Furosemide
By E. Yorik. Trevecca Nazarene University.
Peer-group pressure can be very strong and teasing about the size purchase furosemide 100mg otc arteria epigastrica, position discount furosemide 40 mg on line arrhythmia recognition poster, and colour of the teeth can be very harmful to a child or adolescent. The causes of discoloured teeth may be classified in a number of ways: congenital/ acquired; enamel/dentine; extrinsic/intrinsic; systemic/local. The most useful method of classification for the clinical management of discolouration is one that identifies the main site of discolouration (Table 10. Once the aetiology of the discolouration had been identified the most appropriate method of treatment can be chosen. Ideal and permanent results may not be realistic in the young patient; however, significant improvements are achievable which do not compromise the teeth in the long term. The approach to treatment for all forms of discolouration should be cautious, with the emphasis on minimal tooth preparation. For example, in a case of fluorosis the microabrasion technique may produce some improvement but the patient/parent may still be dissatisfied. Composite veneers can then be placed, although if the child requires subsequent fixed appliance treatment these may be damaged and require replacement before placing porcelain veneers as the definitive restoration in the late teenage years. In the young patient, the apex may be immature, root canal therapy incomplete, and non-vital bleaching therefore precluded. A composite veneer can improve the aesthetics but may fail to adequately disguise the discolouration even with the use of opaqueing agents. Similarly, moderate-to- severe tetracycline discolouration, which fortunately is less common today, is very difficult to treat in the young patient. Long-term full crowns or porcelain veneers often provide definitive treatment, but composite veneers can be acceptable in the adolescent without completely masking the underlying discolouration (Fig. Indirect composite veneers, placed with minimal tooth preparation, may be useful in the management of this problem but this technique has yet to be evaluated. Key Points • Microabrasion should be the first line of treatment in all cases of enamel opacities. Finally, it is very important to bear in mind the expectations of the patient and, often more importantly, the parent. Adequate preoperative explanation, preferably with photographic examples, may help to minimize this problem. Nevertheless, there will remain a group of dissatisfied patients and for medico-legal reasons careful documentation of all cases of cosmetic treatment should be kept. However, it is only more recently that it has been increasingly associated with our younger population. There are three processes that make up the phenomenon of tooth wear: (1) attrition⎯wear of the tooth as a result of tooth-to-tooth contact; (2) erosion⎯irreversible loss of tooth substance brought about by a chemical process that does not involve bacterial action; (3) abrasion⎯physical wear of tooth substance produced by something other than tooth-to-tooth contact. The most frequent cause of abrasion is overzealous toothbrushing, which tends to develop with increasing age. Attrition during mastication is common, particularly in the primary dentition where almost all upper incisors show some signs of attrition by the time they exfoliate (Fig. However, over the past decade the contribution of erosion to the overall process of tooth wear in the younger population has been highlighted. While erosion may be the predominant process, attrition and abrasion may be compounding factors, for example, toothbrush abrasion may be increased if brushing is carried out immediately after the consumption of erosive foodstuffs or drinks. There is very little published evidence on the prevalence or severity of tooth wear in children. In 1993 the National Child Dental Health Survey included an assessment of the prevalence of erosion of both primary and permanent incisor teeth for the first time. The survey reported that 52% of 5-year-old children had erosion of the palatal surfaces of their primary incisors, with 24% showing progression into the pulp (Fig. The prevalence of erosion of the palatal surfaces of permanent incisors was also alarmingly high⎯27% of 15 year olds; however, only 2% showed progression into the pulp. What is unclear at the present time is whether the problem of tooth surface loss is actually increasing or whether these figures reflect an increased awareness. In addition to these three factors certain environmental factors have been linked to tooth wear. However, with the exception of frequent use of chlorinated swimming pools, most environmental and occupational hazards do not apply to children. Dietary causes of tooth surface loss The most common cause of erosive tooth surface loss is an excessive intake of acidic food or drink. Many of these drinks are given to infants in a feeding bottle, and the combination of the highly acidic nature of the drink and the prolonged exposure of the teeth to the acidic substrate may result in excessive tooth surface loss as well as dental caries.
