Overcoming behavioral obstacles to prevent periodontal disease: Behavioral change techniques and self-performed periodontal infection control

It is well established that periodontal infection control, by means of adequate oral hygiene such as daily toothbrushing and interdental cleaning, is essential for prevention of periodontal disease. Evidence suggests that oral health behavioral intervention is more effective if based on a theoretic framework that includes behavioral change techniques based on goals and planning and on feedback and monitoring. This review focuses on factors that influence behavioral changes in oral hygiene measures (both obstacles and facilitators) and a person-centered approach to treatment planning and communication with patients. A person-centered model of oral hygiene is presented that can be integrated into periodontal treatment using different behavioral techniques.     

FS08.3Health‐related quality of life and hand eczema

Aims:  The aims were to study health‐related quality of life (HRQL) in patients with hand eczema, and to compare two different instruments for assessment of HRQL.
Methods:  100 consecutive hand eczema patients (51 females and 49 males) at an occupational dermatology clinic completed the generic questionnaire Short Form‐36 (SF‐36), and the dermatology specific Dermatology Life Quality Index (DLQI). To compare the instruments factor analysis, with a polychoric correlation matrix as input, was performed, thus taking the ordinal aspect of the data into account.
Results:  HRQL was affected by hand eczema, measured with both SF‐36 and DLQI. The mean (SD) sum scores of DLQI was 7.4 (5.8), no difference between genders. However, the SF‐36 showed more impaired HRQL for females than for males in the mental health dimension. There was a high correlation between the instruments for physical health, but lower for mental health.
Conclusions:  Hand eczema has an impact on HRQL, and both SF‐36 and DLQI are suitable instruments. Our conclusion from the factor analysis is that the SF‐36 measures mental health better than the DLQI. The choice of instrument to be used in a specific study depends on the purpose of the study. A generic instrument has the advantage of making comparisons with other diseases possible. The SF‐36 also appears suitable for use in hand eczema studies where gender differences in HRQL are of interest.     

Myeloperoxidase in human lung lavage

Bronchial wash and bronchoalveolar lavage were performed in 12 healthy subjects (five smokers), in order to elucidate whether or not material of neutrophil origin may be phagocytized by lung macrophages in vivo. Cells from different levels in the bronchial tree were obtained by sequential injection and subsequent aspiration of either four 50-ml or five 10-ml aliquots. Each aliquot was used for the determination of total and differential cell counts. The proportion of myeloperoxidase-positive alveolar macrophages was determined by specific immune histochemical staining. The percentage of myeloperoxidase-positive macrophages was highest (median 94.8%, range 37-98.5%) in the 10-ml aliquots and lowest in the last three 50-ml aliquots (median values 1-2.5%) (P less than 0.001). A significant correlation was obtained between the fraction of myeloperoxidase-positive macrophages and the percentage count of bronchoalveolar lavage neutrophils (r = 0.466, P less than 0.05). Furthermore, the cellular myeloperoxidase showed a significant inverse correlation (r = -0.46, P less than 0.05) to the viability of the bronchoalveolar lavage cells. Our findings are compatible with previous demonstrations in animals of neutrophil phagocytosis by lung macrophages and show that this phenomenon in particular occurs in the more proximal airways. The internalization of neutrophils or neutrophil components by airway macrophages may be an important scavenger mechanism for protection of the lung from the deleterious effects of activated neutrophils.     

Treatment developments and the unfolding of the quality of life discussion in childhood medulloblastoma: a review

Purpose

To describe how the quality of life (QOL) discussion in childhood medulloblastoma (MB) relates to treatment developments, survival and sequelae from 1920 to 2014.

Methods

Articles containing “childhood medulloblastoma” and “quality of life” were identified in PubMed. Those containing phrases pertaining to psychological, emotional, behavioral or social adjustment in the title, abstract or keywords were selected. Inclusion of relevant older publications was assured by cross-checking references.

Results

1920–1930s: suction, electro-surgery, kilovolt (KV) irradiation. Survival = months. Focus on operative mortality, symptoms and survival. 1940s: radiotherapy improved. 1950s: chemotherapy and intubation. Survival = years. Opinions oscillated between optimism/awareness of physical sequelae of radiotherapy. 1960s: magnified vision, ventriculo-peritoneal (VP) shunts, megavolt (MV) irradiation. Long-term survival shifted the attention towards neurological problems, disability and carcinogenesis of radiotherapy. 1970s: CT, microscope, bipolar coagulation, shunt filters, neuroanesthesia, chemotherapy trials and staging studies. Operative mortality decreased and many patients (re)entered school; emphasis on neuropsychological sequelae, IQ and academic performance. 1980s: magnetic resonance imaging (MRI), Cavitron ultrasonic aspiration (CUSA), laser surgery, hyper-fractionated radiotherapy (HFRT). Cerebellar mutism, psychological and social issues. 1990s: pediatric neurosurgery, proton beams, stem cell rescue. Reflections on QOL as such. 21st century: molecular genetics. Premature aging, patterns of decline, risk- and resilience factors.

