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Item does not contain fulltext The methodology for the assessment of a negative or positive test in caries prediction models has not received much attention. This study aims to explain how utility technology could be applied in a caries prediction model for the assessment of the cut-off between a negative and a positive test. In this study loss of utilities was assigned to false outcomes of the prediction test. A regression equation with past caries experience variables of 11-year-old children and caries increment in the 11- to 15-year forecast period as outcome was computed. The adjusted explained variance for caries increment was 0.45. Formulas were constructed for the loss of utilities for false-negative tests whereas false-positive tests were corrected with a fixed loss of utilities. Each 11-year-old child of the 252 children was screened at various points of the regression equation. Loss of utilities was calculated for each child on the basis of the validation criterion, the outcome of the test and the actual caries increment of the child. The point on the regression equation with the least loss of utilities for the whole group was taken as the cut-off between a negative and a positive test. If the validation criterion for the prediction period was set on no caries, the prediction model resulted in a sensitivity of 84% and a specificity of 73%. This prediction model has potential when caries incidence is low and resources limited.

Contains fulltext : 51770.pdf (Publisher’s version ) (Closed access) OBJECTIVES: To describe the provision of restorative care and dental operators' opinion about their conditions of service in a South African provincial oral health service system. DESIGN: Assessment of oral health service over a four-month period. SETTING: Gauteng Province, South Africa. SUBJECTS: Dental operators in public oral health service. INTERVENTIONS: Operator interview, collection of treatment statistics, calculation of the mean score of restoration-extraction ratio per operator. MAIN OUTCOME MEASURES: Number and type of restorations and tooth extractions rendered, daily patient load, perceived occupational stress level and opinion about main reasons for operator stress. RESULTS: A total of 88,705 patients had been treated. The mean number of patients treated daily was 26 (SD = 8.4). Operators extracted 39,242 teeth and placed 2992 restorations. The main type of dental treatment was extraction. The mean score of the restoration-extraction ratio per operator was 0.09 in the primary, and 0.07 in the permanent dentition. The mean level of stress was 4.9 (SD = 1.9). The majority of operators regarded patients' high dental anxiety as the main reason for stress, followed by high patient load. The mean level of stress increased with the increase in number of patients treated per day (r = 0.44, p = 0.004) and also with the increase in the number of tooth extractions performed per day (r = 0.41, p = 0.008). CONCLUSIONS: Restorative dental care in this public oral health service is limited, tooth extraction being the predominant treatment provided. High patient load and high patient levels of dental anxiety determine this situation, according to the operators. The health authority should introduce appropriate solutions in order to address the prevailing situation adequately.

Contains fulltext : 50107.pdf (Publisher’s version ) (Closed access) Evidence regarding the caries-inhibiting effect of chlorhexidine varnish is inconclusive. This study investigated the caries-inhibiting effect of the varnish EC40 on pits and fissures of first permanent molars. A two-year randomized controlled trial was carried out among 461 six- to seven-year-old children. In a split-mouth design, one group of molars received EC40 at baseline, 6, 12, and 18 months, and another group at baseline, 3, 12, and 15 months. Control molars did not receive EC40. Adherence to the treatment protocol was good. The dropout rate was 17%. Blinded examiners performed dental examinations.The caries-inhibiting effects of the two EC40 application schemes were comparable. The prevented fraction of caries was 25% (95%CI, 1%, 49%, p = 0.04) after 2 years and 9% (95%CI, -11%, 29%, p = 0.20) one year after termination of the trial, suggesting a short-term benefit from the use of EC40. The efficiency of EC40 is questionable in low-caries-incidence child populations.

Contains fulltext : 50155.pdf (Publisher’s version ) (Closed access) A retrospective cohort study on ECC and associated factors was conducted among mothers with 25- to 30-month-old infants in a community where prolonged breastfeeding was common practice. All infants who consumed sugary supplementary food or rice that was pre-chewed by the mother, or who fell asleep with the breast nipple in their mouths, had ECC. Infants without those habits, and who were breastfed up to 12 months, had no ECC. Breastfeeding during the day beyond the age of 12 months was not associated with ECC, but infants who were breastfed at night > 2 times had an OR for ECC of 35 (CI 6-186), and those who were exposed to > 15 min per nocturnal feeding had an OR for ECC of 100 (CI 10-995). The present study indicates that, in this population, besides the consumption of sugars and pre-chewed rice, nocturnal breastfeeding after the age of 12 months poses a risk of developing ECC.

Contains fulltext : 51309.pdf (Publisher’s version ) (Closed access) A systematic review was performed on studies investigating the effects of implant surface roughness on bone response and implant fixation. We searched the literature using MEDLINE from 1953 to 2003. Inclusion criteria were: (1) abstracts of animal studies investigating implant surface roughness and bone healing; (2) observations of three-month bone healing, surface topography measurements, and biomechanical tests; (3) provision of data on surface roughness, bone-to-implant contact, and biomechanical test values. The literature search revealed 5966 abstracts. There were 470, 23, and 14 articles included in the first, second, and third selection steps, respectively. Almost all papers showed an enhanced bone-to-implant contact with increasing surface roughness. Six comparisons were significantly positive for the relationship of bone-to-implant contact and surface roughness. Also, a significant relation was found between push-out strength and surface roughness. Unfortunately, the eventually selected studies were too heterogeneous for inference of data. Nevertheless, the statistical analysis on the available data provided supportive evidence for a positive relationship between bone-to-implant contact and surface roughness.

Contains fulltext : 49718.pdf (Publisher’s version ) (Closed access) The null hypothesis tested was that there is no difference in the survival percentages of all restorations placed through the Atraumatic Restorative Treatment (ART) approach, with high-viscosity glass ionomer, and those produced through the traditional approach, with amalgam (TA), in the permanent dentitions of children after 6.3 years. Using a parallel group design, we randomly assigned a total of 370 children, aged 6 to 9 years, to the ART group and 311 children, also aged 6 to 9 years, to the TA group. Eight dentists placed a total of 1117 single- and multiple-surface restorations. The cumulative survival percentages for ART glass-ionomer restorations were statistically significantly higher than those of amalgam restorations at all time intervals except the first (p < or = 0.044). After 6.3 years, the cumulative survival percentages of ART and amalgam restorations were 66.1% (SE = 3.1%) and 57.0% (SE = 3.3%), respectively. We concluded that the restorations produced with the ART approach, with high-viscosity glass ionomer, survived longer than those produced with the traditional approach, with amalgam, in the permanent teeth of young children.

