Functional roles of oral reflexes in chewing and biting: phase-, task- and site-dependent reflex sensitivity

Because loading during chewing is not totally predictable and jaw-closing muscles are strong and act over short distances, feedback from oral receptors is important in the control of mastication. Information on such feedback can be obtained by studying reflexes in jaw muscle EMGs. This review will deal with the contribution of reflex mechanisms to modifying motor neuron activity during chewing, and the dependency of reflex sensitivity on motor task, phase of movement, and site of stimulation.     

Genetic power of a Brazilian three-generation family with generalized aggressive periodontitis. II

The genetic power of a Brazilian three-generation family with generalized aggressive periodontitis (GAgP) has been reported. The empirical logarithms of the odds (LOD) score thresholds for genetic linkage analysis of complex diseases proposed by Haines rely on confirmation from independent datasets. This study estimated the power of another large Brazilian family with GAgP for future linkage analysis. The three-generation family was seen at the Dental School of the Federal University of Bahia. Following the previously described methodology, full-mouth periodontal probing at 6 sites/tooth was performed in all 19 family members. Six out of 12 siblings were affected with GAgP. All affected family members were non-smokers and did not present diabetes or any other systemic condition or consanguinity. A parametric simulation (θ=0) was performed on 100 replicates using the statistical software SLINK for linkage analysis. There was maximum expected LOD scores of 3.75 and 3.45 at penetrance rate F=0.98, and both studied phenocopy rates P=0.0 and P=0.02, respectively. The power of the study increased with the increase of the adopted penetrance rates in both studied phenocopy rates. The studied Brazilian three-generation family showed statistical power for future genetic linkage analysis of candidate genes to GAgP.     

Can jua be a weapon in combating oral diseases?

Jua (or Joazeiro) is a plant that has been used in Brazil as a folk remedy for many diseases, but mostly as a dentifrice. Several scientific investigations have been conducted in Brazil to examine the therapeutic use of Jua for oral health. This article presents information about the Ziziphus joazeiro plant, its medicinal use, and its chemical components while also reviewing the literature concerning Jua and especially its anti-plaque activity. Although Joazeiro has been investigated, more studies must be performed to better understand these Jua compounds, their antimicrobial activity, and their mechanism of action. Such studies would confirm whether Joazeiro has the potential to fight or prevent diseases like dental caries and periodontitis.     

The protective nature of pellicle towards toothpaste abrasion on enamel and dentine

OBJECTIVES: To determine the protective nature of pellicle towards toothpaste abrasion. METHODS: The enamel region of human enamel-dentine blocks was indented with a Knoop diamond and the profile across the enamel-dentine junction was measured. Blocks were either exposed to deionised water or placed onto intra-oral appliances and worn in the mouth to produce in situ pellicles. This was followed by a 10-day period of tooth brushing experiments. Each day, specimens were brushed with a slurry of either Toothpaste A (RDA=90) or Toothpaste B (RDA=204) for 25 cycles (10s) on a brushing machine. This was repeated three times per day for a total of 750 brushing cycles. Between brushing cycles specimens were returned to water or in situ. The geometry of the Knoop indents and the enamel-dentine profile were re-measured and the enamel and dentine wear calculated. Specimens were also prepared for TEM analyses. RESULTS: The mean enamel wear (microm) for Toothpastes A and B (water) was 0.23 and 0.06, and for Toothpastes A and B (in situ) was 0.03 and 0.08, respectively. The mean dentine wear (microm) for Toothpastes A and B (water) was 5.08 and 6.03, and for Toothpastes A and B (in situ) was 1.94 and 1.70, respectively. For Toothpaste A, the presence of in situ pellicle significantly (p<0.05) reduced enamel and dentine wear compared to water and for Toothpaste B, dentine wear was significantly reduced compared to water. After tooth brushing, residues of the in situ pellicle layer could be detected on enamel and dentine surfaces by TEM analysis. CONCLUSIONS: The study has demonstrated for the first time that the presence of pellicle can significantly reduce toothpaste abrasion.     

