The impact of molecular genetics on oral health paradigms.
As a result of our increased understanding of the human genome, and the functional interrelationships of gene products with each other and with the environment, it is becoming increasingly evident that many human diseases are influenced by heritable alterations in the structure or function of genes. Significant advances in research methods and newly emerging partnerships between private and public sector interests are creating new possibilities for utilization of genetic information for the diagnosis and treatment of human diseases. The availability and application of genetic information to the understanding of normal and abnormal human growth and development are fundamentally changing the way we approach the study of human diseases. As a result, the issues and principles of medical genetics are coming to bear across all disciplines of health care. In this review, we discuss some of the potential applications of human molecular genetics for the diagnosis and treatment of oral diseases. This discussion is presented in the context of the ongoing technological advances and conceptual changes that are occurring in the field of medical genetics. To realize the promise of this new molecular genetics, we must be prepared to foresee the possibilities and to incorporate these newly emergent technologies into the evolving discipline of dentistry. By using examples of human conditions, we illustrate the broad application of this emerging technology to the study of simple as well as complex genetic diseases. Throughout this paper, we will use the following terminology: Penetrance--In a population, defined as the proportion of individuals possessing a disease-causing genotype who express the disease phenotype. When this proportion is less than 100%, the disease is said to have reduced or incomplete penetrance. Polymerase chain reaction (PCR)--A technique for amplifying a large number of copies of a specific DNA sequence flanked by two oligonucleotide primers. The DNA is alternately heated and cooled in the presence of DNA polymerase and free nucleotides, so that the specified DNA segment is denatured, hybridized with primers, and extended by DNA polymerase. MIM--Mendelian Inheritance in Man catalogue number from V. McKusick's Mendelian Inheritance in man (OMIM, 1998). (+info)
Dental health and viridans streptococcal bacteremia in allogeneic hematopoietic stem cell transplant recipients.
Viridans streptococci were the most common cause of bacteremia in 61 consecutive myeloablative allogeneic hematopoietic stem cell transplant (HSCT) recipients, occurring in 19 of 31 bacteremic patients (61%) during the period of post-transplant neutropenia. Seven of the 19 had more than one viridans streptococcus in the same blood culture. Twenty isolates from 15 patients were Streptococcus mitis. Most viridans streptococci were resistant to norfloxacin, used routinely for prophylaxis. Comparison of the 19 patients with viridans streptococcal bacteremia with a contemporaneous group of 23 allogeneic HSCT recipients with fever and neutropenia but no identified focus of infection found that patients with viridans streptococcal bacteremia were more likely to have severe intraoral pathology while neutropenic (26% vs 0%) and slightly shorter interval between the last dental procedure and the onset of neutropenia (11 vs 14 days). Poor underlying dental health and the use of norfloxacin thus appear to predispose to viridans streptococcal bacteremia. (+info)
Diagnostic codes in dentistry--definition, utility and developments to date.
Diagnostic codes are computer-readable descriptors of patients' conditions contained in computerized patient records. The codes uniquely identify the diagnoses or conditions identified at initial or follow-up examinations that are otherwise written in English or French on the patient chart. Dental diagnostic codes would allow dentists to access information on the types and range of conditions they encounter in their practices, enhance patient communication, track clinical outcomes and monitor best practices. For the profession, system-wide use of the codes could provide information helpful in understanding the oral health of Canadians, demonstrate improvements in oral health, track best practices system-wide, and identify and monitor the progress of high-need groups in Canada. Different systems of diagnostic codes have been implemented by program managers in Germany, the United Kingdom and North America. In Toronto, the former North York Community Dental Services developed and implemented a system that follows the logic used by the Canadian Dental Association for its procedure codes. The American Dental Association is now preparing for the release of SNODENT codes. The addition of diagnostic codes to the service codes already contained in computerized patient records could allow easier analysis of the rich evidence available on the oral health and oral health care of Canadians, thereby enhancing our ability to continuously improve patient care. (+info)
Oral manifestations of Albright hereditary osteodystrophy: a case report.
Albright hereditary osteodystrophy is a hereditary metabolic disorder of dominant autosomal etiology that is commonly characterized by short stature, round face, small metacarpus and metatarsus, mental retardation, osteoporosis, subcutaneous calcification, variable hypocalcemia, and hyperphosphatemia. In this study, we report a clinical case of a 17-year-old woman with Albright hereditary osteodystrophy, and we discuss her clinical, radiographic, and laboratory test characteristics together with the oral manifestations, and we correlate them with the characteristics found in the literature. We also discuss the odontological management of treatment of related periodontal disease and planning for corrections of related malocclusions. (+info)
Costs of medically treated craniofacial conditions.