Use the c2 test to see if the variations in counts are due to statistical variations of radioactivity or the counter is not working properly order furosemide 100 mg fast delivery blood pressure chart age group. The computed c2 far exceeds the theoretical value order furosemide 100 mg amex blood pressure chart and pulse rate, so something in addi- tion to the statistical fluctuations of the counts is operating. Minimum Detectable Activity The efficiency of different detectors is limited by the dead time at high count rates and by statistical fluctuations at low count rates of the back- grounds. Evaluation of Diagnostic Tests It is often required to evaluate the usefulness of a new diagnostic test to determine the presence or absence of a particular disease. This aspect of the test is commonly described by two entities: sensitivity and specificity. The sensitivity of a test is the probability of being able to identify correctly 42 4. By these definitions, it is obvious that a given test may not identify all patients correctly whether or not they have the disease. It should be noted that when sensitivity is assessed for a diseased popu- lation or specificity for a healthy group, the disease or healthy status of the group must be assessed by an established standard diagnostic test. This test is called the “gold standard” and is considered the best method available for comparison. Suggested Readings 43 Answer True positive = 780 True negative = 160 − 15 = 145 False negative = 840 − 780 = 60 False positive = 15 780 780 Sensitivity = 100 92 6. A radioactive sample gives 15,360 counts in 9min: (a) What are the count rate of the sample and its standard deviation? How many counts of a sample are to be collected to have a 1% error at the 95% comfidence level? To achieve an estimated percent standard error of 3%, how many counts must be collected? What is the prob- ability that the variations of measurements are due to statistical varia- tions of the quantity? The majority of radionuclides are arti- ficially produced in the cyclotron and reactor. Some short-lived radionu- clides are available from the so-called radionuclide generators in which long-lived parents are loaded and decay to short-lived daughters. These accelerated particles can possess a few kiloelectron volts (keV) to several billion electron volts (BeV) of kinetic energy depending on the design of the cyclotron. Because charged particles move along the circular paths under the magnetic field with gradually increasing energy, the larger the radius of the particle trajectory, the higher the kinetic energy of the particle. The charged particles are deflected by a deflector (D) through a window (W) outside the cyclotron to form an external beam. When targets of stable elements are irradiated by placing them in the external beam of the accelerated particles or in the internal beam at a given radius inside a cyclotron, the accelerated particles interact with the target nuclei, and nuclear reactions take place. In a nuclear reaction, the incident particle may leave the nucleus after interaction with a nucleon, leaving some of its energy in it, or it may be completely absorbed by the nucleus, depending on the energy of the incident particle. In either case, a nucleus with excitation energy is formed and the excitation energy is disposed of by the emission of nucleons (i. Particle emission is followed by g-ray emission when the former is no longer energetically feasible. Depending on the energy deposited by the incident particle, several nucleons are emitted randomly from the irradiated target nucleus, 44 Cyclotron-Produced Radionuclides 45 Fig. A and B, dees with vacuum; D, deflector; S, ion source; V, alternating voltage; W, window. As the energy of the irradi- ating particle is increased, more nucleons are emitted, and therefore a much wider variety of nuclides is produced. Medical cyclotrons are compact cyclotrons that are used to produce rou- tinely short-lived radionuclides, particularly those used in positron emission tomography. In these cyclotrons, protons, deuterons, and a-particles of low- to-medium energy are available. These units are available commercially and can be installed in a relatively small space. An example of a typical cyclotron-produced radionuclide is 111In, which is produced by irradiating 111Cd with 12-MeV protons in a cyclotron.
