Biomedical subjects

M J Hicks

Publications and source records attributed to M J Hicks.

At least 163 records · Page 9Linked to original sources

PubMed1976

Simplified scheme for identification of prompt lactose-fermenting members of the Enterobacteriaceae.

A brief, simplified scheme involving the spot indole test and colonial morphology was evaluated for genus level identification of prompt lactose-fermenting (PLF) members of the Enterobacteriaceae. One hundred and ninety-four consecutive, clinically important PLF gram-negative rods isolated in a clinical microbiology laboratory were identified by this simplified scheme, as well as by standard biochemical tests, and the API 20E (Analytab Products, Inc., Plainview, N.Y.) system. In the simplified scheme a flat, spot indole-positive colony was identified as Escherichia coli. Spot indole-negative organisms forming nucoid colonies were identified as Klebsiella sp. or Enterobacter sp. on the basis of semisolid motility and ornithine decarboxylase tests. Approximately 94% of the study isolates followed reactions typical for E. coli, Klebsiella sp., and Enterobacter sp. as defined by this simplified scheme. When compared with the standard and Analytab Products Inc. identifications, the overall accuracy was 97.4%. The accuracy of identification of E. coli, Klebsiella sp., and Enterobacter sp. was 98.1%, 95.6%, and 87.5%, respectively. This simplified scheme is recommended for identification of selected PLF isolates in the clinical microbiology laboratory.

Bacteriological Techniques↗

PubMedDate not supplied

Clear cell variant of calcifying epithelial odontogenic tumor: case report and review of the literature.

The calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic neoplasm which was first described by Pindborg in 1955 and accounts for less than 1% of all odontogenic lesions. Recently, a clear cell variant of CEOT has been identified with only eight well-documented cases in the literature. We present an additional case of clear cell CEOT of the mandible and review the salient clinical, radiologic, and histopathologic features of this entity and CEOTs in general. The differential diagnosis of clear cell tumors in the mandible includes: clear cell odontogenic tumor, clear cell ameloblastoma (odontogenic carcinoma), metastatic clear cell adenocarcinoma, primary intraosseous mucoepidermoid carcinoma, acinic cell carcinoma, epithelial-myoepithelial carcinoma, clear cell salivary gland tumors, and clear cell variant of squamous cell carcinoma. Because of the belief that clear cell odontogenic tumors are locally aggressive neoplasms, definitive resection of the entire mass with tumor-free surgical margins and long-term follow-up are recommended.

Diagnosis, Differential↗

PubMedDate not supplied

Histocytologic grading of mucoepidermoid carcinoma of major salivary glands in prognosis and survival: a clinicopathologic and flow cytometric investigation.

BACKGROUND: Controversy exists regarding the role of a 3-tiered grading system for mucoepidermoid carcinoma (MEC) of salivary glands in prognosis and survival. This retrospective investigation evaluated a 3-tiered grading system modified from Healey by Batsakis and Luna and compared various clinical, pathologic, and flow cytometric parameters and overall survival among MECs of differing grades. METHODS: Forty-eight patients with 7 low-grade (LG), 23 intermediate-grade (IG), and 18 high-grade (HG) MECs of parotid (n = 43) and submandibular (n = 5) glands were studied. Data were analyzed using categorical statistics (Wilcoxon, Kruskal-Wallis and Chi-squared tests where appropriate). RESULTS: Mean ages were 42 years for patients with LG tumors; 47 years, IG; and 59 years, HG (p = 0.02). Gender ratio (p < 0.001) changed from female predominance in LG (6 F:1 M) and IG (2.1 F:1 M) to male predominance in HG (3.5 M:1 F). Mean tumor stage was 1.4 LG, 2.4 IG, and 3.6 HG (p < 0.005). Tumor size increased from 2.1 cm for LG to 3.8 cm for HG (p = 0.01). Margins were involved by tumor in 0% LG, 44% IG, and 61% HG (p < 0.001). Lymph node involvement was 0% LG, 22% IG, and 72% HG (p < 0.001). DNA aneuploidy (DNA index < 0.9 or > 1.1) was present in 0% LG, 13% IG, and 28% HG (p = 0.05). Proliferative fraction (S + G2M) was 5% LG, 7% IG, and 13% HG (p = 0.008). Radiotherapy was administered in 14% LG, 35% IG, and 61% HG (p = 0.03). Recurrences (local and/or metastatic) occurred in 0% LG, 39% IG, and 61% HG (p = 0.009). Survival was decreased significantly (p < 0.0001) with increasing tumor grade (100% LG, 70% IG, and 22% HG). CONCLUSION: Histologic grading of mucoepidermoid carcinomas of major salivary glands, using the modified Healey 3-tiered system, correlates well with clinical, pathologic, and flow cytometric factors which influence the prognosis and overall survival in affected individuals.

