0099-2399/92/1807-0344/$03.00/0 JOURNALOFENDODONTICS Copyright© 1992by TheAmericanAssociationof Endodontists
Printed in U.S.A.
VOL.18, NO.7, JULY1992
Anatomical Study of the Root Apex in the Maxillary Anterior Teeth Tadashi Mizutani, DDS, PhD, Norikazu Ohno, DDS, PhD, and Hiroshi Nakamura, DDS, PhD
The purpose of this study was to investigate anatomically the apical portion of the root canal of human maxillary anterior teeth. Thirty maxillary central incisors, 30 maxillary lateral incisors, and 30 maxillary cuspids were used. These were teeth from patients ranging in age from 11 to 73 yr. The root apex and main apical foramen coincided in 16.7% of central incisors and cuspids and in 6.7% of the lateral incisors. The labiolingual diameter of the root canal at the apical constriction of the central incisors, lateral incisors, and cuspids averaged 0.425 ram, 0.369 mm, and 0.375 mm, respectively; and the respective vertical distances between apex and apical constriction were 0.863 mm, 0.825 mm, and 1.010 ram.
polishing disk (#1000)
motor
The desired apical extent of canal preparation in endodontics is the dentinocemental junction (1). Anatomical knowledge of the root canal apex is required in root canal preparation, and anatomical investigations of the apical portion of root canal have been made with both macroscopic observation of specimens and microscopic observation of horizontally sectioned polished specimens. Burch and Hulen (2) reported that in 92.4% of teeth studied the major foramen opened short of
samDle FIG2. Method of polishing by Micropolisher.
labial distal ~ "~:'~÷.~
tooth ax,s~ I
apical view
~
lateral view :
I
sample pedestal FIG3. Relation between tooth axis and sample pedestal.
FIG 1. Method of separatingat cervical potion (Fujita's method). 344
Vol. 18, No. 7, July 1992
Study of Root Apex Inngual
Cenltal incisor
lingual
Lateral Incisor
lingual
Cuspid
-t-
| I •" .
t
345
I
L
I ~asmm
•m - .
|;Sm~
eans
•
•
• Amans
m~,ns
F~G4. Deviations of root apex and apical foramen from the tooth axis. TASLE 1. Deviation of apical foramen center from the root apex (mm) Central Incisor
Lateral Incisor
Cuspid
Position Mean _ SD
Range
Mean _ SD
Range
Mean _ SD
Range
Labiolingually 0.250 __0.068 (La) 0.370 (Lin)-1.100 (La) 0.071 _+0.070 (Lin) 0.600 (Lin)-0.800 (La) 0.119 -+ 0.072 (La) 0.600 (Lin)-0.900 (La) Mesiodistally 0.096 ___0.049 (Me) 0.600 (Me)-0.400 (Dis) 0.062 ___0.057 (Dis)0.670 (Me)-0.570 (Dis) 0.071 ___0.061 (Me) 0.960 (Me)-0.570 (Dis) * Lin, lingual; La, labial; Me, mesial; Dis, d~stal.
the anatomical apex and that the distance between the foramen and anatomical root apex was 0.59 mm. Green (3) indicated that in approximately 50% of teeth the major foramen did not open directly on the apex. Kuttler (4) reported that the distance between the center of the foramen and the narrowest part of the apical canal was from 524 to 659 ~m. However, no investigators have reported a sequential observation of horizontally sectioned specimens. We developed a new method to horizontally section teeth from the root apex in precise sequence, and, using it, investigated anatomically the apical portion of the root canal. MATERIALS AND METHODS Thirty maxillary central incisors, 30 maxillary lateral incisors, and 30 maxillary cuspids were used in this study. These were teeth from patients ranging in age from 11 to 73 yr. All of the teeth had periodontal disease and had been in normal occlusion, but none had periapical disease. In order to investigate the deviation between the root apex and the apical foramen, the tooth axis was determined in accordance with Fujita's method (5) (Fig. 1). The root was cut perpendicularly to the tooth axis at the neck of the tooth and set in position on a polishing disc with its axis at right angles to the disc surface. Then the root was sequentially ground from its apex in steps of 50 #m (Figs. 2 and 3). Between each grinding the ground surface was stained with 0. 1% cresyl fast violet solution, observed under a stereomicroscope, and photographed. All data were computed by a digitizer with a figure-measuring program. The parameters measured were as follows: (a) deviations of root apex and apical foramen center from the axis; (b) deviation of the apical foramen center from the root apex; (c) the perpendicular distance from the root apex to the apical foramen, the cross-
sectional area of the root canal, and both its mesiodistal and labiolingual diameters at the apical foramen (d) the perpendicular distance from the root apex to the apical constriction, the cross-sectional area of the apical constriction, and its mesiodistal and labiolingual diameters at the constriction and (e) the shape of the root canal.
