Timing interventions in relation to temporomandibular joint closed lock duration: a systematic review of ‘locking duration’

Temporomandibular joint (TMJ) ‘closed lock’ (CL) is a clinical condition causing TMJ pain and limited mouth opening (painful locking) that is mostly attributed to disc displacement without reduction (DDwoR), or less commonly to anchored disc phenomenon (ADP). Both conditions are described clinically as CL that can be ‘acute’ or ‘chronic’ depending on the duration of locking. There is, however, no consensus about the duration of locking that defines the acute state and its effect on the success of interventions. This review paper, therefore, aims to provide: (i) a narrative review of the pathophysiological need for early intervention in DDwoR and the clinical implications of acute/chronic CL stages on the management pathway; (ii) a systematic review investigating the effects of locking duration on the success of interventions for CL management. Electronic and manual searches until mid‐August 2013 were conducted for English‐language studies of any design investigating the effects of non‐surgical and surgical interventions for acute or chronic CL (DDwoR or ADP). A total of 626 records were identified, and 113 studies were included. Data extraction and quality assessment were completed for all included studies. Included studies were, however, heterogeneous and mostly of poor‐quality leading to contradictory and inconsistent evidence on the effect of the duration of locking on treatment outcomes. Future high‐quality trials investigating the effect of CL duration on treatment outcome are needed. At present, early intervention by ‘unlock’ mandibular manipulation seems to be the most practical and realistic approach that can be attempted first in every CL patient as an initial diagnostic/therapeutic approach.     

In vitro bonding efficacy of three restorative materials to primary dentin using a one-bottle adhesive system

The shear bond strength to primary dentin of a new single-bottle adhesive with three restorative materials (composite resin, compomer, and amalgam) was evaluated. Statistical analysis of the data showed significant differences among the means of the groups (ANOVA, p < 0.05). Composite resin and compomer were not significantly different from each other but both were statistically higher than amalgam. The fracture mode was not related to the shear bond strength values. The mean shear bond strengths obtained in this study were statistically comparable to those obtained in a previous study which used the same experimental design but included permanent teeth.     

Gender and medicines: an international public health perspective

Despite outstanding progress in the area of medicines, their access and use have not been equitable throughout the world. Fifteen percent of the world's population consumes 91% of the world's production of pharmaceuticals. Only one third of the world population has access to essential medicines. Additionally, studies carried out in developing countries reveal that gender-related barriers in access to health services and medicines are greater for women than men because of social and cultural factors. In high-income settings, women are reported to use more medicines than men. Moreover, the current devastating human immunodeficiency virus (HIV) epidemic impacts women disproportionately. Women are more vulnerable to HIV infection than men biologically but also because of gender inequalities. More social and statistical data, in both developing and developed countries, are needed to fully understand the impact of gender on access to and use of medicines. Improving access to essential medicines will be possible only if countries introduce a gender perspective in their medicine policies.