Adult↗

PubMedDate not supplied

Major histocompatibility complex-restricted lysis of neuroblastoma cells by autologous cytotoxic T lymphocytes.

Vigorous host immune reactivity to neuroblastoma may correlate with better prognosis, but identification of human cytotoxic T-lymphocyte (CTL) responses has been relatively unsuccessful. We generated neuroblastoma-reactive CTL lines from two human leukocyte antigen (HLA) A2+ neuroblastoma patients by stimulation of peripheral blood lymphocytes (PBLs) with irradiated autologous tumor cells pretreated with interferon-gamma in the presence of low concentrations of interleukin-2 (5 U/mL). These lines lyse autologous tumor cells but do not kill HLA mismatched allogeneic tumor cells, Epstein-Barr virus-transformed autologous B cells, or standard natural killer cell targets. Cytotoxic T lymphocytes generated from one patient recognize tumor cells from several HLA-A2 matched children, although the other patient's CTLs do not kill tumor cells from other HLA-A2+ individuals. Pretreatment of CTLs or target cells with appropriate standard monoclonal antibodies demonstrates that these CTLs are major histocompatibility complex class I (HLA-A2) restricted and that the effector cell population is CD8+. Our findings suggest that these tumor cells express at least one common HLA-A2 restricted antigen and at least one unique private epitope. Autologous tumor-specific CTLs can be readily generated from patients' PBLs and maintained in long-term culture using standard techniques.

Antigens, Neoplasm↗

PubMedDate not supplied

Clear cell sarcoma of the kidney: an unusual presentation and review of the literature.

PURPOSE: To describe a child with clear cell sarcoma of the kidney (CCSK) with an unusual presentation, including a primary tumor of the left kidney with metastases to the right kidney and soft tissues of the lower extremities, and to review the literature. PATIENT AND METHODS: An 8-month-old infant presented with hypertension, an abdominal mass, and soft tissue masses in the left thigh and right foot. Imaging studies revealed a large left-sided renal tumor, left paravertebral soft tissue masses, and left thigh mass. At laparotomy, a lesion was noted in the lower pole of the contralateral kidney. CCSK with metastases to the contralateral kidney and to the soft tissues of left thigh, right foot, and left paravertebral region was diagnosed on histopathologic examination. RESULTS: Multimodal oncologic treatment included surgery, chemotherapy, and radiotherapy. Three months after completion of therapy, a soft tissue lesion in the left arm and, later, soft tissue lesions involving multiple parts of the body developed. The patient died 18 months after diagnosis without clinical or radiographic evidence of bone involvement. CONCLUSIONS: In a review of the literature, CCSK is most commonly associated with bone and lung metastases. Soft tissue involvement is uncommon. Metastasis to the contralateral kidney at initial diagnosis has not previously been reported. This case represents an unusual metastatic pattern of CCSK.

Combined Modality Therapy↗

PubMedDate not supplied

Attitudes of major employers toward the employment of people with epilepsy: a 30-year study.

Beginning in 1956, major San Francisco Bay area employers were sampled at 10-year intervals for a 30-year period to assess attitudes toward the employment of epileptic workers. In this time, we documented a trend of sustained positive change that appears to validate the efforts of organizations that have focused on raising public awareness of this disorder.

Attitude to Health↗

PubMedDate not supplied

Does the use of hydrochloric acid damage silicone rubber central venous catheters?

BACKGROUND: Hydrochloric acid (HCl) is commonly used to clear obstructions in central venous catheters (CVC). METHODS: To determine if HCl adversely affects the integrity of a CVC we infused 0.1 N HCl daily into CVC in vitro. At weekly intervals sections of the CVC were removed and examined using scanning electron microscopy. RESULTS: Over 8 weeks, no damage to the CVC was visible. CONCLUSIONS: HCl administration poses no threat to the structural integrity of a CVC.

Catheterization, Central Venous↗

PubMedDate not supplied

Malignant melanoma of soft parts involving the head and neck region: review of literature and case report.

