What is the importance of radiology in obstructive sleep apnea?

Lipomas are rare, and they rarely arise in deep soft tissue. Only few cases associated with obstructive sleep apnea (OSA) have been reported. Because of radiologic examinations (computed tomography and magnetic resonance imaging) in a case with OSA, a rarely observed large lipoma was encountered in the retropharyngeal region. In the case that was followed, the apnea-hypopnea index was measured. The radiologic examination of the upper airway of the case with OSA symptoms was presented.     

Is there an association between obstructive sleep apnea syndrome and periodontal inflammation?

Objectives

The aim of this study is to assess salivary, serum biomarkers, and subgingival bacteria as putative candidates in the potential association between obstructive sleep apnea syndrome (OSAS) and periodontal disease.

Materials and methods

Fifty-two patients were grouped according to the severity of OSAS: 13 participants served as controls, 17 patients had mild-to-moderate OSAS, and 22 severe OSAS. Serum, saliva, and subgingival plaque samples were collected, and clinical periodontal parameters were recorded. Salivary, serum concentrations of interleukin-6 (IL-6), tumour necrosis factor (TNF-α), osteoprotegerin, soluble Receptor activator of nuclear factor kappa B ligand (sRANKL), and apelin were analysed by enzyme-linked immunosorbent assay. Bacterial counts were determined by real-time QPCR on plaque microbial DNA preparations.

Results

There was a significant change in the composition of microbes in plaque particularly in severe OSAS samples (p < 0.01). Statistical analyses indicated significantly higher salivary IL-6 levels in both OSAS groups compared to controls (p < 0.05). Salivary apelin levels were significantly higher in the severe OSAS group compared to the control group. Serum levels of these biomarkers and salivary osteoprotegerin, sRANKL levels were similar in the study groups. The incidence and duration of apnea positively correlated with clinical periodontal parameters (p < 0.05).

Conclusion

OSAS appeared to alter the tested bacteria in plaque, correlate with increasing periodontal disease severity, have additive effect on salivary IL-6.

Clinical relevance

OSAS is likely to associate with periodontal disease.

     

What is the incidence of hypertelorism in Filipino frontonasal encephalocele patients?

It is unclear whether Filipinos with sincipital encephaloceles have true orbital hypertelorism or just telecanthus. Knowing this determines whether orbital osteotomies or medial canthoplasty are more appropriate corrective procedures. To evaluate this, 56 sequential Filipino sincipital encephalocele patients (28 female and 28 male, average age 66.6 months, age range 4 days to 21.8 years) were evaluated for orbital width. Soft tissue measurements of inner and outer canthal position and CT measurements of medial and lateral orbital wall position were obtained. Normative data curves by age and sex for orbital bony and soft tissue distances in normal Filipino children were developed. Data was plotted on these curves and analyzed to determine if encephaloceles were associated with medial widening alone or true hypertelorism. Inner canthal measurements for male were approximately +2.8 standard deviation (SD) and female +2.3 SD wider than average. Medial orbital wall dimensions were wider for male +1.5 SD and female +1.4 SD. Lateral orbital measurements for both male and female clustered around the normative mean (males -0.5 SD and females -0.8 SD). Female outer canthal measurements also clustered around the normative mean (+0.6 SD wider) while male outer canthal measurements averaged approximately +1.1 SD wider than mean. As expected, measurements were wider medially when compared to normative data. However, lateral bony and soft tissue widening was minimal or approached normative averages. This suggests the problem is medial widening only and less invasive procedures such as medial canthoplasty or nasal bony contouring may be the most appropriate surgical management.     

Do oral appliances enlarge the airway in patients with obstructive sleep apnoea? A prospective computerized tomographic study