RESULTS Deviations ofthe root apex and apical foramen center from the axis (Fig. 4). Both the root apex and apical foramen at the central incisors and the cuspids were displaced distolabially. Those of the lateral incisors were displaced distolingually. Coincidence between the root apex and apical foramen was found in five teeth or 16.7% of both central incisors and cuspids, and in two teeth or 6.7% of lateral incisors. Deviation of apical foramen center from the root apex is shown in Table 1. The apical foramen center of the central incisors and the cuspids was displaced mesiolabially and that of the lateral incisors distolingually. The perpendicular distance from the root apex to the apical foramen, the cross-sectional area of the root canal, and both mesiodistal and labiolingual diameters are shown in Table 2. The average perpendicular distance of the cuspids was 0.51 mm, which was longer than that of the central and lateral incisors. The apical foramen of the cuspids was located closer to the cervical side than that of the central and lateral incisors. The area of the apical foramen and both the mesiodistal and labiolingual diameters of the central incisors were larger than those of the lateral incisors and the cuspids. The perpendicular distance from the root apex to the apical constriction, the cross-sectional area of the apical constriction,
346
Mizutani et al.
Journal of Endodontics
TABLE 2. Perpendicular distance from the apex to the apical foramen, the cross-sectional area of the root canal, and both mesiodistal and labiolingual diameters at the apical foramen Central Incisor Mean _ SD Vertical distance (mm) Labiolingual diameter (mm) Mesiodistal diameter (ram) Area (mm ~)
0.450 0.504 0.429 0.150
- 0.053 _+ 0.021 _+ 0.020 _+ 0.009
Lateral Incisor
Range
Mean _+ SD
0.050-1.100 0.281-0.741 0.299-0.837 0.062-0.251
0.440 0.452 0.390 0.123
_ 0.060 _+ 0.028 +- 0.025 + 0.011
Range 0.200-1.800 0.207-0.925 0.216-0.883 0.031-0.324
Cuspid Mean _ SD 0.510 0.425 0.375 0.118
Range
-+ 0.073 _ 0.022 _+_0.018 ± 0.010
0.050-1.600 0.124-0.649 0.143-0.667 0.055-0.275
TABLE 3. Perpendicular distance from the root apex to the apical constriction, the cross-sectional area of the apical constriction, and both mesiodistal and labiolingual diameters at the constriction
Central incisor Lateral incisor Cuspid
Area (ram2)
Mesiodistal (mm)
Labiolingual (ram)
Vertical (mm)
0.115 -+ 0.007* 0,082 _+ 0.006 0.094 _+ 0.009
0,370 _+ 0.012" 0.307 _+ 0.014 0.313 _+ 0,016
0.425 _+ 0,020* 0.369 -+ 0.018 0.375 - 0,022
0.863 +_ 0.108" 0,825 _+ 0.089 1.010 _+ 0,101
* Mean_+SO.