Malignant melanoma of soft parts (MMSP) was originally described as a distinct entity by Enzinger in 1965 and was termed "clear cell sarcoma of tendons and aponeuroses" because of its association with tenosynovial structures. It has been shown immunophenotypically and ultrastructurally that this tumor is derived from neuroectoderm and shares a number of features with cutaneous melanoma. Over 95% of MMSPs present in the extremities, with the head and neck region (1.9%) being an unusual site. This study presents an additional case of MMSP of the head and neck region involving the posterior cervical region in a 15-year-old Hispanic male and reviews the literature on MMSP. Ultrastructural examination showed rudimentary cell attachments, smooth cell membranes, discontinuous basal lamina, scanty glycogen, and occasional premelanosomes in some tumor cells. Cytogenetic analysis showed a reciprocal translocation between the long arms of chromosomes 12 and 22 [t(12:22)(q13;q12.2)], characteristic for MMSP and not seen in cutaneous melanoma. Survival in MMSP has been correlated with tumor size, tumor necrosis, and ploidy status. Overall reported clinical outcome for this tumor is as follows: died of disease, 45%; alive with disease, 23%; no evidence of disease, 30%; and died of other causes, 2%. MMSP represents a distinct entity with a characteristic ultrastructural appearance and a tumor defining cytogenetic translocation.

Adolescent↗

PubMedDate not supplied

Primary intraoral epithelioid hemangioendothelioma presenting in childhood: review of the literature and case report.

Epithelioid hemangioendothelioma (EH) is a recently described vascular neoplasm of borderline or intermediate malignant potential. This tumor arises from medium- to large-sized vessels, primarily involves the soft tissues of the extremities as well as the liver and lung, and rarely occurs in the head and neck region. Only eight well-documented cases of intraoral EH have been reported. We present an additional pediatric case of EH confined to the oral cavity and review the literature regarding EH presenting as an intraoral mass. EH is characterized histopathologically as an epithelioid lesion arranged in nests, strands, and trabecular patterns with infrequent vascular spaces. Occasional erythrocytes within intracytoplasmic lumina may be seen in tumor cells. Ultrastructural examination typically shows intracytoplasmic lumina with pseudopodial cellular membrane extensions. The cytoplasm usually contains intermediate filaments infrequently associated with Weibel-Palade bodies. Neoplastic cells are immunoreactive for factor VIIIR:Ag and Ulex europaeus. Histopathologic features, which may be associated with aggressive clinical behavior, include significant cellular atypia, one or more mitoses per 10 high-power fields, an increased proportion of spindled cells, focal necrosis, and metaplastic bone formation. Because of the intermediate malignant potential of epithelioid hemangioendothelioma, complete tumor resection is recommended for intraoral lesions.

Child↗

PubMedDate not supplied

Recurrent intrapulmonary malignant small cell tumor of the thoracopulmonary region with metastasis to the oral cavity: review of literature and case report.

Malignant small cell tumor of the thoracopulmonary region (MSCT) was first described in 1979 and has been referred to as the Askin tumor. This malignant neoplasm is a member of the peripheral primitive neuroectodermal tumor (PPNET) family and typically involves the periosteum, soft tissue, and extrapulmonary tissue of the thoracic wall. MSCT may also involve the lung parenchyma by local extension or may arise de novo in peripheral lung tissue. Local recurrence, abdominal involvement by tumor extravasation across the diaphragm, and skeletal metastatic disease are relatively common. However, metastasis to the head and neck region and in particular to the oral cavity is extremely rare. We present a recurrent intrapulmonary MSCT with metastasis to the oral cavity in an adolescent Hispanic boy, and review the literature regarding this member of the PPNET family. Differentiation from neuroblastoma may be made based on immunoreactivity for beta 2 microglobulin and HBA71 and lack of immunoreactivity for chromogranin in PPNET and MSCT. Ultrastructural features commonly seen in MSCT and PPNET are round to ovoid tumor cells with occasional cytoplasmic processes with relatively few pleomorphic dense core granules. These tumors lack the gangliocytic and Schwann cell differentiation that is characteristic of neuroblastoma. MSCT and PPNET have a common reciprocal cytogenetic translocation [t(11;22)q(24;q12)], which is shared with Ewing's sarcoma. Prognosis in MSCT is quite dismal, with a 2-year survival of 38% and a 6-year survival of only 14%.

Adolescent↗

PubMedDate not supplied

Comparison of ultrastructural features among neuroblastic tumors: maturation from neuroblastoma to ganglioneuroma.

