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OBJECTIVES: To quantify the associations between sociodemographic factors and oral health-related quality of life (OHRQoL) in dentate and edentulous community-dwelling older adults. DESIGN: Cross-sectional study using a 54-item OHRQoL questionnaire. SETTING: Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Hale, Bibb, and Pickens (rural). PARTICIPANTS: Two hundred eighty-eight participants (Dental Study subjects) aged 65 and older were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in older African Americans and non-Hispanic whites. MEASUREMENTS: Dental Study subjects were queried on their OHRQoL and sociodemographic status and classified into two categories: dentate and edentulous. Bivariate analyses were used to quantify associations between sociodemographic variables and OHRQoL after excluding participants with severe depression. Variables included age, sex, race, marital status, veteran status, residence, income, education, and transportation difficulties. RESULTS: Dentate and edentulous subjects had similar OHRQoL across age, sex, marital status, veteran status, and residence. Analyses suggested a strong association between OHRQoL and race, education, income, and transportation difficulties in dentate subjects. Sociodemographic factors were less strongly associated with OHRQoL in edentulous participants. CONCLUSION: OHRQoL decrements were prevalent in dentate and edentulous subjects. Of dentate persons, African Americans and those with a 6th-grade education or less, with income less than 16,000 dollars/year, and with transportation difficulties were more likely to have decrements in OHRQoL. In edentulous persons, these associations were not statistically significant or were weaker. These findings suggest differential associations between sociodemographic factors and OHRQoL when stratified according to dentate status. [ABSTRACT FROM AUTHOR]

We examined gender differences in frequency and sociodemographic predictors of spousal, non-spousal family, and friendship bereavement events among community-dwelling older adults using data from the UAB Study of Aging. Analysis involved a 30-month observation period of 893 subjects. There were significant differences between women and men for all types of loss. Significant differences were also found in the sociodemographic predictors of loss between and within gender categories. This study revealed the extent to which older women disproportionately bear the burden of loss and points to the need for greater attention to bereavement as a women's issue. [ABSTRACT FROM AUTHOR]

We examined the prevalence and correlates of recent nonspousal family loss among older adults using data from the University of Alabama at Birmingham Study of Aging, a stratified random sample of community-dwelling older adults living in central Alabama. Twenty-three percent of participants reported a recent nonspousal family loss. African American ethnicity, education <12th grade, functional difficulty, restricted life-space mobility, depressive symptomology, pain and other somatic symptoms were associated with recent nonspousal family loss. Compared to non-widowed participants, widows with family loss reported a higher proportion of mental health and activity-limiting physical problems as well as restricted life-space. Programs to improve physical function and enhance health and wellbeing in older bereaved spouses should be expanded to include older adults with nonspousal family loss, particularly targeting the mental health needs of previously widowed persons who lose another family member. [ABSTRACT FROM AUTHOR]

This research examined the extent to which religiosity was predictive of level of depression, even after controlling for race, gender, social support, income sufficiency, and physical health. Data were collected using in-home interviews conducted from 1999 to 2001 with 1,000 adults age 65 to 106. Subjects were recruited from a stratified, random sample of Medicare beneficiaries age 65 and older in five central Alabama counties (three rural and two urban). The sample was stratified by county, race, and sex and included balanced numbers of African American males and females and White males and females. Highly religious persons had lower levels of depression, even when controlling for other known covariates, beta = -.16, t(972) p<.001. Females reported higher levels of depression, beta = .07, t(972) p<.05. Although race was unrelated to depression in the model including gender and religiosity only, African Americans reported fewer symptoms of depression than did Whites when social support, income sufficiency, and physical health were added to the model, beta = -.08, t(972) p<.01. Results suggest the importance of health and social service professionals' drawing upon older adults' positive spirituality in professional interventions to prevent and treat depression. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate the validity and reliability of a standardized approach for assessing life-space mobility (the University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA)) and its ability to detect changes in life-space over time in community-dwelling older adults. DESIGN: Prospective, observational cohort study. SETTING: Five counties (three rural and two urban) in central Alabama. PARTICIPANTS: Community-dwelling Medicare beneficiaries (N=306; 46% male, 43% African American) who completed in-home baseline interviews and 2-week and 6-month telephone follow-up interviews. MEASUREMENTS: The LSA assessed the range, independence, and frequency of movement over the 4 weeks preceding assessments. Correlations between the baseline LSA and measures of physical and mental health (physical performance, activities of daily living, instrumental activities of daily living, a global measure of health (the short form-12 question survey), the Geriatric Depression Scale, and comorbidities) established validity. Follow-up LSA scores established short-term test-retest reliability and the ability of the LSA to detect change. RESULTS: For all LSA scoring methods, baseline and 2-week follow-up LSA correlations were greater than 0.86 (95% confidence interval=0.82-0.97). Highest correlations with measures of physical performance and function were noted for the LSA scoring method considering all attributes of mobility. The LSA showed both increases and decreases at 6 months. DISCUSSION: Life-space correlated with observed physical performance and self-reported function. It was stable over a 2-week period yet showed changes at 6 months. [ABSTRACT FROM AUTHOR]

