Using NHANES oral health examination protocols as part of an esophageal cancer screening study conducted in a high-risk region of China

Background

The oral health status of rural residents in the People's Republic of China has not been extensively studied and the relationship between poor oral health and esophageal cancer (EC) is unclear. We aim to report the oral health status of adults participating in an EC screening study conducted in a rural high-risk EC area of China and to explore the relationship between oral health and esophageal dysplasia.

Methods

National Health and Nutrition Examination Survey (NHANES) oral health examination procedures and the Modified Gingival Index (MGI) were used in a clinical study designed to examine risk factors for esophageal cancer and to test a new esophageal cytology sampling device. This study was conducted in three rural villages in China with high rates of EC in 2002 and was a collaborative effort involving investigators from the National Institutes of Health and the Cancer Institute of the Chinese Academy of Medical Sciences.

Results

Nearly 17% of the study participants aged 40–67 years old were edentulous. Overall, the mean number of adjusted missing teeth (including third molars and retained dental roots) was 13.8 and 35% had 7 contacts or less. Women were more likely to experience greater tooth loss than men. The average age at the time of first tooth loss for those with no posterior functional contacts was approximately 41 years for men and 36 years for women. The mean DMFT (decayed, missing, and filled teeth) score for the study population was 8.5. Older persons, females, and individuals having lower educational attainment had higher DMFT scores. The prevalence of periodontal disease (defined as at least one site with 3 mm of attachment loss and 4 mm of pocket depth) was 44.7%, and 36.7% of the study participants had at least one site with 6 mm or more of attachment loss. Results from a parsimonious multivariate model indicate that participants with poor oral health wemore likely to have esophageal dysplasia (OR = 1.59; 95% CI 1.06, 2.39).

Conclusion

This report describes the first use of NHANES oral health protocols employed in a clinical study conducted outside of the United States. The extent and severity of poor oral health in this Chinese study group may be an important health problem and contributing factor to the prevalence of EC.     

Influence of three different sealants on root dentin demineralization in situ

PURPOSE: To evaluate in situ the onset of initial demineralization in human dentin pretreated either with two different dentin bonding agents or a desensitizer. METHODS: 28 freshly extracted human molars were included in this study. The root surfaces were thoroughly cleaned, thereby removing the cementum. From each tooth four root dentin specimens were prepared. The specimens were distributed among the following experimental groups: C: control group (untreated), S: Syntac Classic, X: Xeno III, and H: Hyposen. For each subject, one dentin specimen of each group was inserted into both buccal aspects of a bilateral intraoral mandibular appliance. The appliances were worn by 14 subjects for 5 weeks day and night. One side was brushed daily with fluoride-containing toothpaste (Aronal) (B). On the other side, plaque was allowed to grow (NB). Individual oral hygiene techniques were performed without any fluorides. During meals, the appliance was stored in 10% sucrose solution. After the in situ period, slabs (150 microm) were ground and studied using polarized light microscopy. RESULTS: For lesion depth, ANOVA revealed significant differences between brushed and unbrushed specimens. In the brushed groups, the following lesion depths were evaluated (mean values and standard deviation in microns): Group B-C: 74.1 (+/- 18.5), Group B-S: 27.6 (+/- 9.6); Group B-X: 28.7 (+/- 9.6), and Group B-H: 34.3 (+/- 20.6). The non-brushed specimens showed following lesion depths: Group NB-C: 101.7 (+/- 23.9), Group NB-S: 59.9 (+/- 13.1), Group NB-X: 52.5 (+/- 12.1), and Group NB-H: 72.9 (+/- 19.9). Compared to the non-brushed groups, lesion depths in the brushed group were significantly decreased (P < 0.05, Tukey's test). The reduction of lesion depths after application of the three agents was significant in both cases (brushed and non-brushed groups). Within the limitations of an in situ study it can be concluded that the demineralization of the root surface can be inhibited by application of dentin adhesives and desensitizers under different oral hygiene conditions.     

From clinician to researcher--a first-hand account

While teaching and clinical care may be somewhat intuitive, research is much less so, and a lack of research experience or opportunity to do research can be frustrating to the faculty member who is trying to become well-rounded. In an effort to ease the transition from clinical teacher to clinical researcher, the faculty of dentistry at Dalhousie University has developed a research mentorship program. The purpose of this paper is to report on the opportunities and challenges that 2 dental clinicians experienced when they participated in the pilot phase of an epidemiologic survey of the oral health status of seniors. In their academic role, these 2 clinical examiners, who were full-time faculty members, concentrated on classroom and clinical teaching. Although neither had previous clinical research experience, both were interested in broadening their horizons by engaging in research in the hope of attaining a variety of positive outcomes.     