Many antiarrhythmic drugs affect depolarized tissue to a greater extent than they affect normally polarized tissue discount furosemide 40mg with amex hypertension 160100. Class I drugs block fast Na+ channels buy furosemide 100 mg without prescription arteria hepatica, thereby reducing the rate of phase 0 depola- rization, prolonging the effective refractory period, increasing the threshold of excitability, and reducing phase 4 depolarization. Quinidine (Quinidex, Duraquin, Cardioquin) (1) Effects and pharmacologic properties (a) At therapeutic levels, direct electrophysiologic effects predominate, including depression of the pacemaker rate and depressed conduction and excitability, pro- longation of Q-T interval, and heart block. Quinidine syncope (dizziness and fainting) may occur as a result of ventricular tachycardia; this condition is associ- ated with a prolonged Q-T interval. Disopyramide (Norpace) (1) Disopyramide has action similar to that of quinidine, but has the longest T1=2 of its class. Lidocaine (Xylocaine) (1) Lidocaine acts exclusively on the sodium channel (both activated and inactivated), and it is highly selective for damaged tissues. Mexiletine (Mexitil) (1) Mexiletine is an agent similar in action to lidocaine, but can be administered orally. Flecainide (Tambocor) and encainide (Enkaid) (1) Flecainide is orally active; it is used for ventricular tachyarrhythmias and maintenance of sinus rhythm in patients with paroxysmal atrial fibrillation and/or atrial flutter. Propafenone (Rythmol) (1) Propafenone has a spectrum of action similar to that of quinidine. Propranolol (Inderal, generic), a nonselective b-adrenoceptor antagonist, and the more selective b1-adrenoceptor antagonists acebutolol (Sectral) and esmolol (Brevibloc) are used to treat ventricular arrhythmias. Esmolol is ultrashort acting, is administered by infusion, and is used to titrate block during surgery. They also are used for a variety of other arrhythmias, including atrial flutter and atrial fibrillation. These drugs act by interfering with outward K currents or + slow inward Na currents. It increases refractoriness, and it also depresses sinus node automaticity and slows conduction. Although electrophysiologic effects may be seen within hours after parenteral administration, effects on abnormal rhythms may not be seen for several days. The antiarrhythmic effects may last for weeks or months after the drug is discontinued. Amiodarone is used for treatment of refractory life-threatening ventricular arrhythmias in preference to lidocaine; additional uses include the treatment of atrial and/or ventricular arrhythmias including conversion of atrial fibrillation and the suppression of arrhythmias in patients with implanted defibrillators; it also possesses antianginal and vasodilatory effects. Serious noncardiac adverse effects include pulmonary fi- brosis and interstitial pneumonitis. Other adverse effects include photosensitivity, ‘‘gray man syndrome,’’ corneal microdeposits, and thyroid disorders (due to iodine in the drug preparation). Solatol prolongs the cardiac action potential, increases the duration of the refractory period, and has nonselective b-adrenoceptor antagonist activity. Uses include treatment of atrial arrhythmias or life-threatening ventricular arrhythmias, and treatment of sustained ventricular tachycardia. Its adverse effects include significant proarrhythmic actions, dyspnea, and dizziness. Dofetilide is approved for the conversion and maintenance of normal sinus rhythm in atrial fibrillation or atrial flutter. Dofetilide is a potent inhibitor of K+-channels and has no effect on conduction velocity. Bretylium inhibits the neuronal release of catecholamines, and it also has some direct anti- arrhythmic action. This drug is used intravenously for severe refractory ventricular tachyarrhythmias and also for prophylaxis and treatment of ventricular fibrillation. These drugs prolong nodal conduction and effective refractory period and have predomi- nate actions in nodal tissues. Verapamil is a phenylalkylamine that blocks both activated and inactivated slow calcium channels. Although verapamil is excreted primarily by the kidney, dose reduction is necessary in the presence of hepatic disease and in the elderly.
Invasive zygomycosis: update on pathogenesis order furosemide 40mg with visa arrhythmia symptoms in children, clinical manifestations proven 100mg furosemide blood pressure jumps up, and management. Two serotypes of exfoliatin and their distribution in Staphylococcal strain isolated from patients with scalded skin syndrome. Clinical manifestations of Staphylococcal scalded-skin syndrome depend on serotypes of exfoliative toxins. Clinical, microbial, and biochemical aspects of the exfoliative toxins causing Staphylococcal scalded-skin syndrome. Staphylococcal scalded skin syndrome in adults: a clinical review illustrated with a case. Generalized staphylococcal scalded skin syndrome in an anephric boy undergoing hemodialysis. Staphylococcal scalded skin syndrome mimicking acute graft-versus-host disease in a bone marrow transplant recipient. Trimethoprim-sulfamethoxazole compared with vancomycin for the treatment of Staphylococcus aureus bacteremia. Recent advances in the treatment of infections due to resistant Staphylococcus aureus. Approaches to serious methicillin-resistant Staphylococcus aureus infections with decreased susceptibility to vancomycin: clinical significances and options for management. Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Defining the group A Streptococcal toxic shock syndrome: rationale and consensus definition. Association with tampon use and Staphylococcus aureus and clinical features in 52 cases. Non menstrual toxic shock syndrome: new insights into diagnosis, pathogenesis, and treatment. Toxic-shock syndrome: epidemiologic features, recurrence, risk factors, and prevention. Development of serum antibody to toxic shock toxin among individuals with toxic shock syndrome in Wisconsin. Epidemiologic analysis of group A Streptococcus serotypes associated with severe systemic infections, rheumatic fever, or uncomplicated pharyngitis. Evidence for superantigen involvement in severe group A streptococcal tissue infections. Streptococcal toxic shock syndrome: synthesis of tumor necrosis factor and interleukin-1 by monocytes stimulated with pyrogenic exotoxin A and streptolysin O. Toxin shock syndrome-associated staphylococcal and streptococcal pyrogenic toxins are potent inducers of tumor necrosis factor production. Streptococcal pyrogenic exotoxin B enhances tissue damage initiated by other Streptococcus pyogenes products. Clinical and microbiological characteristics of severe group A Streptococcus infections and streptococcal toxic shock syndrome. Differences in potency of intravenous polyspecific immunoglobulin G against streptococcal and staphylococcal superantigens: implications for therapy of toxic shock syndrome. The Eagle effect revisited: efficacy of clindamycin, erythromycin, and penicillin in the treatment of streptococcal myositis. Penicillin-binding protein expression at different growth stages determines penicillin efficacy in vitro and in vivo: an explanation for the inoculum effect. Potentiation of opsonization and phagocytosis of Streptococcus pyogenes following growth in the presence of clindamycin. Impact of antibiotics on expression of virulence-associated exotoxin genes in methicillin-sensitive and methicillin-resistant Staphylococcus aureus. Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome—a comparative observational study. Intravenous immunoglobulin G therapy in streptococcal toxic shock syndrome: a European randomized, double blind, placebo controlled trial. Characterization of a strain of community-associated methicillin-resistant Staphylococcus aureus widely disseminated in the United States. Skin and soft-tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus. Necrotizing fasciitis caused by community associated methicillin resistant Staphylococcus aureus in Los Angeles.
Selective intubation of the right main bronchus may be supportive by protecting the non-bleeding right lung buy furosemide 40mg free shipping arteria carotis. Occlusion of the right lung bronchus by coagulating blood could lead to respiratory failure cheap furosemide 100mg on line heart attack vegas. The pa- tient should be placed with his non-bleeding lung up, not down, as the goal is to prevent blood from entering the non-bleeding lung. Diabetes typically causes thickening of glomerular basement membrane, mesangial sclerosis, and arteriosclerosis. Multiple myeloma causes proteinuria via deposition of light chains in the glomeruli and tubules and the development of renal amyloidosis. Wegener’s granulo- matosis and microscopic polyangiitis cause pauci-immune necrotizing glomerulonephritis. Pe- ripheral cyanosis is the result of peripheral hypoperfusion of various causes either due to hypotension, as with heart failure (e. In these cases, the extremities are most affected, with the mucus membranes usually spared. This patient has Eisenmenger’s physiology with right-to-left shunting of deoxygenated blood. Other causes of central cyanosis include severe lung disease, pulmonary arteriove- nous malformations, alveolar hypoventilation, or hemoglobin abnormalities. These, as well as portopulmonary shunts, cause platypnea and orth- odeoxia (dyspnea and desaturation with sitting up). The fistulas, which are preferentially at the base of the lungs, increase the right-to-left shunting (and therefore hypoxemia) when upright. In the supine position, the apex of the lung is better perfused and the hy- poxemia improves. Congenital pulmonary arteriovenous malformations may also cause platypnea and orth- odeoxia. Ventricular septal defects will not cause hypoxemia until they develop right-to- left shunting. Idiopathic edema occurs mostly in women and is characterized by episodes of edema that may include abdominal distention. It is typically diurnal, with worsening after being upright for prolonged periods or in hot weather. Cyclical edema occurs with menstruation and is related to estrogen stimulation of fluid retention. Congestive heart failure, nephrotic syndrome, and cirrhosis are ruled out by history and by physical and laboratory examinations. Initially, therapy should in- clude patient education regarding the need to lie flat for a few hours each day, as well as compression stockings put on in the mornings. Idiopathic edema may be related to ab- normal activation of the renin-angiotensin system, and angiotensin-converting enzyme inhibitors may play a role if conservative interventions are not effective. Diuretics may be beneficial initially but may lose effectiveness if used continuously. Palpitations may arise from cardiac, psychiatric, miscellaneous (thyrotoxicosis, drugs, ethanol, caffeine, cocaine), or unknown causes. While most arrhythmias do not cause palpitations, patients with palpitations and known heart disease or risk factors are at risk of atrial or ventricu- lar arrhythmias. Overall, patients complaining of palpitations >15 min are more likely to have psychiatric causes. History, physical examination, Holter monitoring, and electrocardiography may be used to evaluate for arrhythmias. During the second trimester, blood pressure should fall due to a decrease in systemic vascular resistance. Elevated blood pressure is associated with an increase in perinatal morbidity and mortality. Blood pressure should be performed in the sitting position because in the lateral recumbent po- sition the decrease in preload may cause a reduced blood pressure.