Mobility represents a critical component in the functional and disability assessment of older adults because it is related significantly to the maintenance of elder autonomy and independence. The authors' primary purposes are to raise the consciousness of geriatric social workers about the need to consider mobility as an important aspect of older persons' lives in the context of their environment, and to describe the application of a new strategy of mobility assessment that complements existing methods. First, an overview of the literature is provided that emphasizes the clinical relevance of mobility within the context of functional and disability assessment. Second, an application of the Life-Space Mobility Assessment (LSMA) with seniors is described as complementing the more traditional but less precise and sensitive methods of functional assessments typically used by social workers and other health care practitioners. Theoretical links to person-in-environment and ecology models are reviewed, and the implications for training, practice and research for social workers are discussed. [ABSTRACT FROM AUTHOR]

A method for digital fabrication of an implant-supported soft tissue graft stent to protect, shape, and ensure intimate adaptation of the complete arch graft to the periosteum surrounding dental implants is described. To fabricate the stent, an extraoral scanner was used to convert the implant cast into digital data. Dental design software was then used to fabricate the stent, which is produced by 3-dimensional (3D) printing. Due to the lack of long-term biocompatible 3D printing material, the stent was duplicated in bisacryl resin. The patient reported more comfort and stability with the implant-supported stent than the conventional stent received following a previous debulking surgical procedure., (Copyright © 2018 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Toll-like receptor 5 (TLR5) is considered an attractive target for anticancer immunotherapy. TLR5 agonists, bacterial flagellin and engineered flagellin derivatives, have been shown to have potent antitumor and metastasis-suppressive effects in multiple animal models and to be safe in both animals and humans. Anticancer efficacy of TLR5 agonists stems from TLR5-dependent activation of nuclear factor-κB (NF-κB) that mediates innate and adaptive antitumor immune responses. To extend application of TLR5-targeted anticancer immunotherapy to tumors that do not naturally express TLR5, we created an adenovirus-based vector for intratumor delivery, named Mobilan that drives expression of self-activating TLR5 signaling cassette comprising of human TLR5 and a secreted derivative of Salmonella flagellin structurally analogous to a clinical stage TLR5 agonist, entolimod. Co-expression of TLR5 receptor and agonist in Mobilan-infected cells established an autocrine/paracrine TLR5 signaling loop resulting in constitutive activation of NF-κB both in vitro and in vivo. Injection of Mobilan into primary tumors of the prostate cancer-prone transgenic adenocarcinoma of the mouse prostate (TRAMP) mice resulted in a strong induction of multiple genes involved in inflammatory responses and mobilization of innate immune cells into the tumors including neutrophils and NK cells and suppressed tumor progression. Intratumoral injection of Mobilan into subcutaneously growing syngeneic prostate tumors in immunocompetent hosts improved animal survival after surgical resection of the tumors, by suppression of tumor metastasis. In addition, vaccination of mice with irradiated Mobilan-transduced prostate tumor cells protected mice against subsequent tumor challenge. These results provide proof-of-concept for Mobilan as a tool for antitumor vaccination that directs TLR5-mediated immune response toward cancer cells and does not require identification of tumor antigens.

shRNA-mediated gene-silencing technology paired with cell-based functional readouts reveals potential targets directly, providing an opportunity to identify drugs against the target without knowing the precise role of the target in the pathophysiological processes of interest. By screening a lentiviral shRNA library targeting for major components of human signaling pathways and known drug targets, we identified and validated both canonical as well as 52 novel mediators of FAS and TNF ligand-induced apoptosis. Presence of potential therapeutic targets among these mediators was confirmed by demonstration of in vivo activity of siRNAs against four identified target candidates that protected mice from acute liver failure (ALF), a life-threatening disease with known involvement of death receptor (DR)-mediated apoptosis. Network-based modeling was used to predict small-molecule inhibitors for several candidate apoptosis mediators, including somatostatin receptor 5 (SSTR5) and a regulatory subunit of PP2A phosphatase, PPP2R5A. Remarkably, pharmacological inhibition of either SSTR5 or PPP2R5A reduced apoptosis induced by either FASL or TNF in cultured cells and dramatically improved survival in several mouse models of ALF. These results demonstrate the utility of loss-of-function genetic screens and network-based drug-repositioning methods for expedited identification of targeted drug candidates and revealed pharmacological agents potentially suitable for treatment of DR-mediated pathologies.

