Quantity and distribution of plaque in orthodontic patients treated with molar bands

Objective

The placement of orthodontic bands usually increases plaque accumulation due to numerous mechanical retention sites. The purpose of this investigation was to evaluate the amount and distribution pattern of biofilm in the oral (palatal and lingual) and interproximal regions surrounding orthodontic bands.

Materials and Methods

We evaluated the formation of biofilm on 32 orthodontic bands which had been placed intraorally for 6?C37?months. Two parameters were measured: the percentage of surface covered by biofilm (quantity) and the biofilm distribution pattern of accumulation. We measured these two parameters in four regions of interest: the mesial and distal interproximal regions, as well as the mesial and distal regions of the oral attachment.

Results

The quantity of biofilm formation was similar in all four regions of interest, ranging from 13.3% to 16.8%. In contrast to biofilm quantity, distribution patterns differed in the four regions. In the mesial and distal interproximal regions it appeared as extensive insular areas in 87.5% and 71.9%, respectively, whereas it appeared more often supragingival and linear in nature in regions adjacent to the oral attachment, i.e. in 65.6% and 68.8%, respectively.

Conclusion

Our results indicate that firstly, oral hygiene in the palatal and lingual regions of orthodontic bands seems as difficult as it is in the interproximal areas, thus requiring thorough hygiene in both areas. Secondly, orthodontic patients with a history of periodontal disease require special attention regarding the use of orthodontic bands.     

Respiratory outcome of mid-face advancement with distraction: a comparison between Le Fort III and frontofacial monobloc

Upper airway stenosis in patients with faciocraniosynostosis is very common and often severe. Mid-face advancement, either with a Le Fort III or concomitantly to a monobloc frontofacial advancement, may prevent a tracheotomy or result in its ablation. The amelioration of respiratory function appears to be much better if the mid-face advancement is combined with distraction osteogenesis, although large studies with long-term follow-up are rare. In this study we reviewed the respiratory outcome between Le Fort III with distraction and monobloc advancement with distraction in 55 faciocraniosynostotic patients. Early respiratory results of both procedures were very good and stable at long-term follow-up. The choice between a Le Fort III and a monobloc procedure is made based on presenting morphology, previous surgery, and age. Both can be expected to give a long-lasting improvement of upper airway obstruction.     

Fluoride intake from regular and low fluoride dentifrices by 2-3-year-old children: influence of the dentifrice flavor

This study evaluated the fluoride intake from dentifrices with different fluoride concentrations ([F]) by children aged 24-36 months, as well as the influence of the dentifrice flavor in the amount of fluoride ingested during toothbrushing. Thirty-three children were randomly divided into 3 groups, according to the [F] in the dentifrices: G-A (523 microgF/g), G-B (1,062 microgF/g) and G-C (1,373 microgF/g). Dentifrices A and B are marketed for children, while dentifrice C is a regular product. The amount of F ingested was indirectly obtained, subtracting the amount expelled and the amount left on the toothbrush from the amount initially loaded onto the brush. The results were analyzed by ANOVA, Tukey's test and linear regression analysis (p < 0.05). Children ingested around 60% of the dentifrice loaded onto the brush, but no significant differences were seen among the groups (p > 0.05). Mean daily fluoride intake from dentifrice for G-A, G-B and G-C was 0.022(a) feminine, 0.032(a) feminine and 0.061(b) mg F/kg body weight, respectively (p < 0.01). There was a strong positive correlation (r = 0.86, p < 0.0001) between the amount of dentifrice used and the amount of fluoride ingested during toothbrushing. The results indicate the need for instructing children's parents and care givers to use a small amount of dentifrice (< 0.3 g) to avoid excessive ingestion of fluoride. The use of low-[F] dentifrices by children younger than 6 years also seems to be a good alternative to minimize fluoride intake. Dentifrice flavor did not influence the percentage of fluoride intake.     

Carbachol-induced in vitro secretion of certain human submandibular proteins investigated by mass-spectrometry

Objective

To investigate protein content of saliva produced in vitro by samples of human submandibular gland following stimulation with the muscarinic agent carbachol.

Design

Tissue samples, obtained at surgery from seven patients and showing normal morphological appearance, were tested for 30 min: in absence of carbachol and atropine; in presence of carbachol (10 μM); in presence of carbachol (10 μM) and atropine (20 μM); or in presence of just atropine (20 μM). Medium was analysed by high-performance liquid chromatography-mass-spectrometry. Neither before nor during surgery were the patients exposed to drug treatments that were likely to influence the in vitro secretion.

Results

Proline-rich proteins (PRP)-1 and -3, peptide PC and PB, statherin, cystatins SN, S1 and S2 were invariably found in control gland tissue medium. Mean concentrations of these proteins/peptides in the medium were non-proportionally elevated following carbachol exposure to the gland tissues. Difference between basal release and carbachol-induced secretion achieved statistical significance as to all the proteins/peptides under study but for statherin. Atropine alone or atropine plus carbachol caused no significant changes compared to the basal release of proteins/peptides.

