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Biomedical subjects

H L Needleman

Publications and source records attributed to H L Needleman.

125 records · Page 7Linked to original sources
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Criteria mapping for the fractured permanent incisor.

Since hospital dental departments currently are regulated by the same quality assurance guidelines as other hospital departments, the Joint Commission on Accreditation of Healthcare Organizations now requires that dental departments review and evaluate the quality of care they deliver. Criteria mapping is an audit method that builds logic and decision making into this review process. This method was field tested on patients having fractures of anterior teeth. Statistically significant results were produced using the criteria map developed by this study; both evaluators scored the same in 98.6% of the criteria reviewed.

American Dental Association↗
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Low-level lead exposure and infant development in the first year.

The developmental impact of prenatal and early postnatal low-level lead exposure was assessed in a prospective study of 249 middle and upper-middle class infants with umbilical cord blood lead levels in the range currently considered "normal." Infants were classified into three exposure groups: "low" (less than 3 micrograms/dl), "mid" (6 to 7 micrograms/dl), and "high" (greater than or equal to 10 micrograms/dl). At 6 and 12 months, the lead concentration of capillary blood was measured, and the Bayley Scales of Infant Development administered. At both ages, Mental Development Index scores, adjusted for confounding, were inversely related to infants' umbilical cord blood lead levels. The difference between the mean adjusted scores of the infants in the low and high cord blood lead groups was 5.8 points at 6 months and 7.3 points at 12 months. At neither age were scores significantly related to postnatal blood lead levels. Prenatal exposure to lead levels relatively common among urban populations appear to be associated with less favorable development through the first year of life.

Age Factors↗
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The incidence of post-extraction pain and analgesic usage in children.

A parentally completed questionnaire was used to investigate the incidence of post-extraction pain in children. Significantly more patients in the study group reported pain following dental extraction than did control patients. Increasing age was significantly associated with the report of pain, but not with the use of a pain medication, even when the degree of difficulty of the extraction procedure was standardized. These findings suggest that the report of pain represents a late learned response while medication usage represents an early learned response. Those patients that reported increased severity of pain were significantly more likely to require a pain medication, but the pain medication was most effective for only mild pain. Additionally, male patients were significantly more likely to report complete effectiveness when pain medication was used. Contrary to some popularly held beliefs, the results of this study indicate that children do experience post-extraction pain and some children experience pain of sufficient intensity to require an analgesic for relief of post-extraction pain. Additionally, for a small group of patients, neither aspirin nor acetaminophen are adequate in fully relieving post-extraction discomfort. For these patients other agents may be indicated to fully relieve pain.

Adolescent↗
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Lead levels--comment.

Explore the source record for details and available documents.

Child, Preschool↗
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Early sensory-motor development and prenatal exposure to lead.

As part of a longitudinal study of the early developmental effects of exposure to lead, we administered the Bayley Scales of Infant Development at age 6 months to infants classified into three groups based on their umbilical cord blood lead levels ("low": mean = 1.8 micrograms/dl; "mid": mean = 6.5 micrograms/dl; "high": mean = 14.6 micrograms/dl). No infant had a cord blood lead level greater than 30 micrograms/dl, the level currently regarded as the upper limit of "normal" for young children. Multiple regression analyses indicated that high cord blood levels were associated with lower covariance-adjusted scores on the Mental Development Index. Scores on the Psychomotor Development Index were not significantly related to cord blood lead level. The level of lead in blood at 6 months of age was not associated with scores on either the Mental or Psychomotor Development Index. These data are compatible with the hypothesis that low levels of lead delivered transplacentally are toxic to infants.

Child Development↗
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The neurobehavioral consequences of low lead exposure in childhood.

Children attending non-remedial first and second grades were classified according to the concentration of lead in their shed deciduous teeth. Children in the lowest and highest tenth percentile were studied with a detailed neuropsychological battery under blind conditions. Thirty-nine non-lead covariates were controlled either by matching or in the biostatistical analysis. High lead children tended to have significantly lower IQ scores particularly on the verbal scales of the WISC-R, impaired auditory and language processing, increased reaction times at longer intervals of delay. Their teachers who were blind to the dentine lead levels found an increased incidence of disordered classroom behavior in direct relationship to the concentration of lead in their teeth. Quantitative electroencephalographic analysis demonstrated decreased midline alpha and increased midline delta in high lead subjects. Four years later a subsample of these children was followed up and observed during quiet classroom activity. High lead children tended to spend more time off tasks staring at classmates, out the window or at the observer. These observations demonstrate that lead at doses below those which are associated with frank clinical symptoms produce deficits in intelligence, attention, auditory-language function and disordered classroom behavior.

Behavior↗
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The current status of childhood low-level lead toxicity.

