On-line computerized diagnosis of pain-related disability and psychological status of TMD patients: a pilot study

Temporomandibular disorders (TMD) is a collective term embracing a number of clinical problems, which involve the masticatory musculature, the temporomandibular joint or both. Virtually all theories dealing with the aetiology and treatment of TMD have recognized the importance of psychological factors. This paper reports the development of a computerized on-line program (NUS TMD v1.1) for the diagnosis of pain-related disability and psychological status of TMD patients based on Axis II of the research diagnostic criteria (RDC)/TMD (Dworkin, S.F. & LeResche, L. 1992. Journal of Craniomandibular Disorders: Facial Oral Pain, 6, 301), which was developed to redress the lack of diagnostic criteria in TMD research. Methods adopted by RDC/TMD for use in assessing Axis II status include a seven-item questionnaire for grading chronic pain severity, the Symptom Checklist 90 Revised (SCL-90-R) and a jaw disability checklist. A pilot study, based on 37 new TMD patient records, was conducted to study the pain-related disability and psychological status of TMD patients using this newly developed program. The mean age of the predominantly Chinese population (86.5%) was 32.19 years (range 20-72 years) with a sex distribution of 24 females and 13 males. Most patients (78%) had low disability, with 12 patients having low intensity and 17 patients having high intensity pain. Approximately 73% of the sample population were moderately or severely depressed. Patients that were moderately and severely depressed had significantly higher scores for limitation related to mandibular functioning than normal patients. The three most frequent jaw disabilities were: eating hard foods (84%), yawning (78%) and chewing (65%).     

Recombinant human bone morphogenetic protein-7 in maxillary sinus floor elevation surgery in 3 patients compared to autogenous bone grafts. A clinical pilot study

BACKGROUND/AIMS: This pilot study was designed to determine the clinical bone formation ability of a human recombinant DNA bone morphogenetic protein-7, also referred to as Osteogenic Protein-1 [OP-1] combined with a collagen carrier, implanted in the maxillary sinus of 3 patients. The results were compared with a group of 3 patients treated with sinus floor elevation and autogenous bone grafts. METHODS: 6 consecutive patients, 4 female and 2 male, between 48 and 57 years of age were treated by means of sinus floor elevation for insufficient bone height in the posterior maxilla for implant surgery. 3 patients, 2 female and 1 male, were treated with OP-1 attached to a collagen device. In these patients, 4 maxillary sinus grafting procedures according to Tatum's method were carried out. 1 g of collagen carrier containing 2.5 mg rhOP-1 mixed with 3 ml of saline was placed between the bony floor and the elevated mucosal lining of the most caudal part of the maxillary sinus, in order to increase the vertical bone dimension to place dental implants of a sufficient length. The 3 other patients, also 2 female and 1 male, with a total of 5 sinus sites, were treated with sinus floor elevation and autogenous iliac crest bone grafts. After 6 months, during dental implant preparation, bone cores were taken for histology. Thus, clinical, radiological and histological results of the 2 groups of 3 patients were compared. RESULTS: 6 months after sinus grafting with OP-1, in 1 male, well-vascularized bone-like tissue of good quality was observed clinically. This could be confirmed by histology. In the second, female, patient no bone formation was observed at all. A cyst-like granular tissue mass, without purulent content, was removed. In the 3rd, female, patient, who received bilateral sinus grafts, some bone-like formation was seen, however it showed flexible tissue which led to the decision that at 6 months after the sinus grafting, the implant placement had to be postponed. In all 5 autogenous grafted sinuses a bone appearance similar to normal maxillary bone was observed clinically as well as histologically and dental implants could be placed six months after sinus floor elevation surgery. CONCLUSIONS: These findings indicate that the OP-1 device has the potential for initiating bone formation in the human maxillary sinus within 6 months after a sinus floor elevation operation. However, the various findings in these 3 patients indicate that the behaviour of the material is at this moment insufficiently predictable, in this indication area. Further investigation is indicated before OP-1 can be successfully used instead of the "gold standard" autogenous bone graft.     