TABLE 4. Shape of the root canal Shape
Central Incisor
Lateral Incisor
Cuspid
Circular Oval Ovoid Irregular
17 6 7 0
13 12 4 1
16 7 5 2
and both mesiodistal and labiolingual root canal diameters at the constriction are represented in Table 3. The labiolingual diameters of the root canal at the apical constriction of the central incisors, the lateral incisors, and the cuspids was 0.425 mm, 0.369 mm, and 0.425 mm, respectively. This dimension in all maxillary anterior teeth was approximately 0.050 mm larger than the mesiodistal one. The perpendicular distance between the root apex and the apical constriction of the root canal in the central incisors, the lateral incisors, and the cuspids was 0.863 mm, 0.825 mm, and 1.010 mm, respectively. The shape of the root canal (Table 4) at the apical constriction determined by its cross-section appearance was classified into four categories circular, oval, ovoid, and irregular. Of the maxillary central incisors, lateral incisors, and cuspids examined, mostly circular shapes were observed. Irregular shapes were observed in only three teeth, excluding the central incisors. DISCUSSION It is very important to have anatomical knowledge of the root canal apex in endodontic treatment to ensure long-term treatment success. The apical foramen is not always the most constricted portion of the root canal, and it makes its exit on the mesial, distal, labial, or lingual surface of a root slightly short of the root apex rather than at the root apex itself (6). Burch and Hulen (2) reported that the percentage of apical foramina deviating from the anatomical apex ranged from 78 to 98.9%. Green (3) reported a percentage deviation of 69.3
for the anterior and 50.0 for the posterior teeth; whereas Kuttler (4) reported approximately 80%. Hikichi and Kawaguchi (7) reported a coincidence of the root apex and the apical foramen in 30 to 40% of teeth examined; however; the percentage of maxillary anterior teeth showing deviation in our study ranged from 80 to 90%. Our results are similar to those of Burch and Hulen (2). Green (3) reported that the perpendicular distance from the root apex to the apical foramen in maxillary anterior teeth is approximately 0.3 ram, and Hikichi and Kawaguchi (7) reported values from 0.3 to 0.39 mm. The average perpendicular distance from the root apex to the apical foramen found in the present study was 0.44 to 0.51 mm, a bit larger than the values of Green (3) and Hikichi and Kawaguchi (7). The labiolingual diameter of the apical foramen was larger than the mesiodistal one. Our results are similar to those of Kuttler (4).
In this study, the labiolingual diameter of the root canal in the apical constriction of the maxillary anterior teeth was approximately 0.05 m m larger than the mesiodistal diameter. Our results are consistent with those other studies (2-4), indicating that the labiolingual diameter at the apical constriction in the maxillary anterior teeth is indeed larger than the mesiodistal one. Kuttler (4) reported that the distance between the center of the foramen and the apical constriction was an average of 524 tzm in the age group 18 to 25 and 659 #m in persons above 55 yr of age. In our study, this distance was between 0.825 and 1.010 ram, thus differing from Kuttler's findings. But the foramina are located 0.5 to 1.0 mm cervical from the root apex. The observed contour of the apical constriction in this study was mostly circular of ovoid, which is consistent with studies by Green (3) and Asano et al. (8). The terminal part of the root canal observed by Kuttler (4) and Green (3) was funnel like, whereas in our study it was cylinder like. Perhaps this is due to the population sampled. Drs. Mizutani and Nakamura are in the Department of Endodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan. Dr. Ohno is in the First
Vol. 18, No. 7, July 1992
Study of Root Apex
Department of Anatomy, School of Dentistry, Aichi Gakuin University. Address requests for reprints to Dr. Tadashi Mizutani, Department of Endodontics, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku Nagoya 464, Japan.
347
3. Green D. A stereomicroscopic study of the root apices of 400 maxillary and mandibular anterior teeth. Oral Surg 1956;9:1224-32. 4. Kuttler Y. Microscopic investigation of root apexes. J Am Dent Assoc 1955;50:544-52. 5, Fujita T. The measured criteria of tooth. J Anthrop Soc Nippon
1949;61:1-6. References 1. Weine FS. Endodontic therapy. 4th ed. St. Louis: CV Mosby, 1989:28792.
2. Burch IG, Hulen S. The relationship of the apical foramen to the anatomic apex of the tooth root. Oral Surg 1972;34:262-8.
6. Grossman LI. Endodontic practice. 10th ed. Philadelphia: Lea & Febiger, 1981:193-9. 7. Hikichi S, Kawaguchi Y. A study on the position of the apical foramen of maxillary and mandibular anterior teeth. Jpn J Conserv Dent 1977;20:450-5. 8. Asano S, Hosokawa I, Narita M. Histo-pathological study on shape of root canal of permanent incisors and cuspid teeth using transverse sections. Shikagakuho 1973;73:1232-47.
You Might Like to Know Asthma is now recognized as an inflammatory disease treatable by inhalation corticosteroids. That's the good news. The bad news is that based on this new understanding, it is now proposed to rename the condition, "chronic desquamating eosinophilic bronchitis" (N Engl J Med 324:425). It probably all started when they renamed Vincent's as "necrotizing ulcerative gingivitis." And what happened to "croup," and "quinsy," and "consumption" and all those other good old-fashioned diseases? Is it possible we scientific types take ourselves a little too seriously? Maybe the old folks knew best. Wallace Sturr
Printed in U.S.A.