Lead's toxicity has been recognized since antiquity, and certain themes recur during the history of its understanding. Warnings have been frequently pronounced, and frequently followed by statements that these warnings were exaggerated. Childhood lead poisoning was first discovered in Brisbane, Australia in 1894. The cause, lead on the rails of the porches, was demonstrated by J.L. Gibson, and promptly derided by the business and medical communities. The first lead paint prevention act was passed in Australia in 1920. In the United States, it was believed that if a lead-poisoned child did not die, they recovered with no residua. This was disproved by R.K. Byers in 1943, and the modern era of childhood lead poisoning was begun. In the 1960's, the defined toxic level of lead in the blood was 60 micrograms/dl. In some areas, as many as 20% of children had blood lead levels above 40 micrograms/dl. Questions about silent toxicity at these doses were raised. Studies of lower lead exposure began to be published in the early 1970's. Some reported an effect, others did not. Many of these early studies were of small sample size, used crude measures of outcome, relied on a short term markers of exposure, and had limited control of covariates. In the latter part of the 1970's, studies of better quality reported positive relationships between lead and IQ. We used tooth lead levels to classify asymptomatic 1st and 2nd grade children and, controlling for socioeconomic status, mother's IQ and other potential confounders, demonstrated that high lead in the teeth was associated with decreased IQ, impaired attention, and impaired speech performance.(ABSTRACT TRUNCATED AT 250 WORDS)

Behavior↗
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Effectiveness of a statewide child abuse and neglect educational program for dental professionals.

The purpose of this study was to evaluate the effect of a statewide child abuse and neglect (CAN) educational program. Questionnaires were mailed to a random sample of 2,500 dentists and 2,500 hygienists registered in Massachusetts. Approximately half the responding dentists and hygienists were aware of the existence of the program either via a theme issue of The Journal of the Massachusetts Dental Society or presentations at the Yankee Dental Congresses. Most respondents indicated that the program had increased their awareness and knowledge of CAN and made them more likely to detect and report such cases. However 38.1% of the respondents were not comfortable calling the Department of Social Services (DSS). The major reason cited for not reporting was the lack of an adequate history to confirm suspicions. Approximately one-fifth of the dentists and hygienists reported having seen dental pathology or injuries to children that they suspected to be a result of child abuse or neglect, while 13.6% admitted to seeing at least one suspicious case in the past 12 months. One-third of the respondents stated that they thought at least one of these suspicious cases was definitely the result of abuse. Only a minority of these dentists and hygienists reported to the DSS any of the suspicious cases they'd seen; however, the majority of these reporters were satisfied with the results of their reports.

Adult↗
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Williams syndrome--oral presentation of 45 cases.

Forty-five patients with Williams syndrome (WS) were evaluated for oral abnormalities. The mean age of the patients was 9.25 years, the median age was 6.7 years, and the majority (62.2%) were male. Hypodontia was present in 11.1% of the patients. Abnormal tooth morphology was noted in 12.5% of the primary dentitions and 40.7% of the permanent dentitions. With the exception of the primary mandibular central incisors of males, all mesiodistal incisor crown dimensions were statistically significantly smaller when compared with norms (P < 0.05). At least one hypoplastic enamel defect was present in 9.4% of patients with primary teeth and in 18.5% with permanent teeth. No patients exhibited generalized enamel hypoplasia. More than half of the patients (59.1%) were both caries and restoration free, while only 13.6% presented with clinically active caries. Tongue thrusting was present in 67.7% of the sample, while more than 50% of the patients present with excessive interdental spacing. Patients exhibited a higher than normal prevalence of Class II and III occlusions, open and deep bites and anterior crossbites. No single dental finding was pathognomonic of WS, however two constellations of findings, each occurring in approximately one-third of the sample, were observed: 1) microdontia, anterior crossbite, tongue thrusting, and excessive interdental spacing, and 2) microdontia, deep or open bite, and excessive interdental spacing.

Abnormalities, Multiple↗
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Luxation injuries of primary anterior teeth--prognosis and related correlates.

This study investigated the prognosis and related correlates of 307 luxation injuries of primary anterior teeth sustained by 222 patients. Primary anterior teeth that had sustained luxation injuries were identified from the dental records of a pediatric dental practice. Data collected included: the child's birth date, sex, and occlusion; date, etiology, and type of injury; treatment rendered; and post-traumatic sequelae. The mean age of children at the time of injury was 3.8 years, and the most common etiology was a fall. Those children sustaining intrusions were significantly younger than those sustaining extrusions or avulsions. Sports accidents were more likely to cause lateral luxations, while bike accidents were more likely to cause extrusions and avulsions. Root fractures were significantly associated with lateral luxations. The risk of sustaining a lateral luxation increased as age increased. There was an association between the development of post-traumatic sequelae and the repositioning of displaced teeth. Lateral luxations had a marked increase risk of necrosis when repositioned; conversely, intrusions had a decreased risk of necrosis when repositioned. Those groups with the best post-trauma tooth survival during the first year postinjury were those > 5 years old and < 2 years old. Hypoplastic defects were noted on 7.7% of the succedaneous teeth and their prevalence was not statistically associated with the type of luxation injuries.