Discussion

QOL is a critical outcome measure. Focus depends on survival and sequelae, determined after years of follow-up. Detailed measurements are limited by time, money and human resources, and self-reporting questionnaires represent a crude measure limited by subjectivity. Therapeutic improvements raise the question of QOL versus cure. QOL is a potential primary research endpoint; multicenter international studies are needed, as are web-based tools that work across cultures.     

Clinical signs in the jaw and neck region following whiplash trauma—A 2-year follow-up

Background

Pain in the orofacial region is often reported after whiplash trauma. However, prospective studies evaluating clinical signs related to orofacial pain and disability in whiplash populations are rare. The aim of the present study was to evaluate clinical signs related to pain and dysfunction in orofacial and neck regions after whiplash trauma, in a short- and long-term perspective.

Methods

In total, 84 cases (48 women) diagnosed with neck distortion after a car accident and 116 controls (68 women) were examined within 1 month, and 49 cases (27 women) and 71 controls (41 women) were re-examined 2 years later. Outcome measures were pain on palpation of jaw and neck muscles and maximal jaw opening. Analysis was performed using mixed-models.

Results

Cases and women were at higher risk for pain on palpation of jaw muscles (OR:7.7; p < 0.001 and OR:3.2; p = 0.010 respectively) and neck muscles (OR:12.7; p < 0.001 and OR:2.9; p = 0.020 respectively) but with no significant effect of time. Cases and women also had lower maximal jaw opening (−3.1; p = 0.001 and −3.3; p = 0.001 respectively). There was no significant time effect, but a significant interaction between cases and time (2.2; p = 0.004).

Conclusion

Individuals with a whiplash trauma present a higher risk for pain on palpation in jaw and neck muscles both in a short- and long-term perspective, but show normal jaw movements. No time effect suggests that cases do not spontaneously improve nor get worse. Investigating pain on palpation in the jaw and neck muscles after whiplash trauma can identify individuals at risk for developing long-term orofacial pain and dysfunction.

Significance

Orofacial pain is often reported after whiplash trauma but most previous studies concerning orofacial pain in whiplash populations have been questionnaire studies. Cases with a previous whiplash trauma and women, in general, had higher risk for pain on palpation in the jaw and neck region. Investigating pain on palpation after a whiplash trauma can help to identify individuals at risk of developing long-lasting pain in the orofacial region.     

Percent of plaque on individual tooth surfaces and differences in plaque area between adjacent teeth in healthy adults

Abstract Objectives: To apply a planimetric method to determine the percentage of the tooth area covered by plaque on individual tooth surfaces and to compare the percentage of plaque between adjacent tooth surfaces. Methods: Forty‐three adults, mean age 43.0 years, with no signs of periodontal disease, participated. The subjects underwent comprehensive professional cleaning of all teeth. The subjects were then instructed to maintain their ordinary oral hygiene habits. Plaque was registered after 1 month, on each individual tooth surface by use of P%I. Results: The pattern of plaque accumulation was in large symmetrical, with differences in mean P%I between several adjacent tooth surfaces, e.g. for the maxillary buccal and lingual tooth surfaces between the first and second molars (P < 0.001) and for the lingual tooth surfaces between the canines and the first premolars (P < 0.01). Conclusion: In the present study, it was possible to identify and describe adjacent tooth surfaces with the most pronounced plaque accumulation, to make further improvements of oral hygiene possible.     

Food hypersensitivity and quality of life

PURPOSE OF REVIEW: The present article presents an accessible review of research results on food hypersensitivity and quality of life (QoL), including 15 original articles on the subject. RECENT FINDINGS: Research on food hypersensitivity and QoL covers children and their parents, adolescents and adults. Several domains of QoL are affected, such as family and social activities, emotional issues and family economy. Food-hypersensitive children are to a large extent limited in their autonomous social activities. Food-allergic adolescents have a higher number of weeks absent from school compared with a control group, and a relatively high percentage of food-allergic young adults do not participate in the labour market. Comorbidity has to be taken into consideration when assessing QoL in food-hypersensitive individuals. Research on gender differences in food hypersensitivity and QoL are scarce. SUMMARY: Although development in this research field has only just begun, it is obvious that food hypersensitivity has a significant impact on individuals' and families' QoL. An important advance is the disease-specific QoL measure instruments that have been created. There is still, however, a need for a more in-depth knowledge as a basis for further development of QoL instruments, and as a basis for societal interventions and family/individual support.