Signs and Symptoms of Mandibular Dysfunction in Complete Denture Wearers Five Years after Receiving New Dentures

Studies have shown that signs and symptoms of mandibular dysfunction are a common finding in complete denture wearers. There is, however, a low representation of these patients in clinical series, probably due to their lower propensity to seek help and their greater willingness to accept a certain degree of dysfunction compared to other patients.

The author of this article examined a group of complete denture wearers five years after treatment with new complete dentures. These findings are compared with the situation before treatment and at a six-month follow-up. Clinical signs of dysfunction were a common finding on all three occasions. The favorable decrease of clinical signs that was noted at the six- month follow-up was generally followed by some relapse after five years.

The author stresses that a recall system, including correction of the dentures when needed, is important. This will not only preserve good comfort and extend the life of the dentures, but will also prevent or delay the development of signs and symptoms of mandibular dysfunction.     

UltraPro Hernia System,Prolene Hernia System and Lichtenstein for primary inguinal hernia repair: 3-year outcomes of a prospective randomized controlled trial

Purpose

Chronic pain and discomfort are common after inguinal hernia repair (IHR). In this study, results from a 3-year follow-up from a randomized controlled study comparing three different mesh repairs for postoperative pain, discomfort, Quality of Life (QoL) and patient satisfaction are reported.

Methods

Between November 1, 2006 and January 31, 2009, 309 men, who underwent day surgery for primary unilateral inguinal hernia under local anesthesia, were randomized to three different mesh repairs; UltraPro Hernia System (U), Prolene Hernia System (P) and Lichtenstein procedure (L).

Results

Preoperatively, there were no differences between groups regarding demographics, symptoms, inguinal pain or QoL (SF-36 and a hernia-specific questionnaire). Operating time, postoperative pain, complications and time to full recovery were similar. At 36 months, 21 patients indicated pain [L, n = 6, P, n = 6 and U, n = 9; VAS (median (IQR)): L 0.4 (0.2–1.7), P 0.2 (0.1–2.3) and U 1.6 (0.7–4.6), p = ns]. Physical QoL was reduced in all groups before surgery and was similarly increased to normal levels after 3 months without further changes throughout the study. Although 92 % of participants were satisfied, sixteen percent reported any discomfort from the groin (ns between groups). Five recurrences were reported (L, n = 2, P, n = 1 and U, n = 2, p = ns).

Conclusions

After 3 years of follow-up, all three procedures provided equally good results regarding, pain, discomfort and QoL and could therefore be recommended for primary IHR in LA.

     

The relationship between dental caries status and dental plaque urease activity

INTRODUCTION: Ammonia production from the metabolism of urea by urease enzymes of oral bacteria moderates plaque acidification and may inhibit dental caries, as suggested by in vitro studies and indirect clinical observations. The objective of this study was to examine the relationship of urease activity with dental caries at the clinical level. METHODS: Urease activity was measured in dental plaque and saliva samples from 25 caries-free subjects (CF) and in eight subjects with six or more open caries lesions (CA). Plaque and saliva collection was repeated for each subject 1 week later using identical procedures. RESULTS: Urease-specific activity in the dental plaque of CF subjects was significantly higher compared to that in the subjects with caries. The association of low plaque urease levels with increased caries was further supported by odds ratio analysis using different plaque urease cut-off points. Using a receiver operating characteristic curve it was estimated that there was an approximately 85% probability of correctly classifying the subjects as CA or CF based on the relative ordering of their plaque urease activity levels. No statistically significant differences were observed in salivary urease activity. CONCLUSION: This study suggests that loss of alkali-generating potential of tooth biofilms via the urease pathway has a positive relationship to dental caries.     

Validation and improvement of a predictive model for treatment outcome in patients with temporomandibular disorders

OBJECTIVE: To examine whether it was possible to improve individual prediction of treatment outcome in patients with temporomandibular disorders (TMD) through continuous quality improvement registrations and implementation of changes in clinical routines. MATERIAL AND METHODS: All 5777 patients referred to a specialist clinic for stomatognathic physiology; 2187 TMD patients started treatment. The patients were divided into Muscle or Mainly TMJ symptom groups. Actual treatment outcome was predicted as Good or Dubious based on patient history and clinical findings. The degree of improvement of initial symptoms was graded using a numeric rating scale 0-100. Improvement in initial complaints of 50% or more was judged as a clinically important difference (CID); 989 patients (76%) completed treatment 1992-1998 (Sample 1) and 769 (86%) treatment 1999-2004 (Sample 2). RESULTS: For patients with Muscle symptoms in Sample 1, CID was reached by 90% of those predicted Good and by 56% of those predicted Dubious. In Sample 2, the figures were Good 93% and Dubious 57%. In subgroup Mainly TMJ symptoms, CID was reached by 94% of those predicted Good and by 88% if predicted Dubious in Sample 1. In Sample 2, the figures were the same for those predicted Good, i.e. 94%, and Dubious, 73%. CONCLUSION: Continuous quality improvement registrations and implementation of changes in clinical routines improved the ability to predict individually the actual treatment outcome between patients predicted Good or Dubious, respectively. Rheumatic disease turned out not to be a negative predictor for treatment outcome.     

