes were found in peripheral lymphocytes in 5 cases of the infantile form of glycogenosis type II. In two infants whose blood smears were available, the ultrastructural demonstration of this pathognomonic storage corresponded to well-delineated vacuoles detected by routine light microscopy. Detection of such vacuoles in peripheral lymphocytes by light microscopy and demonstration of glycogen-filled lysosomes by electron microscopy could be a simple and harmless tool for diagnosing the classical form of type II glycogenosis.


Measurement of erythropoietin in chloroleukemic rats. Erythropoietin (Ep) levels were measured in Shay chloroleukemic rats at various stages of anemia. Serum Ep was shown to increase logarithmically as the anemia became more severe. This increase in Ep levels was similar to that observed in normal rats subjected to acute blood loss. Significant levels of Ep were also demonstrated in ascitic fluid extracted from the peritoneal cavity of leukemic rats. These results indicate that the anemia of this disease is not due to a diminished production of Ep.


Murine myeloid leukemia: colony formation in vitro. Normal and myeloid leukemic spleen cells from RF mice were cultured in vitro in plasma clots. In situ histochemical staining and karyotypic analysis of the colonies formed in the clot revealed that the colonies produced by leukemic and normal progenitors were indistinguishable morphologically and cytochemically. Colonies of leukemic origin were identified by in situ karyotypic analysis, a method not previously utilized in studies of hematopoietic proliferation in semi-solid matrices.


Son-sire-regression based heritability estimates of chiasma frequency, using T70H mouse translocation heterozygotes, and the relation between univalence, chiasma frequency and sperm production. T(1;13)70H/+ translocation heretozygous mice were used for assessing heritability values for chiasma frequencies and the epididymal sperm count. The chiasma frequency estimates were based on 15 son-sire pairs, the translocation heterozygotes being maintained in a Swiss random-bred genetic background. The chiasma frequencies were scored separately for the T70H/+ derived multivalent, specific pairing segments within the multivalent and the remaining bivalents. Chiasma counts within these specified parts of the genome were positively correlated. The heritability estimates, significantly greater than zero, ranged from 0.78-0.98, depending on the chromosome segments included. These results indicate a strong genetic control on a cellular basis for the formation of chiasmata in the mouse. Despite significantly positive correlations and regressions between the various chiasma frequencies and the sperm count (for which 29 pairs of observations were available), no significant heritability estimate for the sperm count was obtained. The relation between the chiasma frequency and the sperm count was weakest when the chiasma count was confined to a region of the translocation-caused multivalent in which the absence of a chiasma almost always resulted in the production of an univalent. This indicates that in the translocation heterozygotes used, the overall chiasma frequency has a greater predictive value for the sperm count than autosomal univalence alone.


Toxicity study of cytosine arabinoside and methotrexate in the maintenance therapy of childhood leukemia. A Southwest Oncology Group study. In a toxicity study to determine the feasibility of treating patients with acute lymphocytic leukemia (ALL) using an intravenous combination of cytosine arabinoside (Ara-C) and methotrexate (MTX), the drugs were given either simultaneously or sequentially every two weeks. Twenty-nine patients were studied, 17 treated simultaneously, 12 treated sequentially. The tolerated doses of Ara-C and MTX were 60 mg/m2 and 90 mg/m2, respectively, for the simultaneous treatment schedule and 90 mg/m2 and 150 mg/m2, respectively, for the sequential treatment schedule. The dose-limiting factor of the drug combination was gastrointestinal toxicity. The observed recurrent vomiting on both schedules rendered the treatment unsuitable for maintenance therapy.


Dentin permeation: comparison of diffusion with filtration. A comparison was made between the rate of iodide permeation of dentin by diffusion and by filtration. Before acid etching, filtration only doubled the rate of iodide permeation relative to that obtained by diffusion. After acid etching, filtration produced a 32-fold increase in permeation. Acid etching, by removing occluding debris, facilitates filtration more than diffusion.


Lead in enamel and saliva, dental caries and the use of enamel biopsies for measuring past exposure to lead. Enamel biopsies taken from schoolchildren in a community where exposure to lead was a health hazard were analyzed for lead and fluoride. The children with high enamel lead had significantly higher caries scores than the children with low enamel lead, in spite of the fact that the high lead group also was higher in enamel fluoride. There was no increase in enamel lead with age. The lead in saliva was only a fraction of that in blood. Infants with lead poisoning showed higher saliva lead than a normal infant. The use of the lead in enamel biopsies and in saliva for measuring exposure to lead is discussed.


