Biomedical subjects
Publications and source records attributed to N L Rhodus.
On the basis of recent developments, liver transplantation is no longer considered an experimental procedure. The history and current status of human liver transplantation are reviewed. The complications and side effects of the agents used for immunosuppression are presented. The dental treatment of the patient before and after liver transplantation is discussed in detail.
A national survey of urologists was conducted regarding the need for prophylactic antibiotic coverage for patients with penile implants when undergoing invasive dental treatment. A total of 1,756 questionnaires was sent to urologists in the United States and 297 responses were received, for a participation rate of 17%. The low response rate might be partly related to a low level of concern by urologists due to the lack of reported cases of penile implant infections following invasive dental procedures and the lack of the literature calling attention to this possible association. This is supported by the fact that none of the responding urologists had noted any case of infection of the prosthesis following dental treatment. The majority of urologists who responded did not recommend antibiotic prophylaxis for penile implant patients undergoing invasive dental treatment. The majority of urologists who recommended prophylaxis selected a cephalosporin. None of the responding urologists indicated that they were aware of infection developing in any penile implant patients following invasive dental treatment. The dentist is advised to consult with the urologist of patients with penile implants on an individual basis to determine the need for antibiotic prophylaxis.
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Pilocarpine, a muscarinic-cholinergic agonist drug, has been reported to stimulate salivary flow in patients with salivary gland dysfunction. Previous studies involved heterogeneous groups of patients with salivary gland dysfunction and examined the short-term, single-dose, tablet form of pilocarpine. In this single-blind, placebo-controlled study we examined the long-term effects of pilocarpine administration on patients with definitively diagnosed Sjögren's syndrome (SS). Nine subjects with SS who received pilocarpine, and nine age- and sex-matched SS control subjects who received a placebo, participated. Baseline predosing sialometric and clinical data were obtained for all subjects. The study group used 2% pilocarpine as a liquid ophthalmic drop preparation, four drops three times per day, for 6-weeks. Identically appearing placebo solution with the same dosing schedule and duration was used for the control subjects. Sialometric and clinical examinations were performed. The results indicated a significant overall increase in both whole unstimulated salivary flow (0.15 +/- 0.03 ml/min in study subjects vs 0.02 +/- 0.001 ml/min in control subjects; p less than 0.001) and parotid stimulated salivary flow (0.14 +/- 0.04 ml/min in study subjects vs 0.009 +/- 0.002 ml/min in control subjects; p less than 0.001) in the pilocarpine group as compared with the placebo group. The results of this study support the use of pilocarpine to increase salivary flow in patients with SS.
The purpose of this study was to evaluate the association of periodontal health and human immunodeficiency virus infection among individuals in the early stages of disease who were participating in randomized placebo-controlled clinical trials of zidovudine. Previous reports have described a rapidly progressive periodontitis and atypical gigivitis associated with late stages of infection by the human immunodeficiency virus. A health history was completed by each subject. Baseline oral examinations were completed on 97 asymptomatic patients and nine with AIDS-related complex (ARC) during their regular clinic visit. Follow-up examinations were conducted at 3-month intervals throughout the 48 weeks of the oral study. Evaluations of plaque, calculus, gingival abnormalities, caries, and periodontal disease were conducted. Periodontal measurements included plaque index (PI), gingival index (GI), bleeding index (BI), probing depth (PD), and observation for cratering, necrosis, and tooth mobility on six teeth in each patient. More than half of the subjects had visited their dentist during the previous year and had had an oral prophylaxis; less than 25% of them had had either restorative work or extractions. The mean scores for periodontal indices averaged over the course of the study in asymptomatic and ARC respectively were: PI: 0.9 (SE 0.04) and 0.9 (SE 0.08), 0.818; GI: 1.0 (SE 0.04) and 0.9 (SE 0.07), P = 0.412; BI: 0.6 (SE 0.04) and 0.4 (SE 0.07), P = 0.278; PD: 2.9 (SE 0.05) and 2.6 (SE 0.10), P = 0.140. There was no evidence of cratering, necrosis, or tooth mobility in either group. Few had calculus or dental caries. There were no clinically significant differences detected between ARC versus asymptomatic patients. Dental histories and oral examinations showed that two groups of patients in early stages of HIV-disease were in good periodontal health.
