RESUMEN
BACKGROUND: In this study, the authors examine the cost-effectiveness of light-polymerized resin-based fluoride sealants on primary molars in high caries risk children younger than 6 years. METHODS: The authors examined the cost-effectiveness of pit-and-fissure sealant (PFS) treatment on primary molars by comparing sealed and unsealed molars treated in the outpatient clinic or operating room. Using 1,884 primary molars followed over a 5-year period, the authors used a mixed-effects regression model to estimate the probability of caries development. They used restricted means to estimate years free of caries for carious molars. They used a decision tree to address uncertainty due to PFS treatment failure, predict the expected value associated with each strategy, and estimate the incremental cost-effectiveness ratio using a 3% discount rate to adjust future cost and outcomes to present value. RESULTS: Over 5 years, the cost of care was $90 for unsealed molars and $75 for sealed molars. Unsealed molars remained caries free for 4.32 years compared with 4.85 years in sealed molars. The cost-effectiveness of PFS treatment was dominant, leading to a savings of $25 for each caries-free year gained and overall savings of $742 million for the United States dental health system over a 5-year period. CONCLUSIONS: PFS treatment is associated with cost savings and a delay in caries development and should be considered in children with high caries risk. PRACTICAL IMPLICATIONS: Policy makers should consider reimbursement of PFS treatment on primary molars in high caries risk children.
Asunto(s)
Caries Dental , Selladores de Fosas y Fisuras , Niño , Ahorro de Costo , Caries Dental/prevención & control , Fluoruros Tópicos , Humanos , Diente Molar , Selladores de Fosas y Fisuras/uso terapéutico , Diente PrimarioRESUMEN
GAPO syndrome is a rare autosomal recessive genetic disorder, characterized by growth retardation, alopecia, pseudoanodontia, and progressive ocular changes. This disorder is caused by recessive mutations in the ANTXR1 gene and has characteristic dysmorphic facial features along with connective tissue changes, cardiomyopathy, gonadal dysfunction and craniosynostosis. The most common dental implication of GAPO syndrome is pseudoanodontia caused by eruption failure of the primary and permanent dentition. Currently, there is no standard treatment for patients with GAPO syndrome. Management often includes multidisciplinary care in the surveillance of syndromic sequelae and supportive treatment of symptomatic health concerns, which are unique to each patient. The purpose of this paper is to describe the dental rehabilitation of two brothers with GAPO syndrome.
Asunto(s)
Anodoncia , Hermanos , Alopecia , Atención Odontológica , Trastornos del Crecimiento , Humanos , Masculino , Proteínas de Microfilamentos , Atrofias Ópticas Hereditarias , Receptores de Superficie CelularRESUMEN
STATEMENT OF PROBLEM: Indirect restorations with partial or complete occlusal surface coverage have been recommended to restore teeth with weakened walls in order to prevent cusp fracture. The success of these restorations when performed by dental students is unknown. PURPOSE: The purpose of this retrospective study was to evaluate the clinical performance of adhesively bonded ceramic onlay restorations placed by third- and fourth-year dental students. MATERIAL AND METHODS: Sixty-five ceramic onlays were placed in patients between 2009 and 2015. The onlays were laboratory or chairside fabricated with a computer-aided design and computer-aided manufacturing (CAD-CAM) system, using either IPS e.max Press or IPS e.max CAD. An adhesive technique and luting composite resin agent were used to cement the restorations. Thirty-seven onlays were evaluated clinically using the modified United States Public Health Service (USPHS) criteria. Data were statistically analyzed using the Cox proportional hazards model to compare tooth type and failures and the Fisher exact and McNemar tests to compare the USPHS criteria for significant differences (α=.05). Survival probability was calculated using the Kaplan-Meier algorithm. RESULTS: Five onlays were considered to be failures and needed replacement. According to the Kaplan-Meier analysis, the estimated survival rate was 96.3% after 2 years and 91.5% at 4 years. All 5 of the failures occurred on molars (13.5%) and none on premolars (P=.025). A statistically significant difference was found for marginal discoloration between onlays placed within 0 to 3 years and 3 to 6 years (P<.05) but no differences between any other criteria. CONCLUSIONS: Ceramic onlays placed by dental students demonstrated acceptable long-term clinical performance.