This study evaluated the effect of an anterior mandibular positioning appliance (AMPA) on minimum pharyngeal cross-sectional area (MPCSA) in 32 conscious supine obstructive sleep apnoea (OSA) subjects. The change in MPCSA was measured using low dose computerized tomography, with and without an AMPA in situ. The results showed that the mean presenting respiratory disturbance index (RDI) was 26.6 events/hour, with a body mass index of 28.6 kg/m2 and mean age of 51.5 years. There was a statistically significant increase in MPCSA of 28.34 mm2 on appliance insertion (SD = 59.06 mm2; range -145 to +190 mm2; P = 0.011). The mean mandibular displacement was 5.73 mm (SD = 2.51 mm) in protrusion and 8.27 mm (SD = 4.51 mm) inferiorly. A poor correlation was found between the size of the mandibular displacement and the change in MPCSA (protrusion r = 0.268; inferiorly r = 0.240, P > 0.05). In conclusion, the AMPA significantly increased MPCSA, suggesting that it may be an effective therapy for OSA. There was, however, a wide but unpredictable individual variation of response. As a small number of patients may worsen in their condition with temporary mandibular advancement (TMA), it is essential that all patients treated with TMA should be investigated by polysomnography both before and after treatment.     

What is the role of specialties in dentistry?

Dental specialties have an important, positive role in improving education and practice, stimulating research and defining quality expectations in their areas of expertise. However, it is well-known that general dental practitioners accomplish a significant portion of the dental therapy that commonly is classified as being within the scope of the respective recognized specialty areas. In this column, I have made suggestions about methods for improving the interaction between specialists and generalists and a call for better acceptance by each group of the capabilities of the other.     

Can nocturnal use of implant-retained overdenture improve cardiorespiratory stability of a patient with obstructive sleep apnea? A clinical report

Few studies have evaluated the interaction between conventional complete dentures (CCD) and the respiratory system and the authors are unaware of any that evaluated the interaction between implant-retained overdentures (IROs) and the respiratory system. This clinical report documented the effects of wearing an IRO on the cardiorespiratory stability of an edentulous patient with obstructive sleep apnea (OSA). A 64-year-old woman was referred to the department of otolaryngology because of daytime sleepiness and morning headaches. The patient refused polysomnographic evaluation because of claustrophobia. Overnight pulse oximetry (PO) was performed to detect cardiorespiratory stability during sleep, and the oxygen desaturation index (ODI) of the patient was found to be 20.9. A mandibular advancement device (MAD) was fabricated; however, the patient did not comply with the treatment and stopped using the MAD because of intraoral discomfort. Therefore, the patient started to wear the conventional complete dentures (CCDs) nocturnally to prevent upper airway collapses. Despite the significant drop in ODI score to 12.6, because of displacement, the mandibular denture was converted to an IRO. The PO tests performed after another 6 months revealed an ODI score of 7.8. Wearing CCDs might improve respiratory stability of patients with edentulism during sleep; however, more favorable results could be obtained with IROs.     

Do oral flora colonize the nasal floor of patients with oronasal fistulae?

OBJECTIVE: To determine if oral bacteria colonize the cleft nasal floor in patients with unilateral oronasal fistula when compared with the unaffected nasal floor and whether the results obtained would be of benefit in assessing oronasal fistulae in the clinic. DESIGN: Prospective study of 26 patients with cleft palate and unilateral oronasal fistula. Microbiological culture swabs were taken from the mouth and nasal floors of patients. The unaffected nasal floor was used as a control. Bacterial isolates were identified and compared in the laboratory by a senior microbiologist. MAIN OUTCOMES MEASURE: A significant growth of oral bacteria from the cleft nasal floor when compared with the unaffected nasal floor. RESULTS: Four patients were excluded because no growth was found on any culture plate. In the remaining 22 cases, a light growth of oral flora was found in the cleft nasal floor in only 3 patients. No statistical correlation between culture of oral bacteria and the cleft nasal floor could be found (p =.12). CONCLUSIONS: The relative lack of colonization of the cleft nasal floor by oral bacteria may reflect poor transmission of bacteria through the fistula, competition with commensal nasal flora, or an inability of oral bacteria to survive in a saliva-depleted area. The investigation is not helpful in the assessment of oronasal fistulae in the clinic.     

What is the most fearful intervention in ambulatory oral surgery? Analysis of an outpatient clinic

The aim of this study was to evaluate the levels of fear and anxiety in patients undergoing different types of minor oral surgery procedures by using conventional rating scales adjusted to the population characteristics. A demographic form and translated versions of the Modified Dental Anxiety Scale (MDAS) and Dental Fear Survey (DFS) were completed by 500 patients having hard or soft tissue pathologies, third molar removal, implant placement, tooth extraction procedures and 200 non-clinical participants. MDAS and DFS were highly correlated (r=0.79; P<0.05). The structural properties of the MDAS were similar to the original, but the DFS required substantive changes to achieve comparable measurement properties. Anxiety levels decreased with age and were greater in females, those with higher education and following a previous unpleasant experience (P<0.05 for all). The third molar group scored higher than most of the surgical categories in both questionnaires (P<0.05 for each). DFS showed they tended to avoid surgical procedures and were more susceptible to environmental and chair-side effects (P<0.05 for all). Regarding oral surgery, third molar patients should be targeted to increase overall comfort of the treatment. Assessments should be adjusted to cultural differences.     

