Mel L. Kantor

Patients' attitudes toward screening for medical conditions in a dental setting

OBJECTIVES Previous studies demonstrated the efficacy of chairside medical screening by dentists to identify patients who are at increased risk for developing cardiovascular-associated events and the favorable attitude of dentists toward chairside medical screening. This study assessed patient attitudes toward chairside medical screening in a dental setting. METHODS A self-administered questionnaire of eight five-point response scale questions was given to a convenience sample of adult patients attending an inner-city dental school clinic and two private practice settings. Wilcoxon-Mann-Whitney tests and t-tests were used to compare responses between study groups. Friedman nonparametric analysis of variance was used to compare response items within each question. RESULTS Regardless of setting, the majority of respondents was willing to have a dentist conduct screening for heart disease, high blood pressure, diabetes, human immunodeficiency virus infection, and hepatitis infection (55-90 percent); discuss results immediately (79 percent and 89 percent); provide oral fluids, finger-stick blood, blood pressure measurements, and height and weight (60-94 percent); and pay up to

Prevalence of skeletal and dental anomalies and normal variants seen in cephalometric and other radiographs of orthodontic patients

20 (50-67 percent). Respondents reported that their opinion of the dentist would improve regarding the dentists professionalism, knowledge, competence, and compassion (48-77 percent). The fact that the test was not done by a physician was ranked as the least important potential barrier. While all respondents expressed a favorable attitude toward chairside screening, the mean score was significantly lower among clinic patients across most questions/items. The priority rankings within an item were similar for both groups. CONCLUSIONS Acceptance by patients of chairside medical screening in a dental setting is a critical element for successful implementation of this strategy.

Extreme distal migration of the mandibular second bicuspid. A variant of eruption

Pretreatment cephalometric radiographs may contain important incidental findings that require attention before orthodontic therapy. A review of the cephalometric and dental radiographs of 325 consecutive healthy orthodontic patients revealed 431 notable findings of the skull, cervical spine, and maxillofacial complex. Most of these findings were nonpathologic anomalies or normal variants. If recognized as such by the orthodontist, no further evaluation would be required, thus avoiding unnecessary costs and patient anxiety. However, there were 15 findings (3.5%) that required additional evaluation by physicians or oral and maxillofacial surgeons before or concurrent with the initiation of orthodontic therapy. Familiarity with the appearance and prevalence of skeletal and dental anomalies and normal variants seen in cephalometric radiographs, and the ability to separate those that require follow-up from those that do not, is an important facet of orthodontic practice.

Duplication of the premolar dentition

A five-year study of 26,264 panoramic radiographs found distal positioning of the mandibular second bicuspid associated with a missing adjoining first molar in one of every 505 patients. Following early removal of the first molar, there is a 5% to 10% chance that the second bicuspid will migrate distally. It usually continues until it contacts the root of the second molar, and then rotates up into occlusion adjacent to the parallel with that tooth. Mesial drift seldom occurs in this circumstance; the resulting space between lower first and second bicuspids remains. Early conservative management can be very important in these cases, making periodic x-ray examination advisable whenever a molar has been lost and the adjoining bicuspid has not yet erupted.

The effect of lesion size, restorative material, and film speed on the detection of recurrent caries.

Multiple supernumerary teeth, often associated with various syndromes, is a relatively uncommon isolated dental anomaly. We present a case of a 9-year-old black male patient with complete duplication of the premolar dentition and premolarization of the permanent canines.

Radiographic examination of comprehensive care patients in U.S. and Canadian dental schools

The purpose of this investigation was to study the effect of the size of carious lesions, radiographic density of composite and amalgam restorative materials, and film speed on the radiographic detection of simulated recurrent caries. Radiographs were made of extracted premolars with either large or small recurrent carious lesions simulated adjacent to Class II amalgam or composite restorations with both E-speed and D-speed intraoral film. For each restorative material, teeth that had no simulated caries were compared with teeth that had small and large simulated caries. Recurrent caries is detected best when the lesion is adjacent to radiopaque composite restorations, and detection is poorest when the lesion is next to radiolucent composite restorations. Large carious lesions are identified correctly more often than small lesions, although many lesions are not detected at all, especially those adjacent to radiolucent composite materials. There is no difference between E-speed and D-speed film for the detection of recurrent carious lesions.

Subtraction radiography to assess reproducibility of patient positioning in cephalometrics

Between 1977 and 1987, there was a shift in the radiographic prescribing practices for the dentulous adult comprehensive care patient in U.S. and Canadian dental schools. The number of schools ordering films on the basis of selection criteria or patient need increased from 1 to 13, while the number of schools ordering both an intraoral full-mouth series and a panoramic radiograph decreased from 30 to 13. However, in 1987, there were still 56 schools that expressed a preference for a particular standard examination. In the current study, the panoramic radiograph (with and without supplemental periapical views) was the most frequently stated preferred examination for the edentulous adult patient, and the panoramic and bitewing examination was the most frequently stated preferred examination for the child patient.

Anomalies of the odontoid process discovered as incidental findings on cephalometric radiographs

Subtraction radiography is a way to measure differences in landmark positions between cephalometric films without using tracings that introduce another source of error. This method was used to evaluate the reproducibility of head positioning in 54 pairs of cephalometric films taken within hours of each other, before and after splint removal in orthognathic surgery patients. There were no statistically significant changes in two cranial and four maxillary landmarks; the expected changes in mandibular landmark served to validate the method. The results suggest that patient positioning is not a major contributor to the error of cephalometric methods.

Characteristics of an oral and maxillofacial radiology department. Report of the ad hoc Department Characteristics Committee of the American Academy of Oral and Maxillofacial Radiology.

Two patients with unusual developmental anomalies of the odontoid process of the axis are presented. These anomalies were discovered as incidental findings on the cephalometric radiographs obtained as part of orthodontic treatment. Both patients had severe instability of the cervical spine at the articulation between the first and second cervical vertebrae that required referral to a medical specialist. When this was discovered, both patients were asymptomatic, with normal neurologic findings. Surgical stabilization of the spine was considered but deferred because the patients had no neurologic signs or symptoms. To protect them from head injury, the patients were advised to refrain from contact sports and strenuous exercise, and follow-up evaluations were recommended. These cases emphasize the need to evaluate head and neck structures shown on cephalometric radiographs, independent of the traditional morphometric analysis.

The X-ray in dentistry, and the legacy of C. Edmund Kells

Oral and maxillofacial radiology is a dynamic and multifaceted discipline that plays a critical role in patient care, the education of general dentists and dental specialists, and the academic health of the dental school. Diagnostic and treatment advances in temporomandibular joint disorders (TMD), implants trauma and orthognathic surgery, and craniofacial abnormalities depend heavily on conventional and advanced imaging techniques. Oral and maxillofacial radiology contributes to the education of pre- and post-doctoral dental students with respect to biomedical and clinical knowledge, cognitive and psychomotor skills, and the professional and ethical values necessary to properly prescribe, obtain, and interpret radiographs. The development of an active and successful oral and maxillofacial radiology department, division, or section requires the committment of institutional resources. This document may serve as a guide to dental schools committed to excellence in oral and maxillofacial radiology.