Patient gagging is a common problem during dental procedures such as maxillary impression making. This clinical report describes the use of a chairside intraoral scanner for a patient with a hypersensitive gag reflex. The technique proved to be a more comfortable alternative for the patient and an accurate method for the clinician to capture both hard and soft tissue detail for the fabrication of a definitive obturator., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Interdisciplinary treatment planning is an essential part of orthodontic therapy for patients with partial edentulism, especially when dental implants are to serve initially as anchorage and ultimately as prosthetic abutments for the definitive fixed restoration. A technique is presented for designing and fabricating a computed tomography-based surgical guide to place definitive implants before orthodontic therapy. First, the diagnostic cast and the orthodontic tooth arrangement and diagnostic waxing cast are scanned with a 3-dimensional optical scanner. Three-dimensional renderings of these scans are then merged and superimposed onto the cone beam computed tomography (CBCT) image with implant planning software to develop definitive implant positions. A custom surgical guide is fabricated from these data., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Purpose: To describe a series of 4 patients with Waldenström macroglobulinemia and serous macular detachment, and propose a mechanism for development of subretinal fluid based on optical coherence tomography (OCT) findings., Design: Retrospective observational case series., Methods: The records of patients with Waldenström macroglobulinemia and OCT documentation of serous macular detachment at Wills Eye Institute were reviewed. Data collection included clinical examination, as well as findings on fluorescein angiography (FA) and OCT., Results: Four patients (8 eyes) with Waldenström macroglobulinemia and serous retinal detachment were identified. All eyes had varying degrees of venous stasis retinopathy and intraretinal edema overlying the macular detachment. Three patients had no FA leakage, while 1 patient had macular leakage in a petaloid pattern. Focal outer retinal defects within the detached retina were seen in 4 eyes on OCT imaging. In one eye, development of cystoid macular edema was observed before the outer retinal defect and serous macular detachment. All patients with serous macular detachment had some degree of outer retinal disruption., Conclusion: Discontinuity of the outer retina within the macular detachment may enable immunoglobulins along with accumulated intraretinal fluid to flow into the subretinal space, creating a serous retinal detachment. Even with systemic treatment of the underlying Waldenström macroglobulinemia, the visual prognosis was guarded., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The purpose of this article is to describe the adaptation of a method suggested for prevention of fractures of partial removable dental prostheses to the reinforcement of an existing implant-retained fixed complete dental prosthesis (IRFCDP). The patient, an upper limb amputee, had subjected the original IRFCDP to parafunctional forces generated from use as a replacement hand in a compensatory technique commonly taught in rehabilitation. Advantages of the technique are that it provides an alternative to remaking the entire prosthesis, which was otherwise satisfactory; it adapts to a variety of situations involving anterior tooth reinforcement; and it offers a potential solution to anterior prosthetic tooth damage caused by other types of parafunction. It may also be adaptable to the reinforcement of other types of prostheses. A disadvantage is the possible need to provide a new interim prosthesis or modify an existing one while laboratory repair procedures are completed. Following reinforcement of the IRFCDP, no tooth damage was evident after one year of use. (J Prosthet Dent 2012;107:343-345)., (Copyright © 2012 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Purpose: To report 10 cases of occult choroidal neovascularization (CNV) associated with choroidal nevus managed with intravitreal bevacizumab., Methods: Interventional case series. Each nevus was examined and imaged with fluorescein angiography, B-scan ultrasonography, and optical coherence tomography. Data were retrospectively analyzed to evaluate outcomes of treatment response and visual acuity., Results: Nine patients presented with CNV overlying a chronic choroidal nevus with a posterior margin within 1.5 mm of the foveola. In the 10th patient, the posterior margin of the nevus was located 10 mm from the foveola with extension of subretinal fluid into the macula. The CNV was subfoveolar in four cases, juxtafoveolar in two cases, and extrafoveolar in four cases. Initial visual acuity was 20/20 to 20/50 in 5, 20/60 to 20/100 in 2, and 20/200 or worse in 3 cases. Clinical features included subfoveolar fluid in nine, exudation in five, and hemorrhage in four cases. Intravitreal bevacizumab (1.25 mg/0.05 cc) was injected with regression of CNV in all 10 cases using 2 to 14 injections (median 3 injections). In 2 eyes, after therapeutic response to bevacizumab later consolidation with photodynamic therapy (juxtafoveolar CNV) (n = 1) or conventional laser (extrafoveolar CNV) (n = 1) was provided. In the remaining 8 eyes, after discontinuation of bevacizumab, there was no recurrence of CNV over mean 10.1 months. At overall mean follow-up of 22.5 months, final visual acuity decreased by 1 line in 4 cases and improved by mean of 3 lines (range, 1-8 lines) in 6 cases. There were no adverse effects from bevacizumab injections. All 10 choroidal nevi remained stable., Conclusion: Intravitreal bevacizumab appears to be an effective treatment option for CNV secondary to choroidal nevus. In some cases, depending on the proximity of the CNV to the foveola, photodynamic therapy or conventional laser may be useful adjunctive therapy.

