Xerostomia: evaluation of a symptom with increasing significance

Xerostomia is the subjective sensation of oral dryness. Although it is most commonly associated with salivary gland dysfunction, it may also occur with normal gland activity. Xerostomia may be an early symptom of several morbid systemic conditions with important implications for the medical and dental management of patients. Oral dryness also has negative effects on an individual's emotional well-being and quality of life. The complaint of xerostomia necessitates a complete evaluation of a patient's general health, salivary gland function, and oral motor and sensory abilities. The salivary gland assessment includes symptom review, analysis of glandular secretions, scintiscanning, and minor labial gland biopsy. No single component is sufficient to adequately diagnose the presence, extent, or cause of salivary dysfunction. Treatment of a dry mouth, to date, is mainly palliative in nature, with the intent of preserving oral structures and functions. Better therapies are essential in the management of xerostomia, whatever the cause. The importance of xerostomia as a symptom is increasingly recognized in medicine and dentistry. The dentist is commonly the first health professional to hear this complaint and may be critical in directing a full and appropriate evaluation.     

Effects of systemic fluoride and in vitro fluoride treatment on enamel crystals

Systemically administered fluoride at a concentration of 75 ppm increases the surface roughness of developing enamel crystals in rats, which may be significant in advancing our understanding of the biological mechanism of fluorosis. Thus, the aim of this study was to investigate whether the increased surface roughness may be a result of surface restructuring by the direct action of fluoride at the crystal surface. We examined the fluoride dose-dependent roughening of enamel crystal surfaces in vivo, in the rat, and whether this roughening could be mimicked by the in vitro treatment of rat enamel crystals with neutral pH fluoride solutions. Our results showed that enamel crystal surface roughness increased after treatment with increasing fluoride ion concentrations, whether applied in vitro or administered systemically. This suggests a mechanism, alongside others, for the increased surface roughness of crystals in fluorotic enamel.     

Genomic variation in Streptococcus mutans: deletions affecting the multiple pathways of β‐glucoside metabolism

The genome of Streptococcus mutans UA159 contains two phospho‐β‐glucosidase genes, bglA and celA, which occur in operon‐like arrangements along with genes for components of phosphotransferase transport systems and a third phospho‐β‐glucosidase encoded by the arb gene, which does not have its own associated transport system but relies on uptake by the bgl or cel systems. Targeted inactivation of each of the phospho‐β‐glucosidase genes revealed that bglA is involved in aesculin hydrolysis, celA is essential for utilisation of cellobiose, amygdalin, gentobiose and salicin, and arb is required for utilisation of arbutin. Inactivation of genes for the phosphotransferase systems revealed an overlap of specificity for transport of β‐glucosides and also indicated that further, unidentified transport systems exist. The cel and arb genes are subject to catabolite repression by glucose, but the regM gene is not essential for catabolite repression. Screening a collection of isolates of S. mutans revealed strains with deletions affecting the msm, bgl and/or cel operons. The phenotypes of these strains could largely be explained on the basis of the results obtained from the knockout mutants of S. mutans UA159 but also indicated the existence of other pathways apparently absent from UA159. The extensive genetic and phenotypic variation found in β‐glucoside metabolism indicates that there may be extensive heterogeneity in the species.     

Aspects of the design of modern dental air turbine handpieces*

Air turbine handpieces are manufactured with a wide range of alternative design features which may influence their suitability for particular clinical procedures. In this article a general account of these features is presented and their advantages and disadvantages are discussed. Some deficiencies in current methods of stating equipment specifications are reported and suggested improvements are given. Where appropriate, general recommendations are made regarding handpiece selection for clinical practice.     

Temporomandibular joint dysfunction syndrome: a close association with systemic joint laxity (the hypermobile joint syndrome)