Aim The primary aim of this study is to define and classify root proximity. The secondary aim is to examine the reproducibility of the measurement tools, to study the prevalence per inter-dental area and to examine whether the distance from the cemento-enamel junction (CEJ) to the bone crest (BC) differs between sites with root proximity and their contra-lateral sites without root proximity. Material and methods In order to indicate the location of root proximity, a modification of the Shei ruler was developed, dividing the roots into three equal parts. A radiographic template was used to measure the distance between the roots, in this way determining the severity of the root proximity. The reproducibility of the measurement tool was tested, the prevalence was calculated and the distances CEJ-BC for root proximity sites and contra-lateral sites were recorded. Results A two-digit classification was obtained dividing the root into three locations [apical (A), between (B) and coronal (C)], with each location having the possibility of three different severities of root proximity. The described modification of the Shei ruler and the measurement tool for the severities can be considered as reproducible measurement tools. Root proximity was most prevalent in maxillary molars and between central and lateral incisors in the maxilla and mandible. There was no difference in CEJ-BC distance between the root proximity sites and their contra-lateral sites. Conclusion We can conclude that a two-digit classification for root proximity was established. Root proximity in untreated periodontal patients has no influence on the distance CEJ-BC. However, the location of root proximity becomes important from the moment that periodontal disease has been established at that site. The severity of root proximity is important for choosing treatment options. There is a striking similarity between bone loss patterns and tooth loss and the location of inter-dental spaces where root proximity is most prevalent.

Aim: The aim of this study is first, to examine the prevalence, symmetry and spread of root proximity using the measurement tools and classification as described in part I of the study, and second to examine whether root proximity is a risk marker for periodontal disease. Material and Methods: The radiographs of 227 patients were examined. The study consisted of a study group of 197 patients with advanced periodontal disease with at least one site with bone loss more than one third of the root length and 30 controls without periodontal disease. Every inter-proximal space was assessed on the full-mouth radiographs and a score was assigned according to severity and location. Consequently prevalence of severity and location, symmetry, spread and an odds ratio and relative risk for periodontal disease was calculated. Results: Root proximity is a symmetrical and localized but widespread phenomenon in periodontal patients and to lesser extend in the non-periodontal control group. In periodontal patients root proximity was most often encountered in the coronal and intervening part whereas subjects without periodontal disease had more root proximity in the apical and intervening part where it is less critical. Subjects with bilateral root proximity had a 3.6 times higher chance to have periodontitis. Conclusion: Root proximity must be taken into consideration as a risk marker for periodontal disease.

In a double-blind randomized controlled clinical trial, the caries-reducing effect of semi-annually applied fluoride gel in a low-caries child population initially aged 4.5–6.5 years (n = 773) has been investigated. Secondary analyses of the data were performed to study the caries reduction including non-cavitated lesions. The treatment effect of fluoride gel was calculated as preventive fraction (PF). When enamel lesions were included in DFS count (D2 grade), the PF was 22% as compared to 26% counting dentinal lesions. The PFs showed that the mean effect of professionally applied fluoride gel was highest (71%) for D3S in the permanent dentition and lowest for d3s in the primary dentition (5%). The PFs for approximal and buccal and lingual surfaces of the permanent dentition significantly decreased from 80 to 25% and from 60 to 37% when enamel lesions (D2S) were included. With the exception of the buccal and lingual surfaces, in the primary dentition the PFs varied slightly when enamel lesions were included. Inclusion of non-cavitated lesions in the treatment effect statistics did not change the former conclusion that the treatment effect of fluoride gel application on dental caries reduction in a low-caries child population was considered not clinically relevant.

The principal aim of this study was to assess the postoperative stability of bilateral sagittal split osteotomies (BSSO) using two miniplates. Part I reports on the clinical results including treatment characteristics, nerve functions, TMJ function, occlusional relapse and patient satisfaction. This prospective study evaluated a group of 222 patients who underwent a BSSO for mandibular advancement. The same treatment protocol was used at seven participating institutions at which the patients were treated. A stable occlusion without appreciable relapse was seen in 84% after 2 years of follow-up. A considerable minority (16%) had occlusal relapse. There were no clinical parameters that pointed towards a high risk for relapse except age. The mean operation age of the relapse group was 20.7 years (SD 6.7) and in the stable group 26.1 years (SD 8.2). The function of the inferior alveolar nerve 2 years postoperatively was reported to be normal in approximately 88% of the patients, while 94% had no complaints about nerve dysaesthesia. In approximately 56% of the patients with pre-existing TMJ-dysfunction these signs and symptoms had disappeared. Another group of patients, however, without TMJ-dysfunction preoperatively (22%) developed signs or symptoms of TMJ-dysfunction postoperatively. The sagittal split osteotomy fixed with miniplates appeared to be a relatively safe and reliable procedure giving rise to a high degree of patient satisfaction, despite the fact that some occlusal relapse was seen.

Contains fulltext : 58621.pdf (Publisher’s version ) (Closed access) Over the past few years, there has been an increase in the number of studies reporting on various aspects of the Atraumatic Restorative Treatment (ART) approach. Five randomized clinical trials in which ART restorations with glass ionomers were compared with amalgam restorations in permanent teeth for a maximum period of 3 yrs constituted the database. This meta-analysis divided the publications into 'early' (1987-1992) and 'late' (1995-) studies on the basis of improvements in the approach. The analysis showed that, in the 'early' studies, single-surface amalgam restorations survived statistically significantly longer than comparable ART restorations after 1, 2, and 3 yrs. This trend did not continue into the late group of studies; no statistically significant difference between the 2 types of restorations was found. Based on the available data, it appears that there is no difference in survival results between single-surface ART restorations and amalgam restorations in permanent teeth over the first 3 yrs.

It was the purpose of the study to investigate the caries-reducing effect of semi-annual professional fluoride gel application in a low-caries child population initially aged 4.5–6.5 years during a 4-year follow-up period. In a double-blind randomised controlled trial (n = 773) the effect of sodium fluoride gel on D3MFS and d3mfs was compared with a placebo gel. The mean caries reduction of professionally applied fluoride gel after 4 years in subjects with baseline caries experience D3MFS = 0 as well as d3mfs = 0 was 0.08 D3MFS (SE = 0.06) and 0.36 d3mfs (SE = 0.22). The prevented fraction for D3MFS and d3mfs was 26% (SE = 16%) and 20% (SE = 11%), respectively. It was concluded that in the investigated low-caries 4.5- to 6.5-year-olds, fluoride gel treatment showed a statistically significant (tested one-sided) caries-inhibiting effect on D3MFS, which was considered not clinically relevant, and no significant effect on d3mfs.

A systematic review was performed of published data on the caries-inhibiting effect of preventive measures during orthodontic treatment with fixed appliances. The purpose was to develop evidence-based recommendations about the most effective means of preventing white spot lesions in orthodontic patients. The 15 studies included were divided into four groups based on comparable preventive measures: fluoride, chlorhexidine, sealants and bonding materials. The caries-inhibiting effect of the preventive measures was expressed by the prevented fraction (PF). The overall PF of the fluoride-releasing bonding materials was 20% (SEM 0.09). This effect was, however, not statistically significant. It was impossible to calculate an overall PF for the other preventive measures, but the tendency of their caries-inhibiting effect has been described. The use of toothpaste and gel with a high fluoride concentration of 1,500–5,000 ppm or of complementary chlorhexidine during orthodontic treatment showed a demineralisation-inhibiting tendency. The use of a polymeric tooth coating on the tooth surface around the brackets showed almost no demineralisation-inhibiting effect. Many publications had to be excluded from this systematic review because of improper research designs. Future clinical trials are needed to give evidence- based advice on the optimal caries-prevention strategy.

