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Attachment, positive affect, and competence in the peer group: two studies in construct validation.

2 studies were undertaken to assess the positive affective correlates of secure attachment in infancy and to assess the relation between secure attachment in infancy and competence in the peer group at age 3 1/2 years. In study 1, smiling and smiling combined with vocalizing and/or showing toys distinguished securely from anxiously attached infants during free play at age 18 months. Rated quality of affective sharing distinguished securely from anxiously attached infants during free play at 18 months and 24 months. Thus, secure attachment involves more than the absence of negative or maladaptive behavior directed toward a caregiver. Study 2 assessed cross-age, cross-situational, and cross-behavioral consistency in quality of social adaptation. Quality of infant-mother attachment relationships at age 15 months was related to Q-sort assessments of personal and interpersonal competence in the preschool play-group at age 3 1/2 years. The results contribute to the validation of attachment as an important developmental construct. They also suggest that age appropriate assessment of developmental social competence constructs can be a useful alternative to the study of homotypic behavioral continuity.

Affect↗

Signal functions of infant facial expression and gaze direction during mother-infant face-to-face play.

Recent studies of adult-infant interaction suggest that adults modify their behavior in order to change or maintain an infant's state of arousal. We pursued this question by asking whether mothers modify their actions in response to infant facial expression or gaze direction. Subjects were 7 mother-infant (4--8 month old) pairs in which mothers were instructed to bet their babies to smile. From these filmed interactions the infant's mouth, gaze, and head direction were coded, and the mother's movements were coded as single acts or bouts. Results of an exploratory analysis indicate that, when trying to get a baby to smile using tactile and kinesthetic stimulation, mothers tend to respond to negative changes of affect and attention by changing the content of their actions, taking a long pause, or decreasing the number of acts in a bout.

Arousal↗

Learning display rules: the socialization of emotion expression in infancy.

This study presents data on changes from 3 to 6 months in the type and frequency of infant facial expression. 60 mother-infant dyads were videotaped during play and reunion following a brief separation. Mothers' and infants' facial expressions were coded using the Max muscular components method. The mothers' verbal responses to infant expressiveness were also analyzed. Infants at both ages display a wide range of expressions and a high rate of change. Mothers respond contingently to 25% of infant changes; patterns of contingent responding varied slightly as a function of infant age and sex. Mothers show more contingent responding to older sons' smiles (vs. daughters' smiles) and follow sons' (vs. daughters') expressions with imitative expressions of their own. The only expressive difference between boys and girls at this age is that girls show more frequent interest expressions. Age-related changes included an attenuation of negative affect and a slower lability of expression change for older infants. The mothers' part in these age-related changes is revealed in the following results; Maternal expressions are limited to positive emotions, especially toward younger infants; mothers show less nonverbal and verbal acknowledgment of older infant expression change and do not acknowledge certain infant negative expressions. Finally, we report mother-infant dyadic similarities in expressiveness, including particular expression types and preferential use of the brow or mouth region in expressiveness. These results indicate that socialization of affect expression is occurring during early infancy and that the infants' expressiveness is becoming appropriate according to cultural, gender, and familial demands well before the first birthday.

Affect↗

Treating dental disharmony with mixed media.

The art of designing a new smile often involves more than one cosmetic dental procedure. It is not uncommon to combine media such as tooth whitening with porcelain veneers and crowns to create an entirely new smile. To maintain dental harmony, it is paramount that media are indistinguishable from each other and are consistent with the existing dentition.

Crowns↗

Ridge enhancement and socket preservation utilizing the subepithelial connective tissue graft: a case report.

To prevent postextraction alveolar ridge resorption, various methods, techniques, and materials have been developed and are utilized. The learning objective of this article is to present a review of these materials and procedures and a clinical rehabilitation of a patient with a high smile line utilizing the technique of "socket preservation" to prevent an unaesthetic collapse of the alveolar ridge. A complex periodontal-prosthetic rehabilitation is undertaken to accommodate the patient's high smile line and prevent a possible unaesthetic result. This case report is an extension of several other ridge preservation cases by the author, previously published in this journal. The importance of cooperation and teamwork between the periodontist and the restorative dentist is emphasized.

Adult↗

Free vascularized double muscle transplantation for the treatment of facial paralysis.

Two cases of free neurovascular double muscle transplantation for facial paralysis are reported, with detailed descriptions of the operative technique and follow-up study. The latissimus dorsi muscle segment is placed between the nasolabial fold and the zygoma to substitute for the zygomatic and levator labii muscles, while the serratus anterior muscle segment is placed between the lower lip and the mandibular margin to substitute for the depressor labii muscles. The thoracodorsal nerve is sutured to the stump of the cross-face nerve graft, and the lateral thoracic nerve is sutured to a part of the hypoglossal nerve. The procedure is able to restore a relatively symmetrical smile, especially in patients with a full denture smile. The satisfactory results of this procedure are expected to lead to new prospects in the treatment of facial paralysis.

Adult↗

The trouble with 'quality'.