What is the role of dentists in smoking cessation?

The associations between tobacco use and diseases affecting the oral cavity, such as periodontal disease and cancer, are now well recognised. This has lead to proposals from some members of the profession and the BDA that members of the dental team should provide smoking cessation services. Many dentists have positive attitudes towards the idea of dentists encouraging patients to stop smoking. However the belief that members of the dental team should engage in delivering smoking cessation interventions is not held by all parties. More dentists believe that they should offer smoking cessation support than actually do provide it and reasons for not providing it include time and reimbursement issues, need for further training and poor co-ordination of dental and smoking cessation services.     

What is the function of osteocalcin?

BackgroundOsteocalcin is the most abundant non-collagenous protein in bone and is specifically expressed in osteoblasts. Previous studies using osteocalcin-deficient (Ocn^–/–) mice demonstrated that osteocalcin inhibits bone formation, and serum uncarboxylated osteocalcin functions as a hormone that improves glucose metabolism, induces testosterone synthesis in the testes, and maintains muscle mass. Furthermore, the relationship between serum osteocalcin and glucose metabolism or cardiovascular risk in humans has been reported. However, new Ocn^–/– mice exhibited different phenotypes.HighlightBone volume, formation, and resorption were normal in the new Ocn^–/– mice. The orientation of collagen fibers was parallel to the bone longitudinal direction and the size of apatite crystals was normal, but the c-axis of apatite crystals was random and bone strength was reduced in new Ocn^–/– mice. Glucose metabolism, testosterone synthesis, and muscle mass were normal in new Ocn^–/– mice. Exercise improved glucose metabolism and increased bone formation, leading to an increase in the serum osteocalcin level, which is a marker for bone formation.ConclusionContrary to previous findings, new Ocn^–/– mice revealed that osteocalcin has no function in the regulation of bone quantity, but instead, functions to direct the parallel alignment of the c-axis of apatite crystals with collagen fibrils. Moreover, it has no physiological function as a hormone that regulates glucose metabolism, testosterone synthesis, or muscle mass. These controversial phenotypes require further investigation. The relationship of serum osteocalcin with glucose metabolism or cardiovascular risk suggests the importance of exercise for their improvement.     

What is the dentist's role in the recognition of child abuse?

For a Dutch dentist, the chance to recognise a physical abused child with injuries in the head-neck region, is less than once every 18 months. But child abuse is difficult to recognize. In spite of all this, it's still important for dentists to know how to recognise child abuse, since the effects on a child can be harmful. Child abuse finds its expression in, for example bruises, burns, laceration of the labial frenulum or avulsed teeth. There are also often behavioural problems. Clothes can mask lesions. The fact that child abuse can't be reported anonymously is a misconception. Professionals can report a case of child abuse anonymously to the "Advies en Meldpunten Kindermishandeling", although a not anonymous report is favoured.     

What is the cause of failure of local anesthesia?

Local anesthesia fails in 10% of cases of inferior alveolar nerve block and 7% of all cases of local anesthesia in general practice. Possible causes of failure are infection, wrong selection of local anesthetic solution, technical mistakes, anatomical variations with accessory innervation and anxiety of the patient. In this publication we discuss reasons for frequent failure in case of infection and in inferior alveolar nerve block. Understanding the mechanism of failure in local anesthesia, makes it possible to formulate guidelines to guarantee success. These measures are discussed in detail.     