Treatment of lower denture complaints of patients with an edentulous mandible with a height of at least 15 mm can consist of meticulous construction of a new set of dentures (CD), construction of a new set of dentures following preprosthetic surgery to enlarge the denture-bearing area (PPS), or construction of an implant-retained mandibular overdenture (IRO). The aim of this prospective randomized controlled clinical trial was to evaluate the satisfaction of the above mentioned treatment modalities in resolving lower denture related complaints. Ninety edentulous patients (Cawood class IV and V, mean mandibular height 20.7 +/- 2.7 mm) were randomly assigned to one of these treatment modalities. The main outcome parameters were denture satisfaction and chewing ability, which were assessed using validated self-administered questionnaires focusing on denture-related complaints and problems with chewing different types of food. These parameters were measured before treatment, and 1, 5 and 10 years after treatment. Differences among the three groups were tested by applying a one way analysis of variance and a Tukey's test for multiple comparison. At the I year evaluation, significantly better scores were observed in the two surgical groups (IRO, PPS) than in the CD group (P

Treatment of lower denture complaints of patients with an edentulous mandible with a height of at least 15 mm can consist of meticulous construction of a new set of dentures (CD), construction of a new set of dentures following preprosthetic surgery to enlarge the denture-bearing area (PPS), or construction of an implant-retained mandibular overdenture (IRO). The aim of this prospective randomized controlled clinical trial was to evaluate the satisfaction of the above mentioned treatment modalities in resolving lower denture related complaints. Ninety edentulous patients (Cawood class IV and V, mean mandibular height 20.7 ± 2.7 mm) were randomly assigned to one of these treatment modalities. The main outcome parameters were denture satisfaction and chewing ability, which were assessed using validated self-administered questionnaires focusing on denture-related complaints and problems with chewing different types of food. These parameters were measured before treatment, and 1, 5 and 10 years after treatment. Differences among the three groups were tested by applying a one way analysis of variance and a Tukey's test for multiple comparison. At the 1 year evaluation, significantly better scores were observed in the two surgical groups (IRO, PPS) than in the CD group ( P P

This study aimed to determine whether salivary mutans streptococci and lactobacilli counts could add any value to a combination of caries experience variables that was recently presented for the prediction of caries. Sixty-nine children at the age of 7.5 yr participated in this longitudinal study. Microbiological data were obtained at the ages of 7.5, 9.5 and 11.5 yr and caries data at the ages of 7.5. 9.5. 11.5, 13.5 and 15.5 yr. Spearman's correlation coefficients were computed, and forward multiple regression analyses were carried out using bacterial counts and caries experience parameters as explanatory variables and caries increment as a dependent variable. The explained variance (adjusted R2 value) was the measure used to assess the additional value of bacterial counts to the caries predictive potential of the combined parameters of the past caries experience. Correlation coefficients between bacterial counts and 4-yr caries increment were from 0.22 tip to 0.54. In all cases, the simultaneous streptococcus mutans-lactobacilli counts showed a statistically non-significant additional adjusted R2 value of

Aim of the study was to evaluate the effect of infant orthopaedics (IO) on maxillary dimensions in infants with unilateral cleft lip and palate (UCLP). The study design was a prospective two-arm randomised controlled trial in parallel with three participating academic Cleft Palate Centres. Treatment was assigned by means of a computerised balanced allocation method. One group (IO+) wore passive maxillary plates during the first year of life, the other group (IO-) did not. Maxillary casts, made at birth, and at 15, 24, 48, 78 wk were digitised three-dimensionally. Before lip closure alveolar, midpalatal and posterior cleft width reduced significantly more in IO(+) than in IO(-). After lip closure, the alveolar cleft width reduced significantly more in IO(-). Until soft palate closure the slope of the palatal vault flattened significantly by IO. It is concluded that IO only has a temporary effect on maxillary arch dimensions that does not last beyond surgical soft palate closure. Therefore, infant orthopaedics as a tool to improve maxillary arch form could be abandoned. However, other outcome variables like facial and dental appearance, speech outcome, and cost-effectiveness need to be investigated further in order to assess the comprehensive effect of infant orthopaedics.

Objective: To study the level of and changes in basal metabolic rate (BMR) in children with a solid tumour at diagnosis and during treatment in order to provide a more accurate estimate of energy requirements for nutritional support. Design: An observational study. Setting: Tertiary care at the Centre for Paediatric Oncology, University Hospital Nijmegen. Subjects: Thirteen patients were recruited from a population of patients visiting the University Hospital Nijmegen for treatment. All patients asked to participate took part in and completed the study. Intervention: BMR was measured by indirect calorimetry, under stringent, standardised conditions, for 20 min and on three different occasions in all patients. Continuous breath gas analysis using a mouthpiece was performed. Weight, height and skinfold measurements were performed before each measurement. Main outcome measures: BMR was expressed as percentage of the estimated reference value, according to the Schofield formulas based on age, weight and sex, and in kJ (kcal) per kg of fat-free mass. Results: At diagnosis, the BMR was higher than the estimated reference BMR in all patients and 44% of the patients were considered hypermetabolic. Mean BMR (as percentage of reference) was significantly increased (11.6% (s.d. 6.7%); P=0.001), but decreased during treatment in 12 of the 13 patients (mean decrease 12.7% (s.d. 3.9%); P

The aim of this study was to investigate the influence of a consensus statement on dental practitioners' choice of initial treatment for traumatic dental injuries. Dental practitioners working at government dental clinics in eight cluster sample regions of mainland Tanzania were requested to participate in the study; that is, to record the treatment they provided to children aged 1-17 years seeking dental consultation after injury for a period of 12 months. Six months after the beginning of data collection, a consensus statement was introduced. After the dental practitioners received the consensus statement, the correct treatment they provided increased from 51% to 57%. The unnecessary treatments increased from 54% to 59%, while wrong treatments decreased from 55% to 42%. Only a small improvement was observed in the percentage of correct treatments, but there was a slightly significant improvement in the percentage of wrong treatments provided before and after introduction of the consensus statement. We conclude that the consensus statement had a slight influence on the dental practitioners' choice of initial treatment for dental trauma in the desired direction.

