T he oral hygiene Skill Achievement Index (S.A.I.) is a general method for the direct, quantitative evaluation of oral hygiene skill . The S.A.I. evaluates a person's ability to manipulate a toothbrush and floss in a given fashion. It is applicable to any brushing or flossing procedure. The Index was developed to fulfill all the postulated requirements of a perfect measuring instrument. The key feature of the Index is the evaluation of the position and the motion of the cleaning device on each tooth surface. Consequently, the Index provides a format for the instruction and evaluation of oral hygiene skill. Furthermore, if used in conjunction with other dental indices, it enables one to evaluate hygiene procedures and devices in a controlled fashion.
Abstract Background The sustainability of school-based oral health programs depends on the utilization of effective, efficient treatments and the availability of a trained clinical workforce. The objective of this study was to determine whether registered nurses are comparable to dental hygienists in the application and effectiveness of silver diamine fluoride (SDF) for the prevention of dental caries. Methods CariedAway was a school-based study of SDF versus dental sealants and atraumatic restorations. Within the SDF arm, subjects were treated by either a licensed dental hygienist or a registered nurse, both under the supervision of a pediatric dentist. Although initial treatment assignment in CariedAway was randomized, assignment to provider was not. The proportion of children who remained caries free after two years was assessed for non-inferiority using two-group proportion tests, adjusting for the clustering effect of schools. Results 417 children were analyzed including 298 treated by hygienists and 119 by nurses. The proportion of caries-free individuals was 0.812 and 0.798 for hygienists and nurses, respectively, for a difference of 0.014 (95% CI = -0.07, 0.098) and within the pre-determined non-inferiority margin. Conclusions Nurses may be effective in treating children with silver diamine fluoride in school-based oral health programs.
Abstract Actin constitutes a major component of the cytoskeleton of human polymorphonuclear leukocytes (PMNs). In this study, we present a comprehensive view of the organization of actin in various PMN regions and functional states. Transmission electron microscopic observations were made on whole mount, migrating, and phagocytizing PMNs. Positive identification of actin filaments was made through S‐1 myosin subfragment labeling . In all PMNs studied, actin filaments were primarily organized as a three‐dimensional meshwork. The density of this meshwork was greatest within the cell cortex. At peripheral regions of nonpolarized (viz., no distinct head or tail region) and polarized PMNs, actin filaments organized into parallel bundles or overlapping arcs. These bundles or arcs were oriented either perpendicular or parallel to the cell periphery. At the base of the PMN, actin filaments converged upon dense, plaquelike condensations. This latter pattern of actin organization was also observed in some pseudopods at the cell front and in phagocytic processes engulfing bacteria. In areas of internalized bacteria, the surrounding actin appeared as a loose meshwork. Treatment of PMNs with the antiactin drug, cytochalasin B, revealed shearing of the peripheral actin meshwork, condensation of the meshwork around the nuclear region, and dissolution of the basal plaquelike condensations.
Importance Dental caries is the most common global childhood disease. To control caries, the Centers for Disease Control and Prevention recommends school-based caries prevention, and the World Health Organization lists glass ionomer cement and silver diamine fluoride as essential medicines for oral disease. Objective To determine the noninferiority of silver diamine fluoride with fluoride varnish vs traditional glass ionomer sealants with fluoride varnish after 2 years when provided to children via a school-based health care program. Design, Setting, and Participants The CariedAway study is an ongoing single-blind, cluster randomized, noninferiority trial conducted between February 1, 2019, and June 1, 2023, among 2998 children in 47 New York City primary schools. Children aged 5 to 13 years of any race and ethnicity were recruited from block-randomized schools. Inclusion criteria for schools were a student population of at least 50% Hispanic or Latino or Latina ethnicity and/or Black race and at least 80% of students receiving free or reduced-cost lunch. Statistical analysis is reported through March 2022. Interventions Children received a single application of silver diamine fluoride with fluoride varnish or an active comparator of glass ionomer sealants and atraumatic restorations with fluoride varnish. Main Outcomes and Measures Primary outcomes were caries arrest and incidence after a 2-year follow-up, assessed using mixed-effects multilevel models and clustered 2-sample proportion tests. The noninferiority margin was 10%. Intention-to-treat analysis was performed using multiple imputation. Results A total of 2998 children (1566 girls [52.2%]; mean [SD] age at baseline, 6.6 [1.2] years; 1397 Hispanic or Latino or Latina children [46.6%]; 874 [29.2%] with untreated dental caries) were recruited and treated from September 16, 2019, to March 12, 2020. Follow-up observations were completed for 1398 children from June 7, 2021, to March 2, 2022. The mean (SE) proportion of children with arrested caries was 0.56 (0.04) after experimental treatment and 0.46 (0.04) after control treatment (difference, −0.11; 95% CI, −0.22 to 0.01). The mean (SE) proportion of patients without new caries was 0.81 (0.02) after experimental treatment and 0.82 (0.02) after control treatment (difference, 0.01; 95% CI, −0.04 to 0.06). Analysis of imputed data for the full sample did not deviate from per-protocol analyses. There were no adverse events. Conclusions and Relevance In this randomized clinical trial, silver diamine fluoride with fluoride varnish was noninferior to sealants and atraumatic restorations with fluoride varnish for caries arrest and prevention. Results may support the use of silver diamine fluoride as an arresting and preventive agent in school-based oral health programs. Trial Registration ClinicalTrials.gov Identifier: NCT03442309
Abstract In the past, studies of avian limb morphogenesis emphasized epithelial‐mesenchymal tissue interactions and problems of determination of limb symmetry. In contrast, a recent hypothesis, based on studies of the aggregation rates of dissociated cells and on computer modeling, proposes that the paddle shaped polydactylous limb of the talpid 3 mutant is the result of increased intercellular adhesion of limb bud mesoderm cells during limb development. The notion that differences in intercellular adhesion may have profound effects on limb morphogenesis has not been critically explored previously. The present experimental approach includes studies of cell sorting in aggregates containing both talpid 2 and wild‐type cells. In this system, adhesive differences should result in cell sorting. Instead, cell sorting did not occur, indicating by this test at least, that limb bud mesoderm cells of talpid 2 and wild‐type embryos are equally adhesive. This conclusion finds support from studies involving tissue spreading in fused fragments of talpid 2 and wild‐type limb bud mesenchyme tissue and in studies of kinetics of aggregation of dissociated cells.