Bacterial lipoproteins (BLP) induce innate immune responses in mammals by activating heterodimeric receptor complexes containing Toll-like receptor 2 (TLR2). TLR2 signaling results in nuclear factor-kappaB (NF-κB)-dependent upregulation of anti-apoptotic factors, anti-oxidants and cytokines, all of which have been implicated in radiation protection. Here we demonstrate that synthetic lipopeptides (sLP) that mimic the structure of naturally occurring mycoplasmal BLP significantly increase mouse survival following lethal total body irradiation (TBI) when administered between 48 hours before and 24 hours after irradiation. The TBI dose ranges against which sLP are effective indicate that sLP primarily impact the hematopoietic (HP) component of acute radiation syndrome. Indeed, sLP treatment accelerated recovery of bone marrow (BM) and spleen cellularity and ameliorated thrombocytopenia of irradiated mice. sLP did not improve survival of irradiated TLR2-knockout mice, confirming that sLP-mediated radioprotection requires TLR2. However, sLP was radioprotective in chimeric mice containing TLR2-null BM on a wild type background, indicating that radioprotection of the HP system by sLP is, at least in part, indirect and initiated in non-BM cells. sLP injection resulted in strong transient induction of multiple cytokines with known roles in hematopoiesis, including granulocyte colony-stimulating factor (G-CSF), keratinocyte chemoattractant (KC) and interleukin-6 (IL-6). sLP-induced cytokines, particularly G-CSF, are likely mediators of the radioprotective/mitigative activity of sLP. This study illustrates the strong potential of LP-based TLR2 agonists for anti-radiation prophylaxis and therapy in defense and medical scenarios.

The origin of chronic inflammation preceding the development of prostate cancer (PCa) remains unknown. We investigated possible involvement of mycoplasma infection in PCa by screening prostate biopsies from two groups of Russian men undergoing PCa diagnosis. M. hominis was detected by standard PCR in 15% of the 125 patients in the first group and by quantitative real-time PCR in 37.4% of the 123 men in the second group. In both groups, stratification of patients according to diagnosis showed that M. hominis was present at three times higher frequency in patients with PCa than in those with benign prostatic hyperplasia. No M. hominis was detected in the prostates of 27 men without detectable prostate disease. In addition, PCa-positive men had higher titers of antibodies against M. hominis and average PSA levels were higher in M. hominis-positive men. These data, together with previous observations linking mycoplasma infection with cell transformation, genomic instability and resistance to apoptosis, suggest that M. hominis infection may be involved in PCa development and may, therefore, be a potential PCa marker and/or target for improved prevention and treatment of this disease.

