Recurrent respiratory papillomatosis in northern Sweden: Clinical characteristics and practical guidance

Conclusion: Recurrent respiratory papillomatosis (RRP) patients with high surgical treatment frequency (≥ 1/year, HF) were significantly younger and had a more widespread laryngeal disease compared to a low frequency treated group (< 1 treatment/year, LF). This study confirms the existence of a clinical RRP group, not primarily related to HPV sub-type, but more care-intensive and in need of more vigilant follow-up. Objectives: RRP is associated with high morbidity due to its influence on breathing and voice. The purpose of this study was to characterize RRP patients in northern Sweden and investigate possible predictor factors affecting therapeutic needs. Method: Patients from the regional referral area (northern Sweden) were categorized for age, disease duration, juvenile or adult onset, profile of disease development, number of surgical sessions in relation to disease duration, laryngeal deposition of papilloma, gender, and HPV sub-types, in order to identify patients with increased need for frequent surgical treatment. Results: The median age of the RRP patients (n = 48) was 44.5 years; 34 (71%) were males and 14 (29%) females, most were infected with HPV 6. Patients with high surgical treatment frequency/year were significantly younger and showed more widespread papillomatous vegetation in the larynx, compared to the low frequency treated group.     

Informing a home time measure reflective of quality of life: A data driven investigation of time frames and settings of health care utilization

Objective

To evaluate short- and long-term measures of health care utilization—days in the emergency department (ED), inpatient (IP) care, and rehabilitation in a post-acute care (PAC) facility—to understand how home time (i.e., days alive and not in an acute or PAC setting) corresponds to quality of life (QoL).

Data Sources

Survey data on community-residing veterans combined with multipayer administrative data on health care utilization.

Study Design

VA or Medicare health care utilization, quantified as days of care received in the ED, IP, and PAC in the 6 and 18 months preceding survey completion, were used to predict seven QoL-related measures collected during the survey. Elastic net machine learning was used to construct models, with resulting regression coefficients used to develop a weighted utilization variable. This was then compared with an unweighted count of days with any utilization.

Principal Findings

In the short term (6 months), PAC utilization emerged as the most salient predictor of decreased QoL, whereas no setting predominated in the long term (18 months). Results varied by outcome and time frame, with some protective effects observed. In the 6-month time frame, each weighted day of utilization was associated with a greater likelihood of activity of daily living deficits (0.5%, 95% CI: 0.1%–0.9%), as was the case with each unweighted day of utilization (0.6%, 95% CI: 0.3%–1.0%). The same was true in the 18-month time frame (for both weighted and unweighted, 0.1%, 95% CI: 0.0%–0.3%). Days of utilization were also significantly associated with greater rates of instrumental ADL deficits and fair/poor health, albeit not consistently across all models. Neither measure outperformed the other in direct comparisons.

Conclusions

These results can provide guidance on how to measure home time using multipayer administrative data. While no setting predominated in the long term, all settings were significant predictors of QoL measures.     

Alterations of surface hardness with gypsum die hardeners

STATEMENT OF PROBLEM: Die stones require abrasion resistance, dimensional stability with time, and high surface wettability material properties. PURPOSE: The purpose of this study was to compare the surface microhardness (Knoop) of 4 contemporary gypsum materials with and without surface die hardener. MATERIAL AND METHODS: Materials used were a Type III stone (Microstone) and 3 die stones (Die-Keen, Silky-Rock, and ResinRock). Die hardener was cyanoacrylate (Permabond 910) or Clear Coat. Specimens of stone were hand mixed with distilled room temperature water and vacuum spatulated according to manufacturer's directions. Five cylinders (15 x 15 mm) per group were poured, using vibration, into phenolic ring molds positioned on top of a glass slide. The face of each specimen was polished with 2400-grit Al2O sandpaper. One face of each of 5 specimens/material was coated with cyanoacrylate; 5 specimens/material were coated with Clear Coat, air thinned and dried; and 5 specimens/material had no treatment (control). Knoop hardness (kg/mm2) readings were made on each face (5 readings/time point) 3, 12, and 24 hours after pouring. An ANOVA procedure with post hoc Tukey tests were performed (alpha=.05). RESULTS: Microhardness did not vary between 3 and 24 hours for any material (P>.05). Microstone had significantly lower surface hardness (P<.0001) than the die stones. Specimens coated with die hardener had lower hardness values (P<.001 in all cases) CONCLUSIONS: The 3 types of die stones evaluated in this study did not differ significantly in surface microhardness. Under these conditions, die hardener coatings reduced the surface hardness of the gypsum material.     