Much like that elusive but sought-after commodity, beauty, quality lies to a great extent in the eye and mind of its beholder. Whilst some are content with second-hand goods, others insist that only the best will do, the judgement of what is the best being a very individual phenomenon. The mechanical aspects of quality are those things which are visible or tactile: cleanliness, completeness, adequate numbers, smiling faces, quickly answered phones. All of these may be visible and present in a unit which offers a poor quality service. Behind the smiling faces, the efficiently answered phone, may lie a philosophy of total self-centredness, a value system based on clock watching and working strictly within a job description. This person may never give that important small sacrifice which puts another's needs ahead of their own.

Efficiency, Organizational↗

Enhancing cosmetics through regenerative periodontal procedures.

Patients' desire for more esthetic smiles has prompted the development of periodontal regenerative techniques. Case reports of periodontal therapy in the form of subepithelial connective-tissue grafts and socket retention for problems such as deformed ridges, exposed root surfaces and uneven smile lines will be presented in this article.

Alveolar Ridge Augmentation↗

Hershey Foods Corporation: a case study in managed dental care.

Throughout the development and implementation of Health Smile. Hershey Foods has been committed to quality-based health plan options for its employees that serve as the route to cost-effective care. It is known that the company will need to make a short-term investment, rather than have unrealistic expectations of immediate cost savings. However, much of the long-term potential for Hershey Foods rests on the primary dentist's ability to use resources conservatively for the most effective patient outcomes. Health Smile represents Hershey Foods' best effort at forming a partnership relationship between a purchaser, provider, and a patient.

Health Benefit Plans, Employee↗

In vitro action of various carbamide peroxide gel bleaching agents on the microhardness of human enamel.

The authors verified a decrease in human enamel microhardness after application of the following carbamide peroxide gel bleaching agents for 8 hours daily for 1 week: 10% Nite White, 16% Nite White, Opalescence, Karisma Alpha and Perfect Smile. Statistical analysis showed that these agents caused a decrease in enamel microhardness. Nite White (16%) was the most effective in reducing enamel microhardness and Opalescente the least effective. Nite White (10%), Karisma Alpha and Perfect Smile fell into a statistically intermediate position.

Carbamide Peroxide↗

Variability of facial photographs for use in treatment planning for orthodontics and orthognathic surgery.

Facial photographs are commonly used preoperatively for recording and analyzing skeletofacial and dentofacial deformities prior to orthodontics and/or orthognathic surgery. This study was undertaken to determine the reproducibility of facial photographs over time in any individual patient. Twenty subjects had full-facial frontal and lateral, frontal smile, and lip-to-tooth length (incisor show at rest) photographs taken on 5 different days over a 7- to 14-day period. A total of 18 linear and angular measurements were made on each set of photographs. Standard errors of the 18 measurements over time were generally moderate but varied widely, suggesting that facial photographs have the potential to provide reliable diagnostic information in some cases. In any individual patient, however, there were some variations within measurements that were clinically unacceptable. Measurements made from pictures of the smile were significantly less reliable than those taken at rest, and measurements of vertical head posture and lower lip length were found to be the least reliable. This study suggests that some measurements from facial photographs are generally reproducible over time, but significant individual variations do occur.

Adult↗

The esthetics of anterior tooth aging.

As generations proceed to reinvent themselves in an effort to achieve and maintain youth, cosmetic dentistry faces one of its greatest and most persistent challenges: the restoration of an aging smile. Although the need for this restorative therapy has not yet been adequately studied, the momentum continues to build as aging teeth exhibit physical characteristics that affect their function as well as appearance. This review presents the most common factors influencing the esthetics of anterior tooth aging: coloration; wear and the effects of erosion, attrition, abrasion, and abfraction; and position of teeth relative to each other and surrounding tissues. While dental science seeks to understand how well age-specific restorative procedures can affect patients, the question of the necessity of this therapy remains. Should a healthy smile require treatment? Only time will reveal at what cost and to what extent a younger appearance plays a role in dental science.

Adult↗

["Kangaroo method" in the care of premature infants admitted to a neonatal intensive care unit].