OBJECTIVES: Determining the magnitude of the burden of diseases and health disorders on the U.S. population is a high priority for health policy makers. Conditions such as malignant neoplasms and injuries from craniofacial trauma contribute to adverse oral health. This study estimates the number of cases of diseases and disorders relevant to oral health that are treated annually in the medical care, as opposed to the dental care, system and associated costs. Policy makers can use this cost model to compare the impact of different conditions, to target areas for reducing costs, and to allocate appropriate health resources. METHODS: Data from four national and two state data systems were used to estimate the number of cases of selected dental, oral, and craniofacial diseases and conditions treated in the medical system annually and associated medical and wage/household work loss costs. RESULTS: Per case, the most costly conditions were estimated to be malignant neoplasms at 83,080 US dollars annually (in 1999 dollars), diabetes-related oral conditions at 51,030 US dollars, endocarditis at 48,610 US dollars, and chlamydiae at 41,100 US dollars. Total estimated costs for oral conditions treated in the medical care system in 1996 were approximately 95.9 billion US dollars, including 21.4 billion US dollars in medical costs and 74.4 US dollars billion in wage/household work loss costs. CONCLUSIONS: Conditions treated outside the dental care system are major contributors to oral health costs. They should be an important focus for the National Institute of Dental and Craniofacial Research. (+info)
Taxonomy for competency-based dental curricula.
The objective of this article is to propose a classification of dental competencies. Interest in dental competencies has grown consistently during the last three decades. However, the dental education literature suggests that the term "competency" is understood and used differently by dental schools around the world. The taxonomic classification of dental competencies we propose follows a systematic approach starting at the highest level of complexity, i.e., the professional profile the teaching institution envisions for its graduates, and following in a decreasing degree of complexity to competency function, task, step, movement, and moment. This taxonomy has proved to be useful for more than thirty years in the Dental School of the Peruvian University Cayetano Heredia. Graduates of this school are successful practitioners, teachers, and researchers in Peru and other countries. The classification proposed here should clarify terms, facilitate curriculum design and learning assessment, stimulate further discussion on the matter, and facilitate communication among the dental education establishment. (+info)
A case of soft tissue myoepithelial tumor arising in masticator space.
Soft tissue myoepithelial tumors of the head and neck region are very rare, and only one case of soft tissue myoepithelial tumor occurring in the masticator space has been reported in the world literature. A case of soft tissue myoepithelial tumor with benign histomorphology, but with an invasive growth pattern, occurred in the masticator space of a 46-year- old male patient. Magnetic resonance imaging of paranasal sinus/nasopharynx revealed a well-defined, lobulated heterogeneous mass with high signal intensity and dense calcification in the masticator space between the left mandible ramus and pterygoid process. Grossly, the tumor was a well- circumscribed ovoid solid mass and consisted of yellowish gray glistening firm tissue. Histologically, the tumor showed a multinodular growth pattern and consisted of epithelioid cells in chondromyxoid stroma and of spindle-shaped to ovoid cells in the hyaline stroma. The tumor cells appeared bland, and no mitosis or necrosis was found within the tumor. The tumor focally invaded to adhered bone tissue. Immunohistochemically, the tumor cells were diffusely positive for epithelial membrane antigen, smooth muscle actin, but negative for other epithelial markers. Ultrastructurally, the cytoplasm of the tumor cells contained sparse microfilaments and subplasmalemmal densities. Attenuated desmosomes were commonly seen between the tumor cells. (+info)
Incontinentia pigmenti: clinical observation of 40 Korean cases.
Incontinentia pigmenti (IP) is an uncommon genodermatosis that usually occurs in female infants. It is characterized by ectodermal, mesodermal, neurological, ocular, and dental manifestations. The aim of this study was to clarify clinical symptoms, accompanying diseases, and complications of IP. Forty cases of IP have been reviewed by their medical records, laboratory data, clinical photographs, and telephone survey. Male-to-female ratio was 1 to 19 and their onsets were mostly in utero. They were usually diagnosed during the neonatal period owing to their early expression of skin manifestation. Central nervous system anomalies were found in 46.7%. Ocular disorders and dental defects were detected in 66.7% and 72.7% respectively. The most commonly diagnosed anomalies were hypodontia, retinopathy, and seizure. For better understanding of IP, long term and close cooperation between dermatologists, pediatricians, neuroscientists, genetic counselors, and even dentists is crucial. (+info)