Background and Objectives: In rheumatoid arthritis, joint radiography is still the most frequently used instrument to assess the progression of joint damage. Unfortunately, the poor quality of the radiographic scoring methods available has a negative impact on the power in clinical trials. This study focuses on the influence of the following 4 factors on radiographic scores according to van der Heijde's modification of the Sharp method: intraobserver variation, interobserver variation, follow-up time, and number of measurement occasions within a patient series. Methods: One hundred and seventy-two patients in the early stages of rheumatoid arthritis were followed up. During the first 3 years, radiographs of the hands and feet were taken twice yearly and scored by 3 observers. The scoring process was repeated after an additional 3-year period. Correlation coefficients and differences between observers were calculated to define variability. The influence of the 4 factors on variability was studied. Results: One observer assigned a significantly higher score than the other 2, who had been trained together. Interobserver variability decreased as follow-up time increased. Interobserver correlation coefficients became higher, with smaller differences between observers for progression scores than for absolute scores. Increasing the number of measurements within a patient series led to higher scores. Intraobserver correlation coefficients were high, and a training effect occurred when the time between measurements was 1 year, resulting in lower scores. Conclusions: This study demonstrates that, and shows how, the investigated factors influence the variability of the modified Sharp method. It is extremely important to take interobserver variation into account when designing protocols for multicenter clinical trials. A progression scoring method is recommended for studies assessing radiographic damage or clinical trials. Semin Arthritis Rheum 31:176-190. Copyright © 2001 by W.B. Saunders Company

This study aimed to select past caries experience variables as caries predictors and to compare their prognostic accuracy with the variables used in a method of caries prognosis developed in a Swiss child population. The data used for the analyses originated from an 8–year longitudinal study starting in 1980 on caries of 7.5–year–old Dutch children. Stepwise logistic regression analyses provided predictor variables. The newly introduced variables D23fi, D123fi and D23pifi were interchangeable and the most powerful caries predictors. For the sake of uniformity and ease of application, D23fi (number of fissures of the permanent first molar with non–cavitated or cavitated caries lesions) was chosen as the first variable in the logistic regression equations. The gain in accuracy of the second and third predictor variables (number of sound primary molars and the number of buccal and lingual smooth surfaces of the permanent first molar with non–cavitated or cavitated caries) in the regression equations was limited. The D1 condition of surfaces could be omitted from the prediction models. The present forced three–predictor–regression equations for 7.5–, 9.5– and 11.5–year–old children were evaluated to assess their prognostic performance by using the area under the ROC curve as a measure of prognostic quality. For the present regression equations, the area under the ROC curve was 81–87%, which was higher compared to the Swiss regression equations for caries prognosis.

The present study was aimed at comparing the effectiveness of three minimally invasive restorative treatment approaches for dentinal lesions in occlusal surfaces. The approaches tested comprised a conventional and a modified–conventional treatment and a modified Atraumatic Restorative Treatment (ART). The conventional approach was performed in a university dental clinic whilst the modified–conventional, employing portable equipment, and the modified ART, using hand instruments and a caries removal solution (Caridex®), were carried out in the field. Using the split–mouth design, 430 matched contralateral pairs of occlusal cavities were restored with amalgam or glass–ionomers in permanent molars of 152 school children by one dental therapist. The restorations were assessed using a modified USPHS–Ryge criteria. After 2 years, the cumulative survival percentages for occlusal amalgam and glass–ionomer restorations were 92 and 96%, respectively. The survival of all restorations in the conventional, modified–conventional and the modified ART group was 96, 96 and 91%, respectively. The survival of occlusal amalgam and glass–ionomer restorations per treatment group was as follows: 94 and 99%, respectively (conventional group); 95 and 97%, respectively (modified–conventional group), and 89 and 93%, respectively (modified ART group). The differences in survival percentage between restorations with amalgam and glass–ionomer, and between the three restorative treatment approaches were not statistically significant. In countries facing scarcity in resources for dental care, ART seems a promising restorative approach to occlusal caries in posterior teeth. However, a longer clinical observation period is required to substantiate this initial conclusion.

Objective To study the predictive value of anti–cyclic citrullinated peptide antibody (anti-CCP) in patients with recent-onset rheumatoid arthritis (RA). Methods Outcome in terms of physical disability (Health Assessment Questionnaire) and radiologic damage (modified Sharp method) over 3-year and 6-year periods was determined in an inception cohort of 273 RA patients who had had disease symptoms for >1 year at study entry. Anti-CCP titers were determined at baseline and considered positive as recently described. Their prognostic value was studied by means of multiple regression analysis, in which anti-CCP positivity, sex, age at study entry, IgM rheumatoid factor (IgM-RF) status, Disease Activity Score (DAS), HLA–DR4 status, and (in a separate group of patients) shared epitope status were used as independent variables, and radiologic damage and functional disability as dependent variables. Results Patients with anti-CCP had developed significantly more severe radiologic damage after 6 years of followup. In multiple regression analysis, radiologic damage after 6 years followup was significantly predicted by IgM-RF status, radiologic score at entry, and anti-CCP status. Functional disability was significantly predicted by sex, age at entry, IgM-RF status, and DAS. Conclusion Our data show that in almost 70% of RA patients, anti-CCP antibody is present at the early stages of disease. Anti-CCP–positive patients developed significantly more severe radiologic damage than patients who were anti-CCP negative, although in multiple regression analysis the additional predictive value was rather moderate.

Background: Reliable assessment of growth performance of infants and young children requires reference data increments. Available increment references are based on data fitted to mathematical models, a process that diminishes variation in increment values. Methods: Fully longitudinal data from the multicenter Euro-Growth Study (21 study sites; n = 2145 children) were used to develop sex-specific percentiles for increments in length, weight, and head and mid-upper arm circumferences for selected intervals during the first 36 months of life. Increments (per unit of time) were calculated for 2-, 3- and 6-month intervals from birth to 12 months of age and for 6-month intervals from 12 to 36 months of age. Weight increments were also calculated for 1-month intervals from birth to 6 months of age. The influence of sex, mid-parental height, and study site was determined using analysis of covariance. Comparison with other references was accomplished using percentile values. Results: Mean and standard deviation values as well as selected percentiles (P; P3, P5, P10, P25, P50, P75, P90, P95, and P97) of increments are presented. Length increments of boys were higher than those of girls until 5 months of age but tended to be lower thereafter. Weight increments of boys were higher until 9 months of age. Sex, mid-parental height, and study site explained only between 2% and 13% of the variances of increments. Mean increments were comparable but P10 and P90 substantially differed from published data. Conclusions: The new Euro-Growth references for increments in length, weight, and head and mid-upper arm circumferences provide tools for health workers that should be useful in screening for adequacy of growth during the first 3 years of life.

It has been suggested that the provision of dental implants can improve the oral function of subjects with severely resorbed mandibles, possibly restoring function to the level experienced by satisfied wearers of conventional complete dentures. Nevertheless, a quantitative comparison has never been made and can be drawn from the literature only with difficulty, since studies differ greatly in methodology. To make such a comparison, we measured bite force and chewing efficiency by using identical methods in subjects with overdentures, complete full dentures, and natural dentitions. Our results indicated that bite forces achieved with overdentures on dental implants were between those achieved with artificial and natural dentitions. Chewing efficiency was significantly greater than that of subjects with full dentures (low mandible), but was still lower than that of subjects with full dentures (high mandible) and overdentures on bare roots. Differences in the height of the mandible revealed significant differences in chewing efficiency between the two full-denture groups. Furthermore, subjects with a shortened dental arch exerted bite forces similar to those of subjects with a complete-natural dentition, but their chewing efficiency was limited due to the reduced occlusal area. For all groups combined, a significant correlation was found between maximum bite force and chewing efficiency. Nearly half of the variation in chewing efficiency was explained by bite force alone.

