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J Guggenheimer

Publications and source records attributed to J Guggenheimer.

At least 19 recordsLinked to original sources
PubMed2001

Type 1 diabetes mellitus and oral health: assessment of coronal and root caries.

OBJECTIVES: The oral health of a large cohort of adult insulin-dependent diabetic patients (Type 1), diagnosed 24 years previously with juvenile onset, was comprehensively assessed. This paper describes the prevalence of coronal and root caries in this adult Type 1 diabetic population and evaluates demographic, dietary, behavioral, physiologic, salivary and medical variables associated with decayed and filled surfaces in the crown (DFS) or root (RDFS). METHODS: Type 1 diabetes mellitus subjects participating in this oral health evaluation had been monitored for 6-8 years as participants in the University of Pittsburgh, Department of Epidemiology, longitudinal study of medical complications associated with diabetes. Four hundred and six diabetic subjects received a comprehensive oral health examination during one of their regularly scheduled medical visits. Oral assessments included coronal and root caries, missing teeth, edentulism, periodontal status, soft tissue pathologies, salivary function and health behaviors. Sixteen diabetic subjects and one control subject were edentulous. Coronal and root caries data from the remaining 390 dentate diabetic subjects were compared with 202 dentate nondiabetic control subjects. RESULTS: The adult Type 1 diabetic subjects were not found to have significantly higher DFS rates as compared with our control subjects or published age-adjusted NHANES III findings. Both control and diabetic subjects had low decayed to filled tooth surface ratios. A linear regression model evaluated possible associations with coronal decayed and filled tooth surfaces (DFS) within the diabetic population. Significant factors included older age, women, fewer missing teeth, more frequent use of dental floss, more frequent visits to the dentist during the last 12 months, and diabetic nephropathy. The prevalence of RDFS was higher in the diabetic subjects as compared to recruited control subjects. Neither dietary behaviors nor glycemic control were found to contribute to coronal or root caries. CONCLUSIONS: Factors associated with presence of coronal and root caries and fillings are discussed. Possible causes and implications for the association between DFS and diabetic nephropathy are provided.

Adult↗
PubMed2001

Type 1 diabetes mellitus, xerostomia, and salivary flow rates.

OBJECTIVE: The Oral Health Science Institute at the University of Pittsburgh has completed a cross-sectional epidemiologic study of 406 subjects with type 1 diabetes and 268 control subjects without diabetes that assessed the associations between oral health and diabetes. This report describes the prevalence of dry-mouth symptoms (xerostomia), the prevalence of hyposalivation in this population, and the possible interrelationships between salivary dysfunction and diabetic complications. STUDY DESIGN: The subjects with diabetes were participants in the Pittsburgh Epidemiology of Diabetes Complications study who were enrolled in an oral health substudy. Control subjects were spouses or best friends of participants or persons recruited from the community through advertisements in local newspapers. Assessments of salivary function included self-reported xerostomia measures and quantification of resting and stimulated whole saliva flow rates. RESULTS: Subjects with diabetes reported symptoms of dry mouth more frequently than did control subjects. Salivary flow rates were also impaired in the subjects with diabetes. Regression models of potential predictor variables were created for the 3 self-reported xerostomia measures and 4 salivary flow rate variables. Of the medical diabetic complications studied (ie, retinopathy, peripheral and autonomic neuropathy, nephropathy, and peripheral vascular disease), only neuropathy was found to be associated with xerostomia and decreased salivary flow measures. A report of dry-mouth symptoms was associated with current use of cigarettes, dysgeusia (report of a bad taste), and more frequent snacking behavior. Xerogenic medications and elevated fasting blood glucose concentrations were significantly associated with decreased salivary flow. Resting salivary flow rates less than 0.01 mL/min were associated with a slightly higher prevalence of dental caries. Subjects who reported higher levels of alcohol consumption were less likely to have lower rates of stimulated salivary flow. CONCLUSIONS: Subjects with type 1 diabetes who had developed neuropathy more often reported symptoms of dry mouth as well as symptoms of decreased salivary flow rates. Because of the importance of saliva in the maintenance and the preservation of oral health, management of oral diseases in diabetic patients should include a comprehensive evaluation of salivary function.

Adult↗
PubMed2000

Insulin-dependent diabetes mellitus and oral soft tissue pathologies. I. Prevalence and characteristics of non-candidal lesions.

