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Biomedical subjects

P Weinstein

Publications and source records attributed to P Weinstein.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Treatment outcomes for specific subtypes of dental fear: preliminary clinical findings.

In order to examine the clinical treatment outcome for dental fears, we examined 111 active patient records retrospectively using an 80-item structured format. Subjects were from three fear subtypes: needle phobic (N = 15), gagger (N = 11), and non-specific dental fear (N = 85). Mean subtype Dental Fear Survey scores ranged from 72.3 to 81.0. Patients received either behavioral therapy alone (N = 85) or behavioral therapy with a nitrous oxide or IV sedation adjunct (N = 26). Mean psychological treatment time was 3.9 hours (SD = 2.8 h) and did not differ by fear subtype (p > 0.05). All patients successfully completed initial dental treatment. Relapse of fear requiring additional psychological treatment occurred only in the non-specific fear subtype (rate = 11.2%). Patients receiving pharmacologic adjuncts to behavior therapy (nitrous oxide) experienced less relapse.

Adult↗
PubMedDate not supplied

Dental fear treatment outcomes for substance use disorder patients.

In order to examine the clinical treatment outcome for dental fears, we compared the records of 18 phobics who had co-morbid substance use disorder (SUD) with those of 27 subjects who were phobic without concomitant SUD. Outcomes were determined by calculation of changes in the Dental Fear Survey (DFS) score. Subjects were classified by the Structured Clinical Interview for DSM-III-R. All subjects received exposure-based behavioral therapy with or without pharmacological adjuncts. All 27 subjects in the non-SUD group and 15 of 18 (83.3%) of subjects in the SUD group improved. Non-SUD subjects improved more than SUD's on the avoidance and specific fear, but not on the physiological upset, dimensions of the DFS.

Adult↗
PubMedDate not supplied

Public health impacts of global climate change.

The potential health impacts of climate change are wide-ranging, from direct impacts at familiar local scales, through indirect effects occurring at the regional or ecosystem level, to long term effects on the sustainability of global systems. To assess these potential impacts, there is a need to broaden the scope of health impact assessment. Eco-epidemiology is emerging as a response to this need. Eco-epidemiology entails a shift in focus: from direct (toxicological) to indirect (ecological) mechanisms; and from effects occurring at 'human' temporal and geographical scales to those at regional and geophysical scales. We discuss the potential health impacts of climate change on each scale. At the global scale, interactions and feedbacks between systems are critical determinants of long term outcomes. From an eco-epidemiological perspective, the study of climate change becomes inseparable from the study of global change more generally.

Adult↗
PubMedDate not supplied

A case of aural myiasis in Australia.

A case of aural myiasis that involved Calliphora nociva in an 18-month-old boy is reported. This is thought to be its first documentation. Medical practitioners are encouraged to preserve entomological material from all cases of human myiasis so as to improve the knowledge of the species which are responsible for the condition in Australia.

Australia↗
PubMedDate not supplied

Topical antimicrobial therapy in the prevention of early childhood caries.

PURPOSE: Early childhood caries (ECC) is microbiologically characterized by heavy infection of mutans streptococci (ms) on dental surfaces. Accordingly, it is reasonable to speculate that suppression of dental ms levels would decrease risk for ECC. On this basis, randomized double blind, placebo controlled pilot study was performed to test this concept. METHODS: The study population consisted of 31 subjects (age: 12 to 19 mos; sex: 18F/13M) who were clients of a Women, Infants, and Children (WIC) clinic in Puerto Rico. Inclusion criteria included: (1) unremarkable medical history; (2) presence of 4 maxillary primary incisors (PMI) with no visible defects; (3) clinically caries free; (4) use of a nursing bottle at naptime and/or bedtime which contained a cariogenic substrate; (5) two consecutive ms positive cultures (utilizing Mitis-Salivarius-Bacitracin (MSB) agar) from pooled PMI plaque. The subjects were randomized into 2 groups. The 15 subjects in the experimental group and the 16 subjects in the control group were evaluated every 2 months during the study period. At each evaluation, the subjects had 10% povidone iodine (experimental group) or placebo (control group) applied to their dentition. The placebo was commercial instant tea (without lemon or sweetener) and deionized water. Treatment failure was defined as the appearance of a white spot lesion(s) on any of the PMI during the study period. RESULTS: The mean duration of observation to treatment failure was 155 days; the mean duration of observation for treatment success was 217 days. Five of the 16 control subjects and 0 of the 15 experimental subjects experienced treatment failure (Fisher's exact test: P = 0.04). The Kaplan-Meier estimate for incidence of treatment failure in the placebo group was 48% over 357 days (P = 0.02). CONCLUSION: These observations suggest that topical antimicrobial therapy reduces risk for the development of ECC in high-risk children.