Background: Several concerns have been raised by World Health Organization (WHO) expert groups regarding the adequacy of currently existing growth references, including those currently supported by WHO. As part of a concerted action of the European Union, new references were developed that were based on a well-defined sample of the European population and were compared with existing references. Methods: During the longitudinal, observational multicenter study, anthropometric measurements using standardized methodology were performed in 2245 children between 1 and 36 months of age, and sex-and age-specific growth references for recumbent length, weight, mid-upper arm, thigh, and calf circumferences were developed. Results: The validity of the curve-fitting programs was demonstrated by comparing the selected sex-specific percentile distributions for all indices with the smoothed references. Comparison with the National Center for Health Statistics (NCHS)-WHO references for length and weight for age indicated that the -2 z-score value of the WHO reference as cutoff value shows that a substantial part of the children with suspected failure to thrive should be classified as normal. The references also indicate that the mid-upper arm circumference is age and sex dependent and that a single cutoff value for children less than 5 years of age should no longer be used. Mid-parental height was the best single predictor of recumbent length until 36 months of age. Conclusions: The Euro-Growth references that were developed reflect growth of a well-defined, large cohort of healthy infants and can be used for international comparisons.

Patients with Parkinson's disease(PD) show a serious decrease in performance on tasks which lack explicit guidelines and which necessitate the subject to develop his or her own strategy. Using the California Verbal Learning Task(CVLT) we have found evidence that this phenomenon becomes also manifest in learning and memory. The goal of the present study on PD was to investigate whether or not there is an intrinsic relationship between PD-specific deviant learning characteristics and the severity of motor symptomatology. The results show, as expected, a significant correlation between the severity of bradykinetic/hypokinetic symptoms and the serial clustering gradient of the CVLT: the more bradykinetic PD patients (n = 48) were, the more they were dependent on the externally guided serial learning strategy. The findings are discussed in the context of our hypothesis that the actual deficit in patients with PD is a deficient processing of ambiguous internal cues.

The aim of the present study was to assess the effect of normal growth and development on the Peer Assessment Rating index between 12 and 22 years of age. The sample consisted of 49 nonorthodontic subjects (24 male and 25 females) from the Nijmegen Growth Study. The mean age at the first observation was 12.2 ± 0.7 years and at the second observation 22.1 ± 0.6 years. The dental casts at these ages were scored with the Peer Assessment Rating index. The influence of the Angle classification and the treatment need on changes over time in the Peer Assessment Rating score were evaluated. The mean changes in the PAR scores over time between cases that have more than 30% improvement to those that have less than 30% improvement were calculated. The results indicate that there were no significant differences between the mean Peer Assessment Rating score at 12 years of age (12.20 ± 0.91) and at 22 years of age (12.45 ± 1.28), but there were relevant differences in individual cases. The changes were irrespective of the Angle classification or the treatment need. Changes over time in the weighted Peer Assessment Rating score were mainly correlated to changes in the anterior crossbite and the overjet. This correlation may be influenced, however, by the applied weighting factor for those occlusal traits. (Am J Orthod Dentofacial Orthop 1998;114:224-228)

Objectives: A randomized controlled clinical trial was undertaken, to study the influence of some patient- and operator-dependent variables on the survival of posterior resin-bonded bridges (PRBBs) and to assess the survival of ‘replacement’ PRBBs. This report contains some of the results of the 5-year analysis. Methods: Survival was defined at three levels: (1) complete survival (without any debonding), (2) functional survival (i.e. survival after one loss of retention) and (3) replacement survival (survival of ‘replacement’ PRBBs, inserted after rebonded bridges suffered a second dislodgement). Potential risk factors were analysed with Cox's proportional hazards model and differences were tested for significance with the Breslow test. Observed effects are expressed as conditional-relative-risk (CRR). Survival of ‘replacement’ PRBBs was assessed with the Kaplan-Meier method. Results: Factors showing significant influences on complete survival were: ‘location’ (highest risk for mandibular PRBBs: CRR = 2.2), ‘aetiology’ (higher risk in treatment of aplasia: CRR = 2.9), and ‘time of existence’ (open spaces existing less than 2 years before insertion of PRBB: CRR: 2.0). The factor ‘large open spaces in the mandible’ was a risk for both complete and functional survival (CCR values 3.1 and 3.5, respectively). The survival of mandibular and maxillary ‘replacement’ PRBBs after 5 years was 19 ± 7% and 31 ± 18%, respectively. Conclusions: Risk factors for PRBBs were: ‘location’, ‘aetiology’, ‘time of existence’, ‘isolation method’ and ‘large open spaces in the mandible’. Mandibular ‘replacement’ PRBBs showed such an unacceptably low survival rate that fabrication is not recommended.

Objective: To study the effect of sufficient energy intake, by means of the protocolized administration of naso-gastric tube feeding, on the nutritional status of a child with cancer. Design: A comparative experimental study. Setting: Tertiary care at the Centre for Pediatric Oncology, South East Netherlands, University Hospital, Nijmegen. Subjects: Seven children, newly diagnosed with cancer, were included in the experimental study and all completed the trial period. Fourteen patients were included in the retrospective study. They were randomly chosen from a group of patients previously treated for a malignancy at our department and who had received naso-gastric tube feeding for at least 16 weeks. Intervention: Protocolized (experimental group) vs non-protocolized (retrospective group) administration of naso-gastric tube feeding over a period of 16 weeks. The main difference was the amount of tube feeding administered. In addition to energy from other foods, children in the experimental group received 106±13% of their total daily energy requirements (TDER) by means of tube feeding, whereas children in the retrospective group had received 75±24%. Main outcome measures: Weight as a percentage of weight for height according to the 50th percentile of a healthy reference population=ideal weight. Results: Weight, expressed as a percentage of the ideal weight, increased significantly in the experimental group (18.2±8.4; P=0.01) and the retrospective study group (5.2±7.3; P=0.001). However, the increase was statistically significant in favour of the experimental group (P=0.003), in which all the children reached their ideal weight, compared to 21% in the retrospective group. Conclusion: Aggressive protocolized nutritional intervention during the intensive phase of anti-cancer treatment, in the form of naso-gastric tube feeding that provides the child’s total daily energy requirements, results in considerable improvement in the nutritional status.

Objectives: The aim of this study was to assess the effect of a chlorhexidine varnish on occlusal caries incidence when applied 6-monthly into the fissures of erupting and freshly erupted permanent molars. Methods: In a double-blind clinical trial, 332 children aged 5 6 and 11 12 years attending a Child Dental Health Centre were randomly assigned to a control and an experimental group. Criteria for inclusion in the study were that all first permanent molars in 5–6-year-olds and all second permanent molars in 11–12-year-olds either had recently erupted, or were in a stage of eruption, or would erupt within half a year. At baseline, counts of dmfs/DMFS and mutans streptococci in saliva were recorded. During a maximum of 3 years, every 6 months the occlusal surfaces of molars in the experimental group received a 40% chlorhexidine varnish application, whereas those in the control group received a placebo varnish application. Results: Data of 316 children were analysed and ANOVA showed no significant occlusal caries reduction in this sample of Dutch 5 6 - and 11 12 -year-old children. After stratification into low and high caries risk groups, a statistically significant caries-reducing effect on occlusal caries in permanent molars was found in the group of children with ≥106 mutans streptococci per ml saliva (P Conclusion: Six-monthly application of chlorhexidine varnish has no caries-reducing effect on occlusal caries in recently erupted permanent molars in a population with low caries prevalence.