A pilot study to test the efficacy of oral administration of interferon-alpha lozenges to patients with Sjögren's syndrome

BACKGROUND: Complications from Sj?gren's syndrome-induced xerostomia may cause a significant disruption in daily routines such as speech and eating habits. In addition, the reduction in salivary output may lead to increased incidence of caries, oral ulcers, sialadenitis, periodontal problems, and Candida infections. Interferon-alpha has been suggested as an effective drug therapy to increase salivary output. OBJECTIVE: The objective was to test the efficacy of interferon-alpha lozenges in relieving the symptoms of dry mouth and dry eyes when administered orally to patients with Sj?gren's syndrome in double-blind placebo-controlled and open-label trials. STUDY DESIGN: Twelve patients with a diagnosis of primary Sj?gren's syndrome were provided an Institutional Review Board-approved, written informed-consent form. During the double-blind placebo-controlled study they were randomized to receive 150 IU of interferon-alpha (8 patients) or placebo (4 patients) for 24 weeks with 6-week reevaluations. Five patients who received interferon-alpha in the double-blind placebo-controlled trial were treated in an open-label study for another 24 weeks. Whole saliva was measured during each visit, and symptoms were assessed by questionnaires and visual analog scales. The Wilcoxon signed rank test was used to detect significant changes for each variable. RESULTS: The results indicated that, by the end of 24 weeks, patients who received interferon-alpha had a statistically significant improvement in unstimulated salivary flow rate (P < .05), and statistically significant changes were observed in the median ocular dryness visual analog scale (P < .05) and oral dryness visual analog scale (P < .05). No significant changes were observed among the placebo patients. By the end of 48 weeks, medicated patients had better results than they had at the end of the double-blind placebo-controlled study and showed improvements in whole stimulated salivary flow rate, conditions of throat, and swallowing dry food. CONCLUSION: Oral administration of 150 IU interferon-alpha 3 times a day for the patients with primary Sj?gren's syndrome improved saliva production, relieved symptoms of xerostomia and xerophthalmia, and was well tolerated by the patients.     

What is the survival rate of deciduous molars in cases with agenesis of premolar successors? A systematic review

ObjectivesTo systematically review the literature on the survival rate of deciduous molars in cases of agenesis of premolar successors.Materials and MethodsFour electronic databases and partial grey literature were searched up to November 2020. The PECOS eligibility criteria included (P) second deciduous molar (E) exposed to agenesis of a premolar successor (O) evaluated by the survival rate in the oral cavity, infraocclusion, and root resorption through (S) observational studies. Risk of bias (RoB) was assessed using the checklists from the Joanna Briggs Institute and the level of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) tool.ResultsThree studies were included: one with low, one with moderate, and one with high RoB. Synthesis methods included the frequency of persistent deciduous second molars during the follow-up. Approximately 82% to 89% remained in the oral cavity after 5 to 13 years. The incidence of root resorption was 11%, and the infraocclusion was 1 mm. The level of evidence was considered low for each outcome. There was considerable RoB regarding the observational studies and a need for clinical and radiographic monitoring of the deciduous molars.ConclusionsMaintaining a deciduous molar in the oral cavity in patients with agenesis of the premolar successor is a viable clinical choice since 82% to 89% of the retained molars evaluated were in good condition over a follow-up ranging from 5 to 13 years. Infraocclusion and root resorption did not seem to increase considerably. The level of evidence was considered low for each outcome.     

What is the purpose of launching the World Journal of Stomatology?

Congratulations to the publisher, members of the editorial board of the journal, all the authors and readers for launching the World Journal of Stomatology (WJS) as a new member of the World series journal family! Significant scientific advances and important breakthroughs need to be published to impact dental care and reach an audience of researchers and clinicians who can create more effective dental treatments for their patients. There is a need to share scientific information, methodologies, therapies, and hypotheses related to stomatology, through an open-access format, to reach the widest possible audience. The WJS was created to fulfill the role of disseminating the most significant, innovative and transformational cutting edge research in dentistry. The WJS is a peer-reviewed open-access periodical centered in stomatology, with a multidisciplinary coverage that will publish high-impact articles in all areas of the dental clinical specialties, applied science, epidemiology, trauma and dental care, dental materials, oral biology and microbiology. The WJS is not scared of controversy or challenges to existing doctrine, since they are supported by high-quality science or unequivocal clinical outcomes. The WJS will avoid publishing confirmatory and low-impact articles. The WJS will only publish articles directly relevant to stomatology and dentistry because this is what our readers expect. If you need to share any exciting dental research discoveries and reach the widest possible audience, you will find in the WJS the most helpful resource to publish your papers!