The effects of inorganic ions situated at the enamel surface on the adsorption and activity of acid phosphatase. This study has demonstrated, first, that the affinity of the enamel surface for a biologically active protein-in this case, acid phosphatase-may be modified by first impregnating the mineral with particular inorganic ions. Second, enzymic activity is altered as a function of the inorganic ion incorporated into the enamel surface. Third, strong inhibition of acid phosphatase is demonstrated by ions expected to be released during the carious process which contradicts the postulation that phosphatases are actively hydrolyzing enamel matrix-bound phosphate during the carious attack. Fourth, these results suggest that by incorporating a particular ion into the enamel mineral, a surface with assigned properties may be created which offers some degree of control over subsequent adsorption of organic matter. Thus, it is apparent that by proper selection of inorganic ions and organic macromolecules, both structural properties and biological activities at the enamel-oral fluid interface may be predictably modified.


Effect of SnF2 mouthrinse on initial bacterial colonization of tooth enamel. Microbiologic quantitative methods and scanning electron microscopy were used to observe the effect of stannous fluoride (100 ppm F-) mouthrinse on early plaque formation. An in vivo plaque model system was used on two individuals to test this experimental agent. Following SnF2 mouthrinsing, the total bacterial counts of two-day-old plaque on enamel cylinders were reduced up to 50.8 times or 98% and the streptococcal counts were decreased up to 48.4 times or 97.9%. Scanning electron microscopy confirmed a marked decrease of bacteria on enamel with use of SnF2 mouthrinse. It appears that, in addition to reducing enamel solubility and other properties, SnF2 may also alter bacterial accumulations on teeth.


The effects of fluoride on the percentage bacterial composition of dental plaque, on caries incidence, and on the in vitro growth of Streptococcus mutans, Actinomyces viscosus, and Actinobacillus sp. Administration of 250 mug/ml NaF in drinking water to rats reduced both caries incidence (P less than 0.001) and the percentage of S mutans (0.01 greater than P greater than 0.001) although the percentage of Actinobacillus sp. was increased (P less than 0.001). An Actinobacillus sp. and S mutans FA1 both proliferated in NaF broth only if the NaF greater than 10 mug/ml, which was associated with the inhibition of acid production.


The effect of adsorption on the acid production of caries and noncaries-producing streptococci. Eighteen different Streptococcus strains including S mutans, sanguis, mitis, salivarius, bovis, and 2F2, were assayed for their relative adsorption to synthetic hydroxyapatite and for quantities of lactic acid produced while in the adsorbed state. The results indicated that all S mutans and some S sanguis have an enhanced metabolic activity while adsorbed to hydroxapatite as compared to control suspensions without hydroxyapatite.


Effects of an argon laser on the crystalline properties and rate of dissolution in acid of tooth enamel in the presence of sodium fluoride. Upon exposure to laser radiation, enamel powder mixed with NaF underwent an increase in crystallite size and/or perfection with a significant uptake of fluoride. Incisor teeth lased in the presence of NaF released significantly less calcium and phosphorus into sodium acetate (pH 4.0) compared with unlased controls, suggesting a possible role for the laser in caries prevention.


Improving the fracture resistance of dental ceramic. A time-temperature sequence for optimally strengthening dental ceramic by ion exchange was investigated. Stress relaxation occurs at higher temperatures and/or longer times. Improved strenghts are obtained in a reasonable period of time that could be used for clinical application.


Clinical study of dental cements. VI. A study of zinc phosphate, EBA-reinforced zinc oxide eugenol and polyacrylic acid cements as luting agents in fixed prostheses. A clinical trial for the final cementation of crowns and bridges with a reinforced zinc oxide and eugenol cement, a polyacrylic acid cement and a zinc phosphate cement was made over a 3-year period. The study involved 441 patients for whom 547 bridges and 162 single restorations were cemented. The patients were recalled at 6-month intervals for the duration of the study and the restorations were examined for looseness. Of the 547 bridges 520 remained firmly cemented to the abutment teeth. Of 1,082 bridge retainers, 1,049 remained in position; success and failure by types of retainer will be the subject of a subsequent paper. Of the 162 single restorations 159 remained in place.


Reduction in the modulus of elasticity in orthodontic wires. The modulus of elasticity of stainless steel orthodontic wires was found to be 20% below the normally assumed range of 19.3 to 20.0 x 10(4) MPa (28.0 to 29.0 x 10(6) psi). Use of the latter value can result in significant computational errors in orthodontic applicance mechanics. The lower modulus was attributed to severe cold drawing.