This paper describes the prevalence and severity of gingival recession in Tanzanian adults covering the age range from 20 to 64 years. In addition, it attempts to assess the relationship between the degree of gingival recession and the presence and amount of calculus. In the 20-34 years age group recession occurred in > or = 32% of the buccal, > or = 25% of the lingual, and > or = 13% of the approximal surfaces. These %s increased to > or = 64%, > or = 52%, and > or = 48%, respectively, in the 45-64 years age group. In the 20-34 years age group, lingual surfaces of mandibular incisors and canines followed by buccal surfaces of these teeth were the sites most severely affected with gingival recession. With increasing age, all sites became gradually more severely affected, particularly the buccal and lingual surfaces of the maxillary first molar. The lingual surfaces of mandibular incisors exhibited on an average 1.3 mm, 2.4 mm and 3.2 mm recession in the 20-34 years, 35-44 years and 45-64 years age group, respectively. Most of the correlation coefficients between gingival recession and calculus at the individual tooth surface in three age groups were statistically significant. The highest correlation coefficients (0.50-0.67) were found in the youngest (20-34 years) age group at the lingual surfaces of the mandibular incisors, canine and first premolar and at the buccal surfaces of the mandibular incisors. Based on these findings, the working hypothesis is advanced that longstanding calculus is an important determinant in the onset of gingival recession at sites exhibiting pronounced recession at a young age in populations deprived of prophylactic dental care.

Previous clinical observations have revealed that resin-bonded bridges for posterior tooth replacements are less retentive than anterior resin-bonded bridges. Improved bonding procedures and preparation designs, however, may have a positive effect on the functional durability of these restorations. The present study reports the final analysis of a randomized controlled clinical trial in which different designs of posterior resin-bonded bridges were evaluated for a period of at least 5 years. The operational hypothesis was that the bonding system and the preparation design used in posterior resin-bonded bridges have an influence on the survival and clinical functioning of these restorations. Survival in this study was defined at two levels: (1) 'complete' survival (survival without any debonding), and (2) 'functional' survival (survival including loss of retention on one occasion and successful rebonding of the original RBB without further debonding). With regard to 'complete' survival, no significant differences were found between the bonding systems used for adherence of the restorations to abutment teeth (etching/Clearfil F2, sandblasting/Panavia EX, and silica-coating/Microfill Pontic C). The variable 'preparation form' (conventional preparation form vs. modified preparation form) for complete survival was statistically in favor of the modified preparation form (62% vs. 46%), but did not influence the functional survival. With regard to 'functional' survival, the combination of silica coating and Microfill Pontic C was more retentive than the other bonding systems (90% survival vs. 72% and 75%, p < 0.01). Factor location was found to be highly significant for both survival levels [Cox's PH model, p = 0.0002 (Cox, 1972)]: The five-year 'complete' survival rates were 65% for maxillary restorations and 40% for mandibular restorations, while the five-year 'functional' survival rates were 89% and 68%, respectively. It is concluded that preparation of grooves in abutment teeth for posterior resin-bonded bridges is beneficial to their chance of survival. Resin-bonded bridges placed in the maxilla have a better prognosis than those made in the mandible. The bonding systems used in this study appear to have no influence on the chance of failure. In rebonded posterior resin-bonded bridges, the bonding system silica-coating/Microfill Pontic C was more retentive than the other systems tested.

A meta-analysis was performed on published data on the caries-inhibiting effect of fluoride gel treatment in 6- to 15-year-old children. The purposes of this meta-analysis were: (1) to calculate the overall caries-inhibiting effect of clinical fluoride gel treatment studies, based on explicit selection criteria, and (2) to explore factors potentially modifying the effect of fluoride gel treatment in caries prevention, concerning the baseline caries prevalence of the target population, the general fluoride regimen, and application features. The caries-inhibiting effect of fluoride gel application was assessed by the prevented fraction and the ‘number needed to treat’. The overal prevented fraction of the fluoride gel treatment studies, indicating the reduction of caries incidence by fluoride gel treatment relative to the incidence in the control group, was 22% (95% CI = 18–25%). Multiple regression analysis showed no significant influence on the prevented fractions for the variables ‘baseline caries prevalence’, ‘general fluoride regimen’, ‘application method’, and ‘application frequency’. The ‘number needed to treat’ (NNT), indicating the number of patients that need to be treated in order to prevent 1 DMFS, estimated the efficiency of fluoride gel treatment according to the caries incidence of the target population, including cost/effect relations. It was found that the NNT = 18 in a population with caries incidence 0.25 DMFS per year, and NNT = 3 in a population with caries incidence = 1.5 DMFS per year (treatment duration 1 year). From the standpoint of cost-effectiveness, the additional effect of fluoride gel treatment in current low and even moderate caries incidence child populations must be questioned.

Objectives: Attempts have been made to develop diagnostic methods which enable an early diagnosis of occlusal lesions which are not detectable by visual inspection. The aim of this study was to compare the performance of visual inspection focused on finding signs of fissure decalcification and discoloration, visual inspection upon fibre-optic transillumination (FOTI), and electrical conductance measurements (ECMs) in predicting the onset of occlusal caries in 6- and 11-year-old children. Methods : Fifty children aged 5–7 and 11–15 years, having first or second permanent molar teeth that were not exposed to the oral environment for more than half a year, participated in the study. Following baseline data recording, the diagnostic measurements were repeated six times at 6-month intervals over a period of 2.5 years. Results: Data were collected at predefined sites in the fissures. During the study, 220 of the 652 sites, i.e. 75 of 197 molars in 31 of the 50 children were judged to require a sealant or a sealant restoration. Two examiners jointly decided on the decay status at the sites. Survival plots showed that ECMs were superior to FOTI and fissure discoloration in predicting the onset of occlusal caries, although the differences were small. Conclusion: ECM is a better predictor of occlusal caries than fissure discoloration and FOTI, although the differences among the performance of the three methods in this study were very small. A cost-effective analysis is envisaged to obtain insight into the practical value of ECMs in the prediction of occlusal caries and, thus, into the effectiveness of sealant application.

Data from 14 independent controlled clinical trials on the oral behavior of Classes 1 and 2 amalgam restorations, with a follow-up between five and 15 years, were re-evaluated by secondary analysis for the influence of alloy composition on the survival of amalgam restorations. For the analysis, 3119 restorations were available, which were made from 24 different alloys by a group of seven operators. The alloys were divided into four groups according to their zinc content (zinc-containing and zinc-free) and their copper content (conventional and high-copper). During the follow-up of the trials, the restorations were annually assessed for failures, which were classified as to (1) restoration-, (2) restorative process-, and (3) patient-related reasons. With the restoration-related failures, survival functions of the restorations were estimated by alloy and alloy group. The total number of failed restorations was 481, of which 77% were restoration-related and 14% process-related. Eighty percent of the restoration-related failures were due to some form of fracture of the amalgam. Restorations of conventional zinc-free alloys had the shortest survival. After 13 years, only 25% survived. Zinc and a high copper content had an equally favorable influence on the survival rate, which was 70% after 13 years when either was present. The highest survival rates were of restorations of zinc-containing high-copper alloys: 85% after 13 years. The zinc and copper contents of the alloy contributed to the corrosion resistance of the amalgams, which in turn influenced the survival of the restoration. The current ISO Standard 1559 on alloys for dental amalgam should be modified to account for these factors that influence the survival of amalgam restorations.