OBJECTIVE: More and progressively smaller preterm infants are taken out of the incubator and placed skin-to-skin (kangaroo care) on their mother's chest to promote bonding and breastfeeding. The aim of our study was to know the tolerance to kangaroo care and its security for preterm infants and their mothers, as well as its relationship to breastfeeding. PATIENTS AND METHODS: We studied 445 sessions of 38 stable preterm newborns in our Neonatal Intensive Care Unit (NICU). Their mean birth weight was 1,452 +/- 415 g and gestational age 31.5 +/- 2 weeks (mean +/- SD). The preterm infants, dressed in a diaper and cotton cap, were placed in skin-to-skin contact between their mother's breasts in an upright position and covered with a towel. The kangaroo care duration, temperature, heart rate, respiratory rate, StcO2, and the mother and infant behavioral responses were recorded. During kangaroo care, the preterm infants were nourished by their mother's milk directly by breastfeeding or by intermittent tube feeding, depending on their sucking reflex. The kangaroo care lasted 30-90 minutes, one to eight times a day depending on the availability of the mother. RESULTS: During the kangaroo care, body temperatures, heart rate, respiratory rate and StcO2 remained stable. In the majority of cases, In the majority of cases, the preterm infants showed conduct patterns that indicated good tolerance toward this method, including open hand, sleeping, alert tranquility and even smiles. The breastfeeding sessions were longer than normal because the premature infants alternated short periods of sucking with longer sleep periods. Mothers participated actively looking, talking, touching, smiling and even playing with their preterm infants. CONCLUSIONS: Kangaroo care is a safe and well-accepted method for preterm infants admitted to a NICU and their mothers. Intermittent kangaroo care does not allow for breastfeeding by demand, therefore with the smallest preterm infants, we are obligated to supplement feeding with the mother's milk by tube gavage.

Adult↗

Functional and aesthetic consequences of total platysma resection.

The functional and aesthetic effects of total unilateral platysma resection during ablative surgery is described and outlined for the first time (to our knowledge). The consequences of this resection are analyzed with respect to the partial facial paralysis that is evident. A model describing the dynamics of this paralysis is presented. These data are important in understanding the contribution of the platysma to the smile and the effects of manipulating this muscle during aesthetic and reconstructive neck surgery.

Facial Muscles↗

Temporalis muscle for facial reanimation. A 13-year experience with 224 procedures.

A procedure for temporalis muscle transposition was used to reanimate the paralyzed face in 219 patients. In most cases, facial paralysis had followed an operation to remove an acoustic tumor. Analysis of the results showed this procedure to be highly successful and the method of choice, alone in cases of long-standing facial paralysis or to augment the effects of facial nerve grafting or hypoglossal-facial nerve anastomosis, in reanimating the mouth. It was successful in restoring a smile to 80% of the 219 patients and provided overall improvement in mouth function in 96%. Complications occurred in 21% of patients, with the most common being infection (12% of patients). Since one of us began to use the procedure to reanimate the eye and mouth, results of temporalis muscle transposition have been improved by the following: (1) using the procedure to reanimate the mouth only; (2) performing revision surgery, most often tightening the corner of the mouth (25% of patients), as indicated; (3) transposing only the midsection of the muscle; (4) implanting a prefabricated Silastic prosthesis to fill the muscle defect; (5) when indicated, lengthening the muscle with polytef (Gore-Tex+); and (6) placing the muscle in a tunnel lateral to the superficial musculoaponeurotic system to avoid injuring the underlying facial nerve should some spontaneous recovery of facial nerve function be possible.

Adolescent↗

A congenital contribution to emotional response in early infancy and the preschool period.

Four follow-up studies carried out from the newborn period in three different laboratories have shown that a slow, low-magnitude reaction of the newborn to interruption of sucking is associated in later infancy and the preschool period with the expression of pleasurable emotional response. The basic test of the newborn's response varied slightly in the four studies, but essentially it consisted of establishing a baseline of infant behaviour during 30 to 120 seconds of sucking on a pacifier, then recording amount of (a) bodily activity, (b) crying, (c) the latency to either or both, in the 30- to 135-second period after removal of the nipple. The three aspects of the reaction are consistently intercorrelated, even when allowances are made for artifactual interdependence. Newborns who respond quickly to interruption of sucking also continue to cry and move a lot. Up to the first month a slow, low-magnitude reaction of the newborn is associated with a later low rate of smiling, but beyond the third month there is an inversion and the association is consistently with various manifestations of postive emotional expression.

Age Factors↗

Pre-literate people in New Guinea and Indonesia draw specifically distorted faces, as do 'Western' dyslexics, using a paleo visual-representational mode.

Third World populations with a persisting high percentage of preliterates within individual groups draw specifically distorted patterns of the human face characteristic of 'neolithic art' to a degree negatively correlated with the accessibility of reading instruction. A subgroup of 'Western' dyslexic youths also draw these distorted face patterns, which, moreover, facilitate infants 'smiling response'. These findings suggest the persistence of a developmentally early visual representational mode which proceeds in a global way, disregarding differences in characterizing details, whether of face patterns or of lexical symbols.

Adolescent↗

Galea and subgalea graft for lip augmentation revision.

In this paper we will review the results obtained during the last 2 years with the aponeurotic galea and subgalea for vermillion lip augmentation. The survey was carried out on 42 patients who displayed either an absence of or reduction in the vermillion of one or both lips or a senile lip. In all cases the surgical procedure introduced aponeurotic galea and subgalea in the space found between the orbicular lip muscle and the vestibular mucus, just behind the vermillion. All the operations were performed under local anaesthetic. The size of the aponeurotic galea fragment removed varied in length between 10 and 12 cms. and in width between 1 and 2 cms., using the following parameters for its dimensions: the previous volume of the lips, and the distance between the two buccal commissures when in the "smile position."

Adult↗