These findings are consistent with other population-based studies of ALS and confirm its pernicious nature. Older age, female sex, any bulbar features at onset, short time from symptom onset to diagnosis, lack of a marital partner, and disease severity are key prognostic factors. Serial measurement of severity would likely improve predictions.
A periodontitis epidemic fueled by smoking remained hidden for most of the 20th century. Because this epidemic was hidden, it distorted our understanding of the treatment and etiology of periodontitis. The socioeconomic polarization of this epidemic will dictate alterations in patterns of periodontal care.
Endodontic care, provided by 3,402 dental offices, was assessed from claims data maintained by the Washington Dental Service for 1999. Approximately 5.7 million dental procedures were provided to 880,317 patients by 2,796 general practitioners, 105 endodontists, and 494 other specialists. Of all dental services, 63,321 (1%) were endodontic procedures involving 52,911 (6%) patients. General dentists, endodontists, and other specialists performed 64.7%, 33.7%, and 1.6% of endodontic procedures, the majority of which were root canal therapy. The most frequent tooth types treated by root canal therapy were mandibular first molars (17.0%), maxillary first molars (15.2%), mandibular second molars (11.8%), maxillary second bicuspids (10.3%), maxillary second molars (9.1%), maxillary central and lateral incisors (8.8%), and mandibular second bicuspids (8.0%). Direct and indirect pulp caps by generalists and conventional retreatment and surgical therapy by endodontists made up the majority of the remaining endodontic services. Men had a greater procedure rate than women for most endodontic procedures.
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