Statement of Problem: When making complete dentures, clinicians may have difficulty with selection of properly sized denture teeth., Purpose: The purpose of this study was to determine if there are specific measurements made on an edentulous cast that could be useful to clinicians for selection of proper maxillary anterior denture tooth width., Material and Methods: Following Institutional Review Board approval, measurements were made on 50 maxillary and mandibular sets of complete denture casts and their marked and contoured occlusion rims and record bases consecutively submitted to a dental laboratory. The following 6 measurements were recorded for each set of casts: left mid-maxillary to right mid-maxillary, representing the distance between the respective residual ridge crest points adjacent to each canine eminence; left retromolar pad to right retromolar pad; incisive papilla to left hamular notch; incisive papilla to right hamular notch; left hamular notch to right hamular notch; and incisive papilla to vibrating line. These measurements were statistically compared with the control, the canine-to-canine distance as marked on the contoured maxillary occlusion rim to indicate the relaxed commissures. The casts were also classified as small, medium or large based upon the tooth width specified by the commercial mold guide for their respective canine-to-canine control measurement. The estimation bias was determined for each of the 6 measurements, and for those measurements for which the bias was significantly different from zero, a bias-correction was applied. St. Laurent's coefficient was used to describe the agreement between each (bias-corrected) measurement and the canine-to-canine control. A commercial guide was used to determine the accuracy of each of the 6 bias-corrected measurements in classifying denture teeth width as small, medium or large as compared to the same classification using the canine-to-canine control., Results: The bias-corrected measurement from the left hamular notch mark to the right hamular notch mark, obtained by adding 10 mm, exhibited the greatest degree of agreement with the control. This measurement was also the only one of the 6 that correctly classified more than 50% of both the medium and large casts. None of the 6 measurements classified more than 30% of the small casts correctly., Conclusions: Of the 6 measurements considered here, the bias-corrected measurement from left hamular notch mark to right hamular notch mark was preferred for selecting denture teeth width., (Copyright © 2011 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Background and Objective: To evaluate ranibizumab for exudative age-related macular degeneration previously treated with pegaptanib, bevacizumab, or both., Patients and Methods: This was a retrospective, interventional case series of patients with exudative age-related macular degeneration who were treated with ranibizumab after being initially treated with pegaptanib, bevacizumab, or both. The primary outcome was change in visual acuity following the switch to ranibizumab., Results: One hundred two eyes of 92 patients were identified. Following the switch to ranibizumab, there was an average gain of 0.7 lines in visual acuity. Ninety-four eyes (92%) lost 3 or fewer lines, 29 eyes (28%) gained more than 3 lines, and 3 eyes (3%) lost more than 6 lines after switching to ranibizumab. Lesion type and time between previous vascular endothelial growth factor inhibitor and ranibizumab did not affect the response., Conclusion: Ranibizumab maintained visual acuity in the majority of patients and appears to be an effective treatment regardless of previous anti-vascular endothelial growth factor therapy., (Copyright 2010, SLACK Incorporated.)

Background and Objective: To report foveal optical coherence tomography (OCT) findings in patients with a history of retinopathy of prematurity (ROP)., Patients and Methods: In a case-control study, OCT imaging of the fovea was performed on mostly adult patients with a history of ROP and no significant macular pathology. The same OCT imaging was performed on control subjects who were born full-term., Results: Fourteen eyes of 12 patients with ROP were studied. Mean age was 39 years and mean gestational age at birth was 28 weeks. Of the 11 eyes with no cataract or pseudophakia, median best-corrected visual acuity was 20/40. Three eyes with cataracts had visual acuities of 20/50, 20/60, and 20/100. OCT imaging showed that eyes in the ROP group had a relative loss of the foveal depression, increased macular thickness, and continuation of inner retinal layers within the fovea., Conclusion: OCT imaging demonstrated abnormal foveal architecture in patients with a history of ROP, but most of these patients maintained good visual acuity., (Copyright 2010, SLACK Incorporated.)

Purpose: To describe a case of West African crystalline maculopathy and the optical coherence tomography (OCT) findings., Methods: A 47-year-old West African woman presented with bilateral yellow-green refractile crystals clustered in the fovea. She had proliferative diabetic retinopathy and a long history of chewing kola nuts. Given her history and clinical examination findings, a diagnosis of West African crystalline maculopathy was made., Results: OCT revealed that the foveal crystals were located in the innermost layers of the retina., Conclusions: OCT findings, along with history and examination, can be helpful in confirming the diagnosis of West African crystalline maculopathy.

