Is radius-union an indicator for completed facial growth?

The purpose of this study was to determine if facial or dentoalveolar growth takes place after the occurrence of the radiographic handwrist stage R-J (completed fusion of the proximal epiphysis and diaphysis of the radius), which generally defines the completion of facial growth. Handwrist roentgenograms and lateral head films (LHFs) from 56 subjects (31 male and 25 female) aged 14 to 21 years were examined. Eight cephalometric distances (3 sagittal, 4 vertical, and 1 diagonal) and their changes during 2 different examination periods (from 1 year before to 2 years after the occurrence of R-J) were assessed. The investigation revealed that after the occurrence of R-J vertical dentoalveolar growth changes between 0.5 and 1.75 mm took place in the mandible and in the maxilla in 20% and 10% of the subjects, respectively. Comparing the 2 periods the frequency of the measured growth changes before and after R-J was, on average, almost equal. Because chronological age cannot be used for the assessment of facial growth termination, a reliable indicator for the assessment of facial growth termination is of major importance. After the occurrence of the handwrist stage R-J, most subjects revealed growth changes of less than 1 mm. Especially in the field of tooth implantology, it is important to forecast even small vertical dentoalveolar growth changes. The detected amount of growth after the insertion of an implant can cause esthetic and functional problems.     

The role of the orthodontist in the diagnosis of Gorlin’s syndrome

Gorlin’s syndrome is a relatively rare generalized disorder. Its diagnosis in childhood is usually through oral abnormalities. Some of the most frequent clinical features of this syndrome are discovered through radiographs commonly used in orthodontia. Thus, the orthodontist may be able to contribute to its diagnosis. The article shows three clinical cases that illustrate the role that the orthodontist may play in diagnosis of this syndrome. (Am J Orthod Dentofacial Orthop 1999;115:89-98)     

Chronic orofacial pain; atypical facial pain?

Difficult to diagnose pain in the orofacial area may be a challenge to the dental practitioner. There still is uncertainty about the taxonomy of chronic orofacial pain, and even more so about its etiology. Treatment of chronic orofacial pain may aim at goals which are set in advance, but also at the underlying pain mechanisms. The disentanglement of pain into different pain mechanisms may be facilitated by applying a pharmacodiagnostic test. This test consists of intravenously administering several medications in low doses in orofacial pain patients. The response to the administration of these pharmaca is reported by means of a visual analogue scale (VAS) for pain. The profile, resulting from the consecutive VAS-scores, may be used as a guide for further treatment. Before the start of any treatment, the dentist should judge whether he himself is able to treat the patient or referral to a specialist is required.     

Effects of physical and sexual abuse in facial pain: direct or mediated?

Research has identified a relationship between a history of physical and/or sexual abuse and a range of psychological, functional, and physical factors; however, the nature of this relationship has not been tested. We hypothesize two different mechanisms through which an abuse history could influence later life distress and dysfunction. A history of abuse could increase an individual's vulnerability to emotional distress or could increase an individual's tendency to attend, amplify, and over-interpret somatic symptoms. The purpose of this study was to test the influence of emotional distress and somatic focus on the relationship between a history of physical and/or sexual abuse and later chronic painrelated disability in patients with temporomandibular disorders. The subjects were 139 female patients evaluated at a facial pain clinic. Of the 139 subjects, 49% (n = 69) reported a history of physical and/or sexual abuse. Abused subjects reported significantly higher levels of anxiety, depression, and somatic symptoms than nonabused subjects. Path analysis with latent variables, using the LISREL-8 (Scientific Software International, Inc., Chicago, Illinois) statistical program was used to test the hypothesized relationships. When emotional distress and somatic focus were tested as mediators, the path coefficient from somatic focus to physical functioning was significant (beta = -0.38) while the path coefficient from negative emotion to physical functioning was not significant. These results favor somatization as the hypothesized mechanism over the emotional distress vulnerability hypotheses.     