VOL.18, NO.7, JULY1992
Anatomical Study of the Root Apex in the Maxillary Anterior Teeth Tadashi Mizutani, DDS, PhD, Norikazu Ohno, DDS, PhD, and Hiroshi Nakamura, DDS, PhD
The purpose of this study was to investigate anatomically the apical portion of the root canal of human maxillary anterior teeth. Thirty maxillary central incisors, 30 maxillary lateral incisors, and 30 maxillary cuspids were used. These were teeth from patients ranging in age from 11 to 73 yr. The root apex and main apical foramen coincided in 16.7% of central incisors and cuspids and in 6.7% of the lateral incisors. The labiolingual diameter of the root canal at the apical constriction of the central incisors, lateral incisors, and cuspids averaged 0.425 ram, 0.369 mm, and 0.375 mm, respectively; and the respective vertical distances between apex and apical constriction were 0.863 mm, 0.825 mm, and 1.010 ram.
polishing disk (#1000)
motor
The desired apical extent of canal preparation in endodontics is the dentinocemental junction (1). Anatomical knowledge of the root canal apex is required in root canal preparation, and anatomical investigations of the apical portion of root canal have been made with both macroscopic observation of specimens and microscopic observation of horizontally sectioned polished specimens. Burch and Hulen (2) reported that in 92.4% of teeth studied the major foramen opened short of
samDle FIG2. Method of polishing by Micropolisher.
labial distal ~ "~:'~÷.~
tooth ax,s~ I
apical view
~
lateral view :
I
sample pedestal FIG3. Relation between tooth axis and sample pedestal.
FIG 1. Method of separatingat cervical potion (Fujita's method). 344
Vol. 18, No. 7, July 1992
Study of Root Apex Inngual
Cenltal incisor
lingual
Lateral Incisor
lingual
Cuspid
-t-
| I •" .
t
345
I
L
I ~asmm
•m - .
|;Sm~
eans
•
•
• Amans
m~,ns
F~G4. Deviations of root apex and apical foramen from the tooth axis. TASLE 1. Deviation of apical foramen center from the root apex (mm) Central Incisor
Lateral Incisor
Cuspid
Position Mean _ SD
Range
Mean _ SD
Range
Mean _ SD
Range
Labiolingually 0.250 __0.068 (La) 0.370 (Lin)-1.100 (La) 0.071 _+0.070 (Lin) 0.600 (Lin)-0.800 (La) 0.119 -+ 0.072 (La) 0.600 (Lin)-0.900 (La) Mesiodistally 0.096 ___0.049 (Me) 0.600 (Me)-0.400 (Dis) 0.062 ___0.057 (Dis)0.670 (Me)-0.570 (Dis) 0.071 ___0.061 (Me) 0.960 (Me)-0.570 (Dis) * Lin, lingual; La, labial; Me, mesial; Dis, d~stal.
the anatomical apex and that the distance between the foramen and anatomical root apex was 0.59 mm. Green (3) indicated that in approximately 50% of teeth the major foramen did not open directly on the apex. Kuttler (4) reported that the distance between the center of the foramen and the narrowest part of the apical canal was from 524 to 659 ~m. However, no investigators have reported a sequential observation of horizontally sectioned specimens. We developed a new method to horizontally section teeth from the root apex in precise sequence, and, using it, investigated anatomically the apical portion of the root canal. MATERIALS AND METHODS Thirty maxillary central incisors, 30 maxillary lateral incisors, and 30 maxillary cuspids were used in this study. These were teeth from patients ranging in age from 11 to 73 yr. All of the teeth had periodontal disease and had been in normal occlusion, but none had periapical disease. In order to investigate the deviation between the root apex and the apical foramen, the tooth axis was determined in accordance with Fujita's method (5) (Fig. 1). The root was cut perpendicularly to the tooth axis at the neck of the tooth and set in position on a polishing disc with its axis at right angles to the disc surface. Then the root was sequentially ground from its apex in steps of 50 #m (Figs. 2 and 3). Between each grinding the ground surface was stained with 0. 1% cresyl fast violet solution, observed under a stereomicroscope, and photographed. All data were computed by a digitizer with a figure-measuring program. The parameters measured were as follows: (a) deviations of root apex and apical foramen center from the axis; (b) deviation of the apical foramen center from the root apex; (c) the perpendicular distance from the root apex to the apical foramen, the cross-
sectional area of the root canal, and both its mesiodistal and labiolingual diameters at the apical foramen (d) the perpendicular distance from the root apex to the apical constriction, the cross-sectional area of the apical constriction, and its mesiodistal and labiolingual diameters at the constriction and (e) the shape of the root canal.