Asunto(s)
Competencia Clínica , Incrustaciones , Estudiantes de Odontología , Adulto , Cerámica , Resinas Compuestas , Diseño Asistido por Computadora , Recubrimiento Dental Adhesivo/métodos , Fracaso de la Restauración Dental , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
A locus on chromosome 1p34-36 (DYX8) has been linked to developmental dyslexia or reading disabilities (RD) in three independent samples. In the current study, we investigated a candidate gene KIAA0319-Like (KIAA0319L) within DYX8, as it is homologous to KIAA0319, a strong RD candidate gene on chromosome 6p (DYX2). Association was assessed by using five tagging single nucleotide polymorphisms in a sample of 291 nuclear families ascertained through a proband with reading difficulties. Evidence of association was found for a single marker (rs7523017; P=0.042) and a haplotype (P=0.031), with RD defined as a categorical trait in a subset of the sample (n=156 families) with a proband that made our criteria for RD. The same haplotype also showed evidence for association with quantitative measures of word-reading efficiency (i.e., a composite score of word identification and decoding; P=0.032) and rapid naming of objects and colors (P=0.047) when analyzed using the entire sample. Although the results from the current study are modestly significant and would not withstand a correction for multiple testing, KIAA0319L remains an intriguing positional and functional candidate for RD, especially when considered alongside the supporting evidence for its homolog KIAA0319 on chromosome 6p. Additional studies in independent samples are now required to confirm these findings.
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Cromosomas Humanos Par 1 , Dislexia/genética , Proteínas Nucleares/genética , Polimorfismo de Nucleótido Simple , Carácter Cuantitativo Heredable , Adolescente , Secuencia de Bases , Distribución de Chi-Cuadrado , Niño , Mapeo Cromosómico , Marcadores Genéticos , Predisposición Genética a la Enfermedad , Variación Genética , Haplotipos , Humanos , Datos de Secuencia Molecular , Receptores de Superficie Celular , Análisis de RegresiónRESUMEN
Children with closed head injury (CHI) perform poorly on complex tasks requiring working memory (WM). It is unclear to what extent WM itself is compromised, and whether WM varies with factors related to the CHI, such as injury severity, age at injury, and time since injury. We studied verbal WM in 126 school-age children with CHI, divided into mild, moderate, and severe injury severity groups. WM distributions were significantly skewed toward lower scores in the moderate and severe groups, although the distribution in the mild group was normal. Age at injury and time since injury predicted WM components only for the moderate group. Survivors of moderate or severe childhood CHI have persisting WM deficits limiting the computational workspace required for many cognitive tasks.
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Traumatismos Cerrados de la Cabeza/clasificación , Traumatismos Cerrados de la Cabeza/fisiopatología , Memoria a Corto Plazo/fisiología , Adolescente , Factores de Edad , Análisis de Varianza , Niño , Demografía , Femenino , Escala de Coma de Glasgow/estadística & datos numéricos , Humanos , Masculino , Pruebas Neuropsicológicas , Regresión PsicológicaRESUMEN
We studied the metacognitive functioning of children with severe and mild traumatic brain injury (TBI) and typically developing children. To test metacognition for memory, children were tested on a modified Judgment of Learning task. We found that children with severe TBI were impaired in their ability to predict recall of specific items prior to study-recall trials, but were unimpaired in predicting recall on a delayed test when the judgment was made after study-recall trials. Metacognitive knowledge impairment for memorial abilities was also demonstrated in children with severe TBI by poor estimation of memory span and exaggerated overconfidence in performance. To test metacognition within the language domain, we gave children a sentence anomaly detection and repair task in which spoken sentences were monitored for semantic anomalies. Children with severe TBI were impaired on the detection of semantic anomalies, especially under conditions of high memory load. However, metalinguistic knowledge in the form of adequate repairs of anomalous sentences, was preserved. Results are discussed in terms of effects of age at test and injury severity.