The patient does not have any other signs or symptoms of sys- temic vasculitis and does not describe risk factors or other findings consistent with cho- lesterol emboli discount 100 mg furosemide with visa blood pressure high heart rate low. Cervical spondylosis is possible discount 100mg furosemide with visa hypertension guideline update jnc 8, but this is typically a disease process of C2–C4 nerve roots and presents with pain in the neck radiating into the back of the head, shoulders, and arms. The thoracic outlet contains the first rib, the subclavian artery and vein, the brachial plexus, the clavicle, and the lung apex. Neurogenic thoracic outlet syn- drome results from compression of the lower brachial plexus. Signs may include weak- ness of the intrinsic muscles of the hand and diminished sensation on the palmar surface of the fourth and fifth digits. Symptoms include fatigue, weight loss, abdominal pain, head- ache, and hypertension. Mixed cryoglobulinemia is a small-vessel vasculitis most often associated with hepatitis C infection. Skin involvement with leukocytoclastic vasculitis and palpable purpura are the most common presenting features. Proliferative glomerulonephritis is present in 20–60% of individuals and is the most common cause of morbidity. Ischemic colitis typically pre- sents with abdominal pain out of proportion to the examination as in this case, but the mesenteric angiogram would show atherosclerotic narrowing rather than aneurysmal di- latation. Hepatocellular carcinoma is not associated with vasculitis and typically presents with vague abdominal pain and obstructive jaundice. The physical examination is suggestive of amyloidosis with classic waxy papules in the folds of his body. The laboratories are re- markable for renal failure of unclear etiology with significant proteinuria but no cellular casts. This could also account for the en- larged heart seen on the echocardiogram and the peripheral neuropathy. The fat pad biopsy is generally reported to be 60 to 80% sensitive for amyloid; however, it would not allow a diagnosis of this patient’s likely myeloma. A right heart catheterization probably would prove that the patient has restrictive cardiomyopathy secondary to amyloid depo- sition; however, it too would not diagnose the underlying plasma cell dyscrasia. Renal ul- trasound, although warranted to rule out obstructive uropathy, would not be diagnostic. Similarly, the electromyogram and nerve conduction studies would not be diagnostic. The bone marrow biopsy is about 50 to 60% sensitive for amyloid, but it would allow evaluation of the percent of plasma cells in the bone marrow and allow the diagnosis of multiple myeloma to be made. Light chains most commonly deposit systemically in the heart, kidneys, liver, and nervous system, causing organ dysfunction. In these organs, biopsy would show the classic eosinophilic material that, when exposed to Congo red stain, has a characteristic apple-green birefringence. Rheumatoid factor is occasionally positive in relapsing polychondritis but is usu- ally low titer when present. Saddle-nose deformity, which is present in 25% of patients with relapsing polychondritis, may be confused with Wegener’s granulomatosis. The bacteria of septic arthritis usually enter the joint via hematogenous spread through synovial capillaries. The concurrent presence of pseudogout does not preclude the diag- nosis of septic arthritis. Antibiotics, prompt surgical evaluation of possible arthro- scopic drainage, and blood cultures to rule out bacteremia are all indicated. Prompt local and systemic treatment of infection can prevent destruction of cartilage, joint instability, or deformity. If the smear shows no organisms, a third-generation cephalosporin is reasonable empirical therapy. In the presence of Gram-positive cocci in clusters, antistaphylococcal therapy should be instituted based on community prevalence of methicillin resistance or recent hospitalization (which would favor empirical vancomycin). Nonsteroidal anti-inflammatory agents might be a possi- bility depending on the patient’s renal function and gastrointestinal history. Usually this occurs in the absence of intrinsic shoulder disease, in- cluding osteoarthritis and avascular necrosis.