Collagen biochemistry of the two layers of carious dentin. The amino acid composition and intermolecular cross links of collagen fibers in the two layers of carious dentin, differentiated by a 0.5% basic fuchsin-propylene glycol-stain, were biochemically investigated. No difference in the pattern of amino acid composition of collagen fibers was found between the first and second layers of carious dentin and the sound dentin. However, obvious differences in the intermolecular cross links of collagen fibers were found between the three layers. Namely, compared with the sound dentin, the second layer of carious dentin had decreased cross links and increased precursors. This change is considered to be reversible. Contrastingly, in the first layer, both the cross links and the precursors remarkably decreased. In addition, the hexitollysines (protein-saccharide compounds probably related to bacterial metabolism) were found and several peaks of unknown materials appeared. This indicates irreversible destruction of cross-linkage in the first layer of carious dentin.


Properties and distribution of inorganic pyrophosphatase in rabbit dental pulp. Some properties and the intracellular distriubtion of inorganic pyrophosphatase in rabbit dental pulp were determined. This enzyme was sensitive to Mg2+, and not inhibited by imidazol and CN- which are inhibitors of alkaline phosphatase. Inorganic pyrophosphatase was found predominantly in the supernatant fraction.


Quantification of pulpal blood flow in developing teeth of dogs. Pulpal blood flow was determined in 32 dogs ranging in age from 6 weeks to 18 months by the isotope fractionation method incorporating diffusible and nondiffusible tracers. Dogs were placed into selected age groups by the developmental status of the canine teeth. For the teeth sampled, the maxillary first, second, and third incisors along with the canines and first molars, pulpal blood flow was determined to be not different in teeth at various developmental stages. For some dental pulps, alveolar mucosa, and bone, the tracers were not determining equivalent blood flows. Because of incomplete trapping of the 7- to 10 mu microspheres and the flow limitation of 86Rb, the 15 mu spheres would appear to be a reliable indicator of "total" blood flow to pulpal tissues. However, in alveolar mucosa and bone, and 15 mu microspheres may not be completely trapped and thus, may underestimate blood flow to these tissues. Within the age range of these dogs, tissue blood flow was not dependent upon the stages of oral development.


Association between HLA-antigens and periodontal disease. Patients with periodontitis juvenilis and patients with periodontitis were tissue typed. In the juvenile group, frequencies of tissue type specificities HLA-A9, HLA-A28, and HLA-BW15 were significantly increased as compared to the findings in the general population. In the periodontitis groups, no significant tissue type deviations were found.


Phagocytosis of collagen by human gingival fibroblasts in vitro. Human gingival fibroblasts cultivated on collagen-coated cover slips had collagen fibrils in deep folds of the cell membranes after one hour and fully interiorized fibrils by 24 hours. In 5-day sections, fibrils were within dense bodies, some containing multiple dense granules (40 to 50 nm) aligned along the surface of the interiorized collagen fibrils.


The effect of diphenylhydantoin on fibroblasts in vitro. It was found that 0.02 mM was the higher concentration of drug which is not toxic and is compatible with normal cell morphology and growth over a period of a week. Using this concentration of drug there was no consistent stimulation of cell growth. A small increase in cell number was noted, however, in some cultures during the first 24 hours of culture. DpH at a concentration of 0.02 mM in the presence of ascorbic acid decreased collagen prolyl hydroxylation in "old" W1-38 cultures but a concentration of 0.1 mM was required to decrease the values to a similar extent in "young" cultures. A concentration of 0.02 mM DpH had no effect on hydroxylation in an "old" HGF culture. It is speculated that in a responsive individual a reduction of collagen prolyl hydroxylation may play a role in the etiology of DpH-induced gingival enlargement and congenital malformations.


A method for the in vitro toxicity testing of dental restorative materials. An vitro method of toxicity testing of dental restorative materials is described in which their clinical usage is closely simulated. The test material was separated from the cells by either a synthetic filter or dentine slice. Toxic effects were quantiated by determining changes in enzyme activity by scanning and integrating microdensitometry.


Graphic digitizer analysis of the myelinated axon spectrum in the inferior alveolar nerve of the cat. The diameter spectrum and other parameters indicating size and shape of myelinated axons were established in a cross-section of the inferior alveolar nerve obtained at the mandibular foramen. The spectrum is bimodal with approximately equal numbers of axons in the Aalpha and Adelta-range, in contrast to unimodal spectra of certain branches contributing to the inferior alveolar nerve.


