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Biomedical subjects

R W Valachovic

Publications and source records attributed to R W Valachovic.

12 recordsLinked to original sources
PubMed1991

The regulation of dental licensing: the dark ages?

Current state laws regulating the licensure of dentists place severe restrictions upon the freedom of movement of practitioners. Most state laws were enacted during a period when a strong rationale for regulating public health and welfare existed. Today, these laws hamper the free movement of dentists and are anachronisms in an era of national standards and practices. The authors contend that the extant laws rest upon outdated assumptions and serve economic and protectionist goals rather than public health and safety. This Article examines the history and application of the traditional justifications for state licensure and their present ramifications. The authors suggest that replacing the current regulatory system with a national clinical examination and a national licensure program will best serve the interests of the public and the dental profession.

Dental Care↗
PubMed1990

Dentofacial development in long-term survivors of acute lymphoblastic leukemia. A comparison of three treatment modalities.

Ninety-seven children who were diagnosed with acute lymphoblastic leukemia before 10 years of age and treated with chemotherapy alone, chemotherapy plus 1800-cGy cranial irradiation (RT), or chemotherapy plus 2400-cGy RT were evaluated for effects of therapy on dentofacial development. All patients were seen at least 5 years postdiagnosis. Dental abnormalities were determined from panoramic radiographs, and craniofacial evaluations were made from lateral cephalometric radiographs. Ninety-one (94%) of all patients and 41 (100%) of patients younger than 5 years of age at diagnosis had abnormal dental development. The severity of these abnormalities was greater in children who received treatment before 5 years of age and in those who received RT. Observed dental abnormalities included tooth agenesis, arrested root development, microdontia, and enamel dysplasias. Craniofacial abnormalities occurred in 18 of 20 (90%) of those patients who received chemotherapy plus 2400-cGy RT before 5 years of age. Mean cephalometric values of this group showed significant deficient mandibular development. The results of this study suggest that the severity of dentofacial-developmental abnormalities secondary to antileukemia therapy are related to the age of the patient at the initiation of treatment and the use of cranial RT.

Adolescent↗
PubMed1990

Statistical methods for comparing dental diagnostic procedures.

In dental diagnosis, there are typically two or more clinical diagnostic procedures which may be used either independently or jointly to reach a conclusion regarding the presence of a particular disease in a patient. To determine which of these diagnostic procedures are more accurate, statistical methods may be applied to research data in which the true health status as well as the diagnosis provided by each clinical procedure are available on each observation. Results arising from this type of analysis can be of great interest to clinicians when the diagnostic procedures themselves are costly, painful, or even potentially harmful to the patient. Considered here is the special situation encountered in dental research in which each patient can have multiple concurrent cases of a certain disease such as caries, for then the statistical evaluation of diagnostic procedures is even further complicated. This report describes several statistical approaches for comparing the efficacy of diagnostic tests and illustrates their application on data from a study of diagnostic radiographs for dental caries.

Adult↗
PubMed1989

Efficacy of dental radiographic practices: options for image receptors, examination selection, and patient selection.

Many technical factors and treatment philosophies affect the way dental radiology is practiced. Some, like minimum tube filtration, are legislated. Others, like proper darkroom techniques, are universally acknowledged as essential. Still others, like the selection of an image receptor and the selection of the type of examination, are the subject of much discussion and debate. This article addresses some of the more controversial options and choices facing dental practitioners by reviewing the standard assessment techniques available to help make appropriate decisions, by summarizing and analyzing available data, and by offering recommendations for practice.

Efficiency↗
PubMed1988

Clinical indicators of radiographically detectable dental diseases in the adult patient.

A comprehensive analysis of the relationship between clinical observations in dental patients without symptoms and oral disease as detected by full-mouth and panoramic dental radiographs in a large population of patients has never been reported. Knowledge of these relationships is necessary in the design of a diagnostic decision process (clinical algorithm) that can predict which patients require dental radiographs for the diagnosis of dental caries or periodontal disease to be confirmed or refined. An accurate clinical algorithm could reduce the number of radiographs that are taken of certain routinely seen dental patients without symptoms, thus reducing unnecessary exposure x-radiation as well as potentially reducing health care costs for these patients. A sample of 602 adult men on whom a complete series of panoramic, posterior bitewing, and periapical dental radiographs and an independent oral examination were performed provided the opportunity to evaluate the relationship between clinically observed oral disease indicators and independent radiographic evidence of dental caries and periodontal disease. The analysis suggests that combinations of several clinical indicators can predict with some success which patients without symptoms will benefit most from oral radiographs. The presence of several carious lesions on oral examination was the best predictor of radiographic detection of dental caries. Clinical indicators tht appear to predict radiographic evidence of periodontal disease are clinical measures of pocket depth, mobility, and the patient's denture status. An important finding is that because of the high prevalence of gingivitis and plaque, these indicators were not related to radiographic evidence of periodontal disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Longitudinal radiographic analysis of carious lesion progression.

