How may stressful experiences contribute to the development of temporomandibular disorders?

Temporomandibular disorders (TMD) comprise the most common cause of chronic facial pain conditions, and they are often associated with somatic and psychological complaints including fatigue, sleep disturbances, anxiety, and depression. For many health professionals, the subjectivity of pain experience is frequently neglected even when the clinic does not find any plausible biologic explanation for the pain. This strictly biomedical vision of pain cannot be justified scientifically. The purpose of this study is to demonstrate, by original articles from the literature and recent studies conducted in our own laboratory, the biological processes by which psychological stress can be translated into the sensation of pain and contribute to the development of TMD. The role of the hypothalamic–pituitary–adrenal axis, the serotoninergic and opioid systems in the pathogenesis of facial pain is exposed, including possible future therapeutic approaches. It is hoped that knowledge from apparently disparate fields of dentistry, integrated into a multidisciplinary clinical approach to TMD, will improve diagnosis and treatment for this condition through a clinical practice supported by scientific knowledge.     

Effect of water storage on tooth displacement in maxillary complete dentures

The purpose of this study was to investigate the effect of water storage at 37 degrees C (1 week, 1 month and 3 months) on tooth displacement in maxillary complete dentures. Ten maxillary dentures were constructed with Clássico acrylic resin using the conventional method of packing in metallic flasks. Metallic reference pins were placed in the incisal border of the central incisors (I), labial cusp of the first premolars (PM), and mesiolabial cusp of the second molars (M). Twelve hours after final flask closure, the acrylic resin was cured in water at 74 degrees C for 9 h. The flasks were removed from the thermo-polymerizing unit after water-cooling and the dentures were deflasked, finished and stored in water at a temperature of 37 degrees C for 1 week, 1 month and 3 months. At deflasking and at the water storage intervals, the I-I (incisor to incisor), PM-PM (pre-molar to pre-molar), and M-M (molar to molar) transversal distances, and LI-LM (left incisor to left molar) and RI-RM (right incisor to right molar) anteroposterior distances were measured using an optical microscope with 0.0005 mm accuracy. Data were submitted to ANOVA and Tukey's test (5%). Comparing the evaluation periods for each individual transversal and anteroposterior reference point, no statistically significant differences were observed among deflasking and the water storage intervals for I-I, PM-PM, M-M and RI-RM distances (p>0.05). For LI-LM, however, deflasking values were statistically different from those of 1-week, 1-month and 3-month water storage intervals (p<0.05), which, in turn, did not differ statistically to each other (p>0.05). These results confirm the complexity of tooth displacement in complete dentures. From a clinical standpoint, the difference observed in LI-LM distance after water storage would not be detected by the patients during clinical use.     

Evaluation of endodontic treatments performed by students in a Brazilian Dental School

The aims of this study were to evaluate the clinical outcomes of root canal treatments performed by final-year students in the Dental School of Piracicaba, State University of Campinas, SP, Brazil, during the year 2000 and to evaluate the success rate of these treatments at follow-ups conducted one and three years later (2001-03). All 579 endodontic treatments performed by final-year students were selected for this investigation. Detailed personal and dental history was obtained from the patient's records. Clinical and radiographic follow-up examinations were performed. For 78.8 percent of the cases, dental caries was recorded as the cause for performing endodontic treatment; for 8.8 percent, prosthetic reasons were given; and for 12.4 percent, failure of the endodontic treatment was the reason. The largest percentage (30.7 percent) of recalled patients was examined after one year; the success rate at this follow-up evaluation ranged from 83 percent to 96 percent depending on the pulp status prior to the root canal treatment. After three years, only 8 percent of treated patients returned; assessment for them revealed a 75.5 percent success rate. Dental caries is still the main reason for endodontic treatment. This level of success of the root canal treatment in a Brazilian dental school is similar to other reports in the literature.     

In vitro assessment of the antimicrobial action and the mechanical ability of chlorhexidine gel as an endodontic irrigant

The objective of this study was to assess the chlorhexidine gluconate gel as an endodontic irrigant. First the ability of chlorhexidine gel to disinfect root canals contaminated in vitro with Enterococcus faecalis was investigated. A scanning electron microscope was also used to evaluate its cleansing ability compared with endodontic irrigants commonly used, such as sodium hypochlorite and chlorhexidine gluconate liquid. The results indicated that the chlorhexidine gel produced a cleaner root canal surface and had an antimicrobial ability comparable with that obtained with the other solutions tested. It was concluded that chlorhexidine gluconate in gel form has potential for use as an endodontic irrigant.     

The Effect of Brushing on Surface Roughness of Denture Lining Materials

PURPOSE: The purpose of this study was to test the effect of brushing on surface roughness of two resilient liners (Luci Sof and Sofreliner) compared with an acrylic resin (QC 20). MATERIALS AND METHODS: Twenty specimens of each material were prepared (25 mm x 14 mm x 3 mm). Ten specimens served as controls and were stored in distilled water and not brushed. The remaining ten specimens were subjected to mechanical brushing, using an MSEt plus machine to simulate brushing at a rate of 5.0 strokes per second (30,000 cycles). Surface roughness measurements were recorded before and after brushing. Random samples were analyzed using scanning electron microscope. Data collected were analyzed by a two-way analysis of variance using material and treatment as variables, followed by Tukey's test (alpha= 0.05). RESULTS: Initial surface roughness of materials indicated that QC 20 was the smoothest (0.13 microm), and Luci Sof the roughest (0.68 mum). Sofreliner had an intermediate value (0.31 microm). All materials were significantly different. Mechanical brushing significantly increased surface roughness in all the materials. Although there was no statistical difference between QC 20 and Luci Sof after mechanical brushing (0.88 and 1.00 microm, respectively), both differed significantly from Sofreliner (7.74 microm). CONCLUSION: The two resilient liners and the acrylic resin became rougher, to a greater or lesser extent, when subjected to mechanical brushing.     

