Stuart L. Fischman

Inter-examiner Reliability in Caries Trials

A statistical model is given for representing the several components of variability present in measurements (e.g., DMFS scores) given by examiners to patients. Methods for making inferences about the intraclass correlation coefficient of reliability are presented and illustrated on a real set of data. The proper analysis of data from a reliability study is shown to depend on the planned design and analysis of the clinical or field trial to be conducted following the reliability trial.

Reliability of discrete measurements in caries trials.

Two versions of the kappa statistic, which corrects the observed proportion of agreement for the proportion of agreement to be expected by chance alone, are presented for measuring intra- and inter-ex

Focal epithelial hyperplasia: A light and electron microscopic study of one case

Abstract Samples of tissue from a lesion diagnosed as focal epithelial hyperplasia were observed by light and electron microscopy in order to confirm the presence of viral particles and to study ultrastructural features. Cytoplasmic alteration included deep indentations into the nuclei associated with granules 50 to 100 A in diameter, concentric whorls of rough endoplasmic reticulum around smooth reticulum vesicles, and rarefaction of perinuclear cytoplasm. Spinous cell nuclei frequently contained a sparse scattering of viruslike particles 350 to 450 A in diameter. Superficial cells were incompletely keratinized and contained intact profiles of several cytoplasmic organelles.

The nature and extent of jaw involvement in Gaucher disease: Observations in a series of 28 patients

A wide variety of osteoarticular pathoses plague the clinical course of many patients with Gaucher disease. Osseous lesions involving the jaws have been described, usually as isolated case reports. The purpose of this study was to ascertain the nature and extent of mandibulo-maxillofacial pathosis in 28 patients with documented Gaucher disease by means of panoramic radiography. Twenty-five of the 28 patients displayed radiographic evidence of jaw involvement. The most prevalent finding was gross widening of marrow spaces; frank radiolucencies, endosteal scalloping, cortical thinning, root resorption, and inferior displacement of the mandibular canal or effacement of its cortices were also seen. A previously unreported finding was delayed eruption of permanent teeth, which was seen in more than one half of the patients who were under 20 years of age. Osseous changes throughout the jaws may be more common than previously suspected and may alert the dentist to the presence of the disease.

Histopathologic, ultrastructural, and immunologic findings in an oral psoriatic lesion☆

There has been some controversy over whether psoriasis can involve the oral mucosa. An oral lesion in a 32-year-old man with a psoriatic scalp lesion has been studied by light and electron microscopy and by immunologic methods. Results from each of these three techniques are consistent with previous findings in psoriatic lesions and suggest that oral psoriasis can occur.

Hamster Cheek Pouch Bioassay of Dentifrices Containing Hydrogen Peroxide and Baking Soda

The objective of this study was to determine the effects of hydrogen peroxide alone and in combination with 7,12-dimethylbenza[a]anthracene (DMBA) in the oral cavity because H2o2, has been implicated as a complete carcinogen or cocarcinogen in two animal models. In the two independent studies, golden Syrian hamsters were used to evaluate the carcinogenic and cocarcinogenic potential of dentifrices containing H2o2 and NaHCO3. In the first study, the cocarcinogenic potential of a dentifrice containing 0.75% H2O2/ 5% baking soda was compared with that of a commercial dentifrice with similar ingredients except baking soda and H2O2. In the second study, the cocarcinogenic potential of a dentifrice formulated with 1.5% H, sb>2O2/7.5% baking soda was compared with a mixture of 3% H2O2/baking soda. All materials were applied to the right cheek pouches of experimental animals, and the left cheek pouches were untreated. In the first study. 0.5% DMBA was administered five times weekly for 20 weeks, and the dentifrices were applied immediately after the DMBA. Dentifrices or mineral oil alone were also applied five times weekly. In the second study. 0.5% DMBA or 0.25% DMBA were applied three times weekly for 16 weeks; dentifrices (or 3% H2O2/baking soda) were applied five times weekly for 16 weeks. The dual-phase dentifrice containing 0.75% H2O2/5% baking soda was not carcinogenic, and in combination with DMBA resulted in no observable acceleration of tumor onset, compared with DMBA alone. In fact, animals treated with 0.5% DMBA and the H2O2/baking soda dentifrice had a significantly delayed onset of tumor formation than did animals treated with DMBA alone. In the second bioassay, an increased latency period for tumor formation was observed with 0.5% DMBA and a dual-phase dentifrice containing 1.5% H2O2/7.5% baking soda, compared with 0.5% DMBA alone. With 0.25% DMBA, latency was not affected by addition of the dual-phase dentifrice. In contrast, animals receiving 0.25% DMBA and 3% H2O2/ NaHCO3 had a significantly lower rate of tumor formation and overall mass incidence. Croton oil also reduced the rate of tumor formation when applied with 0.25% DMBA. Histopathologic examination of cheek pouches revealed squamous cell carcinomas in the majority of DMBA-treated animals. Cheek pouches of DMBA-treated animals killed at interim times indicated a progression from keratotic changes and/or dyskeratosis at 6 weeks with the occurrence of carcinomas in approximately half the animals examined at 12 weeks. No significant histopathologic abnormalities were observed in animals not receiving DMB A other than slight keratosis in the oral mucosa of one or two animals per group. These results demonstrated that an oral product containing baking soda and hydrogen peroxide was not carcinogenic, and that baking soda and H2O2 did not enhance the tumorigenicity of DMB A. Furthermore, the tumor-igenic response of DMBA was reduced by coadministration of 3% H2O2 and sodium bicarbonate.

Exceptional oral manifestations of amyloid light chain protein (AL) systemic amyloidosis.

Oral amyloidosis is usually presented in the tongue and is often associated with multiple myeloma. We present three patients with unusual oral manifestations of primary amyloidosis, which to the best of our knowledge have not been previously published. In two cases the oral manifestation was overt at the time of diagnosis and all cases ended in patient mortality. Since these oral manifestations can contribute to the diagnosis of systemic amyloidosis, clinicians should be made aware of them. Future research should assess the significance of oral manifestation as a prognostic indicator.

Dentinogenesis imperfecta traceable through five generations of a part American Indian family

Abstract A case of dentinogenesis imperfecta is reported in which the pedigree is traced through five generations with a number of multiple marriages. The histologic appearance was typical of the condition, although certain variations are recorded: both smooth and scalloped dentinoenamel junction; fracture of enamel just superficial to this junction, leaving some enamel attached to the dentin; duplication of the granular layer of Tomes; variations in the degree and distribution of the associated yellow-orange pigment. Theoretical considerations for the development of this condition are discussed.

Examiner Standardization for Caries Studies

Examiners in clinical control programs customarily undergo an intensive period of training to standardize their interpretation of diagnostic criteria. Data are presented summarizing examiner error rates in calibration examinations and reversal rates in a field study.

Estimating Examiner Consistency with DMFS Measures

Within- and between-examiner reliability estimates were considered for standardization data. However, within-examiner stability was demonstrated to be the important measure of examiner consistency in the clinical trial because it directly affects the precision of the study. Finally, an argument is also made against the use of reversal rates in the assessment of examiner consistency.