Neuroblastic tumors have the unique ability to differentiate and mature. This family of tumors is composed of the neuroblastoma, ganglioneuroblastoma, and ganglioneuroma. These tumors are derived from primordial neural crest cells that form the sympathetic nervous system. The purpose of this study was to characterize the ultrastructural features of neuroblastic tumors in a pediatric population. Forty-five neuroblastic tumors (15 neuroblastomas, 15 ganglioneuroblastomas, and 15 ganglioneuromas) were examined using standard transmission electron microscopic techniques. Undifferentiated neuroblastomas were composed of primitive cells with rare neurite-like processes containing clear secretory vesicles and no Schwann cell differentiation. Poorly differentiated and differentiating neuroblastomas showed more frequent neuritic processes with infrequent dense core granules and infrequent immature Schwann-like cells. Ganglioneuroblastomas possessed an admixture of cell types, including immature ganglion cells without associated satellite cells, intermediate cells, and differentiating neuroblasts. The neuropil contained immature Schwann cells encasing haphazardly arranged neuritic processes. Ganglioneuromas were composed of mature ganglion cells with occasional binucleation. The neuropil contained mature Schwann cells with well-organized neuritic processes and abundant collagen deposition. Differentiation or maturation of tumor cells, neuritic processes, and Schwann cells may thus be discerned ultrastructurally in primary neuroblastic tumors in pediatric patients.

Cell Differentiation↗

PubMedDate not supplied

Multifocal osteosarcoma: an unusual presentation.

PURPOSE: Report the unusual presentation, clinical course, and cytogenetic abnormalities in a child with multifocal osteosarcoma. PATIENTS AND METHODS: A 10-year-old boy had multifocal osteosarcoma involving the entire skeleton, pleura, bone marrow, and lungs. He had marked anemia, thrombocytopenia, and severe hypocalcemia at diagnosis. RESULTS: Despite aggressive chemotherapy, he died from progressive disease 1 month after diagnosis. Cytogenetic analysis of tumor cells within the pleural fluid showed multiple chromosomal abnormalities with amplification of the c-myc oncogene. CONCLUSION: Multifocal osteosarcoma should be considered in the differential diagnosis of a child with pancytopenia and multiple bone lesions. Amplification of the c-myc oncogene may have had a significant role in the pathogenesis, etiology, and rapid progression of this patient's multifocal disease. Additional studies will be needed to determine the biologic significance of c-myc amplification in multifocal osteosarcoma.

Child↗

PubMedDate not supplied

Oral candidiasis in children with immune suppression: clinical appearance and therapeutic considerations.

Children and adolescents with immune compromise and suppression are particularly susceptible to the development of oral candidiasis. In fact, oral candidiasis is the most common oral manifestation in HIV-infected children. Oral candidiasis has been linked to a depressed immune system, more rapid progression to AIDS, more advanced stage of disease in AIDS, and decreased survival. Several different forms of candidiasis may be recognized clinically. These forms are 1) pseudomembraneous candidiasis; 2) erythematous (atrophic) candidiasis; 3) papillary hyperplasia; 4) chronic hyperplastic candidiasis; 5) angular cheilitis; and 6) median rhomboid glossitis. Diagnosis of candidiasis is primarily based upon clinical appearance; in some cases, however, exfoliative cytology and/or biopsy of the lesion may be necessary. It is also possible to culture the lesion to determine the specific subtype of candidia and to evaluate the susceptibility of the fungus to specific antifungal agents. Both topical and systemic treatment by antifungal medications are readily available.

Antifungal Agents↗

PubMedDate not supplied

Enamel caries formation and lesion progression with a fluoride dentifrice and a calcium-phosphate containing fluoride dentifrice: a polarized light microscopic study.