Ninety-one patients receiving routine dental treatment at the University of Minnesota School of Dentistry participated in an electrocardiogram screening study. The purpose of the study was to evaluate patient reaction to electrocardiogram screening in a dental school clinic. The vast majority of patients indicated the test was easy and did not intrude on the dental appointment. Most of the patients reported that the test was a valuable service and should be available in the dental office. None of the patients indicated that the tests should not be performed in the dental office. Few patients expressed any significant concern or anxiety about the test either before or after it was completed. Twenty-six percent (24/91) of the patients were found to have a cardiac arrhythmia; however, most of these were nonserious arrhythmias (18/24) and would not have had an impact on planned dental procedures. Six patients were identified with arrhythmias that required medical referral before dental treatment was started.
A common problem in the institutionalized as well as the free-living elderly is inadequate nutrition. This problem will continue in significance as the population continues to age. Previous studies have indicated a variety of nutritional deficiencies in the diets of older adults. Chronic degenerative diseases and usage of multiple pharmacologic agents are also prevalent in the geriatric population and confound this complex problem. A common observation among the many contributing factors to the problem of relative or absolute malnutrition in seniors is that many individuals exhibit the sign/symptom of xerostomia (dry mouth). Recent studies indicate that nearly one in five older adults exhibit xerostomia. Xerostomia increases the difficulty of these older adults in obtaining the proper nutrition. Problems in lubricating, masticating, tolerating, tasting and swallowing food contribute significantly to the complex physiological and psychological manifestations of aging. To this date the literature fails to demonstrate an association between xerostomia and malnutrition in the elderly.
Recent studies indicate that nearly one in five older adults has xerostomia (dry mouth). Salivary gland dysfunction and/or inadequate saliva increases the difficulty of these older adults in obtaining proper nutrition. Problems in lubricating, masticating, tolerating, tasting, and swallowing food contribute notably to the complex physiological and psychological manifestations of aging. To our knowledge, the literature has not demonstrated an association between xerostomia and malnutrition in the elderly. We randomly selected 67 older adults from institutionalized and free-living geriatric populations. Nutritional intake analysis was performed on both groups of study subjects, who were found to have xerostomia by use of sialometry, and on control subjects matched for age, sex, and physical status. Intake of total energy, protein, dietary fiber, total fat, saturated fat, cholesterol, sodium, potassium, vitamin A, vitamin C, thiamin, riboflavin, vitamin B-6, calcium, iron, and zinc was compared with the 1989 Recommended Dietary Allowances. Subjects' intakes were also compared with that of a control group. Medical systemic information and number and types of medications were compared among the groups. Statistical analysis of the data indicated significant (p less than .001) inadequacies in the nutritional intake patterns of institutionalized and free-living older adults with xerostomia. Subjects with xerostomia (more than 75% of the free-living and institutionalized seniors) had significant deficiencies of fiber, potassium, vitamin B-6, iron, calcium, and zinc. Taste and food perception were significantly reduced in the elders with xerostomia. Our study indicates the potential contribution of xerostomia to the high prevalence of geriatric malnutrition in the United States.
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Previous studies have documented the occurrence and potential clinical significance of MSMR cysts. Studies also have alluded to a relationship between the MSMR cyst and certain signs or symptoms of disease. We determined the prevalence of MSMR cysts in a general clinic population and identified some important correlations with clinical signs and symptoms.
Representative adult patient populations seeking treatment at a dental school in 1976 and 1986 were analyzed for the prevalence and the characteristics of medical conditions. Patients' records (N = 3,000) were randomly selected from the examination clinics and reviewed for the presence and types of compromising medical conditions. The results indicated a significant increase in the percentage of dental patients who had medical conditions in 1986 as compared with 1976 (P less than .001), as well as significant changes in the types of medical conditions present. These data indicate an increase in the number of patients with medical problems in the general dental school patient population.
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Xerostomia presents a difficult challenge for the clinician to manage and a serious problem for the afflicted patient. Patients with dysfunctional or hypofunctional salivary or lacrimal glands suffer considerably both emotionally and physically. Because of the ever-increasing geriatric population, health practitioners can expect to encounter a substantial number of patients with xerostomia or salivary gland disorders. Early detection and appropriate management will improve the quality of these patient's lives.
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