The role of cone beam computed tomography in the management of unfavourable fractures following sagittal split mandibular osteotomy

Cone beam computed tomography (CBCT) has been at the forefront of recent technological advances within the maxillofacial region. CBCT is useful in the accurate assessment and planning of patients undergoing orthognathic surgery. We propose that it also has a role in the post-operative evaluation of a subgroup of patients who have suffered complications at the time of surgery. We present two cases where unfavourable splits occurred during a bilateral sagittal split osteotomy (BSSO) of the mandible. Both cases were investigated post-operatively with CBCT with the aim of identifying the potential cause of the unfavourable split and to establish accurate localization of the condyle in the glenoid fossa following intra-operative attempts at proximal segment control. CBCT should be considered for evaluation of the mandible following an unfavourable split where it is deemed that plain radiographs would not provide adequate information.     

Evaluation of a Fixed,Weight-Based Dose of 3-Factor Prothrombin Complex Concentrate Without Adjunctive Plasma Following Warfarin-Associated Intracranial Hemorrhage

Introduction

Data regarding use of prothrombin complex concentrate (PCC) for international normalization ratio (INR) reversal in warfarin-associated intracranial hemorrhage (wICH) is variable with regards to dosages, adjunctive agents, and product choice. In 2012, we implemented a fixed, weight-based [30 IU/kg] dosing protocol of 3-factor PCC (3PCC) utilizing a rapid infusion rate and no requirement for fresh frozen plasma (FFP) following factor product administration. We aimed to evaluate the impact of this protocol on immediate and delayed INR reversal in patients admitted with wICH in the absence of FFP co-administration.

Methods

We conducted a retrospective review of patients receiving 3PCC following wICH between January 1, 2012 and December 10, 2013. The primary objective was to determine the percentage of patients achieving goal INR (≤1.4) following 3PCC administration. Patients were excluded if their bleed was not intracranial in origin, received a dose outside of the specified protocol, or were given FFP as an adjunctive agent.

Results

We included 35 patients with a mean presenting INR of 3.2 ± 1.3. Thirty patients (85.7 %) achieved goal INR (≤1.4) following one dose of 3PCC. The mean INR after infusion of 3PCC was 1.3 ± 0.2. The median duration between 3PCC infusion and subsequent INR was 48.0 min (30–70.1 min). Vitamin K was utilized in 33 (94.3 %) patients. No patient experienced a thromboembolic event within 7 days of 3PCC administration.

Conclusions

Fixed, weight-based dosing of 3PCC without adjunctive FFP resulted in high rates of complete INR reversal without significant adverse events.     

Mechanism and Site of Inhibition of AMPA Receptors: Pairing a Thiadiazole with a 2,3-Benzodiazepine Scaffold

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CAGS AND ACS EVIDENCE BASED REVIEWS IN SURGERY. 49: Is a diverting loop ileostomy and colonic lavage an alternative to colectomy for the treatment of severe Clostridium difficile–associated disease?

Objective: To determine whether a colon-sparing diverting ileostomy with colonic lavage reduces mortality in patients with severe Clostridium difficile–associated disease (CDAD) when compared with colectomy. Design: Retrospective cohort study. Setting & patients: Forty-two patients with diagnosed severe, complicated CDAD who were treated at the University of Pittsburgh Medical Center or VA Pittsburgh Health Care System between June 2009 and January 2011 with diverting loop ileostomy and colonic lavage (warmed polyethylene glycol 3350/electrolyte solution via the ileostomy and postoperative antegrade instillation of vancomycin flushes via the ileostomy). Patients were compared with a historical control group of 42 patients who had a colectomy. Main outcome: Resolution of CDAD. Results: There was no significant difference in age, sex, pharmacologic immuno-suppression and Acute Physiology and Chronic Health Evaluation-II (APACHE-II) scores between the current cohort and historical controls. In the ileostomy group, surgery was performed laparoscopically in 35 patients (83%). This treatment strategy resulted in reduced mortality compared with the historical population (19% v. 50%; odds ratio [OR] 0.24, p = 0.006). Preservation of the colon was achieved in 39 of 42 patients (93%). Conclusion: Loop ileostomy and colonic lavage are an alternative to colectomy in the treatment of severe, complicated CDAD, resulting in reduced morbidity and preservation of the colon.