The Impact of Frailty and Comorbidity on Institutionalization and Mortality in Persons With Dementia: A Prospective Cohort Study

Objectives

The predictive value of frailty and comorbidity, in addition to more readily available information, is not widely studied. We determined the incremental predictive value of frailty and comorbidity for mortality and institutionalization across both short and long prediction periods in persons with dementia.

Scanning electron microscopy of panitumumab-induced eyelash and hair alterations – Pili canaliculi

Panitumumab is a monoclonal antibody against the epidermal growth factor receptor used in metastatic colorectal cancer; in addition to tumor cells, it acts on epidermal keratinocytes and on the outer root sheath and presents skin toxicity in up to 90% of cases. A scanning electron microscope was used to examine the eyelashes and hairs of a 65-year-old patient with eyelash trichomegaly, curly hair, and paronychia undergoing treatment with panitumumab. Grooving in the hair shafts were identified, which were more evident in the eyelashes. Similar to oral epidermal growth factor inhibitors (erlotinib and gefitinib), panitumumab can cause acquired pili canaliculi.     

The Effect of a 2-Year Intervention Consisting of Diet,Physical Exercise,Cognitive Training,and Monitoring of Vascular Risk on Chronic Morbidity—the FINGER Randomized Controlled Trial

Objective

To verify whether a multidomain intervention lowers the risk of developing new chronic diseases in older adults.

Identification of periodontal pathogens and severity of periodontitis in patients with and without chronic kidney disease

Objective

In this study of patients with chronic periodontitis (CP), the severity of the disease and the main periodontal pathogens identified in patients with chronic kidney disease (CKD) were compared with those detected in individuals without systemic disease.

Design

Nineteen patients with CP without evidence of systemic disease (control group), 25 patients with CP and CKD who were in the pre-dialysis stages (pre-dialysis group), and 22 patients with CP and CKD who were on renal replacement therapy (RRT group) were examined. The severity of CP was based on the investigation of probing depth (PD) and clinical attachment level (CAL). The definition and stage of CKD were based on the criteria proposed by the Kidney Disease Outcomes Quality Initiative of the National Kidney Foundation. Glomerular filtration rate (GFR) was estimated using the equation of Modification of Diet in Renal Disease and the identification of microorganisms in subgingival plaque was performed using polymerase chain reaction (PCR).

Results

Candida albicans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were more common in patients who were on RRT and pre-dialysis than in control subjects. CP was more severe in patients with CKD. A strong association was observed between the frequency of C. albicans (P = 0.056), P.gingivalis (P = 0.008), T. denticola (P = 0.013) and CAL, when CKD patients were compared with the control group.

Conclusion

CP is more severe and is associated with increased frequency of C. albicans, P. gingivalis, T. forsythia, and T. denticola in patients with CKD.     

Esthetic evaluation of root coverage outcomes: a case series study

The aim of this study was to conduct a 1-year full esthetic evaluation of the treatment outcomes of gingival recession using the root coverage esthetic score (RES) system. One hundred patients with 195 single or multiple recessions were treated using different techniques. One year after surgery, the clinical outcomes were evaluated. Only 21 of 195 (11%) treated recessions obtained the maximum RES score (10), while 68 recessions (35%) showing complete root coverage obtained lower scores. Both single and multiple recessions treated with a coronally advanced flap with or without connective tissue grafting achieved similar RES scores. Free gingival grafts showed the lowest score.     

Root curvature: differences among dental morphotypes and modifications after mechanical instrumentation

BACKGROUND: This study was designed to describe a method for measuring root curvature of extracted teeth, compare root curvature of four different dental morphotypes before mechanical instrumentation, and measure root curvature after mechanical instrumentation. METHODS: Fifty-five maxillary (14 central incisors, 13 lateral incisors, 14 cuspids, 14 premolars) extracted teeth were analyzed. Measurements were recorded on the horizontal plane at the most apical point of the cemento-enamel junction (CEJ). A 4 mm wide root portion on the buccal aspect was selected and recorded on this plane. A digital scanner traced the circle coinciding with the profile of this root portion and calculated its radius, arc, chord, and arrow (i.e., the perpendicular bisector of the chord). Since root curvature is the inverse of the radius (1/r), the radius was related to root curvature; the arc to the mesio-distal dimension of the root portion; and the reduction of the arrow to root flattening after mechanical instrumentation. The measurements were recorded four times: before treatment (baseline), after polishing, after a first root planing, and after a second root planing. The radii of each dental morphotype (upper central incisors, upper lateral incisors, upper canines, upper premolars) recorded in the first measurement were calculated and used for the statistical analyses: one-way analysis of variance (ANOVA) test and the Tukey multiple comparison method were used to study the curvature. The measurements of the radius, the arc, and the arrow at the four times were used for the statistical analyses: the two-way ANOVA test and the Tukey multiple comparison method were applied in the study of the root modifications after mechanical instrumentation. The accuracy and reliability of the method were also evaluated. RESULTS: The mean radii of the four dental morphotypes were: central incisors: 3.613 +/- 0.258 mm; lateral incisors: 2.558 +/- 0.256 mm; canines: 2.822 +/- 0.238 mm; and premolars: 2.321 +/- 0.179 mm. The statistical analyses revealed differences among central incisors, canines, lateral incisors, and premolars. There was no statistically significant difference between lateral incisors and premolars. Regarding the root modifications after mechanical treatment, the radius did not show statistically significant differences in any of the comparisons. The arc and the arrow did not show significant differences between baseline and polishing, while they did show significant differences after the second root planing. CONCLUSIONS: This study indicates that: 1) the method of measuring is accurate and reliable; 2) there are statistically significant differences among the root curvatures of different dental morphotypes; and 3) polishing did not modify the root. A vigorous root planing did not modify root curvature, but it did reduce the mesio-distal dimension and flatten the root surface slightly.     

Integration of composite and ceramic restorations in tetracycline-bleached teeth: a case report

The success of an esthetic rehabilitation depends on the understanding of the patient's need and expectation. The management of patients with moderate to severe tetracycline-stained teeth is very challenging. Tooth whitening may be a valid alternative to more aggressive treatments; however, patients should be aware of the limitations of tooth whitening therapy. Clinicians may select differing treatment plans; tooth whitening can improve intrinsic discoloration in a way so that no further treatment is required. Once tooth whitening is completed, direct or indirect restorative procedures may be afforded to match the existing restoration with the bleached tooth structure. This article describes a conservative clinical approach to rehabilitate the smile of a patient with moderate to severe tetracycline-stained teeth using a combination of tooth whitening and direct composite and indirect porcelain restorations in the maxillary anterior segment. CLINICAL SIGNIFICANCE: The combination of tooth whitening and adhesive restorations allows clinicians a significantly more conservative approach to intrinsically stained teeth; tooth preparation for porcelain veneers and porcelain-fused-to-metal and full-ceramic crowns can be restricted to conditions in which persistent tooth discoloration or significant loss of both dentin and enamel exists.