Cone beam computed tomography findings in temporomandibular joint of chronic qat chewers: Dimensional and osteoarthritic changes

The social habit of chewing qat (also known as khat) is widely practised in East Africa and the Arabian Peninsula. It has been linked with various oro-facial conditions, including temporomandibular joint disorders (TMD). This cross-sectional, comparative study sought to investigate the effects of qat chewing on temporomandibular joint (TMJ), using cone beam computed tomography (CBCT). A total of 85 Yemeni males were included. The participants were divided into two groups: Qat chewers (QC; n = 41) and non-qat chewers (NQC; n = 44). Relevant data were obtained using a structured questionnaire and standardised clinical examination. Additionally, CBCT images of the TMJs were obtained, and then, osteoarthritic changes and TMJ dimensions were analysed. SPSS 21 was used for statistical analyses, with a significant level was set at 0.05. Compared to NQC, a significantly higher proportion of QC presented with clinical signs of TMDs. The qualitative CBCT findings revealed significantly higher osteoarthritic changes in QC than in NQC: osteophyte (51.2% vs 22.7%; P = .008), subcortical sclerosis (48.8% vs 27.3%; P = .047), articular surface flattening (46.3% vs 6.8%; P = .009) and subcortical cysts (43.9% vs 4.5%; P < .001). However, CBCT quantitative findings (condylar dimensions) did not show significant differences between the two groups. The chewing side of the QC group showed slightly more changes compared to the non-chewing side. The results demonstrate that qat chewing has detrimental effects on TMJ manifested mainly as osteoarthritic changes. Further large-scale studies are recommended.     

Width of keratinized gingiva and the health status of the supporting tissues around dental implants

PURPOSE: This cross-sectional study was performed to determine whether an association exists between the width of keratinized mucosa and the health of implant-supporting tissues. MATERIALS AND METHODS: Data on 200 dental implants were collected. Periodontal parameters measured included Plaque Index, Gingival Index, width of keratinized mucosa, thickness of keratinized mucosa, radiographic bone level, and bleeding on probing. Statistical analysis was accomplished with the t test, Wilcoxon rank sum test, and logistic and linear regression models. Significance was established when P was less than .05. RESULTS: The mean Gingival Index score, Plaque Index score, and radiographic bone loss were significantly higher for those implants with a narrow zone (< 2 mm) of keratinized mucosa. Implants with a narrow zone of keratinized mucosa also were more likely to bleed upon probing, even after adjusting for Plaque Index, smoking, thickness of the gingiva, and time since implant placement (adjusted odds ratio, 2.37; 95% confidence interval, 1.04 to 5.83). Significant independent association also was found between the width of keratinized mucosa and radiographic bone loss in favor of wider zone of keratinized mucosa. CONCLUSION: Increased width of keratinized mucosa around implants is associated with lower mean alveolar bone loss and improved indices of soft tissue health.     

Chemoprophylaxis during transrectal prostate needle biopsy: critical analysis through randomized clinical trial

Purpose

To compare the efficacy of three chemoprophylaxis approaches in prevention of post-transrectal biopsy infectious complications (TBICs).

Methods

Patients were randomly assigned to receive ciprofloxacin 3 days 500 mg B.I.D 3 days starting the night prior to biopsy (standard prophylaxis), augmented prophylaxis using ciprofloxacin and single preprocedure shot of 160 mg gentamicin IM (augmented prophylaxis) and rectal swab culture-based prophylaxis (targeted prophylaxis). Patients were assessed 2 weeks prior to biopsy, at biopsy and 2 weeks after. Primary end point was occurrence of post-TBICs that included simple UTI, febrile UTI or sepsis. Secondary end points were post-biopsy change in the inflammatory markers (TLC, ESR and CRP), unplanned visits, hospitalization and occurrence of fluoroquinolones resistance (FQ-R; bacterial growth on MacConkey agar plate with 10 μg/ml ciprofloxacin) in the fecal carriage of screened men.

Results

Between April/2015 and January/2017, standard, augmented and targeted prophylaxes were given to 163, 166 and 167 patients, respectively. Post-TBICs were reported in 43 (26%), 13 (7.8%) and 34 (20.3%) patients following standard, augmented and targeted prophylaxes protocols, respectively (P?=?0.000). Post-TBICs included UTI in 23 (4.6%), febrile UTI in 41 (8.2%) and sepsis in 26 (5.2%) patients. Significantly lower number of post-biopsy positive urine culture was depicted in the augmented group (P?=?0.000). The number of biopsy cores was statistically different in the three groups (P?=?0.004). On multivariate analysis, augmented prophylaxis had independently lower post-TBICs (OR 0.2, 95% CI 0.1–0.4, P?=?0.000) when compared with the other two groups regardless of the number of biopsy cores taken (OR 1.07, 95% CI 0.95–1.17, P?=?0.229). Post-biopsy hospitalization was needed in four (2%), one (0.6%) and ten (6%) patients following standard, augmented and targeted prophylaxes, respectively (P?=?0.014). However, sepsis-related hospitalization was not statistically different. Post-biopsy changes in the inflammatory markers were significantly less in augmented prophylaxis (P?<?0.05). FQ-R was depicted in 139 (83.2%) of the screened men.

Conclusion

Augmented prophylaxis with single-dose gentamicin is an effective and practical approach. Targeted prophylaxis might be reserved for cases with contraindication to gentamicin.