Purpose: To describe a series of 3 immunocompetent patients with the sporadic form of orbital Burkitt lymphoma and review the outcomes of such patients reported in the scientific literature., Methods: Retrospective review of medical records and the literature. Cases of orbital Burkitt lymphoma in immunocompromised and African patients were excluded from the review. Measured parameters included gender, age, ocular signs, imaging results, the range of systemic involvement, and treatment., Results: Current cases and review of the scientific literature resulted in 16 immunocompetent patients with sporadic orbital Burkitt lymphoma. The median age at presentation was 12 years. Most common ocular signs at presentation were proptosis (13/16), external ophthalmoplegia (9/16), and eyelid edema (7/16). Optic neuropathy was noted in 5 of 16 patients. Concomitant paranasal sinus involvement was present in 8 of 16 patients. Fourteen (88%) of the patients had systemic involvement, of which the most common locations were central nervous system (6/16), lymphatics (6/16), bone marrow (6/16), and liver (4/16). Survival data were available for 13 patients. Seven patients (54%) died within 12 months of presentation., Conclusions: Sporadic orbital Burkitt lymphoma occurs in immunocompetent individuals with a wide age range. Fifty percent presented with adjacent paranasal sinus involvement. Concurrent or eventual systemic involvement is common. The large number of patients with central nervous system involvement in our review of the literature supports the role of lumbar puncture and neuroimaging in the workup of all patients with orbital Burkitt lymphoma. Prognosis remains guarded, with significant mortality within 1 year of presentation.

Purpose: To evaluate myopia in adults with retinopathy of prematurity (ROP)., Design: Observational case series., Methods: Axial length (AL), corneal radius (CR), and AL/CR ratio were measured in myopic adults with ROP using ultrasound A-scan biometry and keratometry, respectively., Results: Twenty-five eyes of 18 patients (mean age, 48 years) were studied. Mean gestational age at birth was 29 weeks. The average refraction was -5.23 diopters, AL 24.43 mm, CR 7.45 mm, and AL/CR ratio 3.28. On average, myopic adults with ROP had a shorter AL and decreased CR (increased corneal curvature), but a similar AL/CR ratio, relative to adults with the same degree of myopia who were born full-term. Myopic adults with ROP also had increased lens thickness (LT) and shallow anterior chamber depth (ACD)., Conclusions: Myopic adults with ROP had a shorter AL and smaller CR than expected for their degree of myopia. However, AL/CR ratios for these patients were similar to the values of adults who were born full-term. These results suggest that the refractive element most responsible for myopia in adults with ROP is higher corneal curvature (decreased CR), whereas the predominant factor in adult myopic individuals who were born full-term is increased AL. We believe that increased LT and shallow ACD make a lesser contribution to myopia in adults with ROP.

This article describes a method of in-office fabrication of an occlusal device for treatment of bruxism patients seeking a less costly alternative to laboratory-processed splints. This technique eliminates the need for mounted casts and the expense and delay associated with commercial laboratory involvement. It also minimizes patient and operator exposure to acrylic resin monomer and high temperatures associated with its polymerization reaction by use of a light-polymerized blue urethane dimethacrylate resin.

As an adjunct to infection control in dental impression procedures, several manufacturers have incorporated disinfectants into irreversible hydrocolloid impression materials. However, these compounds have been shown to be tissue irritants and capable of producing allergic reactions. An anonymous, self-administered questionnaire was distributed to 56 second-year dental students who had used an irreversible hydrocolloid containing a quaternary ammonium compound as an antimicrobial (Jeltrate Plus) to make impressions during a summer preclinical occlusion course. Within the limitations of this report, the incorporation of a quaternary ammonium compound into an irreversible hydrocolloid impression material resulted in a greater incidence of dermal and mucosal irritation.

