Herbal and dietary supplements for treatment of anxiety disorders

Use of complementary and alternative medicine has increased over the past decade. A variety of studies have suggested that this use is greater in persons with symptoms or diagnoses of anxiety and depression. Data support the effectiveness of some popular herbal remedies and dietary supplements; in some of these products, particularly kava, the potential for benefit seems greater than that for harm with short-term use in patients with mild to moderate anxiety. Inositol has been found to have modest effects in patients with panic disorder or obsessive-compulsive disorder. Physicians should not encourage the use of St. John's wort, valerian, Sympathyl, or passionflower for the treatment of anxiety based on small or inconsistent effects in small studies. Although the evidence varies depending on the supplement and the anxiety disorder, physicians can collaborate with patients in developing dietary supplement strategies that minimize risks and maximize benefits.     

Braces and splints for musculoskeletal conditions

Braces and splints can be useful for acute injuries, chronic conditions, and the prevention of injury. There is good evidence to support the use of some braces and splints; others are used because of subjective reports from patients, relatively low cost, and few adverse effects, despite limited data on their effectiveness. The unloader (valgus) knee brace is recommended for pain reduction in patients with osteoarthritis of the medial compartment of the knee. Use of the patellar brace for patellofemoral pain syndrome is neither recommended nor discouraged because good evidence for its effectiveness is lacking. A knee immobilizer may be used for a limited number of acute traumatic knee injuries. Functional ankle braces are recommended rather than immobilization for the treatment of acute ankle sprains, and semirigid ankle braces decrease the risk of future ankle sprains in patients with a history of ankle sprain. A neutral wrist splint worn full-time improves symptoms of carpal tunnel syndrome. Close follow-up after bracing or splinting is essential to ensure proper fit and use.     

The use of biopsy in dental practice. The position of the American Academy of Oral and Maxillofacial Pathology

Biopsy is the gold standard of diagnostic procedures. The American Academy of Oral and Maxillofacial Pathology has stated its position concerning biopsy use in dental practice, believing that using the procedure more frequently will enhance diagnosis and contribute substantially to the quest for more evidence-based practice. Biopsy is a technique within the scope of practice of general dentists. It is vital to understand that biopsy is a tool for the diagnosis of myriad benign and malignant oral conditions. More frequent use of biopsy in dental practice will likely reduce the number of successful lawsuits brought for delay or failure to diagnose. This article offers 10 guidelines to dentists to help assure the success of the procedure.     

Effect of a stannous fluoride dentifrice on plaque formation and removal: a digital plaque imaging study

OBJECTIVE: A repeated measures digital imaging technique (Digital Plaque Image Analysis-DPIA) was used to assess the antiplaque effectiveness of a 0.454% stannous fluoride dentifrice. METHODOLOGY: Subjects were qualified to enter the study based upon a previous assessment of dental plaque accumulation while brushing with a standard (non-antimicrobial) fluoridated dentifrice. Fourteen qualifying subjects were entered into a cross-over study design, including the use of a standard 0.243% sodium fluoride (NaF) dentifrice, or a 0.454% stannous fluoride (SnF,) dentifrice. Cross-over periods were separated by a one-week washout. During the assigned treatments, subjects visited the imaging laboratory on six separate days over two weeks, reporting each day for three separate assessments of plaque accumulation, as assessed by DPIA. On each "grading day," subjects entered for plaque assessments prior to morning tooth brushing, and without consuming any food or beverages. Following this morning "pre-brushing" assessment, subjects brushed with the assigned dentifrice and then had plaque immediately reassessed (morning post-brushing). Subjects also reported to the imaging clinic for an afternoon plaque regrowth assessment. Subjects were again required to avoid food and drink for one hour prior to this measurement. RESULTS: The SnF2 dentifrice was observed to produce statistically significant reductions in dental plaque, measuring 24.4% in the morning pre-brushing, and 27.9% in the afternoon assessment. Tooth brushing was observed to significantly reduce plaque on the teeth in the morning post-brushing for subjects using either the standard NaF or the SnF2 dentifrice. There were no statistically significant differences in plaque coverage on teeth following tooth brushing with the NaF (6.3% coverage) or SnF2 (6.2% coverage) dentifrices. CONCLUSION: Use of a 0.454% SnF2 dentifrice produced statistically significant reductions in dental plaque formation as compared to the similar use of a standard 0.243% NaF dentifrice.     