Anti-Infective Agents, Local↗
PubMedDate not supplied

Dental experiences and parenting practices of Native American mothers and caretakers: what we can learn for the prevention of baby bottle tooth decay.

This study attempts to gather information concerning the dental experiences, beliefs, and parenting practices of Native Americans. Five Native American women were trained to conduct interviews in their own language. After pilot testing, seventeen questions were asked. Sixty-two interviews were taperecorded and transcribed. Content analysis was performed on the transcriptions. Results indicate maternal and caretaker upset and displeasure with the dental experiences of adults and children. Fear and pain were prominent. Parenting practices indicate children are expected to clean their own teeth at about a year of age and parental awareness of risks associated with sleeping with a bottle. About half of the mothers and caretakers who used a bottle as a pacifier report engaging in one or more protective activities such as removing the bottle when the child falls asleep. Mothers and caretakers with greater parenting experience are likelier to be aware of these protective activities. In conclusion, results of this study highlight the importance of providing positive dental experiences for mothers and caretakers and the need to be aware of actual parenting practices before making recommendations or counseling mothers or caretakers.

Adult↗
PubMedDate not supplied

Taking bitewing radiographs in preschoolers using behavior management techniques.

Radiographs are essential diagnostic tools to enable dentists to make adequate decisions and treatment plans. Treatment plans for young children, however, are quite often based on no or less than ideal radiographs. Getting successful bitewing radiographs from young children demands both behavior management techniques and adequate equipment. This report reviews the literature, and presents a modified technique of taking radiographs in young children. The technique was successfully used with 156 three-to-five-year-old children from Yakima County, Washington. Behavioral management of the children employed several techniques: building rapport, tell-show-do, modeling, positive reinforcement and increasing the child's sense of control. The equipment and placement technique were designed to be as atraumatic as possible. Positive experiences in the dental office often enhance a child's future cooperation. The techniques presented are simple to learn and use in treating very young children.

Behavior Therapy↗
PubMedDate not supplied

Mutans streptococci prevalence in Puerto Rican babies with cariogenic feeding behaviors.

PURPOSE: Previous studies have demonstrated that babies are at higher risk for mutans streptococci (ms) colonization if their mothers have dense salivary ms reservoirs relative to babies who have mothers with negligible salivary reservoirs. This communication provides data that identifies another potential risk factor (use of a nursing bottle at bedtime and/or naptime that contains a substrate other than water) for baby infection by ms. METHODS: The study population consisted of 60 babies (28 males/32 females; mean age 15 mos; age range 12-18 mos) who were all healthy, caries free, and slept with a nursing bottle that contained a substrate other than water (NB+). Pooled maxillary incisor plaque and saliva samples were obtained and immediately placed in Reduced Transparent Fluid (RTF); they were serially diluted and plated onto Mitis Salivarius Agar plus Bacitracin (MSB) and blood agar plates within 4 hours of collection; the plates were incubated in an anaerobic environment for 48 h at 37 C and then placed for 24 h under aerobiosis prior to examination; representative ms colonies were isolated and subjected to mannitol and sorbitol fermentation tests for taxonomic verification. Plates with colony counts between 20 and 300 were utilized to determine the % of ms in each sample. RESULTS: Fifty one of the 60(85%) babies harbored ms in at least 1 of the 2 samples. The 95% confidence interval for the proportion of subjects with detectable levels of ms was 73%-93%. Fisher's exact test showed that babies 16-18 mos age were more likely to have detectable levels of ms than babies 12-15 mos age (p = 0.01). Levels of ms in plaque and saliva were as follows: < 0.1% (plaque 27/51, mean age 15 mos, sd 1.77; saliva 28/51, mean age 15 mos, sd 1.76); 0.1%-1.0% (plaque 4/51, mean age 14 mos, sd 1.5; saliva 6/51, mean age 15 mos, sd 1.46); > 1.0% (plaque 14/51, mean age 16 mos, sd 2.1; saliva 11/51, mean age 16 mos, sd 1.91). The density of infection did not vary by age for plaque (P = 0.32) or saliva (P = 0.64). CONCLUSION: These findings support the concept that NB+ is a strong indicator for ms infection in Puerto Rican babies; that prevalence of infection increases with age; and that density of infection does not vary with age in this population.

Age Factors↗
PubMedDate not supplied

The reliability and validity of the RAPIDD scale: readiness assessment of parents concerning infant dental decay.

