Population-to-practitioner ratios have long been the primary index in the designation of health manpower shortage areas. This paper documents that application of the widely used population-to-dentist index results in understatement of the need for dental health manpower in rural areas. Through the analysis of utilization data collected from a statewide health screening program in Colorado, the practice of sole reliance on the population-to-dentist indices as an indicator of need was tested. Another measure, the area-(square miles) to-dentist ratio was formulated, examined, and found to be a more useful referent of the need for additional health manpower in rural areas. Utilization of dental services in sparsely settled rural counties of Colorado was unrelated to population-to-dentist ratios. A strong, statistically significant association of utilization with land area-to-dentist ratios was found. The findings of this analysis suggest a need for reevaluation of needs assessment methodologies used in the designation of health manpower shortage areas. Indices more sensitive to consumer circumstance than to the number of health care providers available must be considered.

Colorado↗

PubMed1977

The handicapped person--patient and pupil.

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Career Choice↗

PubMedDate not supplied

Crown size asymmetry in males with fra (X) or Martin-Bell syndrome.

We measured the mesio-distal and bucco-lingual crown diameters of 13 males with the fra(X) or Martin-Bell syndrome. Fluctuating crown-size asymmetry was calculated and compared with values obtained in normal Caucasian children and also with a sample of 19 males with Down syndrome. A statistically significant increased asymmetry was found in the fra(X) males when compared to normal control individuals. In the maxilla, Down syndrome males showed a significantly higher tooth crown asymmetry than fra(X) males. (less than 0.02); in the mandible, no significant differences were found between the 2 groups. It is suggested that crown size asymmetry be included in the evaluation of fra(X) males.

Down Syndrome↗

PubMedDate not supplied

Serum antibody response to Actinobacillus actinomycetemcomitans in Down's syndrome.

Persons with Down's syndrome (DS) are susceptible to severe and precocious periodontal disease. Several organisms have been implicated in the etiology of periodontal disease, including Actinobacillus actinomycetemcomitans (Aa). It is unknown whether circulating antibodies correlate with the severity of periodontal disease in DS. This study determined the circulating antibody titers to Aa in sera of DS and normal patients. Eleven DS patients with periodontal disease (pocket depth > 4 mm), five DS patients with gingivitis (inflammation and pocket depth < or = 3 mm), and 10 non-DS healthy subjects had blood drawn and analyzed for antibody response to Aa. Conventional enzyme-linked immunosorbent assay (ELISA) with goat anti-human IgG was performed for Aa-reactive serum diluted 1:200 to 1:12,800. Geometric mean titer was calculated, and significant differences were noted between the control group and the DS groups (p = 0.05), with the DS periodontal group having the highest response, followed by the DS gingivitis and normal controls, respectively. The DS groups were not significantly different. DS patients may exhibit a higher Aa antibody response, due to the presence of the organism, previous exposure, or in proportion to the extent of their periodontal condition.

Adult↗

PubMedDate not supplied

Great expectations.

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Child↗

PubMedDate not supplied

A retrospective study of chloral hydrate, meperidine, hydroxyzine, and midazolam regimens used to sedate children for dental care.

PURPOSE: The purpose of this retrospective study was twofold: a) to examine the behavior and physiology of pre-school children each sedated with 1 of 3 drug regimens based on patient age, dental needs, and pre-operative clinical impression; and b) to determine the association between pre-operative behaviors to the behavior and physiology of the sedated children. METHOD: Records of more than 600 patients sedated at Columbus Children's Hospital dental clinic over a two-year period were culled for patients who ranged in age from 2 to 5 years of age and had received one of three different drug regimens: a) chloral hydrate and hydroxyzine (CH-H), b) chloral hydrate, meperidine, and hydroxyzine (CH-D-H), or c) midazolam (M). A minimum of 300 patients (100/drug regimen) were randomly selected. The standard sedation sheet used in all sedations at the clinic included, among other factors, pre-operative assessments of patient behavior, interaction, and cooperation. Physiological and behavioral variables during the intraoperative sedation periods were also available. These periods included initial baseline vitals, vitals following drug administration, topical and local drug administration, rubber, dam placement, and a minimum of the first 15 minutes of restorative procedures. The three drug regimens were compared for these variables. Data were entered into SPSS for data analysis using one-way ANOVA, Chi-square, regression analysis, and descriptive statistics. RESULTS: The results indicated significant mean differences in patient age, weight, and duration by drug regimen (F = 20.3, P < 0.001; 16.2, P < 0.001; and 48.7, P < 0.001, respectively). ANOVA indicated a significant difference among drug regimens for percent of quiet, sleeping, and struggling behaviors. Quiet behavior accounted for 26%, 41%, and 67% of all behaviors for CH-H, CH-D-H, and M, respectively. Sleep accounted for 50%, 43%, 0.4% and struggling 11%, 8%, and 19% for CH-H, CH-D-H, and M, respectively. Pre-operative behaviors were also significantly different and patient cooperation was the only variable found minimally predictable of intra-operative behaviors (R = 0.32, P < 0.001). Significant differences among drug regimens were found for heart rate (HR) and mean arterial blood pressure (MAP) during certain procedures (e.g., CH-H produced lower MAP compared to the other drug regimens); however, all physiological variables were within normal limits for the children. CONCLUSION: Significant differences were found for behavioral and physiological variables among the drug regimens (e.g., CH-D-H produced significantly more quiet and sleeping behaviors than M). Prospective studies are needed to confirm these findings.

Analysis of Variance↗