Objectives: To determine prevalence and correlates of fecal incontinence in older community-dwelling adults., Design: A cross-sectional, population-based survey., Setting: Participants interviewed at home in three rural and two urban counties in Alabama from 1999 to 2001., Participants: The University of Alabama at Birmingham Study of Aging enlisted 1,000 participants from the state Medicare beneficiary lists. The sample was selected to include 25% black men, 25% white men, 25% black women, and 25% white women., Measurements: The survey included sociodemographic information, medical conditions, health behaviors, life-space assessment (mobility), and self-reported health status. Fecal incontinence was defined as an affirmative response to the question "In the past year, have you had any loss of control of your bowels, even a small amount that stained the underwear?" Severity was classified as mild if reported less than once a month and moderate to severe if reported once a month or greater., Results: The prevalence of fecal incontinence in the sample was 12.0% (12.4% in men, 11.6% in women; P=.33). Mean age+/-standard deviation was 75.3+/-6.7 and ranged from 65 to 106. In a forward stepwise logistic regression analysis, the following factors were significantly associated with the presence of fecal incontinence in women: chronic diarrhea (odds ratio (OR)=4.55, 95% confidence interval (CI)=2.03-10.20), urinary incontinence (OR=2.65, 95% CI=1.34-5.25), hysterectomy with ovary removal (OR=1.93, 95% CI=1.06-3.54), poor self-perceived health status (OR=1.88, 95% CI=1.01-3.50), and higher Charlson comorbidity score (OR=1.29, 95% CI=1.07-1.55). The following factors were significantly associated with fecal incontinence in men: chronic diarrhea (OR=6.08, 95% CI=2.29-16.16), swelling in the feet and legs (OR=3.49, 95% CI=1.80-6.76), transient ischemic attack/ministroke (OR=3.11, 95% CI=1.30-7.41), Geriatric Depression Scale score greater than 5 (OR=2.83, 95% CI=1.27-6.28), living alone (OR=2.38, 95% CI=1.23-4.62), prostate disease (OR=2.29, 95% CI=1.04-5.02), and poor self-perceived health (OR=2.18, 95% CI=1.13-4.20). The following were found to be associated with increased frequency of fecal incontinence in women: chronic diarrhea (OR=6.39, 95% CI=2.25-18.14), poor self-perceived health (OR=5.37, 95% CI=1.75-16.55), and urinary incontinence (OR=4.96, 95% CI=1.41-17.43). In men, chronic diarrhea (OR=5.38, 95% CI=1.77-16.30), poor self-perceived health (OR=3.91, 95% CI=1.39-11.02), lower extremity swelling (OR=2.86, 95% CI=1.20-6.81), and decreased assisted life-space mobility (OR=0.73, 95% CI=0.49-0.80) were associated with more frequent fecal incontinence., Conclusion: In community-dwelling older adults, fecal incontinence is a common condition associated with chronic diarrhea, multiple health problems, and poor self-perceived health. Fecal incontinence should be included in the review of systems for older patients.

This study examines the relationships that exist between social isolation, support, and capital and nutritional risk in older black and white women and men. The paper reports on 1000 community-dwelling older adults aged 65 and older enrolled in the University of Alabama at Birmingham (UAB) Study of Aging, a longitudinal observational study of mobility among older black and white participants in the USA. Black women were at greatest nutritional risk; and black women and men were the groups most likely to be socially isolated and to possess the least amounts of social support and social capital. For all ethnic-gender groups, greater restriction in independent life-space (an indicator of social isolation) was associated with increased nutritional risk. For black women and white men, not having adequate transportation (also an indicator of social isolation) was associated with increased nutritional risk. Additionally, for black and white women and white men, lower income was associated with increased nutritional risk. For white women only, the perception of a low level of social support was associated with increased nutritional risk. For black men, not being married (an indicator of social support) and not attending religious services regularly, restricting activities for fear of being attacked, and perceived discrimination (indicators of social capital) were associated with increased nutritional risk. Black females had the greatest risk of poor nutritional health, however more indicators of social isolation, support, and capital were associated with nutritional risk for black men. Additionally, the indicators of social support and capital adversely affecting nutritional risk for black men differed from those associated with nutritional risk in other ethnic-gender groups. This research has implications for nutritional policies directed towards older adults.

Statement of Problem: A variety of treatment philosophies persist concerning the need for coincidence of centric occlusion (CO) and maximum intercuspation (MI) in prosthodontic restoration; however, no consensus exists., Purpose: The purpose of this study was to determine the philosophies of dental educators throughout the United States at both the predoctoral and postdoctoral levels and to compare their attitudes toward desirable maxillomandibular relationships in defined clinical situations., Material and Methods: A survey was constructed with 5 clinical scenarios presented describing patients with a difference between maximum intercuspation and centric occlusion. The survey was mailed to 171 dentists involved in either predoctoral or postdoctoral dental programs in the United States; including 56 dental schools; the Army, Navy, and Air Force postdoctoral programs; 8 Department of Veterans Affairs postdoctoral programs; and 7 hospital-based programs. Descriptive statistics of the responses were provided. Chi-squared (alpha=.05) and Fisher's exact test analyses (alpha=.05) comparing predoctoral and postdoctoral program responses for each question were performed., Results: Forty-three predoctoral dental school program responses were received. Forty-one postdoctoral program directors, including the dental school-based programs, 3 armed service branches, 2 Veterans Administration programs, and 1 hospital-based program responded to the survey. Fifteen respondents indicated that they represented both predoctoral and postdoctoral programs, and these data were deleted from the sample. Summarized results for each question reflect on whether the clinicians philosophically believed patients were better off with the elimination of an existing occlusal interference between MI and CO or not. There was no statistically significant difference seen between the predoctoral and postdoctoral responses., Conclusion: The controversy regarding the preferred mandibular position for treatment of dentulous and partially edentulous patients continues among dental educators at both the predoctoral and postdoctoral levels in the United States.