OBJECTIVE: A large epidemiologic study on oral health has found that several oral soft tissue lesions were more prevalent in subjects with insulin-dependent diabetes mellitus than in control subjects without diabetes. Our objective in part I of this article is to characterize those lesions not associated with Candida. STUDY DESIGN: This cross-sectional study determined the prevalence and characteristics of oral soft tissue diseases identified during a comprehensive oral evaluation of 405 adult subjects with diabetes and 268 control subjects without diabetes. RESULTS: Twenty specific oral soft tissue lesions were identified. Nearly twice as many subjects with diabetes as subjects without diabetes were found to have one or more oral soft tissue lesions (44.7% vs 25.0%; P <.0001). Subjects with diabetes also had significantly higher prevalence rates for 7 lesions, 3 of which were non-candidal: fissured tongue, irritation fibroma, and traumatic ulcers. (Four lesions generally associated with Candida infection-median rhomboid glossitis, denture stomatitis, generalized atrophy of the tongue papillae, and angular cheilitis-will be described in part II of this article.) There were no differences found between the subjects with diabetes and the control subjects for lichen planus, gingival hyperplasia, or salivary gland disease. CONCLUSIONS: Oral soft tissue lesions were seen more frequently in subjects with insulin-dependent diabetes than in the control subjects. Characterization of 3 non-candidal lesions suggests that they are associated with trauma, delayed healing, or both.

Adult↗
PubMed2000

Insulin-dependent diabetes mellitus and oral soft tissue pathologies: II. Prevalence and characteristics of Candida and Candidal lesions.

OBJECTIVE: To assess the prevalence of Candida albicans and oral infection with Candida in patients with insulin-dependent diabetes mellitus (IDDM). STUDY DESIGN: This cross-sectional study compared the prevalence of candidiasis in 405 subjects with IDDM and 268 nondiabetic control subjects. Assessments included evidence of clinical manifestations of candidiasis and a quantitative measure of Candida pseudohyphae in a cytologic smear from the midline posterior dorsal tongue. RESULTS: More subjects with IDDM than control subjects without IDDM (15.1% vs 3.0%) were found to have clinical manifestations of candidiasis, including median rhomboid glossitis, denture stomatitis, and angular cheilitis. IDDM subjects were also more likely to have any Candida pseudohyphae in their cytologic smears (23.0% vs 5.7%; P <.0001), as well as pseudohyphae counts of >10/cm(2) (7.1% vs 0.8%; P <.0001). Diabetic subjects with median rhomboid glossitis were more likely to have a longer duration of IDDM and complications of nephropathy and retinopathy. Denture stomatitis was associated with smoking, retinopathy, higher Candida counts, poor glycemic control, and longer duration of IDDM. A multivariate regression analysis found 3 factors to be significantly associated with the presence of Candida pseudohyphae in the subjects with IDDM: current use of cigarettes (odds ratio, 2:4), use of dentures (odds ratio, 2:3), and elevated levels of glycosylated hemoglobin (odds ratio, 1:9). The use of antimicrobials, immunosuppressants, or drugs with xerostomic side effects was not related to the presence of Candida. CONCLUSIONS: Candida pseudohyphae and oral soft tissue manifestations of candidiasis were more prevalent in subjects with IDDM than in control subjects without diabetes. The presence of Candida pseudohyphae was significantly associated with cigarette smoking, use of dentures, and poor glycemic control.

Adult↗
PubMed2000

Diabetes and oral health promotion: a survey of disease prevention behaviors.

BACKGROUND: Diabetes is a chronic metabolic disease known to affect oral disease progression. The authors surveyed health behaviors essential for preventing dental and periodontal diseases and maintaining oral health is a population of adult patients with type 1 (insulin-dependent) diabetes. The goals of this study were to assess these patients' oral health behaviors, access to dental care and need for improved health education. METHODS: As part of a dental and periodontal examination, 406 subjects with type 1 diabetes completed a questionnaire regarding their oral health attitudes, behaviors and knowledge. The authors also evaluated 203 age-matched nondiabetic control subjects. RESULTS: The authors found that diabetic subjects' tobacco use and oral hygiene behaviors were similar to those of the nondiabetic control subjects. Diabetic subjects, however, more frequently reported the cost of dental care as a reason for avoiding routine visits. Most of these subjects were unaware of the oral health complications of their disease and the need for proper preventive care. CONCLUSIONS: Patients with diabetes appear to lack important knowledge about the oral health complications of their disease. The results of this survey did not indicate improved prevention behaviors among the subjects with diabetes compared with nondiabetic control subjects. CLINICAL IMPLICATIONS: Dentists have an opportunity and the responsibility to promote good oral health behaviors such as regular dental examinations, proper oral hygiene and smoking cessation that may significantly affect the oral health of their diabetic patients.

Adolescent↗
PubMed2000

Tobacco and athletics. Update and current status.

