James A. Lalumandier

Childhood lead exposure and uptake in teeth in the Cleveland area during the era of leaded gasoline

Childhood uptake of lead from exposure to atmospheric leaded gasoline in the United States has been studied using mainly blood lead levels. Since reliable blood lead techniques were used only after the peak use of leaded gasoline, the prior exposure history is unclear. The well-documented decline in blood lead levels after the mid-1970s could represent the continuation of a historic steady decline in exposure from many sources. Alternatively, the post-1970s decline might represent the declining phase of a unimodal rise and fall corresponding closely to usage of leaded gasoline. To assess these possibilities, lead concentration and 207Pb/206Pb isotope ratios were measured in the enamel of permanent molar teeth formed between 1936 and 1993 in mainly African-American donors who grew up in the Cleveland area. Tooth enamel preserves the lead concentration and isotope ratio that prevails during tooth formation. Historical trends in enamel lead concentration were significantly correlated with surrogates of atmospheric lead exposure: lead in sediments of two dated Lake Erie cores, and lead consumed in gasoline. About two-thirds of the total lead uptake into enamel in this period was attributable to leaded gasoline, and the remainder to other sources (e.g. paint). Enamel 207Pb/206Pb isotope ratios were similar to those of one lake sediment. Multivariate analysis revealed significant correlation in neighborhoods with higher levels of traffic, and including lake sediment data, accounted for 53% of the variation in enamel lead levels. Enamel lead concentration was highly correlated with reported African-American childhood blood levels. The extrapolated peak level of 48microg/dL (range 40 to 63) is associated with clinical and behavioral impairments, which may have implications for adults who were children during the peak gasoline lead exposure. In sum, leaded gasoline emission was the predominant source of lead exposure of African-American Cleveland children during the latter two-thirds of the 20th century.

Asymmetry of the Articular Eminence in Dentate and Partially Edentulous Populations

Abstract The purpose of this study was to assess the degree of right-left asymmetry of the glenoid fossa. The specific aims were (1) to determine whether there were relationships between age, number of teeth, slope of the articular eminence, fossa depth, and the degree of right-left asymmetry, and (2) to compare the right-left asymmetry of two populations, one characterized by an acceptable occlusion (A-Occ), the other by an unacceptable occlusion (partially edentulous; Un-Occ). A-Occ was defined as possessing a minimum of 28 teeth that would allow for hand articulation of the mandibular teeth to the maxillary teeth. Un-Occ had fewer than 17 teeth, which would make it impossible to articulate the mandible with the maxilla. The sample included 20th century dry skulls: 70 African-American (44 male, 26 female) and 64 European-American (49 male, 15 female), ranging in age from 21-105 (mean 47.1±19.9). The medial (M), central (C), and lateral (Lat) aspects of the right (R) and left (L) slopes of the articular eminence were measured in a sagittal plane. The R and L fossa depth also were measured. The raw absolute differences |R-L| and relative differences [|R-L|/|R+L|x100] of the articular slope angles (M, C, and Lat) and fossa depths were computed. Statistical analysis included paired t-tests, independent t-tests, and Pearson’s correlation coefficients, significance at p≤0.05. Ninety percent (90%) of the population exhibited right-left asymmetry of the glenoid fossa. The right articular slopes (M, C, and Lat) were significantly steeper than the left articular slopes; the right fossa depths were significantly deeper than the left. There generally were no differences in the articular slope steepness or fossa depths between the partially dentate and the dentate, nor were there statistical differences between the two groups in the raw absolute differences or relative differences of the M, C, and Lat slopes or fossa depths. No significant relationships were found between right-left asymmetry, age, or number of teeth. With only 10% of the subjects exhibiting symmetry of the glenoid fossa depths or articular slope angles, clinicians should consider bilateral asymmetry the norm and not an anomaly.

The Angle of the Articular Eminence in Modern Dentate African-Americans and European-Americans

Abstract The purpose of this study was to determine if there were differences in the angle of eminentia of two 20th century populations based on race, age, gender, and number of teeth and whether there was asymmetry of the angles of eminentia. The sample included dry skulls from the Hamann-Todd Osteological collection as follows: 80 African-Americans (AA, 53 males and 27 females) and 62 European-Americans (EA, 49 males and 13 females), ranging in age from 16-77 years. The lateral, central, and medial aspects of the right and left slopes of the articular eminence were measured in a parasagittal plane. Independent t-tests, paired t-tests, and Pearson correlation coefficients were computed. For the AA population, the right central, lateral, and medial angles of eminentia were steeper than the corresponding left angles (paired t-test, p<0.05); for the AE males only the right lateral and medial angles were significantly steeper than the corresponding left angles (paired t-test, p<0.05). There were no significant relationships between age or number of teeth and the angle of eminentia measurements, nor were there differences in angle of eminentia by gender. There were two differences by race: the EA males had steeper left central and left medial angles than the AA males (independent t-test, p<0.05). The central angle of eminentia was consistently steeper than the medial angle (paired t-test, p<0.01), and the lateral was generally steeper than the medial.

A multimethod investigation including direct observation of 3751 patient visits to 120 dental offices.

This report defines verbal interactions between practitioners and patients as core activities of dental practice. Trained teams spent four days in 120 Ohio dental practices observing 3751 patient encounters with dentists and hygienists. Direct observation of practice characteristics, procedures performed, and how procedure and nonprocedure time was utilized during patient visits was recorded using a modified Davis Observation Code that classified patient contact time into 24 behavioral categories. Dentist, hygienist, and patient characteristics were gathered by questionnaire. The most common nonprocedure behaviors observed for dentists were chatting, evaluation feedback, history taking, and answering patient questions. Hygienists added preventive counseling. We distinguish between preventive procedures and counseling in actual dental offices that are members of a practice-based research network. Almost a third of the dentist’s and half of the hygienist’s patient contact time is utilized for nonprocedure behaviors during patient encounters. These interactions may be linked to patient and practitioner satisfaction and effectiveness of self-care instruction.

Educating and Treating School Children Impacts Much More than the Child

Abstract The Healthy Smiles Sealant Program dramatically impacts the dental school, university, schoolchildren and community. Expanding the program district-wide necessitated modifying the dental school curriculum to emphasize the importance of improving the oral health of society. At the university, the president points to the dental school as the symbol of engagement with the community in educating nearly 11,000 children, treating 4,500 children and referring 2,300 children during the 2003-2004 school year.