To determine the relationship between ankle/brachial indices (ABIs) and morbidity and mortality in patients with peripheral arterial disease (PAD), a historical cohort study was performed. A total of 154 patients who had undergone noninvasive arterial assessment of the lower extremities in 1989 and 1990 were selected for this purpose. Selection criteria were age >40 years at the time of investigation, a resting ABI

In the Leuven Growth Study of Belgian Boys the growth and physical performance of Belgian boys followed longitudinally between 12 and 19 years were studied. Subsequently, a subsample (n = 240) of Flemish-speaking males were reexamined at 30 and 35 years. A first question relates to the individual growth patterns in a variety of physical fitness characteristics. The three strength tests (static, functional, explosive) show curves that are qualitatively similar to those for height and weight. Their adolescent spurts occur after the height spurt. Flexibility and the two speed tests appear to reach maximum velocities prior to the height and weight spurts. Longitudinal principal component analysis was applied to the study of growth patterns of several somatic and motor characteristics. The results for height show three components sufficient to provide an adequate representation of the original information. The first component characterizes the general position of an individual growth curve. Components 2 and 3 reflect fluctuation in percentile level during the age period studied and can be conceived as indices of stability and are related to age at peak height velocity (APHV) and peak height velocity (PHV), respectively. Relationships between somatic characteristics, physical performance, and APHV have been studied in a sample of 173 Flemish boys, measured yearly between +/- 13 and +/- 18 years and again as adults at 30 years of age. The sample was divided into three contrasting maturity categories based on the APHV. There are consistent differences among boys of contrasting maturity status during adolescence in body weight, skeletal lengths and breadths, circumferences, and skinfolds on the trunk. There are no differences in skinfolds on the extremities. None of the differences in somatic dimensions and ratios among the three contrasting maturity groups are significant at 30 years of age except those for subscapular skinfold and the trunk/extremity skinfold ratio. During adolescence, speed of limb movement, explosive strength and static strength are negatively related to APHV; thus, early maturers performed better than late maturers. However, between late adolescence and adulthood (30 years), the late maturers not only caught up to the early maturers, but there were significant differences for explosive strength and functional strength in favor of late maturers. Finally, age-specific tracking, using inter-age correlations, of adult health- and performance-related fitness scores were investigated. In addition, the independent contribution of adolescent physical characteristics to the explanation of adult fitness scores was also studied. Tracking between age 13 and age 30 years was moderately high (46% of variance explained) for flexibility, low to moderate (between 19% and 27% of variance explained) for the other fitness parameters and low for pulse recovery and static strength (7% to 11% of variance explained). Between age 18 and age 30 years the tracking was high for flexibility, moderately high for explosive and static strength, and moderate for the other fitness parameters except for pulse recovery. The amount of variance of adult fitness levels explained increased significantly when other characteristics observed during adolescence entered the regressions or discriminant functions.

A sample of 267 patients with maxillary hyperplasia, a Class I or Class II/I occlusion and anterior vertical open bites, collected from three different institutions, was analysed regarding stability after surgical corrections. Skeletal and dento-alveolar stability of the maxilla, and positional changes of the mandible and of the incisors were evaluated. All patients underwent Le Fort I intrusion osteotomies and in 92 patients segmentation of the maxillae was performed. An additional bilateral sagittal split advancement osteotomy was performed in 123 patients. Intraosseous wire fixation was used in 153 patients and rigid internal fixation in 114 patients. Cephalometric radiographs were collected before orthodontic treatment, before surgery, immediately after surgery, one year postoperatively and at the latest follow up. The mean follow up was 69 months (range 20-210 months). It can be concluded that patients with anterior open bites, treated with a Le Fort I osteotomy in one-piece or in multi-segments, with or without bilateral sagittal split osteotomy, exhibited good skeletal stability of the maxilla. Rigid internal fixation produced the best maxillary and mandibular stability. The mean overbite at the longest follow up was 1.24 mm and a lack of overlap between opposing incisors was present in 19%. The overbite did not differ significantly between the different treatment procedures, probably due to compensatory movements of the mandibular and maxillary incisors.

Background. When determinants of nutrition guidance practices for primary care physicians (PCPs) are identified, the key question remains: what is the mechanism of action? This knowledge is essential in order to understand how PCPs practice nutrition guidance. Methods. Mail questionnaires (result of focus-group discussions and in-depth interviews) were sent to a nationwide random sample of 1,000 PCPs in the Netherlands, who had been in practice for between 5 and 15 years (633 respondents). The mechanism of action of determinants of nutrition guidance practices of PCPs was identified by means of linear structural relationship analysis (LISREL) using a postulated model. Results. The postulated model on the mechanism of action was confirmed. The model demonstrates that nutrition guidance practices of PCPs are directly and significantly based on a few predisposing factors; driving forces and perceived barriers may act as significant intermediary variables. The predisposing factors, driving forces, and perceived barriers were identified. Conclusion. Policies to improve nutrition guidance practices of PCPs may, in the future, benefit from a LISREL model analysis of determinants of these practices to become more effective. Using multiple regression analysis to ascertain the determinants of these practices could result in missing important predisposing factors and “hidden” intermediary factors and lead, therefore, to an incomplete understanding of the mechanism of action.

In a cross-sectional survey, plasma concentrations of alpha- and gamma-tocopherol, alpha- and beta-carotene (cis and trans isomers), lycopene, and retinol were determined by reversed-phase HPLC, and ratios of plasma alpha-tocopherol to cholesterol were calculated in 208 Swiss individuals ages 0.4-38.7 years. The influence of age, sex, and season of sampling was studied. Age was a significant predictor of all plasma concentrations except alpha-carotene. No sex-related differences were observed. Season of sampling affected alpha-tocopherol and retinol (higher in winter) and gamma-tocopherol and cholesterol concentrations (higher in winter and spring than in the other seasons). After correction for seasonal influences, age differences were 0.24 micromol/L per year for alpha-tocopherol, 0.04 micromol/L per year for retinol, and 0.04 micromol/L per year for cholesterol concentrations; ratios of plasma alpha-tocopherol to cholesterol were not affected by age. We constructed age-specific reference intervals from the regression line and a multiple of the standard deviation. Separate regression equations are presented for seasons with low and high values.