The effects of a fluoride dentifrice (Colgate Total) and a calcium-phosphate containing fluoride dentifrice (Enamelon) on caries-like enamel lesion formation and progression were evaluated in vitro. One quarter from each tooth (n = 12) was assigned to one of the study groups: 1) control group [artificial saliva only]; 2) Colgate Total; and 3) Enamelon. The dentifrices were applied to the enamel windows (3 minutes, 3 time per day for 14 days). Following treatment, enamel lesions were created with an acidified gel. After lesion initiation, sections were obtained for polarized light microscopy. To evaluate lesion progression, enamel windows with caries-like lesions in each test group were treated again for 14 days, returned to acidified gels for lesion progression, and then sections were obtained for polarized light microscopy. Mean lesion depths (polarized light, water imbibition) were as follows: 1) Lesion Initiation: Control 109 +/- 19 microns, Colgate Total 76 +/- 14 microns, Enamelon 63 +/- 17 microns; 2) First Lesion Progression: Control 164; +/- 24 microns, Colgate Total 124 +/- 22 microns, Enamelon 110 +/- 19 microns; 3) Second Lesion Progression: Control 235 +/- 23 microns; Colgate Total 172 +/- 27 microns, Enamelon 153 +/- 18 microns. Both Colgate Total and Enamelon enhanced the resistance of sound enamel and caries-like enamel lesions to a continuous in vitro cariogenic challenge when compared with matched controls (P < .05, ANOVA, DMR). Enamelon provided a further reduction in lesion depth for all periods when compared with Colgate Total (P > .05, ANOVA, DMR). Addition of bioavailable calcium and phosphate ions to a fluoride dentifrice may improve the ability of enamel to resist caries initiation and subsequent lesion progression.

Analysis of Variance↗

PubMedDate not supplied

Surface topography and enamel-resin interface of pit and fissure sealants following visible light and argon laser polymerization: an in vitro study.

This in vitro study compared the effects of visible light and argon laser polymerization of pit and fissure sealants on surface topography and the enamel-sealant interface. Twenty caries-free human molars and premolars underwent soft tissue debridement and a fluoride-free prophylaxis. Fluoride-releasing sealant (UltraSeal XT Plus, South Jordan, UT 84095) was placed on the occlusal surfaces per the manufacturer's instructions, but underwent either visible-light polymerization for 30s (n = 10), or argon laser polymerization (0.231 J/cm2) for 10s (n = 10). The sealed teeth were thermocycled (500 cycles, 5 degrees to 50 degrees C) in artificial saliva. Surface morphology was evaluated by SEM. The teeth were sectioned for polarized light and SEM evaluation of the enamel-sealant interface, with two sections per tooth prepared for SEM. Phosphoric acid was used to unmask the enamel-sealant interface with one section; while the other section was not exposed to the phosphoric acid. Surface morphology of the sealant material was similar with both visible light and argon laser polymerization; however, there was a tendency for occasional areas of mild, focal cratering of the sealant surface with laser-curing. The junction between sealant and adjacent unsealed enamel was a relatively smooth transition without gaps, microspaces, crazing, exfoliative changes, or microfractures with both visible light and laser cured sealants. Acid treatment of the sections revealed resin tags which extended into the adjacent enamel for a considerable distance on SEM examination. The resin tas were similar in length and morphology with both visible light and argon laser curing. The enamel-sealant interface with visible light and laser curing showed intimate contact between the sealant and etched occlusal enamel with close apposition of the sealant. No microspaces were identified between the sealant and the occlusal enamel. An intact, interdigitating interface between a sealant and the adjacent etched enamel provides the first line of defense against a cariogenic challenge. Visible-light and argon laser curing allows for an intimate enamel-sealant interface without microspaces and protects sealed enamel from cariogenic challenges. The benefit of argon laser polymerization, fluoride release and mechanical protection of sealant material may provide improved caries resistance in sealed pits and fissures and adjacent nonsealed enamel surfaces.

Argon↗

PubMedDate not supplied

Dental caries in HIV-infected children: a longitudinal study.

PURPOSE: The purpose of this descriptive longitudinal clinical study was to determine primary and permanent dentition caries status in HIV-infected children, and to compare caries status with the CD4 percentage (CD4%) and immune suppression category. MATERIALS AND METHODS: 73 children up to 9 years of age with vertical HIV transmission were evaluated for caries in the primary dentition at baseline and at 6 month intervals over a 30 month period; while 19 HIV-infected children between 5 and 11 years of age had their permanent dentition evaluated for caries at baseline and at 6 month intervals over a 24 month period. Caries status was also compared with CDC CD4 percentage (> 25%, 15-24%, < 15%), and CDC immune suppression categories (immune suppression: none, moderate, severe). With primary dentition caries, comparisons were made among all children (2-9 yr-olds, N = 73), < 2 yr-olds (N = 28), 2 to 4 yr-olds (N = 20), and 5 to 9 yr-olds (N = 25), and compared with NHANES III data. Caries-free status was also determined. RESULTS: During the 30-month period, there was an almost two-fold increase in primary tooth surface caries for the 2 to 9 year-olds. Caries-free status in the primary dentition declined from 60% at baseline to 37% at the 30-month period. With 5 to 11 years-olds, DMFS and DMFT remained relatively stable, while the proportion of caries-free individuals declined from 72% at baseline to 50% at 18 months. Caries in the primary dentition was increased substantially for those in the low CDC CD4 percentage categories and CDC moderate to severe immune suppression categories. CONCLUSION: Primary dentition caries status in HIV-infected children is considerably greater than that for the US pediatric population, and increases with decreasing CD4 percentage and moderate to severe immune suppression. HIV-infected children with caries-free primary dentitions are less frequent than in the US pediatric population, and caries-free status decreases with age, lower CD4 percentage and moderate to severe immune suppression.