Bone formation after sinus augmentation with engineered bone

Objectives: The aim of the following investigation was to quantify the resorption rate of tissue-engineered bone grafts in the maxillary sinus using volume measurements. MATERIAL AND METHODS: Sinus floor augmentation using autologous bone grafts from the iliac crest (n=17, group 1) was compared with commercially produced transplants of human cells seeded on polyglycolid-polylactid (PLGA) scaffolds (Oral Bone) (n=14, group 2). RESULTS: The total resorption rate for autologous transplants 3 months post operation was 29%, while the tissue-engineered bone showed a resorption rate of 90%. The autologous bone had a bone density of up to 266-551 Hounsfield units (HU), while sufficient mineralization of tissue-engineered bone was found in only one case (152 HU). CONCLUSION: In this clinical study, the use of autologous cancellous bone grafts in sinus augmentation was more reliable than scaffolds containing cultured osteoblasts. Further tissue-engineered bone transplants should be examined to draw general conclusions about the use of tissue-engineered grafts compared with autologous bone grafts for maxillary sinus augmentation.     

Conventional radiographs: are they still the standard in localization of projectiles?

The penetration of air gun pellets in facial soft tissue can cause major problems during the removal of foreign bodies, although conventional radiography, computed tomography, image-guided surgical removal, and ultrasound have been applied to facilitate the procedure. It was the aim of the present case report to introduce a modified intraoperative method for the localization of air gun pellets, based on the use of radiopaque markers in conventional radiographs. A 66-year-old patient attempted to commit suicide by using an air gun. The pellet hit the right temporal region. A computed tomographic (CT) scan was acquired to localize the foreign body. The first attempt to remove the pellet through the penetrating wound failed. Because of a dislodgement of the pellet, the CT scan could no longer be used for the localization of the air gun pellet. As the air gun pellet was positioned under the zygomatic arch, ultrasound was unable to identify its position. Successful intraoperative localization of the projectile was performed after fixation of radiopaque markers to the skin in the region of the estimated localization, with conventional radiographs in 2 planes, acquired with a mobile dental x-ray device. Although the markers remained attached to the patient as reference makers, the air gun pellet was removed easily. The use of radiopaque markers in conventional radiographs in 2 planes allows fast, intraoperative localization of radiopaque foreign bodies within soft tissue. The procedure can be carried out with a conventional x-ray device that should be available in every oral and maxillofacial practice. The use of reference markers should be considered a standard procedure for the localization of radiopaque foreign bodies in the head and neck.     

Enlightenment about the new Architect-i2000 estradiol (Abbott Laboratories) immunoassay during in vitro fertilization

OBJECTIVE: We assessed a new estradiol (E2) immunoassay on the Architect-i2000 (Abbott Laboratories) for monitoring ovulation stimulation for IVF-ET and re-establishing clinical cut-off points. The method has been modified to improve E2 measurements especially at normal and low concentrations. DESIGN AND METHOD: E2 was determined for 552 samples, from 83 women, presenting normal follicular status and undergoing 100 cycles of IVF treatment. We assessed the value of this assay for down-regulation of E2 concentration limit using gonadoliberin-releasing hormone agonist (GnRHa), and monitoring of the ovarian hyperstimulation, expected range of E2 per mature follicle prior to the administration of exogenous hCG and day 3 concentration limit. We compared results with our routine method (E2-6II Advia-Centaur; Siemens-Diagnostics) for which decision-making values were known. RESULTS: Considering E2 concentrations obtained with the new Architect-i2000 assay for patients treated with GnRHa for 2 weeks, the cutoff-point for ovarian down-regulation should be set down at 110 pmol/L to maintain 100% of sensitivity. Considering day 3 concentration limit determination, results were not significantly different from those obtained with our routine method. The mean E2 values per mature follicle fell into the range generally expected. CONCLUSION: E2 determination with the new E2 Architect-i2000 assay could be used to monitor ovulation, in patients undergoing IVF-ET, in combination with transvaginal ultrasound.     

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