The 1990's marked the beginning of a new era in the war against tobacco. This time, however, the major initiatives to exert control of and reduce tobacco use were directed at the tobacco industry. To succeed, these efforts had first to overcome intense political, economic, and other obstacles that are inexorably intertwined with the influential power base of tobacco interests that are, in turn, supported by the vast wealth of the tobacco industry. There were also disturbing revelations of an increase in new tobacco users among American youth. Furthermore, the intimate associations between athletics and the use of smokeless tobacco appear not to have abated. Another generation of tobacco users must now be provided with all the available science, techniques, and support systems to reduce or eliminate use of tobacco. Members of the dental profession must continue to monitor the use of all forms of tobacco by their patients; provide counseling; initiate intervention and cessation programs; and, particularly, discourage teenagers from initiating use. Similar efforts are required from physicians.

Adolescent↗
PubMed1999

Type 1 diabetes mellitus and oral health: assessment of periodontal disease.

BACKGROUND: The periodontal disease status of 320 dentate adults, diagnosed 23.7 years previously with Type 1 insulin dependent diabetes mellitus, was evaluated. These patients had been monitored at 2-year intervals as part of a large University of Pittsburgh longitudinal study assessing the medical complications associated with insulin dependent diabetes. METHODS: During one of their regularly scheduled medical examinations, a group of 320 adult dentate subjects (mean age of 32.1 years) received a periodontal examination as part of a comprehensive oral health assessment. The oral health assessment collected data regarding demographics, oral health behaviors, tooth loss, coronal and root caries, salivary functions, and soft tissue pathologies. For the periodontal assessments, 3 facial sites (mesial, midcervical, distal) of the teeth in the right maxillary/left mandibular or left maxillary/right mandibular quadrants were evaluated for calculus, bleeding on probing (BOP) and loss of gingival attachment (LOA). RESULTS: Attachment loss was significantly greater for older patients whereas BOP and calculus levels were relatively constant across age categories. Univariate analyses of factors possibly related to extensive periodontal disease (LOA > or =4 mm for at least 10% of sites examined) indicated an association with older age; lower income and education; past and current cigarette smoking; infrequent visits to the dentist; tooth brushing less than once per day; older age of onset; longer duration of diabetes; and the diabetic complication of neuropathy. A multivariate regression model of all possibly significant factors found current cigarette use (odds ratio [OR] = 9.73), insulin dependent diabetes onset after 8.4 years of age (OR = 3.36), and age greater than 32 years (OR = 3.00) explained the majority of the extensive periodontal disease in this group of diabetic patients. CONCLUSIONS: Management and prevention of extensive periodontal disease for Type 1 diabetic patients should include strong recommendations to discontinue cigarette smoking.

Adult↗
PubMed1998

Type 1 diabetes mellitus and oral health: assessment of tooth loss and edentulism.

OBJECTIVE: The oral health of an adult population previously diagnosed with juvenile onset insulin dependent-diabetes was comprehensively assessed. The goal of this exploratory cross-sectional evaluation was to described the characteristics related to partial tooth loss edentulism in subjects with Type 1 diabetes mellitus. METHODS: An adult population of 406 Type 1 diabetes mellitus subjects, who had been monitored for 6-8 years as part of a University of Pittsburgh longitudinal study of medical complications associated with diabetes, received an oral health examination for missing teeth, edentulism, coronal and root caries, periodontal status, and oral health behaviors. RESULTS: Of the 406 subjects evaluated, 204 had no missing teeth, 186 had partial tooth loss (1-27 missing teeth), and 16 were edentulous. Patients who had partial tooth loss or who were edentulous were generally older; had lower incomes and levels of education; and had higher rates of nephropathy, neuropathy, retinopathy, and peripheral vascular disease. A logistic regression model found partial tooth loss to be significantly associated with extensive periodontal disease in remaining teeth (OR = 7.35), a duration of diabetes longer than 24 years (OR = 5.32), not using dental floss (OR = 2.37), diabetic neuropathy (OR = 2.29), household income less than $20,000 (OR = 2.21), multiple coronal caries and fillings (OR = 1.98), and bleeding on probing (OR = 1.82). CONCLUSIONS: Although the majority of these adult Type 1 diabetes patients had serious medical complications associated with their diabetes, the possible impact of diabetes mellitus on oral health should be included in their overall management.

Adolescent↗
PubMed1998

Reliability of self-reported heart murmur history: possible impact on antibiotic use in dentistry.

Administration of prophylactic antibiotics to a dental patient with a history of heart murmur, rheumatic fever or mitral valve prolapse should be based on a reliable diagnosis of heart valve disease. The authors conducted a study of 68 diabetic patients who reported having these conditions and found that at least 65 percent of these patients actually had no evidence of a pathological heart murmur during two previous physical examinations. They concluded that a self-reported history of heart valve disease should not be the sole criterion for antibiotic premedication.