CD4 Lymphocyte Count↗

PubMedDate not supplied

Kinetic cavity preparation effects on secondary caries formation around resin restorations: a polarized light microscopic in vitro evaluation.

The purpose of this in vitro study was to compare the effect of conventional handpiece and kinetic cavity preparation (KCP, air abrasion) techniques of cavity preparation on caries-like enamel lesion formation. After a fluoride-free prophylaxis, twelve human molars were examined macroscopically to ensure that buccal and lingual surfaces were caries-free. Unfilled cavities were prepared in mesiobuccal (conventional [CU]) and mesiolingual (air abrasion [AU]) enamel surfaces. Cavities were prepared in distobuccal (conventional [CF]) and distolingual (air abrasion [AF]) enamel surfaces and restored with composite resin following placement of a bonding agent. Acid-etching of cavity walls was performed only with the conventionally prepared cavities restored with resin. Air abrasion (KCP) prepared cavities were restored without acid-etching of the cavity walls. Teeth were thermocycled (500 cycles, 5 degrees to 50 degrees C, 500 cycles) and exposed to an artificial caries medium for caries initiation and progression. After caries formation, two longitudinal sections were taken from unfilled and filled cavity preparations and examined by polarized light microscopy for wall lesion presence and mean surface lesion depth. Surface lesion depths were similar among groups after the caries initiation period (CU = 225 microns; AU = 237 microns; CF = 241 microns; AF = 251 [p > .05, ANOVA, DMR]), and progression (CU = 437 microns; AU = 415 microns; CF = 405 microns; AF = 429 um [p > 0.05, ANOVA, DMR]). Extensive wall lesions were present in all CU and AU; while small wedge-shaped wall lesions were significantly (p < .05, ANOVA, DMR) fewer in CF (19 percent & 21 percent) and AF (17 percent & 21 percent) following caries initiation and progression compared with unfilled controls. Resin restorations placed in cavities prepared by air abrasion (KCP) and conventional handpiece techniques provided similar degrees of protection against a secondary caries-like challenge.

Acid Etching, Dental↗

PubMedDate not supplied

Dental emergencies in a university-based pediatric dentistry postgraduate outpatient clinic: a retrospective study.

The purpose of this retrospective study was to determine the prevalence and types of dental emergencies occurring in a university-based, pediatric dentistry postgraduate outpatient clinic. All patients presenting for emergency dental care during scheduled clinic hours over a three year were identified, and their charts were retrieved. Each record was reviewed for demographic information, chief complaint and clinical diagnosis. Only those charts with both chief complaints and clinical diagnoses recorded were included in this study. A total of 816 patients received emergency care, representing 15.3 percent of all patient treated during the study period. The patient population had a slight female predilection (53 percent female, 47 percent male) and a mean age of 5.1 years (range 10 days to 15 years). Ethnicity (39 percent African-American, 36 percent Hispanic, 24 percent Caucasian <1 percent Asian-American) was similar to that for the clinic in general. Reimbursement for dental care was primarily via Medicaid (91 percent) with <10 percent covered by insurance or payment by responsible parents. For one quarter of the children, the emergency visit was their first dental visit. Reasons for seeking emergency included 1) pain or discomfort due to caries [30.1 percent] with 27 percent due to early childhood caries; 2) dental trauma [23 percent];3) eruption difficulties [18 percent] with 27 percent due to early childhood caries; 2) dental trauma [23 percent];3 eruption difficulties [18 percent];4) soft tissue pathoses [16 percent]; 5) problems with orthodontic appliances or space maintainers [10 percent]; and 6) lost restorations [2 percent]. Pain and bleeding were the most common reasons for seeking emergency dental care. Most causes for seeking outpatient emergency dental care are disease processes which may be avoided by infant oral health and preventive dentistry programs and early treatment intervention.

Academic Medical Centers↗