This study assessed the instrument, Readiness Assessment of Parents concerning Infant Dental Decay (RAPIDD), as a measure of parental readiness to change children's dental behaviors. The 38-item instrument based on four constructs (Openness to Health Information, Valuing Dental Health, Convenience/Difficulty, Child Permissiveness) was administered to a random sample of parents of 6-to-36 month old children on Saipan, Commonwealth of the Northern Mariana Islands, USA. Alpha values for each construct's internal consistency ranged from 0.51 to 0.75. Correlations were found with feeding (e.g., Convenience/Difficulty and receiving bottle (r = .24, p < 0.01)) and oral hygiene (e.g., Valuing Dental Health and tooth-cleaning (r = .27, p < 0.01)). Parental responses were used to categorize respondents into precontemplators (16 percent), contemplators (77 percent), and actions (6.7 percent). This categorization was associated with the number of decalcified and decayed surfaces (alpha 2 = 34.8, p = 0.04; alpha 2 = 65.7, p < 0.01). This suggests that parental readiness is associated with infant dental health and that most parents would be willing to contemplate prevention.

Attitude to Health↗
PubMedDate not supplied

Clinical outcomes for early childhood caries: influence of aggressive dental surgery.

PURPOSE: The objective of this study was to assess the relationship between the number of stainless steel crowns (SSCs) placed, number of surfaces at risk (SAR) post dental surgery, and the risk for relapse in patients treated for Early Childhood Caries (ECC). METHODS: The study population consisted of 57 children treated for ECC under general anesthesia, ranging in age from 2.3 to 7.3 years old at the time of entry. Dental surgery utilized an aggressive approach: teeth that had necrotic pulps or were nonrestorable were extracted; decayed primary mandibular incisors that could not be treated by stripping were extracted; primary maxillary incisors with 3 or more carious surfaces were extracted; single-surface lesions of primary molars that did not compromise cusp integrity were restored with intracoronal amalgam restorations; primary maxillary, incisors and canines with smooth-surface lesions affecting 2 or less surfaces were treated with intracoronal composites; primary molars and canines requiring vital pulp therapy were restored with SSCs; primary molars with caries lesions affecting 2 or more surfaces (including smooth-surface, white-spot lesions) were restored with SSCs; primary canines with caries affecting 3 or more surfaces were restored with stainless steel crowns; topical fluoride was applied after all restorative therapy was completed. The cohort was examined for new caries lesions 6 months post dental surgery. Relapse was defined as the presence of new smooth-surface caries lesions as defined by Radike. Comparisons between relapse (R) and nonrelapse (NR) groups, with respect to the number of SSCs placed and the number of SAR, were performed using t tests and Wilcoxon tests. A 0.05 level of significance was employed in all statistical tests. RESULTS: Twenty-one of the 57 (37%) patients relapsed. No statistically significant difference for the number of SSCs placed or SAR existed between the R group (SSCs: mean = 4.57, median = 4 +/- 2.18; SAR: mean = 39.76, median = 40 +/- 13.62) and NR group (SSCs: mean=5.44, median = 5.5 +/- 2.62; SAR: mean = 39.98, median = 39.5 +/- 15.19). CONCLUSIONS: The risk for relapse in children treated for ECC is not associated with the number of SSCs placed or SAR; aggressive dental surgery for ECC does not result in acceptable clinical outcomes.

Child↗
PubMedDate not supplied

Dental fear of Japanese residents in the United States.

The purpose of this study was to investigate dental fear in a sample of Japanese adults and to make preliminary comparisons with a previously described US sample. The survey instrument was translated into Japanese and then translated back into English and was sent to 839 Japanese residing in the Seattle area. A total of 419 (49.9%) usable questionnaires were returned. Results indicate a level of fear higher than the US population (only 17.9% were not at all afraid). Fear level did not vary by age; most respondents (73.3%) acquired their fear in early childhood. While reported utilization was lower than the American sample, the percentage of Japanese respondents who reported being hurt at the last appointment was high (68.0%). Japanese respondents indicated that 35% of dentists appeared to be in a hurry, hurry being associated with being hurt. Japanese coping practices appeared to differ from the American sample. For example, 14.7% of the Japanese whereas 28.2% of the US sample requested the dentist to stop treatment.

Adolescent↗
PubMedDate not supplied

Common fears and their relationship to dental fear and utilization of the dentist.

Common fears were studied by household telephone interviews and mail survey in Seattle, Washington, to determine their relationship to dental fear and to utilization of the dentist. Dental fear was either the first or second most common fear, with a prevalence estimated between 183 and 226 persons per 1000 population. Dental fear was associated with fears of heights, flying, and enclosures. Respondents with multiple common fears other than fear of dentistry were more likely to delay or cancel dental appointments, report a longer period since their last visit to the dentist, and report poorer oral health and less satisfaction with oral appearance. Over 22 percent of the dentally fearful group reported two or more accompanying common fears.

Adult↗