Objectives: To define racial similarities and differences in mobility among community-dwelling older adults and to identify predictors of mobility change., Design: Prospective, observational, cohort study., Participants: Nine hundred and five community-dwelling older adults., Measures: Baseline in-home assessments were conducted to assess life-space mobility, sociodemographic variables, disease status, geriatric syndromes, neuropsychological factors, and health behaviors. Disease reports were verified by review of medications, physician questionnaires, or hospital discharge summaries. Telephone interviews defined follow-up life-space mobility at 18 months of follow-up., Results: African Americans had lower baseline life-space (LS-C) than whites (mean 57.0 +/- standard deviation [SD] 24.5 vs. 72.7 +/- SD 22.6; P < .001). This disparity in mobility was accompanied by significant racial differences in socioeconomic and health status. After 18 months of follow-up, African Americans were less likely to show declines in LS-C than whites. Multivariate analyses showed racial differences in the relative importance and strength of the associations between predictors and LS-C change. Age and diabetes were significant predictors of LS-C decline for both African Americans and whites. Transportation difficulty, kidney disease, dementia, and Parkinson's disease were significant for African Americans, while low education, arthritis/gout, stroke, neuropathy, depression, and poor appetite were significant for whites., Conclusions: There are significant disparities in baseline mobility between older African Americans and whites, but declines were more likely in whites. Improving transportation access and diabetes care may be important targets for enhancing mobility and reducing racial disparities in mobility.

Patients with limited mouth opening are a common occurrence in prosthodontic practice. The majority of these patients can be treated with exercise and stretching movements before impressions are made. Some will not respond to these procedures because of facial scarring and surgical manipulation of the facial muscles. This article presents an impression procedure for overcoming such reduced mouth opening.

Subpontic osseous hyperplasia has been portrayed in both the historical and the current literature as occurring exclusively in the mandibular posterior region. This article presents the clinical, radiologic, and microscopic documentation of subpontic osseous hyperplasia occurring in the maxillary first molar region.

This article describes a modified light-curing method that minimizes wax spacer heating and distortion. In addition, this method eliminates the need for tinfoil adaptation or use of a coating to make an air barrier in the fabrication of light-cured custom trays for removable prosthodontics.

Bonding to dentin and enamel has increased restorative treatment options, provided the materials are used to optimum advantage. Restorative dentists must understand the indications and the proper mechanisms for using these materials. As with many techniques and procedures, it takes more time to describe than to accomplish. The tooth-conditioning and cementing steps are standard treatment procedures used daily in most dental offices. Tin-plating and preparing the metal surface are laboratory procedures and consume no chair time. The clinical advantages of bonding--such as resistance to microleakage and recurring decay, enhanced retention, preservation of tooth structure, and extended restoration prognosis--far outweigh the modest increase in placement time.

This work compared the tensile strength of two glass compositions with published values of currently available dental porcelains. The influence of several variables, such as air and vacuum firing, firing temperature, surface roughness, immersion in water, and the inclusion of filler particles, on the inherent strength of the glass compositions is also discussed. The authors developed a glass frit having a tensile strength of 102.4 MPa as determined by the biaxial flexure technique. This value compares favorably with the reported strength of commercial brands of feldspathic porcelains. The strength of this glass was not significantly reduced as a result of surface abrasion or immersion in distilled water.

Awareness of the need to incorporate an effective infection control program within a prosthodontic practice requires the faculty of a prosthodontic residency program to present a clear and workable model that will allow the flexibility necessary to accommodate the changes in infection control procedures and materials. The use of the barrier system to insulate the operatory, resident, faculty, and dental laboratory is discussed. Current disinfection and sterilization methods used to maintain the barriers are recommended.

This technique allows construction of a detachable custom tray by the dental laboratory before the distal extension RPD framework is returned to the dentist. This permits a framework try-in with unencumbered physiologic relief, rapid attachment of the custom tray, subsequent impression making, and possibly jaw relation records all in one patient visit.

This study evaluated the positional accuracy of dies with four die tray systems. The die trays were: (1) Accu*trac Precision die system, (2) Model-Tray system, (3) Sterdo Split model tray, and (4) Tricodent One*Cast die tray system. Positional change of the dies was measured by using an Olympus binocular scanning tunneling microscope (STM). Positional change of the dies was the difference between preremoval and postremoval die position. Results show that all four die tray systems are not significantly different in most measurement categories, although the Model-Tray system was significantly different from the other die tray systems in one measurement category.