Analysis of Variance↗
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Effect of familial hypophosphatemic rickets on dental development: a controlled, longitudinal study.

Familial or X-linked hypophosphatemic rickets (XLHR) is the most common type of rickets in developed countries today. While the dental manifestations of rickets are well reported, there is little information regarding its relationship to dental development and other dental anomalies. This investigation studied the rate of dental development and associated dental anomalies in 19 XLHR subjects compared with 38 race-, age-, and sex-matched control children. The results showed that in both XLHR and control children, no significant differences existed in dental age compared with the respective chronological age, indicating that rickets did not affect the rate of dental development. Longitudinal growth curves of seven XLHR and matched control children substantiated that relationships of dental to chronological ages were comparable in both groups. Male XLHR subjects showed significantly increased tendency for dental taurodontism with mean Crown-Body (CB):Root (R) ratio of 1.1 compared with 1.0 in females and 0.8 in controls (P < 0.02). Male XLHR children also showed significantly increased prevalence (50%) of ectopic permanent canines compared with control children (8%, P < 0.01).

Adolescent↗
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Conscious sedation of pediatric dental patients using chloral hydrate, hydroxyzine, and nitrous oxide--a retrospective study of 382 sedations.

This retrospective study assessed the effectiveness and safety of chloral hydrate (55 mg/kg), hydroxyzine (1 mg/kg), and nitrous oxide in the sedation of 336 uncooperative pediatric dental patients over 382 sedation sessions, and identified variables associated with effectiveness including: sex, weight, age, and preoperative behavior of the patient; route and combinations of the sedative drugs; and sex of the operating and monitoring dentists. The operating and monitoring dentists rated the sedation session as either effective or ineffective and also as either heavy, moderate, light or poor. The mean age of the children was 2.6 years and mean weight was 14.1 kg. Seventy-four percent of the sedation sessions were deemed effective. Boys had more effective sessions (80.6%) than girls (65.1%) (P = 0.001). Also, the percentage of sedations rated as effective increased as the preoperative behavior was more positively rated (P = 0.001). Oral regimen of chloral hydrate alone or in combination with oral hydroxyzine was more effective (75.5%) than rectal administration of chloral hydrate alone (65.7%) (P = 0.09). There was no significant difference in effectiveness when chloral hydrate was administered orally alone or in combination with oral hydroxyzine. Sedation sessions rated effective had longer operative times, included more sextants of treatment, were more likely to include restorative treatment, and were less likely to include extractions than the ineffective sedations. Vomiting was the only complication reported, occurring in 8.1% of the sedations. Vomiting did not vary significantly with either route of administration or inclusion of hydroxyzine in the oral regimen. Pulse rates were significantly higher for children in the ineffective sedation sessions. This sedative drug regimen was deemed safe and effective for treating young and uncooperative pediatric dental patients.

Administration, Oral↗
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Alveolar bone height of primary and first permanent molars in healthy seven- to nine-year-old children.

The purpose of the study was to establish baseline values of the alveolar bone height of the primary molars and first permanent molars in sample of healthy U.S. seven- to nine-year-old children. Direct measurements of the distance from the cementoenamel junction (CEJ) to the alveolar crest (AC) on 223 pairs of bitewing radiographs from 223 subjects were made using a digimatic caliper under standardized conditions. The distance from the CEJ to the AC had medians from 0.58 mm to 1.39 mm (range 0.0 to 4.44 mm) for the primary molars and from 0.00 mm to 0.64 mm (range -1.35 to 2.15 mm) for the mesial aspect of the permanent molars. There were no statistically significant differences in the distance from CEJ to AC between teeth on the right and left sides of the mouth. The distances from CEJ to AC were always greater in the maxilla than in the mandible for similar primary molar sites, but only true for the mesial aspect of the permanent first molar at age nine. As a tooth is positioned more anteriorly in the mouth, the distance from CEJ to AC was greater. On the whole, males had greater distances than females and eight-year-olds had larger distances than seven- or nine-year-olds. Differences were observed in the measured distances for the different age and sex-groups and may be attributable to variations in eruption and exfoliation patterns. The distance was significantly greater in areas of interproximal restorations and open contacts, and there was a tendency for the distances to be greater in areas of interproximal caries.

Alveolar Process↗