RESULTS Deviations ofthe root apex and apical foramen center from the axis (Fig. 4). Both the root apex and apical foramen at the central incisors and the cuspids were displaced distolabially. Those of the lateral incisors were displaced distolingually. Coincidence between the root apex and apical foramen was found in five teeth or 16.7% of both central incisors and cuspids, and in two teeth or 6.7% of lateral incisors. Deviation of apical foramen center from the root apex is shown in Table 1. The apical foramen center of the central incisors and the cuspids was displaced mesiolabially and that of the lateral incisors distolingually. The perpendicular distance from the root apex to the apical foramen, the cross-sectional area of the root canal, and both mesiodistal and labiolingual diameters are shown in Table 2. The average perpendicular distance of the cuspids was 0.51 mm, which was longer than that of the central and lateral incisors. The apical foramen of the cuspids was located closer to the cervical side than that of the central and lateral incisors. The area of the apical foramen and both the mesiodistal and labiolingual diameters of the central incisors were larger than those of the lateral incisors and the cuspids. The perpendicular distance from the root apex to the apical constriction, the cross-sectional area of the apical constriction,
346
Mizutani et al.
Journal of Endodontics
TABLE 2. Perpendicular distance from the apex to the apical foramen, the cross-sectional area of the root canal, and both mesiodistal and labiolingual diameters at the apical foramen Central Incisor Mean _ SD Vertical distance (mm) Labiolingual diameter (mm) Mesiodistal diameter (ram) Area (mm ~)
0.450 0.504 0.429 0.150
- 0.053 _+ 0.021 _+ 0.020 _+ 0.009
Lateral Incisor
Range
Mean _+ SD
0.050-1.100 0.281-0.741 0.299-0.837 0.062-0.251
0.440 0.452 0.390 0.123
_ 0.060 _+ 0.028 +- 0.025 + 0.011
Range 0.200-1.800 0.207-0.925 0.216-0.883 0.031-0.324
Cuspid Mean _ SD 0.510 0.425 0.375 0.118
Range
-+ 0.073 _ 0.022 _+_0.018 ± 0.010
0.050-1.600 0.124-0.649 0.143-0.667 0.055-0.275
TABLE 3. Perpendicular distance from the root apex to the apical constriction, the cross-sectional area of the apical constriction, and both mesiodistal and labiolingual diameters at the constriction
Central incisor Lateral incisor Cuspid
Area (ram2)
Mesiodistal (mm)
Labiolingual (ram)
Vertical (mm)
0.115 -+ 0.007* 0,082 _+ 0.006 0.094 _+ 0.009
0,370 _+ 0.012" 0.307 _+ 0.014 0.313 _+ 0,016
0.425 _+ 0,020* 0.369 -+ 0.018 0.375 - 0,022
0.863 +_ 0.108" 0,825 _+ 0.089 1.010 _+ 0,101
* Mean_+SO.