Association between facial measurements and polymorphisms in human epidermal growth factor and transforming growth factor β1

The aim of the study was to evaluate the association between genetic polymorphisms in human epidermal growth factor (EGF) (rs4444903) and transforming growth factor β1 – (TGF-β1) (rs1800470) with facial measurements in patients with dentofacial deformities. A total of 144 adult patients with dentofacial deformities were included. Facial linear and angular measurements were traced in lateral cephalometric radiographs used Dolphin 2D software. Cells from oral mucosa were collected for DNA to be extracted. The polymorphisms were genotyped using real-time polymerase chain reaction (PCR). Probabilites of less than 0.05 were accepted as significant. The rs4444903 heterozygous patients had a decrease in the mandibular length (p = 0.043) and the length of the mandibular base (p = 0.008), and homozygous A patients also had a reduction in the length of the mandibular base (p = 0.013) compared with homozygous G patients. Patients AG had an increase in measurement of the anterior facial height (p = 0.032) and in ANS-Me distance (p = 0.022) when compared with homozygous A. To the rs1800470, heterozygous patients had an increase in the length of the mandibular base (p = 0.043) when compared with homozygous A. Heterozygous AG patients had an increase in angular measurements in TGF-β1 polymorphism for the upper gonial angle, when compared with the homozygous AA (p = 0.032). Genetic polymorphisms in EGF and TGF-β1 are associated with facial measurements in a Brazilian population of patients with dentofacial deformities.     

The peripherally inserted central venous catheter; friend or foe?

The use of a peripherally inserted central catheter (PICC) is now commonplace in clinical practice both for monitoring and intravenous administration of drugs or fluids. The authors describe the case of a complication not previously reported following placement of a PICC prior to a head and neck procedure. The literature on complications following PICC use is reviewed.     

The microscopy in dental medicine: gadget or necessity?

In recent years full-blown technical revolutions have changed the face of dentistry. The introduction of the operating microscope in dental surgery was not among the slightest ones. The article wants to show what a brilliant instrument the surgical microscope turned out to be for the dental practice. The microscope offers a homogeneous illumination of the surgical field, without shadows, quite the contrary, with a lot of contrast and a great 3D effect. It provides a clear view throughout treatment (in marked contrast with endoscopes). Thanks to the view optimization by means of the intense light and the magnification, technical precision is very much enhanced during ever expanding therapeutic procedures.     

Lower incisor position in different?malocclusions?and?facial patterns

Introduction: The position of lower incisor has been of considerable concern when planning an orthodontic treatment, having been recognized as one of diagnostic keys, Very important in the development of malocclusion and facial pattern. Objectives: In this study we claim to determine the importance of the position and inclination of lower incisor in the different malocclusions and facial patterns, and to base which of the cephalometric measurement parameters are the mostreliable.Material and Methods: Ninety lateral radiographies were taken, and they were classified by skeletal malocclusion and facial pattern.These teleradiographies have been performed cephalometric analysis, which includelower incisor position belong the following analysis: Ricketts, Riolo, Tweed, McHorris, Jarabak-MSE and Holdaway. Study Design: Cross-sectional study where we perform statistical analysis Anova test, Pearson correlations and Bonferroni analysis. Results: The analyzed measurements present a statistically significant differentiation in lower incisor inclination respect to the anterior cranial base, McHorris angle, angulation of lower incisor respect to occlusal plane and mandibular plane. Conclusions: There are statistically significant differentiation in lower incisor position and inclination respect the malocclusion and individual facial pattern. Key words:Lower incisor, cephalometric analysis, facial patterns, facial biotype, skeletal malocclusions.     

The cause of drooling in children with cerebral palsy – hypersalivation or swallowing defect?

Summary. Objective. To determine whether or not drooling in children with cerebral palsy is due to hypersalivation. Population and methods. The study population consisted of 10 children with cerebral palsy who were identified as having severe drooling, and a matched control group composed of 10 unaffected children who had no known physical or mental disabilities. Salivary flow rate was compared between the cerebral palsied children and the control group using the chin‐cup collection drool quantification method described by Sochanjwskyj. Components of the system included a cup‐like collection device, a vacuum pump, plastic tubing, an airtight collection chamber, and calibrated test tubes held against the subject's chin with elastic straps attached to an orthodontic head bonnet. Statistical analysis was completed using the Student's t‐test and Fisher's Exact Probability test. Results. The ages of the population ranged from 5·2 to 15·6 years, mean age (± SE) of 10·56 ± 1·13 years. There was no statistically significant difference in the rate of salivary flow rate between the two groups’ mean ± SE: cerebral palsy group 0·220 ± 0·018; control group 0·334 ± 0·052 (P = 0·053). The results were further confirmed by comparing the buffering capacity (P = 1·00) and concentrations of the sodium (P = 0·065) and potassium ions (P = 0·058) in the saliva of the study groups. Conclusions. Children with cerebral palsy who drool do not appear to produce excess saliva. Their salivation is similar to the control children.     

