Beweislastumkehr – Studien müssen zeigen,dass Trinken bis Abruf in den Operationssaal nicht sicher ist

Die Anaesthesiologie -     

Brief relaxation versus music distraction in the treatment of dental anxiety: a randomized controlled clinical trial

BACKGROUND: Dental anxiety is a significant cause of poor dental health. Because patients often prefer nonpharmacological interventions, the clinical effectiveness of clearly structured approaches is of particular interest. METHODS: This prospective randomized controlled study compares a brief relaxation method (BR) with music distraction (MD) and with a control group (C). The authors randomly assigned 90 patients with dental anxiety to BR, MD or C groups. They assessed the outcomes by means of the state anxiety subscale of the State-Trait Anxiety Inventory. RESULTS: Both BR and MD reduced dental anxiety significantly. In contrast, patients in the C group did not exhibit a significant change in their anxiety level. BR was significantly superior to MD. Stratification according to the patient's general level of dental anxiety revealed that BR also was particularly effective in highly anxious subjects, whereas MD did not have a clinically relevant effect on these subjects. CONCLUSIONS: BR appears to be a safe, economically sound and effective nonpharmacological approach to the short-term reduction of dental anxiety. Additional investigations are needed to validate these findings in a larger clinical trial and to determine the long-term effects of this intervention. CLINICAL IMPLICATIONS: Relaxation techniques are a pragmatic, effective and cost-saving method of facilitating dental treatment in anxious patients.     

The effect of disc thickness and trauma on disc surface friction in the porcine temporomandibular joint

The pathomechanics of osteoarthritis in the human temporomandibular joint (TMJ) are unknown. Compromised lubrication is a potential factor, but, lubrication within even the normal TMJ is not understood completely. Weeping lubrication is a concept that may be applicable to the TMJ. A characteristic of weeping lubrication is a slow increase in friction during static loading. The rate of increase in friction is related to the rate of lateral movement of synovial fluid away from the loading area. The TMJ disc is expected to be the main source of TMJ lubrication. This study tested two variables, disc thickness and magnitude of trauma to the disc, as factors that can affect the rate of flow of synovial fluid and thus alter lubrication of the disc surfaces. To test these variables, TMJ disc surface friction was measured before and after an impulse load. Before the impulse load, all discs demonstrated a gradual increase in friction during light static loading. The rate of increase in friction was inversely related to the disc thickness (R(2)=0.75). After an impulse load of known magnitude and peak force, disc surface friction was higher. The magnitude of this surface friction was correlated with the magnitude of the impulsive blow (R(2)=0.89) and the area of surface damage (R(2)=0.85). Disc thickness was a significant factor in determining the minimal impulse needed to produce higher surface friction (R(2)=0.99). These results confirm that disc thickness and trauma to the disc affect surface friction in the TMJ, and therefore may be important factors in compromised lubrication and the development of osteoarthritis.     

Dental Utilization by Low-income Mothers

Objective : This study examines the influence of predisposing, enabling, and need variables on whether low-income mothers sought dental care during the past year. This report is a substudy of mothers and children on their self-reported health status, utilization, access, and satisfaction with health care in general. Methods : A convenience sample of 502 mothers and youngest child younger than 6 years old was administered a face-to-face questionnaire in four Ohio counties. Information was collected at county human services offices and WIC clinics between November 1995 and July 1996. Using whether or not the mother sought dental care as the dependent variable, logistic regression models were created for the variables within the predisposing, enabling, and need characteristics separately and together. Results : Fewer than one-half of the mothers sought dental care during the past year. Variables associated with the predisposing characteristic explained little about who sought care. Those mothers who have Medicaid coverage are 2.7 times more likely to have a dental visit than those without insurance. Moreover, those mothers who perceive any dental need are several times less likely to have received dental care than those who have no perceived need. Conclusion : Even among a somewhat homogeneous population of low-income women, source of payment for dental services and perceived need for dental care are discriminating variables in determining who seeks dental care.     

Validated numerical modeling of the effects of combined orthodontic and orthognathic surgical treatment on TMJ loads and muscle forces.

Investigations of the changes in the mechanics of the craniomandibular system as a result of treatment have been limited by the lack of validated models of this system. The aims of this project were to (1) validate numerical model predictions of temporomandibular joint (TMJ) eminence morphology and muscle forces produced during molar biting and (2) use the validated models to calculate the changes in TMJ and muscle forces as a consequence of treatment involving orthognathic surgery. Ten volunteers participated; their combined orthodontic and orthognathic surgical treatments were completed. Three-dimensional anatomical data from each subject were used in computer models to predict the sagittal TMJ eminence morphology and joint and muscle forces for each subject, consistent with the neuromuscular objectives of minimizing joint loads and muscle effort. The actual shape of the eminence in each subject was measured with jaw tracking. Surface electromyographic recordings were a measure of the muscle forces involved in static molar biting. Model predictions were compared with measured data from the subjects for eminence shape (R(2) = 0.96) and for muscle activity ratios (R(2) = 0.98). The strength of these relationships validated the models for use in calculating changes in joint loads and muscle forces after treatment. The results suggested that the mechanics of the masticatory system are affected by the combined treatments. The TMJ loads increased in 8 subjects. The average increases in condylar and muscle forces were 4% relative to the applied bite force, but in 1 case the increases were up to 20%. Therefore, although average increases in the forces were small, some persons may experience biologically significant increases in joint and muscle forces as a result of treatment.     

Ethical Challenges in Hematopoietic Cell Transplantation for Sickle Cell Disease

Hematopoietic cell transplantation (HCT) using an HLA-identical sibling donor offers a very high likelihood of cure with good outcomes for patients with sickle cell disease (SCD), and alternative donor HCT for SCD is an area of active clinical research. Thus, HCT is a potential option for a growing number of patients with SCD. This expanded use of HCT has raised several ethical questions. Who is eligible for HCT, in terms of both disease severity and psychosocial factors? Should affected children with matched sibling donors undergo HCT only when they have declared themselves as having significant symptomatology? Regarding donors, special ethical challenges include the use of preimplantation genetic diagnosis to conceive an HLA-identical sibling. In this review, we critically analyze various ethical challenges related to HCT for SCD, and offer recommendations to guide clinical care.