A randomised controlled trial of the caries-preventive efficacy of a chlorhexidine-containing varnish in high-caries-risk adolescents

A professionally applied two-stage chlorhexidine varnish, Chlorzoin((R)), was developed to achieve sustained release and minimise the problems of staining and bad taste associated with chlorhexidine mouthrinses. The primary aim of this randomised controlled clinical trial was to assess the efficacy of Chlorzoin in reducing the caries increment in high-caries-risk adolescents. Secondary aims included investigating the effect of compliance upon caries increment, the effect of Chlorzoin upon salivary mutans streptococci levels and assessing the benefit of individual dental health advice by dental auxiliaries in a community setting. 1,240 children, initially aged 11-13 years, assessed to be at high caries risk were recruited into the trial. The trial design involved four arms: an observational group, a control group, an active (Chlorzoin) varnish group and a placebo varnish group. All subjects were examined annually by a calibrated examiner who was blind to the group allocation. Three-year caries increments were calculated using clinical, clinical and fibre-optic transillumination, and clinical and bitewing data sets. The results indicated that the use of Chlorzoin had an initial effect on mutans streptococci levels but that no long-term reduction in caries increment or mutans streptococci infection could be detected. One reason for this lack of efficacy may have been the regimen of reduced frequency of varnish applications after the initial period. Children who followed the protocol and, therefore, were seen regularly by dental auxiliaries had a lower caries increment than those who did not. This finding was independent of varnish allocation. In summary, under this regimen, Chlorzoin has been found to be effective in decreasing salivary mutans streptococci but ineffective as a caries-preventive agent in high-risk Scottish children when applied pragmatically in a community setting.     

Microleakage study of various soft denture liners by autoradiography: effect of accelerated aging

STATEMENT OF PROBLEM: The longevity of soft denture liners is a major clinical problem. Debonding of the soft liner from the denture base material is one of the factors that influence their longevity. Debonding of the soft liner can be attributed to microleakage at the interface. PURPOSE: This study investigated microleakage at the interface of various soft liners and base materials. MATERIALS AND METHOD: Six soft liners were investigated. Forty specimens of each material in disk form (10 mm in diameter, thickness of approximately 4 mm) were prepared. Twenty specimens of each material were stored in an accelerated weathering tester for 900 hours. For 2 days, all disks were immersed in (45)Ca radioisotope solution, then they were embedded in acrylic resin blocks and sectioned longitudinally. Autoradiographic imaging was used to determine microleakage at the interface of the soft liners and their bases. RESULTS: Significant differences between nonaged materials were found (P<.05).The difference between Molloplast B and Mucopren (silanized) was not significant (P<.05). Differences among aged materials were significant (P>.05). Differences between Mucopren (nonsilanized), Mucopren (silanized), and Ufigel P-Tokuyama were not significant (P<.05). Significantly decreased microleakage characteristics were determined for Molloplast B, Mucopren (nonsilanized) and Ufigel P liners after aging. CONCLUSION: Microleakage of Mucopren and Molloplast B lining materials was the lowest. However, the microleakage of Flexor and Simpa was the highest. The aging process did not significantly affect the microleakage characteristics of the Simpa, Flexor, Mucopren (silanized), or Tokuyama materials. Molloplast B, Mucopren (nonsilanized), and Ufigel P materials should significantly decrease microleakage properties after aging.     

An in vitro study of microleakage of occlusal composite restorations polymerized by a conventional curing light and a PAC curing light

With the increase in usage of bonded dentistry procedures, so comes the development of advanced technology to polymerize it. The purpose of this in vitro study was to evaluate the microleakage of sealants and resin restorations utilizing two different curing lights. The conventional Ortholux curing light (OCL) and the Plasma Arc Curing (PAC) light attached to the KCP air abrasion unit of American Dental Technologies were utilized to polymerize sealants and resin restorations on extracted third molars and premolars. Forty-eight caries-free teeth were divided into 4 groups of 12 specimens. Occlusal sealants were polymerized on groups 1 and 3. Class I composite resin restorations were polymerized on groups 2 and 4. The PAC light polymerized group 2 and the OCL was used for groups 3 and 4. Therefore a comparison between the two light sources' polymerization could be measured by evaluating the microleakage of the two sets of specimens. The PAC light polymerized the Z100 adhesive for 5 seconds and the OCL polymerized it for 10 seconds. The Z100 A-1 composite placed in two 1 mm increments was polymerized with the PAC light for 10 seconds and the OCL for 40 seconds. The teeth were thermocycled 200 times between 5 degrees C and 55 degrees C. The teeth, coated with fingernail polish excluding the occlusal surface, were soaked in 5% methylene blue for 4 hours, removed, and rinsed with water. The teeth were invested in clear resin (Castin Craft) and sectioned longitudinally using an Isomet diamond saw. Microleakage was scored "0" if no leakage was present. Scored "1" if the leakage was present to 1/2 the preparation depth. Scored "2" if the leakage was present past the 1/2 way point but not to the pulpal floor of the preparation. A score of "3" was used if the leakage reached the pulpal floor. Unpaired t-Tests were used to statistically analyze the data. A significant difference (p < 0.05) was found between groups 1 and 3. The PAC light used to polymerize the sealants in group 1 produced no microleakage. A significant difference (p < .005) was found between groups 2 and 4. The OCL produced less microleakage (16 and 20 out of 24 sections) than the resin restorations polymerized with the PAC (only 8 of 24 sections with no microleakage. The 10-second cure by the PAC light appears to be insufficient in polymerizing a class I composite resin restoration. Possibly longer exposures with the PAC would produce less microleakage. Further research needs to be performed to evaluate if the PAC light, with an intensity of 1196 mW/cm2, may be producing high levels of strain within the setting composite. This strain may be responsible for the statistically significant increase in microleakage of the restorations polymerized with the PAC light.). It appears the PAC light would be best utilized to cure sealants and/or possibly polymerize orthodontic brackets. The conventional curing light appears to remain the best choice for polymerizing class I composite restorations.     