Sixty-two patients admitted for elective reconstructive surgery of the temporomandibular joint (TMJ) and eight seen as outpatients with a chief complaint of TMJ dysfunction during the same time interval were evaluated for possible etiologic factors contributing to the disease. All hospitalized patients had severe, end-stage degenerative changes within the TMJ, whereas outpatients had less severe disease and did not require surgery. TMJ dysfunction in some patients was said to be a result of established causes including bruxism, malocclusion, and trauma. No patient in this series had evidence of a systemic inflammatory polyarthritis. Of the 70 patients, 38 (54%) met criteria, based on those of Carter and Wilkinson, as modified by Beighton et al., sufficient to warrant a diagnosis of the hypermobile joint syndrome. Five patients had classic Ehlers-Danlos syndrome and therefore were not patients with "benign hypermobility," and an additional two cases were described as "marfanoid" and as possible Ehlers-Danlos syndrome, respectively. Radiographs showed TMJ hyperextensibility in four hypermobile patients. Long-term surgical outcome was identical in the hypermobile and nonhypermobile groups. The incidence of hypermobility in this series is strikingly higher than the expected incidence in an otherwise population. Magnetic resonance images of the TMJs on separate groups of asymptomatic normal and hypermobile women identified excessive anterior movement in the hypermobile group, together with abnormal anterior disk position in some. We hypothesize that hypermobility within the TMJ may cause accelerated disk destruction and degenerative disease.     

Amoxycillin with clavulanic acid and tetracycline in periodontal therapy

The effects of tetracycline and amoxycillin with clavulanic acid on the clinical parameters and subgingival flora of eight patients with rapidly progressive periodontitis was assessed. Subjects received either tetracycline 250 mg four times daily or amoxycillin 250 mg with clavulanic acid 125 mg three times daily for a period of 2 weeks together with subgingival scaling and root planning. Both treatment regimens produced significant reductions in bleeding on probing and probing pocket depths which were still present 16 weeks after the antibiotic therapy. A significant reduction in the mean percentage of black-pigmented Bacteroides spp., Fusobacterium nucleatum and anaerobic corroding bacilli was also obtained. Both treatment regimens were equally effective in reducing the clinical parameter and altering the subgingival flora. The MIC values for Bacteroides gingivalis (Porphyromonas gingivalis). Bacteroides intermedius (Prevotella intermedia) and F. nucleatum to amoxycillin with clavulanic acid remained constant throughout the period of investigation. The MIC values of these organisms to tetracycline increased.     

Motor control of velopharyngeal structures during vowel production

This investigation was designed to measure the ability of normal adult speakers to exert voluntary control over velopharyngeal positioning. Speakers were asked to phonate the vowels [a] and [i] at 50 percent and 75 percent of complete velopharyngeal closure, using visual feedback of velopharyngeal opening and closing gestures from a phototransducer. The musculature of the velopharyngeal mechanism was hypothesized to act as a coordinated system that may demonstrate both motor flexibility and plasticity (Folkins, 1985) when forced to function in a novel way. Evidence of both motor system responses to a novel speaking condition was observed. Speakers were able either to phonate at intermediate closure levels without having to learn new motor rules, or to learn new rules for velopharyngeal muscle activation that resulted in the ability over time to position the velopharyngeal mechanism appropriately. As such, support is derived for the notion (Folkins, 1985) that speakers develop motor rules or coordinative structures involving the velopharyngeal mechanism that govern velopharyngeal movement. The characteristics of this coordinative structure framework has not yet been described, however, and are the subject of ongoing research efforts.     

Periodontal tissue reactions to orthodontic extrusion

Orthodontic tooth extrusion is used at crown lengthening procedures or in conjunction with periodontal therapy aimed at eliminating or reducing angular bone defects. A technique for orthodontic extrusion combined with resection of the supracrestal attachment fibers (fiberotomy) was recently proposed as an adjunct to certain restorative procedures. The aim of the present investigation was to analyze reactions of the periodontal tissues to orthodontic extrusion when combined with fiberotomy. In 5 beagle dogs, the mesial roots of the 2nd, 3rd and 4th hemisected mandibular premolar were used as target roots while the distal roots served as reference units. After a baseline examination, an orthodontic extrusion device (stent) was installed and reactivated at 2-week intervals during an 8-week period of active tooth movement. Immediately following the installation of the stent and once every 2nd week, the target roots were exposed to fiberotomy. After the active period, the teeth were retained in their new position for a period of 8 weeks. Clinical, radiographical and histological measurements were performed. The results from the investigation demonstrated that orthodontic extrusion combined with supracrestal fiberotomy resulted in a coronal displacement of the tooth and was associated with pronounced recession of the gingival margin and extensive loss of connective tissue attachment. The degree of gingival recession and the amount of loss of connective tissue attachment were, however, less extensive than the amount of tooth extrusion. Thus, repeated fiberotomy obviously failed to entirely prevent coronal migration of the attachment apparatus. It was also observed that undesired attachment loss had occurred at the reference roots.