Conclusions

In vitro studies on salivary glands make it possible to study protein secretion from individual glands and thus, to reveal the contribution of the various types of gland to protein/peptide content of whole saliva. The disproportional responses to carbachol may imply that the proteins/peptides are not confined to the same cells or to the same intracellular locations and are therefore not secreted as packages at parasympathetic cholinergic activity.     

Palatine perforation induced by cocaine

Worldwide, the use of cocaine has an increased over the years, various secondary effects have been described. Here we present a 48 years old female with a 2-month evolution bucconasal ulcer in the hard palate induced by cocaine usage accompanied by swallow and phonation dysfunctions. Ethiopathogenesis, differential diagnoses and treatment are discussed.     

Additional phenotypic features of Muenke syndrome in 2 Dutch families

In about 30% of the patients with syndromal craniosynostosis, a genetic mutation can be traced. For the purpose of adequate genetic counseling and treatment of these patients, the full spectrum of clinical findings for each specific mutation needs to be appreciated. The Pro250Arg mutation in the FGFR3 gene is found in patients with Muenke syndrome and is one of the most frequently encountered mutations in craniosynostosis syndromes. A number of studies on the relationship between genotype and phenotype concerning this specific mutation have been published. Two Dutch families with Muenke syndrome were screened for the reported characteristics of this syndrome and for additional features. New phenotypical findings were hypoplasia of the frontal sinus, ptosis of the upper eyelids, dysplastic elbow joints with restricted elbow motion, and mild cutaneous syndactyly. Incidentally, polydactyly, severe ankylosis of the elbow, fusion of cervical vertebrae, and epilepsy were found. Upper eyelid ptosis is thought to be pathognomonic for Saethre-Chotzen syndrome but was also observed in our series of patients with Muenke syndrome. Because Muenke and Saethre-Chotzen syndrome can have similar phenotypes, DNA analysis is needed to distinguish between these syndromes, even when a syndrome diagnosis is already made in a family member.     

A Collective Review on Mesh-Based Repair of Umbilical and Epigastric Hernias

In accordance with the tension-free principles for other hernias, umbilical and epigastric hernia repair should probably be mesh-based. The number of randomized studies is increasing, most of them showing significantly less recurrences with the use of a mesh. Different devices are available and are applicable by several approaches. The objective of this review was to evaluate recent literature for the different types of mesh for umbilical and epigastric hernia repair and recurrences after mesh repair. A multi-database search was conducted to reveal relevant studies since 2001 reporting mesh-based repair of primary umbilical/epigastric hernia and their outcomes in adult patients. A total of 20 studies were included, 15 of them solely involved umbilical hernias, whereas the remaining studies included epigastric hernias as well. A median of 124 patients (range, 17–384) was investigated per study. Three quarters of the included studies had a follow-up of at least 2 years. Six studies described the results of laparoscopic approach, of which one reported a recurrence rate of 2.7 %; in the remaining studies, no recurrences occurred. Two comparative studies reported a lower incidence of complications and postoperative pain after laparoscopic repair compared to open repair. Seventeen studies reported results of open techniques, of which seven studies showed no recurrence. Other studies reported recurrence rates up to 3.1 %. A wide range of complication rates were reported (0–33 %). This collective review showed acceptable recurrence rates for mesh-based umbilical and epigastric hernia repair. A wide range of devices was investigated. A tendency toward more complications after laparoscopic repair was found compared to open repair.     

Ischemic stroke in prediabetic patients

To describe the clinical characteristics of first-ever ischemic stroke (IS) patients with prediabetes, and to compare them with diabetes mellitus (DM) and non-DM patient characteristics. Retrospective analysis of a prospective series of first-ever acute IS patients. Patients were classified as non-DM (HbA1c during admission <5.7 % and no previous evidence of 2 or more fasting glucose >126 mg/dL), prediabetes (HbA1c from 5.7 to 6.4 %), and DM (previous DM diagnosis or HbA1c ≥6.5 % independently of current blood glucose). Demographic and clinical characteristics were compared between the three groups, along with outcome data [early neurological deterioration (END), 3-month poor outcome, 3-month mortality, outcome after rtPA treatment]. No demographic differences were observed. Prediabetic patients had more arterial hypertension (p = 0.006) and higher waist circumference (p < 0.0001) than non-DM patients, and DM patients had more hypercholesterolemia (p < 0.0001), body mass index (p = 0.017), and coronary artery disease (p = 0.005) than prediabetics. There were differences in TOAST subtype distribution (p < 0.0001). There were no differences in rtPA treatment success rate between groups. Multivariate analysis adjusted by age and stroke severity showed that DM but not prediabetes is an independent factor associated with END and 3-month poor outcome. Prediabetic patients with IS exhibit an “intermediate” vascular risk factor profile between that of non-DM and DM patients. In contrast to DM patients, IS prognosis in patients with prediabetes is similar to non-DM patients.