Short-term outcomes of Altis® single-incision sling procedure for stress urinary incontinence: a prospective single-center study

Introduction and hypothesis

Data on Altis® (Coloplast), a new adjustable single-incision sling (SIS) procedure for the treatment of female stress urinary incontinence (SUI), are scarce. Our aim was to evaluate the efficacy and complication rates of this procedure.

Methods

In this prospective observational study, a total of 52 women with SUI were implanted with an Altis® sling in an ambulatory setting. Before and after intervention (3, 6, and 12 months), women completed the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). In addition, patients underwent a cough stress test at each evaluation and a post-voiding residual urine volume estimation at 3 months. The main outcomes measured were subjective cure (ICIQ-SF?=?0), subjective improvement (ICIQ-SF >0 and < preoperative ICIQ-SF), and objective cure (negative cough stress test and no pad usage) rates. De novo overactive bladder (OAB) symptoms, changes in voiding habits and adverse events were also analyzed.

Results

The subjective cure rate at 12 months was 84.0 %, with an additional improvement rate of 8.0 %. The objective cure rate was 90.2 %. Later postoperative complications included 1 case of vaginal extrusion (requiring surgical removal of the eroded mesh segment), 3 cases of vaginal exposure of the adjustment thread (managed conservatively), de novo urgency in 3 patients, and mild dyspareunia in 2 patients.

Conclusions

The Altis® sling is a safe and effective SIS procedure for the treatment of SUI with a short-term follow-up.     

Stratification of complexity in congenital heart surgery: comparative study of the Risk Adjustment for Congenital Heart Surgery (RACHS-1) method, Aristotle basic score and Society of Thoracic Surgeons-European Association for Cardio- Thoracic Surgery (STS-EACTS) mortality score

Objective

To determine whether stratification of complexity models in congenital heart surgery (RACHS-1, Aristotle basic score and STS-EACTS mortality score) fit to our center and determine the best method of discriminating hospital mortality.

Methods

Surgical procedures in congenital heart diseases in patients under 18 years of age were allocated to the categories proposed by the stratification of complexity methods currently available. The outcome hospital mortality was calculated for each category from the three models. Statistical analysis was performed to verify whether the categories presented different mortalities. The discriminatory ability of the models was determined by calculating the area under the ROC curve and a comparison between the curves of the three models was performed.

Results

360 patients were allocated according to the three methods. There was a statistically significant difference between the mortality categories: RACHS-1 (1) - 1.3%, (2) - 11.4%, (3)-27.3%, (4) - 50 %, (P<0.001); Aristotle basic score (1) - 1.1%, (2) - 12.2%, (3) - 34%, (4) - 64.7%, (P<0.001); and STS-EACTS mortality score (1) - 5.5 %, (2) - 13.6%, (3) - 18.7%, (4) - 35.8%, (P<0.001). The three models had similar accuracy by calculating the area under the ROC curve: RACHS-1- 0.738; STS-EACTS-0.739; Aristotle- 0.766.

Conclusion

The three models of stratification of complexity currently available in the literature are useful with different mortalities between the proposed categories with similar discriminatory capacity for hospital mortality.     

Effects of unilateral stereotactic posterior striatotomy on harmaline‐induced tremor in rats

Although long known and the most prevalent movement disorder, pathophysiology of essential tremor (ET) remains controversial. The most accepted hypothesis is that it is caused by a dysfunction of the olivocerebellar system. Vilela Filho et al. [2001; Stereotact Funct Neurosurg 77:149–150], however, reported a patient with unilateral hand ET that was completely relieved after a stroke restricted to the contralateral posterior putamen and suggested that ET could be the clinical manifestation of posterior putamen hyperactivity. The present study was designed to evaluate this hypothesis in the most often used model of ET, harmaline‐induced tremor in rats. Fifty‐four male Wistar rats were randomly distributed into three groups: experimental (EG), surgical control (SCG), and pharmacological control (PCG) groups. EG animals underwent stereotactic unilateral posterior striatotomy. SCG rats underwent sham lesion at the same target. PCG served exclusively as controls for harmaline effects. All animals received, postoperatively, intraperitoneal harmaline, and the induced tremor was video‐recorded for later evaluation by a blind observer. Thirteen animals were excluded from the study. Limb tremor was reduced ipsilaterally to the operation in 20 of 21 rats of EG and in two of nine of SCG, being asymmetric in one of 10 of PCG rats. Comparisons between EG × SCG and EG × PCG were statistically significant, but not between SCG × PCG. Limb tremor reduction was greater in anterior than in posterior paws. Lateral lesions yielded better results than medial lesions. These results suggest that the posterior striatum is involved with harmaline‐induced tremor in rats and support the hypothesis presented. © 2013 Wiley Periodicals, Inc.