Adolescent↗
PubMed1997

Oral candidiasis: clinical manifestations, diagnosis, and treatment.

Oral candidiasis (candidosis) is an infection with multiple manifestations. To prevent prolongation of undiagnosed cases, it is essential that the dental clinicians have an understanding of the etiology, pathogenesis, and treatment of this disease. The learning objective of this article is the identification of the various clinical features of candidiasis. The underlying causes of oral candidiasis include antibiotic therapy, poor denture hygiene, xerostomia, immune deficiencies, diabetes, and some less common conditions. Candidal infection may be superimposed on other mucosal diseases and may disguise the underlying disease. The diagnosis is established using clinical appearance and patient history, and it may require diagnostic tests. A significant segment of the population carries intraoral Candida, without any symptoms of infection, complicating the use of diagnostic tests.

Adult↗
PubMed1994

The importance of screening edentulous patients for oral cancer.

A study of the dental status of 947 patients with oral cancer was conducted to determine how dentists might gain better access to patients in whom this disease develops. This access could lead to earlier diagnosis and thereby improve the prognosis. Dental profiles revealed that 68% of the patients were partially or totally edentulous, 14% had neglected teeth, and the remaining 18% had intact dentitions. The mean age of patients was 61.7 years. Efforts should be made to promote the recall of edentulous patients. This may facilitate an earlier discovery of many oral cancers.

Adult↗
PubMed1991

Implications of smokeless tobacco use in athletes.

After almost falling into obscurity, smokeless tobacco use began to increase almost simultaneously with the reduction in cigarette smoking that was influenced by the Surgeon General's first Report on Smoking and Health in 1964. Consumption of smokeless tobacco was stimulated by media promotion using professional athletes; and large numbers of impressionable male teenagers, assuming that it was a safe alternative to smoking, began to use this product, particularly snuff. The nicotine content of smokeless tobacco is equivalent to that of cigarettes and, therefore, will produce habituation and addiction. It may also expose the long-term user to a number of adverse physiologic effects on the cardiovascular system that are similar to those attributed to smoking. Smokeless tobacco contains N-nitrosamines that have a potential carcinogenic effect on the tissues with which they come into contact in the oral cavity. A hazard of short-term use is irreversible gingival recession. The contact of snuff with the oral mucosa can produce leukoplakia that is readily visible and will alert the dentist. The dental professional team must actively strive to prevent initiation of smokeless tobacco use and assist with cessation of this habit.

Humans↗
PubMed1990

"Megalith".

Explore the source record for details and available documents.

Aged↗
PubMed1990

Thermally induced 'nicotine' stomatitis. A case report.

A palatal lesion resembling "nicotine" stomatitis was found in a woman who did not smoke. However, the patient frequently drank extremely hot beverages. After she was instructed to reduce the temperature of the beverages, the lesion almost completely resolved. This suggests that heat was the primary cause of this lesion and also implicates heat as the major cause of nicotine stomatitis.

Aged↗
PubMed1989

Factors delaying the diagnosis of oral and oropharyngeal carcinomas.

Most squamous cell carcinomas of the oral cavity and oropharynx are not diagnosed until they have attained at least the T2 stage (greater than 2.0 cm). This study identifies factors which may contribute to the delayed diagnosis of these tumors, despite the fact that they frequently arise at sites readily accessible to examination. Personal interviews of 149 patients with oral and oropharyngeal squamous cell carcinoma revealed delays by patients of one day to more than one year (mean, 17 weeks) before seeking care. Furthermore, delay by doctors occurred in 45 instances (30%). Neither short nor long delays had a statistically significant relationship to tumor T stage at the time of diagnosis. The length of patient delay was also not related to age, gender, amount of education, or history of alcohol consumption. The authors concluded that the early carcinomas were probably asymptomatic and subsequent manifestations were commonly misinterpreted as benign or innocuous oral/dental problems. These inconspicuous or misleading perceptions may be primarily responsible for the advanced stages of these tumors at the time of discovery. Emphasis must, therefore, be placed upon gaining access to high-risk individuals for periodic oral and oropharyngeal examinations and upon educational efforts to increase the skill of primary health care providers in recognizing this problem.

Adult↗
PubMed1986

Changing trends of tobacco use in a teenage population in western Pennsylvania.

Information on tobacco use was obtained from an anonymous questionnaire distributed to 609 8th, 9th, and 10th grade students in the Pittsburgh area. The data disclosed that 22 per cent of the girls and 11 per cent of the boys were smoking. However, 35 per cent of the young men reported using smokeless tobacco; snuff dipping (6 per cent), tobacco chewing (10 per cent), and snuff and/or tobacco chewing (19 per cent).

Adolescent↗