Rationale and methods for crown lengthening. Surgical crown lengthening should not be attempted when tooth fractures extend into the middle third of the root. Excessive bone reduction on the fractured tooth and necessary blending of osseous contours over adjacent teeth may result in mobility or furcation involvement. In addition, the necessary osseous surgery may create precipitous changes in the bony architecture that will be bridged by soft tissues. This results in increased pocket depth and an unhealthy situation. If the tooth in question has a hopeless prognosis or the osseous surgical procedure would create a poor crown-root ratio, furcation involvement, mobility, or esthetic problems, crown lengthening should be avoided. In cases such as these, extraction may be indicated.


An evaluation of the clinical laboratory as an adjunct to dental practice. A study was completed at the University of Kentucky College of Dentistry in which 172 randomly selected adult dental patients were subjected to a battery of laboratory screening tests as a part of the initial examination procedure. The tests performed included rapid plasma reagin test, complete blood cell count, and determinations of serum glucose, blood urea nitrogen, and serum cholesterol values. Nearly 17% of the patients had at least one abnormal laboratory value. Thirty-three percent of the values were so abnormal that the patients required medical care. For the total group, the rate of detection of previously undiagnosed medical problems was 6.9%. Elevated serum glucose values were found most frequently.


Nitroblue tetrazolium and Limulus assays for bacteremia after dental extraction: effect of topical antiseptics. Bacteremia that occurs after dental extraction is common. This study assessed the effect of topical antisepsis on the incidence and magnitude of post-extraction bacteremia. On hundred patients scheduled for elective tooth extraction were randomized among four groups: contr-l, mouthrinsing with sodium-p-toluene sulfonchloramide (chloramine-T), toothbrushing with chloramine-T, and irrigation with Lugol's solution. The results showed that 84% of the control group and 59% of the treatment groups had positive blood cultures (290 organisms isolated) after dental extraction. The duration and magnitude of these bacteremias were diminutive as documented by the six serial blood cultures taken for each patient, colony counts per milliliter of blood, and nitroblue tetrazolium and Limulus assays. Brushing the teeth or rinsing the mouth with chloramine-T before dental extraction significantly reduced the incidence of bacteremia (P less than .025) and the number of different organisms recovered from each patient (P less than .05). Thus, topical treatment with chloramine-T is a simple and effective means of reducing the incidence of postextraction bacteremia.


Ethyl alcohol by the oral route as a sedative in dentistry. The history and social use and misuse of alcohol have been reviewed. Alcohol is an effective mild sedative drug for dental therapy when used in suggested dosage, and its use is encouraged. Guidelines and contraindications for administration have been suggested.


Chronic granulomatous disease: report of case and review of the literature. A man with chronic granulomatous disease had severe gingivitis and ulcerous lesions in the buccal mucosa and palatal plate. After the use of good hygiene procedures, his condition improved greatly. It is possible that oral symptoms reported in this disease are due in part to accumulations of plaque. A review of the literature on chronic granulomatous disease is included.


Cleidocranial dysostosis: a multidisciplinary approach to treatment. To ensure eruption of the dentition in patients with cleidocranial dysostosis, close collatoration between the oral surgeon and the orthodontist is essential to determine the sequence of extraction, the teeth to be ligated, the preferred technique of ligation, and the approach for surgical exposure.


Prosthodontic therapy for cleidocranial dysostosis: report of case. Objectives of treatment of the oral manifestations of cleidocranial dysostosis should include restoring the vertical dimension of occlusion, building out the maxilla, establishing of functional occlusion, improving appearance and phonation, and improving the patient's mental well-being.


Cleidocranial dysostosis: report of case. In the treatment of oral problems of patients with cleidocranial dysostosis, the multidisciplinary approach should be considered. The collective abilities of the oral surgeon, the prosthodontist, and the orthodontist should be utilized to determine the most effective treatment.


Biopsy technique: the pathological considerations. As the dental profession moves toward additional emphasis in detection of disease and sophistication in diagnosis, biopsy is being used with increasing frequency as a diagnostic tool. This article states and elucidates simple ground rules that govern the rationale of surgical sampling of pathologic tissue. The three most common deficiencies that hamper interpretation (tissue artifact, inadequate clinical information, and inappropriate tissue sampling) are discussed, and the biopsy approach to various types of clinical lesions is reviewed.


Physical properties of dental silver-tin amalgams with high and low copper contents. Newly developed amalgams such as Tytin, Sybraloy, and Dispersalloy had low static creep, high compressive strength, and similar values for both diametral tensile strength and dimensional change in comparison with conventional amalgams such as Kerr Spheraloy, Caulk Spherical, Shofu Spherical, and Caulk 20th Century Micro Cut. The data for physical properties were evaluated statistically, and the amalgams were ranked according to the numerical position assigned to each property.