TABLE 4. Shape of the root canal Shape
Central Incisor
Lateral Incisor
Cuspid
Circular Oval Ovoid Irregular
17 6 7 0
13 12 4 1
16 7 5 2
and both mesiodistal and labiolingual root canal diameters at the constriction are represented in Table 3. The labiolingual diameters of the root canal at the apical constriction of the central incisors, the lateral incisors, and the cuspids was 0.425 mm, 0.369 mm, and 0.425 mm, respectively. This dimension in all maxillary anterior teeth was approximately 0.050 mm larger than the mesiodistal one. The perpendicular distance between the root apex and the apical constriction of the root canal in the central incisors, the lateral incisors, and the cuspids was 0.863 mm, 0.825 mm, and 1.010 mm, respectively. The shape of the root canal (Table 4) at the apical constriction determined by its cross-section appearance was classified into four categories circular, oval, ovoid, and irregular. Of the maxillary central incisors, lateral incisors, and cuspids examined, mostly circular shapes were observed. Irregular shapes were observed in only three teeth, excluding the central incisors. DISCUSSION It is very important to have anatomical knowledge of the root canal apex in endodontic treatment to ensure long-term treatment success. The apical foramen is not always the most constricted portion of the root canal, and it makes its exit on the mesial, distal, labial, or lingual surface of a root slightly short of the root apex rather than at the root apex itself (6). Burch and Hulen (2) reported that the percentage of apical foramina deviating from the anatomical apex ranged from 78 to 98.9%. Green (3) reported a percentage deviation of 69.3
for the anterior and 50.0 for the posterior teeth; whereas Kuttler (4) reported approximately 80%. Hikichi and Kawaguchi (7) reported a coincidence of the root apex and the apical foramen in 30 to 40% of teeth examined; however; the percentage of maxillary anterior teeth showing deviation in our study ranged from 80 to 90%. Our results are similar to those of Burch and Hulen (2). Green (3) reported that the perpendicular distance from the root apex to the apical foramen in maxillary anterior teeth is approximately 0.3 ram, and Hikichi and Kawaguchi (7) reported values from 0.3 to 0.39 mm. The average perpendicular distance from the root apex to the apical foramen found in the present study was 0.44 to 0.51 mm, a bit larger than the values of Green (3) and Hikichi and Kawaguchi (7). The labiolingual diameter of the apical foramen was larger than the mesiodistal one. Our results are similar to those of Kuttler (4).
In this study, the labiolingual diameter of the root canal in the apical constriction of the maxillary anterior teeth was approximately 0.05 m m larger than the mesiodistal diameter. Our results are consistent with those other studies (2-4), indicating that the labiolingual diameter at the apical constriction in the maxillary anterior teeth is indeed larger than the mesiodistal one. Kuttler (4) reported that the distance between the center of the foramen and the apical constriction was an average of 524 tzm in the age group 18 to 25 and 659 #m in persons above 55 yr of age. In our study, this distance was between 0.825 and 1.010 ram, thus differing from Kuttler's findings. But the foramina are located 0.5 to 1.0 mm cervical from the root apex. The observed contour of the apical constriction in this study was mostly circular of ovoid, which is consistent with studies by Green (3) and Asano et al. (8). The terminal part of the root canal observed by Kuttler (4) and Green (3) was funnel like, whereas in our study it was cylinder like. Perhaps this is due to the population sampled. Drs. Mizutani and Nakamura are in the Department of Endodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan. Dr. Ohno is in the First
Vol. 18, No. 7, July 1992
Study of Root Apex
Department of Anatomy, School of Dentistry, Aichi Gakuin University. Address requests for reprints to Dr. Tadashi Mizutani, Department of Endodontics, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku Nagoya 464, Japan.
347
3. Green D. A stereomicroscopic study of the root apices of 400 maxillary and mandibular anterior teeth. Oral Surg 1956;9:1224-32. 4. Kuttler Y. Microscopic investigation of root apexes. J Am Dent Assoc 1955;50:544-52. 5, Fujita T. The measured criteria of tooth. J Anthrop Soc Nippon
1949;61:1-6. References 1. Weine FS. Endodontic therapy. 4th ed. St. Louis: CV Mosby, 1989:28792.
2. Burch IG, Hulen S. The relationship of the apical foramen to the anatomic apex of the tooth root. Oral Surg 1972;34:262-8.
6. Grossman LI. Endodontic practice. 10th ed. Philadelphia: Lea & Febiger, 1981:193-9. 7. Hikichi S, Kawaguchi Y. A study on the position of the apical foramen of maxillary and mandibular anterior teeth. Jpn J Conserv Dent 1977;20:450-5. 8. Asano S, Hosokawa I, Narita M. Histo-pathological study on shape of root canal of permanent incisors and cuspid teeth using transverse sections. Shikagakuho 1973;73:1232-47.
You Might Like to Know Asthma is now recognized as an inflammatory disease treatable by inhalation corticosteroids. That's the good news. The bad news is that based on this new understanding, it is now proposed to rename the condition, "chronic desquamating eosinophilic bronchitis" (N Engl J Med 324:425). It probably all started when they renamed Vincent's as "necrotizing ulcerative gingivitis." And what happened to "croup," and "quinsy," and "consumption" and all those other good old-fashioned diseases? Is it possible we scientific types take ourselves a little too seriously? Maybe the old folks knew best. Wallace Sturr