Influence of surface hardener on gypsum abrasion resistance and water sorption

STATEMENT OF PROBLEM: Abrasion is a major concern when gypsum products are used for dies, leading to the frequent recommendation that surface hardeners should be used before waxing or scanning. PURPOSE: This study evaluated abrasion resistance and water sorption with 4 commonly used gypsum die materials with and without the application of surface die hardeners. MATERIAL AND METHODS: Three ADA Type IV (Vel-Mix, ResinRock, and Silky-Rock) and 1 Type V die material (Die-Keen) were evaluated for abrasion resistance after application of 2 surface hardeners (Permabond 910 cyanoacrylate and Clear Coat). Thirty specimens of each material were fabricated using an impression of a standard brass die machined with 1-mm high ridges, sloped 45 degrees. Gypsum materials were mixed according to manufacturers' recommendations and allowed to set 1 hour before separating. All replicated dies were allowed to bench set for 14 days before testing. One hour before testing, specimens were arbitrarily assigned to 1 of 3 treatment subgroups (n=10/group): no treatment (control), coated with Permabond 910, or coated with Clear Coat. In the coated groups, die hardener was painted over the grooves and air dried. Abrasion resistance (measured by weight loss) was evaluated using a reciprocal abrasion device in which a stylus applied a 50-g mass perpendicular to the ridges. Mass loss was determined using an analytical balance before and after each test cycle. Five sets of 20 unidirectional passes were made on each specimen. A scanning electron microscope was used to evaluate the surface of specimens in each treatment subgroup. Water sorption was also evaluated using 2 Type IV (Silky-Rock, ResinRock) and 1 Type III (Microstone) gypsum materials. Specimen dies were separated 1 hour after pouring the impression and allowed to bench set 1 week before testing. Five specimens from each material group received a coating of a surface hardener 1 hour before testing. Specimens were placed in distilled water for 15 minutes and differences in mass were determined using an analytical balance before and after each test. A 2-way analysis of variance was completed followed by a Tukey post hoc test (alpha=.05). RESULTS: The 2-way analysis of variance revealed an interaction between product and surface coating (P=.0459). Given this interaction, the 12 combinations determined by surface treatment and material type were considered individually using the Tukey method. Vel-Mix, control (2.62 +/- 2.64 mg) had the most material loss and Vel-Mix, Clear Coat (0.48 +/- 0.29 mg) had the least material loss. Water sorption results indicated an interaction between the gypsum material and the surface treatment (P<.0001). The control groups of Microstone (299.2 +/- 49.6 mg) and Silky-Rock (159.0 +/- 8.5 mg) showed the most water sorption compared with the other treatment groups. CONCLUSIONS: This study demonstrated that a significant improvement in abrasion resistance occurred only with specific gypsum/surface hardener material combinations. Also, water sorption decreased significantly for Microstone and Silky-Rock gypsum materials when a surface hardener was used.     

The implant-supported overdenture as an alternative to the complete mandibular denture

BACKGROUND: Approximately one-third of Americans older than 65 years of age are fully edentulous, requiring replacement of missing teeth. While the conventional denture may meet the needs of many patients, others require more retention, stability, function and esthetics, especially in the mandible. The implant-supported prosthesis is an alternative to the conventional removable denture. METHODS: This article describes the strengths of the implant-supported mandibular overdenture. The authors also outline the risks of this approach. They performed a review of recent literature to summarize the reported success rate of implants used to support a mandibular overdenture. RESULTS: The literature review indicates that implants placed in the anterior mandible (anterior to the foramen) have a success rate better than 95 percent. Patients have reported a high degree of satisfaction with the implant-supported overdenture. CONCLUSIONS: The literature indicates that implant-supported overdentures in the mandible provide predictable results with improved stability, retention, function and patient satisfaction compared with conventional dentures. Implants placed in the anterior mandible have a success rate equal to or greater than 95 percent. CLINICAL IMPLICATIONS: When planning treatment for patients with edentulous mandibles, clinicians should consider the implant-supported prosthesis.     

