Global oral health inequalities: oral infections-challenges and approaches

Four oral mucosal infections were identified as Global Oral Health Priorities: (a) HIV and associated viral, bacterial, and fungal infections; (b) tuberculosis; (c) NOMA; and (d) sexually transmitted diseases. Huge global inequalities exist in all four. HIV-associated infections constitute the major challenge. Oral manifestations of AIDS can be specifically diagnostic, indicating a significant role for dentists within health teams. The World Workshops in Oral Health & Disease in AIDS have identified a research program, elements of which are being implemented. Data on oral mucosal involvement in tuberculosis, syphilis, and gonorrhea are incomplete in developed countries and virtually non-existent in low- and middle-income countries, indicating the need for further epidemiological studies. Oral manifestations of tuberculosis and sexually transmitted diseases are largely associated with general health, so action programs should be integrated with agencies treating the systemic diseases. NOMA is very much in the oral health domain. It is a preventable disease associated with malnutrition and unidentified bacterial factors. Prevalence is probably grossly overestimated at present; but nevertheless it constitutes a challenge to the profession, especially in the NOMA belt. Current treatment is surgical, but plans for its eradication should be achievable. The global oral health community, especially the IADR, has a major role to play.     

Kimura disease in the parotid gland

Kimura disease (KD) is a rare entity that occurs primarily in Asian people characterized histopathologically by a lymph-folliculoid granuloma with infiltration of the mass and the surrounding tissues by eosinophils, often with concomitant peripheral blood eosinophilia and elevated serum immunoglobulin E, generally seen in the head and neck region, especially preauricular area. In this article, we present the case of a 14-year-old male patient with KD on his left parotid area. The clinical, radiologic, surgical, and pathologic findings of KD are discussed in this article.     

Lip impressions: a new method for monitoring morphological changes in orofacial granulomatosis

AIM: To develop and evaluate an objective method for assessing lip size and treatment-related morphological changes in orofacial granulomatosis (OFG) patients. MATERIALS AND METHODS: Patients with swollen lips because of OFG (n=21) were enrolled. A light-body polyvinylsiloxane material was used to take lip impressions before and after treatment (n=10), or during treatment (n=11). Plaster models were cast from the impressions and the lips were measured using callipers. The intra-examiner and inter-examiner reproducibility of the technique were assessed. RESULTS: OFG patients had significantly larger lips than controls (P<0.0001). The coefficient of variation on repeated measurements of the same impression was 1.6% and for duplicate impressions was 2.6%. Significant reduction in lip size was shown in all 10 patients after diet restriction (P<0.002). Seven of 11 patients whose impressions were taken at least 3 months after the initiation of cinnamon- and benzoate-free diet also showed reduction in lip size during follow up (P<0.002). CONCLUSIONS: Serial lip impressions appear to be reliable for routine quantification of morphological changes of the lips in OFG patients. We present a new reproducible and sensitive method for assessing changes in lip size in response to treatment in OFG.     

HIV: infection control issues for oral healthcare personnel

AIM: To present the essential elements of an infection control/exposure control plan in the oral healthcare setting with emphasis on HIV infection. METHODS AND MATERIALS: A comprehensive review of the literature was conducted with special emphasis on HIV-related infection control issues in the oral healthcare setting. RESULTS: Currently available knowledge related to HIV-related infection control issues is supported by data derived from well-conducted trials or extensive, controlled observations, or, in the absence of such data, by best-informed, most authoritative opinion available. CONCLUSION: Essential elements of an effective HIV-related infection control plan include: (1) education and training related to the etiology and epidemiology of HIV infection and exposure prevention; (2) plans for the management of oral healthcare personnel potentially exposed to HIV and for the follow-up of oral healthcare personnel exposed to HIV; and (3) a policy for work restriction of HIV-positive oral healthcare personnel. CLINICAL SIGNIFICANCE: While exposure prevention remains the primary strategy for reducing occupational exposure to HIV, knowledge about potential risks and concise written procedures that promote a seamless response following occupational exposure can greatly reduce the emotional impact of an accidental needlestick injury.     

Synthesis, characterization, shrinkage and curing kinetics of a new low-shrinkage urethane dimethacrylate monomer for dental applications.

OBJECTIVES: The aim of the study was to synthesize and characterize an isophorone-based urethane dimethacrylate (IP-UDMA) resin-monomer and to investigate its shrinkage and curing kinetics. METHODS: The IP-UDMA monomer was synthesized through the reaction of polyethylene glycol 400 and isophorone diisocyanate followed by reacting with HEMA to terminate it with methacrylate end groups. The reaction was followed using a standard back titration method and FTIR spectroscopy. The final product was purified and characterized using FTIR, (1)H NMR, elemental analysis and refractive index measurement. The shrinkage-strain of the specimens photopolymerized at circa 700mW/cm(2) was measured using the bonded-disk technique at 23, 35, and 45 degrees C. Initial shrinkage-strain-rates were obtained by numerical differentiation of shrinkage-strain data with respect to time. Degree-of-conversion of the specimens was measured using FTIR spectroscopy. The thermal curing kinetics of the monomer were also studied by differential scanning calorimetry (DSC). RESULTS: The characterization methods confirmed the suggested reaction route and the synthesized monomer. A low shrinkage-strain of about 4% was obtained for the new monomer. The results showed that the shrinkage-strain-rate of the monomer followed the autocatalytic model of Kamal and Sourour [Kamal MR, Sourour S. Kinetic and thermal characterization of thermoset cure. Polym Eng Sci 1973;13(1):59-64], which is used to describe the reaction kinetics of thermoset resins. The model parameters were calculated by linearization of the equation. SIGNIFICANCE: The model prediction was in a good agreement with the experimental data. The properties of the new monomer compare favorably with properties of the commercially available resins.     

