Other

Rosacea is a chronic disorder affecting the facial convexities, characterized by frequent flushing, persistent erythema, and telangiectases. During episodes of inflammation, additional features are swelling, papules, and pustules. The exact etiology of this dermatitis is unknown, and theories abound. Infectious foci, especially dental foci, seem to be rarely associated with the onset and progression of this disease. Dermatologic treatments are determined by the severity of the disease. But eradication of infectious foci, and in this case eradication of dental foci, may generate a significant improvement and may lead to a recovery.

To understand the pathology of peri-apical infection and causes of endodontic treatment failures depsite reasonably good endodontic treatment, an experimental animal study was undertaken.

A woman aged 57 consulted her dentist because of intermittent pain in her right upper jaw associated with blurring of vision in her right eye. Both symptoms occurred towards evening and were relieved by sleep. There was no history of haloes, ocular pain or redness of the eye. The pain was unrelated to chewing. The dentist extracted two teeth first an impacted right upper third molar (wisdom tooth); then, when the pain persisted, the right upper second molar, which had previously been treated forcaries.

“Most vital statistics indicators of the health of Americans were stable or showed modest improvements between 1997 and 1998. The preliminary birth rate in 1998 was 14.6 births per 1000 population, up slightly from the record low reported for 1997 (14.5). The fertility rate, births per 1000 women aged 15 to 44 years, increased 1% to 65.6 in 1998, compared with 65.0 in 1997. The 1998 increases, although modest, were the first since 1990, halting the steady decline in the number of births and birth and fertility rates in the 1990s. Fertility rates for total white, non-Hispanic white, and Native American women each increased from 1% to 2% in 1998. The fertility rate for black women declined 19% from 1990 to 1996, but has changed little since 1996. The rate for Hispanic women, which dropped 2%, was lower than in any year for which national data have been available. Birth rates for women 30 years or older continued to increase. The proportion of births to unmarried women remained about the same at one third. The birth rate for teen mothers declined again for the seventh consecutive year, and the use of timely prenatal care (82.8%) improved for the ninth consecutive year, especially for black (73.3%) and Hispanic (74.3%) mothers. The number and rate of multiple births continued their dramatic rise; the number of triplet and higher-order multiple births jumped 16% between 1996 and 1997, accounting, in part, for the slight increase in the percentage of low birth weight (LBW) births. LBW continued to increase from 1997 to 1998 to 7.6%. The infant mortality rate (IMR) was unchanged from 1997 to 1998 (7.2 per 1000 live births). The ratio of the IMR among black infants to that for white infants (2.4) remained the same in 1998 as in 1997. Racial differences in infant mortality remain a major public health concern. In 1997, 65% of all infant deaths occurred to the 7.5% of infants born LBW. Among all of the states, Maine, Massachusetts, and New Hampshire had the lowest IMRs. State-by-state differences in IMR reflect racial composition, the percentage LBW, and birth weight-specific neonatal mortality rate for each state. The United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth increased slightly to 76.7 years for all gender and race groups combined. Death rates in the United States continue to decline, including a drop in mortality from human immunodeficiency virus. The age-adjusted death rate for suicide declined 6% in 1998; homicide declined 14%. Death rates for children from all major causes declined again in 1998. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.”

Treatment of dental diseases such as dental decay and periodontal disease cost the United States public an estimated USD 37 billion in 1994 (2). As such, the cost of dental treatment was higher than the cost of treating eye disease, diabetes or arthritis, among others. The highly individualized,labor intensive methods used to debride, repair and replace the involved teeth account for the enormity of this expense. This expense will increase, as more people, with more teeth, are living longer. The magnitude of this problem in terms of potential dental needs isillustrated by the relative and absolute numbers of older individuals who will be dentate in 2000 compared with 1900. In 1900, about 4% of the UnitedStates population was older than 64 years of age and about 60% were edentulous, giving a total of l.2 million dentate individuals. In 2000, 1 6% of the United States population will be older than 64 years and about 25% edentulous ( 1 18, 162), giving a total of 39 million dentate individuals. Thus, over a century the number of older dentate individuals at risk of developing dental caries and periodontal disease increased by 32 times.

The modern patient, however, has evolved from being a patient to being a consumer. Our patients now view dental purchases much the same way that they view other consumer purchases.

The case of a woman with short neuralgiform paroxysmal pain of 2 years duration is described. Pain attacks were always accompanied by ipsilateral lacrimation and conjunctival injection. Standard anti-neuralgic therapy, amitriptyline and indomethacin, failed to eliminate or reduce pain. At the end of a 30-month active period the patient seemed to have gone into remission. We believe this to be a case of short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), the first reported in the dental literature and the 24th in the general medical literature. The differential diagnosis of the case and relevant literature are discussed.

“The report shows that Alzheimer’s disease  AD. brain creatine kinase  CK. is modified such that the nucleotide binding site of CK is blocked and that abnormal partitioning of CK between the soluble and pellet fractions occurs. First, CK activity was 86% decreased in AD brain homogenates in comparison to age-matched controls. Secondly, over a 23.5 fold greater 32P photoincorporation of w 32 x 32 a P 8N3ATP was observed into CK of control vs. AD samples. Also, a 7.4-fold increase of enzyme induced P incorporation was observed in controls vs. AD samples by incubation with wg 32PxATP. Thirdly, Western blot analysis showed that CK copy numbers in the AD homogenate were decreased by less than 14% in comparison to controls. However, analysis showed that control supernatant and pellet fractions contained 10.3 and 0.4 times the CK copy number found in the corresponding AD fractions. 32P incorporation by both photolabeling and enzyme catalyzed incorporation of radiolabel followed CK activity and not CK copy number. Further, wa 32PxADP and w 32 x 32 g P ATP incorporated P into control brain and purified brain CK equally well, indicating that a mechanism different from g-phosphoryl transfer is involved in the enzymatic incorporation of radiolabel. Also, the level of abnormal partitioning of CK into AD brain pellet correlated with the decreased w32Px8N3GTP photolabeling and abnormal partitioning of b-tubulin, a protein known to be aberrantly modified in the AD brain. This indicates that a common chemistry is affecting both CK and tubulin in AD.”

We appreciate being given an opportunity to respond to the concerns expressed by Dr. Marilyn Moffat, President of the American Physical Therapy Association. Dr. Moffat takes us to task for having conducted a strict review of the literature in which we included only those studies that used control groups. We were surprised at Dr. Moffat’s comments, as our mandate was to present “the results from rigorous and methodologically sound clinical trials and studies published in peer reviewed journals.” This was explained very clearly by James Lipton in the introduction to this series of articles,
which were part of the Health Technology Assessment Conference on Management of Temporomandibular Disorders (TMD), sponsored by the National Institute of Dental Research and the National Institutes of Health Office of Medical Applications of Research.