Reality or wishful thinking: do bicycle helmets prevent facial injuries?

Standard bicycle helmets are designed to protect the cranial vault. Numerous studies have demonstrated the beneficial effect of standard bicycle helmets on craniocerebral trauma, but their protective effect on facial injuries remains unclear. Therefore, this study used data obtained by an accident research unit to investigate the protective effect of standard bicycle helmets on facial injuries. A total of 31,634 bicycle accidents were registered between 1999 and 2015; of these, 7004 met the study requirements. Demographic characteristics, technical information (relative collision speed, collision type, collision partner, helmet use), and clinical data (injury type) relating to these accidents were analyzed. Of all affected cyclists, 1005 (14.3%) had a facial injury (fracture and/or soft tissue injury). Bicycle helmets were worn in 11.8% of accidents. Of these, 75.4% involved males and 24.6% involved females. The bicycle helmet did not protect against facial injuries. Furthermore, sex and the type of collision partner were found to be risk factors for facial injuries. In the future, helmet designs should be modified to improve facial protection, and better education should be provided to the public regarding the benefits of bicycle helmets.     

Changes in growth and morphology of the condyle following mandibular distraction in minipigs: overloading or underloading?

OBJECTIVE: Loading of temporomandibular tissues during mandibular distraction may cause changes in condylar growth and cartilage thickness. This study examines the effects of distraction on the condyle in a large animal model by explicitly measuring growth and in vivo loading. DESIGN: Unilateral mandibular distraction was carried out on 20 growing minipigs divided into three groups. One group underwent distraction but not consolidation, whereas the other two groups were allowed a period of consolidation of either 1 or 2 weeks. Animals received fluorochrome and 5-bromo-2'-deoxyuridine (BrdU) labelling and masticatory strain was measured from the condylar neck. Condylar strain was also recorded in an age-matched sample of eight animals that received no distraction surgery. Immunohistochemical procedures were used to identify dividing prechondroblasts and histological analysis was used to measure mineral apposition rate, count dividing cells, and measure the thickness of condylar cartilage. RESULTS: Strain magnitude, particularly compressive strain, was much larger on the non-distraction side compared to the distraction side condyle. Compared to normal loading levels, the distraction side condyle was underloaded whereas the condyle on the intact side was overloaded. Mineral apposition and cartilage thickness were greater on the distraction side condyle compared to the opposite side. Differences between the sides were most pronounced in the group with no consolidation and became progressively reduced with consolidation time. CONCLUSIONS: Increased mineralisation and cartilage thickness on the distraction side condyle are associated with reduced, not increased loading, perhaps because of disruption of the distraction side masseter muscle.     

The new dental biology--threat or opportunity?

A clinician argues that the new biology is a threat or an opportunity depending on the perspective practitioners take. New approaches should be seen as extensions of the services dentists can provide patients rather than restrictions. Different parts of the new biology will become available in the office at different times, and will be implemented by general practitioners or specialists, depending on their character. Important innovations in diagnosis and prevention are emerging currently. New relationships with medicine will be forged rather than dentistry becoming part of medicine. Innovations in dental education and continuing education will accelerate the coming changes.     

Oro‐facial pain and nutrition: a forgotten relationship?

Oro‐facial pain (OFP) is known to exert profound impacts on quality of life including functionally and psychosocially mediated changes in dietary intake and thereby nutrition. This commentary explores the evidence base available on chronic oro‐facial pain, diet and nutrition and discusses current dietary guidance for individuals with chronic OFP; potential impact of chronic OFP on eating and nutritional status; impact of nutritional status on pathophysiology of chronic OFP; and potential role of nutrition in the management of chronic OFP.