A comparison of student performance in a simulation clinic and a traditional laboratory environment: three-year results

With simulation clinics, dental schools have improved their preclinical laboratories to provide a more realistic clinical teaching environment. However, there is very little data to support the assumption that these facilities actually improve student performance of technical skills. This study compared the scores of two fixed preparations for full cast crowns by third-year dental students. One of the preparations was made in the simulation clinic manikin, and the other was prepared on the bench top. Three prosthodontic faculty members scored the preparations in the areas of occlusal reduction, axial reduction, resistance and retention, and margination. The study also compared the performance of three classes of dental students: one class with no experience in the simulation clinic, one with one year of experience, and one with two years of experience. The amount of time since completing the fixed prosthodontics course among the students was also evaluated. This was done because the third-year students at the University of Iowa rotate through a series often-week clerkships rather than a comprehensive care model. (Therefore, not all students start clinical prosthodontics at the same time.) In addition, all student participants completed a questionnaire that addressed their perception of their clinical readiness prior to treating their first fixed prosthodontic patient. When we compared the classes of years 1, 2, and 3 by average preparation score, we found a significant difference among the scores for teeth prepared on the bench top (p = 0.0001) but not for the teeth prepared in the mannequin (p = 0.1176). For Year 1 (no simulation clinic experience), the amount of elapsed time following completion of the fixed prosthodontic course was not significant for the tooth prepared on the bench top or in the manikin (p = 0.57113 and 0.0661). For Year 2 (one year of simulation clinic experience), the elapsed time following completion of the fixed prosthodontic course was significant for the tooth prepared on the bench top (p = 0.0482), but it was not significant for the tooth prepared in the manikin (p = 0.2968). For Year 3 (two years of simulation clinic experience), the amount of elapsed time following completion of the fixed prosthodontic course was not significant for the tooth prepared on the bench top or in the manikin (p = 0.7275 and 0.6007). The questionnaire revealed that, in general, the majority of the students perceived their clinical readiness as more than adequate. These results are mixed in that students with more bench top experience scored better on the bench top, and students with more manikin experience scored equally in both environments.     

Dental location of Streptococcus mutans and Streptococcus sobrinus in humans harboring both species

The distribution and prevalence of Streptococcus mutans and Streptococcus sobrinus were determined in plaque samples from the cervical areas of all buccal, lingual and approximal tooth surfaces and from the fissures of all occlusal sites in 40 subjects harboring both species. S. mutans was detected more often and in higher numbers than S. sobrinus. There were more teeth detected with S. mutans only than with S. sobrinus only. Most teeth harbored both of these mutans streptococci species, indicating a positive association. The highest numbers of CFU for both species were detected on the molars, with the lowest incidence on the anterior teeth. The presence of S. mutans was relatively similar on all teeth tested, while the presence of S. sobrinus was relatively higher on the molars compared to the anterior teeth. S. mutans and S. sobrinus were found to colonize the buccal surfaces in almost equal numbers. On all other surfaces, S. mutans was detected more frequently or in higher numbers compared to S. sobrinus. No significant differences could be found in the relative proportions of S. mutans and S. sobrinus between sound, decayed or filled tooth surfaces.     

Importance of infection level of mutans streptococci for recolonization of teeth after chlorhexidine treatment

The recolonization pattern of mutans streptococci after reduction by a 1 % chlorhexidine gel was followed in plaque samples of 8 subjects over a 26-week period. Plaque samples from all available tooth surfaces were examined and the absence or presence of mutans streptococci was expressed on a scale from 0 to 4. Comparison of infection scores showed that heavily infected surfaces (Scores 3 and 4) occurred more frequently on molars than on other teeth before treatment. Such surfaces were most difficult to disinfect. Surfaces with pretreatment Scores 3 and 4 were more readily recolonized than surfaces less infected before treatment. On only about half of the tooth surfaces was the level of infection similar or identical with the pretreatment score after 26 weeks. The results indicate that tooth surfaces with high infection level of mutans streptococci are more rapidly recolonized by mutans streptococci even if these microorganisms have been suppressed to undetectable levels by the antimicrobial treatment.