In order to investigate the relationship between cognitive function and daily used drugs in the elderly we performed an observational, cross–sectional study in 5 homes for the elderly in the region of Nijmegen, the Netherlands. Participants were 497 residents of these homes. For all these subjects the daily used drugs, classified according to the Anatomical Therapeutic Classification system, were registered and global cognitive function was measured as the total score on the Mini Mental State Examination. Adjusting for age and education, there was a small but significant and positive correlation between the use of metoprolol and the total MMSE score. The use of CNS drugs was not related to the total MMSE score. All eleven most frequently used drugs together explained 2.9% of the variance in the MMSE scores. These results indicate that there is a negligible association between daily drug use and cognitive function in these subjects.

Statural growth during puberty was studied longitudinally in 28 patients treated for acute lymphoblastic leukaemia. All patients received prophylactic cranial irradiation. The age at diagnosis was below 7 years, the age at final investigation was above 16 years for girls and above 18 years for boys. Growth was analysed using the Kernel estimation. In girls the onset of puberty and menarche was at a younger age, as compared to reference values, and the duration of the pubertal growth spurt was shorter. Compared to early maturing girls, the growth velocity at peak height velocity was lower. This resulted in a final height which was shorter than expected on the basis of the height standard deviation score before the start of puberty. In boys the duration of the pubertal growth spurt was shorter and the height gain during the growth spurt less than in the reference population. In both sexes the bone age development was accelerated.

The role of the interdigitation of posterior teeth in maxillomandibular growth and development was studied longitudinally in Macaca fascicularis monkeys. Fourteen monkeys were divided into a control group (n = 7) and an experimental group (n = 7). At the start of the study, the mean age of the animals was 29 weeks. At that stage the interdigitation in the experimental group was eliminated by grinding the cusps of the molars and canines. The animals were followed until 143 weeks of age and studied with the aid of tantalum implants and lateral radiographs. The findings indicated that elimination of the interdigitation resulted in a deviating anteroposterior relationship between the jaws and a significant inhibition of the vertical growth of the maxilla in the second half of the experimental period, while total face height was not noticeably affected. As a result, a more prognathic mandible and a more mesial occlusion developed. It can be concluded that the interdigitation plays a role in the regulation of vertical and anteroposterior facial growth and constitutes an important factor in the jaw relation in Macaca fascicularis monkeys.

Objective. To validate the European League Against Rheumatism (EULAR), the American College of Rheumatology (ACR), and the World Health Organization (WHO)/International League Against Rheumatism (ILAR) response criteria for rheumatoid arthritis (RA). Methods. EULAR response criteria were developed combining change from baseline and level of disease activity attained during followup. In a trial comparing hydroxychloroquine and sulfasalazine, we studied construct (radiographic progression), criterion (functional capacity), and discriminant validity. Results. EULAR response criteria had good construct, criterion, and discriminant validity. ACR and WHO/ILAR criteria showed only good criterion validity. Conclusion. EULAR response criteria showed better construct and discriminant validity than did the ACR and the WHO/ILAR response criteria for RA.

Weight for height of 92 patients (51 girls and 41 boys) treated for acute lymphoblastic leukemia (ALL) was evaluated in a longitudinal study. Fifty-four patients received cranial irradiation (CI) with a dose of 18 or 24 Gy and 38 patients did not receive CI. Seventy-seven patients were treated according to a normal-risk protocol and 15 patients received more intensive chemotherapy according to a high-risk protocol. In most of the patients the duration of follow-up was 12 years for irradiated patients and 4.5 years for the nonirradiated patients. Thirty of 92 patients were treated according to a protocol without CI, but with a difference in the use of corticosteroids: 19 patients received dexamethasone during the remission-induction and maintenance treatment and 11 patients received prednisone. The influence of dexamethasone vs. prednisone, sex, CI and high-dose vs. low-dose chemotherapy on weight for height was evaluated. Patients who received dexamethasone showed a significant increase in weight for height immediately after the start of therapy. In patients who received CI, weight for height significantly increased after the first year of treatment. The overweight in these patients persisted during the whole follow-up period. The weight for height of patients treated with prednisone and of patients who did not receive CI was below the mean of the normal population during treatment but was not different from normal after cessation of therapy. No difference in weight gain was seen between boys and girls and between patients who were treated with high vs. normal-risk protocols.

OBJECTIVES: To determine the prevalence of musculoskeletal complaints of the back, arms or neck, and legs among nurses, and to investigate the relation between these complaints and various work related and personal variables. METHODS: A questionnaire survey was carried out in four nursing homes in The Netherlands. RESULTS: The response was 95% and resulted in 846 completed questionnaires. It was found that a large proportion of the subjects regularly had back complaints (36%) but also had arm or neck (30%) and leg complaints (16%). Almost all respondents (89%) considered nursing work as physically strenuous. Most of them complained of working under time pressure (69%), increased work pressure (70%), and having no opportunity to take a break from the work (70%). The physical variables which seem to trouble the subjects most were lifting (65%), working in awkward postures (47%), and stooping (34%). Moreover, 53% of the subjects responded that the ergonomic lay out of the ward was disagreeable. Most of the work related variables under study seemed to be associated with musculoskeletal complaints. For all types of complaints the strongest associations were found with having to lift heavy loads. Apart from physical stress various aspects of work pressure showed strong associations with the occurrence of musculoskeletal complaints. The variables on the ergonomy of the ward showed less clear associations with musculoskeletal complaints than were found for physical stress and work pressure. CONCLUSIONS: From these results it may be concluded that future research of health risks of nursing work should have a wider focus than the relation between physical workload and low back pain.

A meta-analysis was performed on published data on the caries-inhibiting effect of chlorhexidine treatment. The results of the various studies are difficult to evaluate because of various treatment procedures, dissimilar features of participants, and different presentations of study results. A meta-analysis provides a more structured approach than the traditional review, due to systematic analysis and numerical processing of the available information. The objectives of this meta-analysis were: (1) to assess a more accurate estimate of the caries-inhibiting effect of chlorhexidine treatment than provided by individual studies, and (2) to explore factors potentially modifying the effect of chlorhexidine treatment in caries prevention, i.e., the application method, application frequency, target population, the fluoride regime, and caries criteria. Caries reduction was expressed by the prevented fraction, indicating the percentage reduction of caries incidence in the chlorhexidine group. For all prevented fractions, 95% confidence intervals were calculated. The overall caries-inhibiting effect of the chlorhexidine treatment studies was 46% (95% CI = 35% - 57%). Multiple-regression analysis showed no significant influence on the prevented fractions for the variables "application method", "application frequency", "caries risk", "fluoride regime", "caries diagnosis", and "tooth surface".

This study compared the experiences with surgical procedures and treatment effects of a mainly implant-supported overdenture retained by a transmandibular implant with those of an implant tissue-supported overdenture retained by two cylindrical endosseous implants. Treatment had been assigned according to a balanced allocation method to 95 patients, including a control group who received only conventional complete dentures. Since some of the patients refused the allocated treatment, the "intention to treat" analysis was applied. The results show that the experiences with surgical procedures were significantly more positive for the transmandibular implant group than the endosseous implant group. The differences with respect to satisfaction, complaints, and subjective chewing ability were not statistically significant. These results were unexpected because the overdentures retained by the transmandibular implants were, to a much larger extent, supported by the implant than were the overdentures retained by two endosseous implants.