Information on the rate at which carious lesions progress through the enamel of human teeth in an adult population was obtained from dental radiographs taken at 3-yr intervals, over a 10-yr period on 602 men. Clinical measures of calculus deposition, plaque accumulation, gingival inflammation, tooth mobility, periodontal pocket depth, and gingival recession were studied to find predictors that might be of value to the clinician for determining how frequently radiographs should be taken. We estimate that 50% of the enamel lesions on mesial and distal surfaces, if left untreated, would not progress into the dentin until 73 months had elapsed after the lesion was initiated. Significant differences in the progression rate were associated with the arch and tooth type. Patient age, number of decayed or filled surfaces, degree of gingival inflammation, amount of recession, and plaque accumulation were positively associated with more rapid caries progression, while greater numbers of teeth present were predictive of slower disease progression.

Adult↗
PubMed1987

Longitudinal study of the diagnostic yield of panoramic radiographs in aging edentulous men.

Participants in the Veterans Administration Dental Longitudinal Study who were edentulous and for whom longitudinal panoramic radiographs were available were followed through four examination cycles, representing approximately 10 years. It was observed that 13 (39%) of the 33 subjects examined had one or more positive radiographic findings at the initial examination. No changes occurred in the findings noted during the initial panoramic radiographic examination, and no new findings were observed over the study period. Although the initial baseline panoramic examinations yielded several positive radiographic findings, few were of a nature that materially affected the initial treatment plan.

Adult↗
PubMed1986

Clinical efficacy of dental radiography in the detection of dental caries and periodontal diseases.

This article reports the ability of dental radiographs to correctly detect evidence of dental caries and periodontal disease (sensitivity) and to correctly establish the absence of these diseases (specificity). The analysis used a unique data set that was collected as part of the Veterans Administration Dental Longitudinal Study in Boston. Periapical, panoramic, and posterior bitewing radiographs were independently compared with a consensus radiographic standard of all three radiographs read simultaneously. Findings showed that the sensitivities of all three radiographs to detect dental caries were lower than expected, at approximately 60%, whereas the sensitivities to detect evidence of periodontal disease averaged approximately 85%. Panoramic radiographs were substantially less sensitive for detecting dental caries than periapical and posterior bitewing radiographs, but no difference between these modalities was observed in the analysis of sensitivity to periodontal disease. The proportion of false-negative and false-positive readings from dental radiographs was substantial and requires further investigation.

Adult↗
PubMed1986

The use of panoramic radiography in the evaluation of asymptomatic adult dental patients.

This article examines the efficacy of panoramic radiography alone and in combination with intraoral films as part of the "full-mouth" radiographic evaluation of asymptomatic dental patients in the diagnosis of dental caries and periodontal disease. Three full-mouth radiographic surveys--the panoramic alone, the panoramic plus posterior bitewing, and the periapical plus posterior bitewing--are compared. Two forms of measurement--comparative and incremental--were used to identify the radiographic survey with the highest single diagnostic yield when measured against the consensus standard. The findings show that the panoramic radiograph alone exhibits very low sensitivities to dental caries, ranging from 0.6% on anterior teeth to 25.6% on premolars. Even when posterior bitewing radiographs are added to the panoramic films, the sensitivities are significantly below those of the full-mouth periapical and bitewing survey. In contrast, the sensitivities of all three radiographic surveys in the diagnosis of periodontal disease are quite high, ranging from 87% to 96%, so that differences are not clinically significant. However, specificities tended to be low for periodontal disease and high for caries. Thus, for dental caries and (to a lesser extent) periodontal disease, the panoramic radiograph was inferior to the full-mouth intraoral series in its ability to correctly detect evidence of the disease.

Adult↗
PubMed1986

Examiner reliability in dental radiography.

In long-term investigations involving a large number of study participants, it is frequently necessary to employ the use of multiple examiners who must exhibit high levels of inter- and intra-examiner reliability in order to minimize examiner bias, which can distort scientific findings. This report on the calibration of four examiners in a large project investigating the efficacy of dental radiography shows high levels of examiner reliability using various statistical measures of agreement. Levels of intra-examiner agreement using Cohen's Kappa index were 0.75 and higher at baseline, and remained at approximately the same level (0.80) throughout the 24-month period of the study. The Kappa index of inter-examiner agreement among the six pairings of the four examiners ranged from 0.68 to 0.80 for caries and 0.72 and 0.83 for periodontal disease. Values of four statistical measures of agreement (proportional agreement, Kendall's rank correlation, Cohen's Kappa index, and Cohen's weighted Kappa index) were determined to show the importance of using measures, such as the Kappa index, which take chance agreement into account.

Adult↗
PubMedDate not supplied

An analysis of dental services based in the emergency room.

This study evaluated the utilization, cost-effectiveness, and marketing of emergency dental services in a 700-bed university-affiliated hospital. Sequential analysis of 445 emergency room dental visits was performed during a 3-month period. Services were most used on weekend days by patients who had chief symptoms lasting varying lengths of time (43% had them 21 days). The majority of patients sought care for relief of pain. A diagnosis of infection was made in 82% of the patients. An analysis of costs, revenues, marketing, and service design is included.

Cost-Benefit Analysis↗