Oral health status and prosthodontic conditions of Chinese adults: a systematic review

PURPOSE: To assess oral health and prosthodontic conditions of Chinese adults and the changes in these conditions over time. MATERIALS AND METHODS: PubMed was searched by combining the keyword China with dental health survey, oral health, tooth loss, DMFT (decayed/missing/filled teeth), dental prosthesis, or dentures. After selection, 12 studies remained. Data were obtained from these studies on DMFT, DMFT components, and teeth present and were tested against the following independent variables using analysis of variance: age, residence, and year of data collection. RESULTS: DMFT increased with age (P = .0001). Rural subjects presented higher DMFT based on the higher "decayed" component (P = .003), which increased markedly for subjects over 45 years of age. The number of teeth present decreased with increasing age (P = .0002). The results showed that Chinese subjects who are 65 years old have an average of 20 teeth. Urban subjects had more teeth present (P= .05), although no difference was seen for the "missing" component of DMFT. In general, few prosthodontic data could be extracted from the selected studies, and these data were often unspecific or inconclusive. CONCLUSIONS: The "filled" component of DMFT remained consistently low for all ages, indicating limited care. All outcomes were independent from year of data collection, indicating unchanged care. Outcome aggregation on the number of functional teeth and prosthetic care was impossible. For future reports, it is recommended to include additional information about location and function (in terms of occluding pairs) of teeth present when describing oral health status.     

Traumatic neuroma following sagittal split osteotomy of the mandible

A 16-year-old male underwent bilateral sagittal split osteotomy of the mandible to correct a mandibular deficiency. Twenty-one years later, a routine panoramic radiograph revealed a radiolucent lesion on the left side of the mandible. The lesion was biopsied. As the patient did not have symptoms and the lesion was connected to the inferior alveolar nerve, the lesion was not totally excised in order to preserve nerve function. The histological features were consistent with traumatic neuroma, and no further surgical procedure was planned.     

Development and psychometric properties of the Self-Efficacy Scale for transfers for caregivers of children requiring transfer assistance

OBJECTIVE: To test the psychometric properties of a newly developed measure of caregiver self-efficacy, the Caregiver Self-Efficacy Scale for Transfers (CSEST), a 14-item questionnaire that measures the perceived self-efficacy of adult caregivers of dependent children and focuses on their perceived abilities and the challenges of assisting a child with restricted transfer ability. DESIGN: Reliability and validity study using survey data. SETTING: Community-based survey study. PARTICIPANTS: Adult caregivers (eg, mother, father, grandparent) of dependent minors who require transfer assistance. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Using the Rasch measurement model, the CSEST was tested for reliability and separation, validity (hierarchical and content), and factor structure. RESULTS: The CSEST yields data with sufficient reliability (reliability indices of .96 and .94 for respondents and items, respectively) as well as sufficient separation of levels of self-efficacy (item separation index, 4.13; person separation index, 5.23). The CSEST has a stable hierarchical structure with adequate content validity (standardized chi2 fit statistics <2.0) and point biserial correlations greater than .67. Factor analysis confirmed 2 insubstantial subscales; the 14-item CSEST accounted for greater than 85% of the total variance. CONCLUSIONS: The CSEST yields reliable data and valid inferences of self-efficacy from adult caregivers of children requiring transfer assistance. The CSEST may identify areas of need and/or difficulty with transfers for parents caring for dependent children.     

Effects of storage, RNA extraction, genechip type, and donor sex on gene expression profiling of human whole blood

BACKGROUND: Gene expression profiling of whole blood may be useful for monitoring toxicological exposure and for diagnosis and monitoring of various diseases. Several methods are available that can be used to transport, store, and extract RNA from whole blood, but it is not clear which procedures alter results. In addition, characterization of interindividual and sex-based variation in gene expression is needed to understand sources and extent of variability. METHODS: Whole blood was obtained from adult male and female volunteers (n = 42) and stored at various temperatures for various lengths of time. RNA was isolated and RNA quality analyzed. Affymetrix GeneChips (n = 23) were used to characterize gene expression profiles (GEPs) and to determine the effects on GEP of storage conditions, extraction techniques, types of GeneChip, or donor sex. Hierarchical clustering and principal component analysis were used to assess interindividual differences. Regression analysis was used to assess the relative impact of the studied variables. RESULTS: Storage of blood samples for >1 week at 4 degrees C diminished subsequent RNA quality. Interindividual GEP differences were seen, but larger effects were observed related to RNA extraction technique, GeneChip, and donor sex. The relative importance of the variables was as follows: storage < genechip < extraction technique < donor sex. CONCLUSION: Sample storage and extraction methods and interindividual differences, particularly donor sex, affect GEP of human whole blood.