Expression of fatty acid synthase (FASN) in oral nevi and melanoma

Oral Diseases (2011) 17 , 808–812 Objective: The aim of this study was to determine the expression of fatty acid synthase (FASN) in oral nevi and melanomas, comparing the results with correspondent cutaneous lesions. Materials and Methods: Expression of FASN was evaluated by immunohistochemistry in 51 oral melanocytic lesions, including 38 intramucosal nevi and 13 primary oral melanomas, in 10 cutaneous nevi and in 14 melanomas. Results: Fatty acid synthase was strongly expressed only in melanomas, either of the oral mucosa or cutaneous. On the other hand, most oral and cutaneous nevi were negative, with a few oral cases showing focal and weak expression. Conclusion: Fatty acid synthase is expressed in malignant melanocytes, and it can be a helpful marker to distinguish oral melanomas from oral melanocytic nevi.     

Focal dermal hypoplasia: a case report and literature review

Focal dermal hypoplasia (FDH), also known as Goltz-Gorlin syndrome, is an autosomal dominant disease affecting tissues derived from the ectoderm and mesoderm. Knowledge and early diagnosis of the craniofacial alterations commonly found in patients with FDH provide oral health care professionals with effective preventive and therapeutic tools. This article aims to review the craniofacial characteristics present in FDH and the main systemic manifestations that have implications for dental management, while presenting a new case of the syndrome with novel oral findings.     

Characterization of dental nociceptive neurons

Selective blockade of nociceptive neurons can be achieved by the delivery of permanently charged sodium channel blockers through the pores of nociceptive ion channels. To assess the feasibility of this application in the dental area, we investigated the electrophysiological and neurochemical characteristics of nociceptive dental primary afferent (DPA) neurons. DPA neurons were identified within trigeminal ganglia labeling with a retrograde fluorescent dye applied to the upper molars of adult rats. Electrophysiological studies revealed that the majority of dental primary afferent neurons showed characteristics of nociceptive neurons, such as sensitivity to capsaicin and the presence of a hump in action potential. Immunohistochemical analysis revealed a large proportion of DPA neurons to be IB(4)-positive and to express TRPV1 and P2X(3). Single-cell RT-PCR revealed mRNA expression of various nociceptive channels, including the temperature-sensitive TRPV1, TRPA1, TRPM8 channels, the extracellular ATP receptor channels P2X(2) and P2X(3), as well as the nociceptor-specific sodium channel, Na(V)1.8. In conclusion, DPA neurons have the electrophysiological characteristics of nociceptors and express several nociceptor-specific ion channels. Analysis of these data may assist in the search for a new route of entry for the delivery of membrane-impermeant local anesthetics.     

Diagnostic quality of dynamic high-resolution ultrasonography of the TMJ--a pilot study

The aim of this study was to compare sensitivity, specificity, accuracy and positive and negative predictive value for high-resolution ultrasonography (HR-US) in diagnosing degenerative changes, effusion and disk displacement using magnetic resonance imaging (MRI) as a reference. Over a period of 6 months, 100 patients with TMJ disorders (200 TMJs) were investigated by an experienced radiologist with HR-US and magnetic resonance imaging (MRI). The MRI investigation showed degenerative changes in 190 joints (95%), while an effusion was found in 59 (29.5%) joints. At closed-mouth position a disc dislocation was found in 138 joints (69%) and in maximum-mouth-opening position disc dislocation was diagnosed in 76 joints (38%). In the determination of degenerative changes HR-US showed a sensitivity of 94%, a specificity of 100% and an accuracy of 94%. In the detection of effusion HR-US yielded a sensitivity of 81%, a specificity of 100% and an accuracy of 95%. In the determination of disk displacement at closed-mouth position HR-US showed a sensitivity, specificity and an accuracy of 92% each. At maximum-mouth-opening position HR-US reached a sensitivity of 86%, a specificity of 91% and an accuracy of 90%. The results of the current study imply that HR-US is a valuable diagnostic imaging method of the TMJ which can be used as an alternative method to a MRI-investigation, but is yet not able to replace it. Further studies have to be done to reduce false-negative results.