Positioning oral health as a fundamental priority As dentistry acts locally furosemide 100mg for sale arteria3d pack unity, its future demands that along with other health issues throughout the it must think and act globally buy 40mg furosemide visa blood pressure normal lying down. The leadership of the American dental profession is essential to establish and Success in preventing and controlling oral disease reinforce the importance and relevance of oral in the United States is dependent upon an ability to health to total health. Dentistry must be fully share knowledge and expertise with others around involved in international organizations and activi- the world. Also, there is a unique opportunity to ties for research, education and clinical practice. Global Health Recommendation-1: The American dental profession should be an active partner and Global Health Recommendation-4: The dental leader in the global environment. In order to strengthen linkages among all investi- gators so that future collaborative research initia- The experiences and programs of each country tives will be facilitated, it is desirable to provide provide the basis for global resources that can be training for researchers and educators from various used to improve the practice of dentistry, facilitate countries. Global Health Recommendation-8: The interna- Microbial infections can rapidly be spread around tional dental community should foster the develop- the world. Monitoring the deter- Global Health Recommendation-9: The interna- minants of oral diseases, and of oral health and dis- tional dental community should foster research ease status on a global level, is critical for the assess- training for investigators from developing coun- ment of the effectiveness of delivery systems, service tries. Many manufactur- tional dental profession should work to establish ers who have sold through distributors are now cre- and maintain a strong global data bank that would ating websites and are selling products to dentists capture information which helps to prevent the and laboratories through the Internet. With the spread of diseases and promote the best clinical globalization of the production and distribution of practices. It is important that the global dental community work Having a dental workforce prepared for interna- together to see that the identification process of tional collaborations in each country also is critical products is very clear and in compliance with local to global health. All aspects of dentistry must standards for dental products and equipment should be addressed––research, education and practice. Fortunately, technologies are now available for effi- cient communication and timely transfer and stor- Global Health Recommendation-11: The interna- age of information and data. An investment in the tional dental community should support the emerg- training of personnel who could work with global ing development of standards for dental education resources and databases is needed. These activities should provide educational benefits for local practitioners, a process critical to sustain the health of the involved community. An impor- tant benefit of strengthening the educational com- ponent of volunteer efforts is that it will enhance the perception of the importance of oral health among the general populations of those countries. Global Health Recommendation-12: The global dental community should foster the expansion of international volunteer activities to include educa- tional components for local practitioners and popu- lations. Achievement of this goal will require the combined efforts of dental education, dental research, dental practice, industry, gov- ernment, and the public. For purposes of this discussion, clinical practice includes, but is not limited to, those oral health services provided by dentists in the dental office and those community-based programs such as community water fluoridation, oral cancer screening and sealant programs. Clinical care is influenced by the demographics of the population, patterns of dental disease, and the expectations of both patients and providers. Demographically, the United States population is growing older, and more ethnically and culturally diverse. There is increased recognition of the impact of the role of race, culture, beliefs and behavior on health outcomes. This growing awareness may lead to a paradigm shift from a medical model of oral health care based on disease to a health model based on health promotion. Changes underway in the clinical practice of dentistry will make improved oral health for all Americans a real possibility in the next two decades. To help make that possibility a reality, this chapter examines the following issues and discusses their likely impact on clinical practice and practice management. This chapter discusses six major areas: x Trends, disease patterns and use of dental services; x New concepts in patient-based diagnosis, treatment planning and disease management; x Market force issues affecting demand; x Technological advances affecting the dental workplace; x The dental workforce, including its composition and the role of allied health personnel; and, x The organization of dental practices. Tooth loss can be categorized by extent ––complete loss of teeth (or complete edentulism) Oral Health Status and Trends and partial loss of teeth, ranging from one to many (partial edentulism). Higher income and edu- only 16% of children are caries free in their perma- cational levels and increased access to dental insur- nent dentition. In 1996, 65% of persons two years of age ing for all ages, with a corresponding increase in and older visited a dentist (U. The average Ameri- can has fewer caries and is retain- 30 ing more teeth into old age. At the same time, it must address the increas- Percentage of People who are Edentulous, by Age Group ingly complex demands of its more fortunate patients and its Age Group 1971-1974 1988-1994 aging patients. The diseases, and the management of other conditions, latter is characterized by services which may be such as wear of hard tissue, oral infections, oral can- viewed as elective and addresses improvements in self- cer, developmental disorders, intentional and unin- esteem and quality of life.