Dogs as Sentinels for Flavivirus Exposure in Urban,Peri-Urban and Rural Hanoi,Vietnam

Diseases caused by flaviviruses, including dengue fever and Japanese encephalitis, are major health problems in Vietnam. This cross-sectional study explored the feasibility of domestic dogs as sentinels to better understand risks of mosquito-borne diseases in Hanoi city. A total of 475 dogs serum samples from 221 households in six districts of Hanoi were analyzed by a competitive enzyme-linked immunosorbent assay (cELISA) for antibodies to the pr-E protein of West Nile virus and other flaviviruses due to cross-reactivity. The overall flavivirus seroprevalence in the dog population was 70.7% (95% CI = 66.4–74.8%). At the animal level, significant associations between seropositive dogs and district location, age, breed and keeping practice were determined. At the household level, the major risk factors were rural and peri-urban locations, presence of pigs, coil burning and households without mosquito-borne disease experience (p < 0.05). Mosquito control by using larvicides or electric traps could lower seropositivity, but other measures did not contribute to significant risk mitigation of flavivirus exposure in dogs. These results will support better control of mosquito-borne diseases in Hanoi, and they indicate that dogs can be used as sentinels for flavivirus exposure.     

Effects of inverse ratio ventilation and positive end-expiratory pressure in oleic acid-induced lung injury

Continuous as well as cyclic (with each expiration) lung collapse in acute respiratory failure can be reduced by positive end-expiratory pressure (PEEP) or short expiration times, as in inverse ratio ventilation (IRV). In 20 pigs with oleic acid-induced lung edema, we compared the effects of a PEEP of 20 cm H(2)O with IRV, using an inspiratory-to-expiratory ratio of 3:1 without external PEEP. During IRV, expiration times of 0.5 or 1.0 s were obtained with respiratory rates of 30 breaths/min or 15 breaths/min, respectively. In 15 animals, ventilation-perfusion relationships were studied through the multiple inert gas elimination technique, and lung morphology was studied with computed tomography. In another five pigs, blood flow distribution was studied with perfusion scintigraphy. All three ventilatory modes had similar effects on mean arterial blood pressure, cardiac output, oxygen delivery, and mean airway pressure. PEEP reduced shunt and improved oxygenation to a greater extent than the two modes of IRV, although there was a large variation within each group. The improvement, irrespective of which ventilatory mode was superior in a particular pig, was caused by greater and more even aeration of the lung, whereas the perfusion distribution with PEEP was the same as with IRV. Thus, the strategy of stabilizing the lungs through short expiration times, as in IRV, did not offer any advantages in our lung injury model.     

Iron absorption during iron supplementation in blood donors.

The total amount of iron absorbed from a total supplementation of 2000 mg of iron was studied after a blood donation. 10 regular blood donors and 10 subjects without previous blood loss were included in the study. No subject had received any iron treatment before the investigation. Both groups were given one sustained release tablet containing 100 mg of iron as Fe SO4 once daily for 20 days. The iron in these tablets was labelled with 59Fe. The total amount of iron absorbed from the tablets was measured by a whole body counting technique. Laboratory tests including haematological data, desferrioxamine tests and sternal marrow punctures were made before and after the iron treatment. The non-donors lost a mean amount of 215 mg iron by phlebotomy and the total iron absorption from the tablets was only 94 mg (4.7%). In the regular blood donors the corresponding iron loss was 276 mg and the absorption was 280 mg (14%). The iron supplementation given in this study covered the iron losses in the regular blood donors but not in the non-donors. This iron prophylaxis will present a depletion but not a reduction of the iron stores in blood donors with high donation frequency.     

Modifying the vessel walls in porcine kidneys during machine perfusion

Background

Endothelial glycocalyx regulates the endothelial function and plays an active role in maintaining vascular homeostasis. During ischema and reperfusion, the glycocalyx is rapidly shed into the blood stream. A Corline heparin conjugate (CHC; Corline systems AB, Uppsala, Sweden) consists of 70 heparin molecules that have the capacity to adhere strongly to biological tissues expressing heparin affinity. We hypothesized that CHC could be used to restore disrupted glycocalyx in vivo in kidneys from brain-dead pigs.

Materials and methods

Brain death was induced in male landrace pigs (n = 6) by inflating a balloon catheter in the epidural space until obtaining negative cerebral perfusion. The recovered kidneys (n = 5 + 5) were perfused by hypothermic machine perfusion using two Lifeport kidney transporters (Organ Recovery Systems, Chicago, IL). CHC (50 mg) (including 25 mg biotinylated CHC) or 50 mg unfractionated heparin (control) was added to the perfusion fluid in the respective machines. In one case, the kidneys were used only for dose escalation of CHC with the same procedure.

Results

CHC was detected by immunofluorescence and confocal microscopy in the inner surface of the vessel walls. The binding of CHC in the kidney was confirmed indirectly by consumption of CHC from the perfusion fluid.

Conclusions

In this first attempt, we show that CHC maybe used to coat the vessel walls of perfused kidneys during hypothermic machine perfusion, an approach that could become useful in restoring endothelial glycocalyx of kidneys recovered from deceased donors to protect vascular endothelium and possibly ameliorate ischemia and reperfusion injuries.