Assessment of arch constriction in patients with bilateral cleft lip and palate and isolated cleft palate: a pilot study

The objective of this study was to test the use of the modified Huddart/Bodenham scoring system on patients with a bilateral cleft lip and palate (BCLP) or an isolated cleft palate (CP). Study models of 5- and 10-year-old patients with BCLP (n = 19) and isolated CP (n = 55) from the Cleft Services in Scotland database were scored using the system by four examiners on two separate occasions to test inter- and intraexaminer reliability. The weighted kappa statistic was used to evaluate reliability. The interexaminer reliability ranged from 0.48 to 0.74 (moderate to good agreement) for the BCLP group and 0.77 to 0.86 (good to very good agreement) for the isolated CP group. The number of study models available for the BCLP group was small due to the low incidence of this cleft group, but the scoring system was shown to be reliable when used in cleft types other than unilateral cleft lip and palate. The modified Huddart/Bodenham scoring system provides a useful tool suitable for assessing arch constriction in all types of orofacial clefting, which is objective, sensitive, and versatile.     

A new method for lateral pterygoid electromyographic electrode placement

STATEMENT OF PROBLEM: Making electromyographic recordings of the lateral pterygoid muscle (LP) is difficult because of potential electrode damage to, for example, the maxillary artery and long buccal nerve, and because of pain and reduced jaw mobility characteristic of many orofacial pain patients. PURPOSE: The purpose of this study was to develop a reliable intraoral placement technique for the inferior head of the lateral pterygoid (IHLP) that minimizes jaw displacement. MATERIAL AND METHODS: In 2 dried skulls and 7 human cadavers, it was estimated that, with the mandible in an ipsilateral closed position, a straight needle could be used to position fine-wire electrodes into the midportion of IHLP by inserting the needle through the mucosa adjacent to the distal root of the maxillary second molar, towards the external auditory meatus and parallel to the buccal alveolar bone of the maxilla. The needle avoided the maxillary artery and long buccal nerve. Using this approach in 5 adults, 2 fine-wire electrodes were placed into the IHLP. Placement was verified by computer tomography (CT) and electromyography. RESULTS: In all subjects, the ideal insertion depth to place the electrodes in the middle of IHLP was 29 mm. CONCLUSIONS: This technique is a reliable method for IHLP electrode placement for patients with impaired jaw function, minimizing risk of damage to major structures.     

National Italian Guidelines for caries prevention in 0 to 12 years-old children.

AIM: Oral and dental health improved tremendously over the last fifty years in Italy but still prevalence of dental caries in children remains a significant clinical problem. This report describes the National Italian Guidelines for caries prevention. METHODOLOGY: A panel of experts coordinated by the Italian Society of Paediatric Dentistry (SIOI) planned to elaborate the national Italian guidelines for caries prevention in children. The structure of the guidelines has been planned to follow the principles of modern caries treatment and management as well as science based dentistry. The main procedure was based on a hierarchic evaluation of literature. CONCLUSION: The guidelines are planned for dentist working in primary dental care, however, they are also designed to be of interest for other care professionals such as paediatricians, gynecologists, pharmacists and general medical practitioners and also for parents and/or guardians of the children.     

Scanning electron microscope assessment of several resharpening techniques on the cutting edges of Gracey curettes

AIM: Treatment of periodontal diseases is based on efficient scaling and root planing (SRP) and adequate maintenance of the patient. The effectiveness of SRP is influenced by operator skill, access to the subgingival area, root anatomy, and the quality and type of instrument used for SRP. The aim of this study was to evaluate the cutting edges of Gracey curettes after manufacturing and after resharpening using several techniques. METHODS AND MATERIAL: The cutting edges of a total of 41 new #5-6 stainless steel Gracey curettes were evaluated blindly using scanning electron microscopy (SEM). The quality of the cutting edges was evaluated blindly by a calibrated examiner using micrographs. Data were analyzed using a Kruskal Wallis test and non-parametric two-way multiple comparisons. RESULTS AND CONCLUSIONS: Different sharpening techniques had significantly different effects on the sharpness of cutting edges (p<0.05). Sharpening by passing the lateral face of curettes over a sharpening stone and then a #299 Arkansas stone produced a high frequency of smooth, sharp edges or slightly irregular edges between the lateral and coronal faces of the curettes. Sharpening by passing a blunt stone over the curette's lateral face produced the poorest quality cutting edge (a bevel). Sharpening of the coronal curette face produced extremely irregular cutting edges and non-functional wire edges. Sharpening with rotary devices produced extremely irregular cutting edges.