The longitudinal follow up of a universal neonatal hearing screen: The implications for confirming deafness in childhood

Abstract

Objective: To examine the implications of universal neonatal screening for confirming deafness in early childhood. Design: A cohort that had received a universal neonatal hearing screen was followed-up until school entry, and confirmation of deafness compared with that from parallel cohorts that had not received the screen. Study: Three 10-year cohorts were compared: a cohort of 35 668 enrolled for universal neonatal hearing screening, a historical cohort of 31 538 when neonatal screening was unavailable, and a cohort of 32 890 when targeted screening was in place. Results: Prevalence of deafness by school age was 3.65/1000 with a neonatal yield of 1.79/1000. The screen had been 89% sensitive to moderate and worse deafness, 79% to unilateral deafness, and 49% to mild impairments. The median age of confirmation had been reduced from 218 to 16 weeks, but for those not identified neonatally there had been no significant improvement in the age of confirmation over the previous 25 years. The yield from post-neonatal screens had been reduced from 1.8/1000 to 0.2/1000, and with a yield of 0.8/1000, reactive referral remained a more effective route to identification. Conclusions: Even with UNHS in place post-neonatal routes to identification need to be maintained and improvements investigated.     

Minimal intervention dentistry for managing dental caries – a review

This publication describes the history of minimal intervention dentistry (MID) for managing dental caries and presents evidence for various carious lesion detection devices, for preventive measures, for restorative and non‐restorative therapies as well as for repairing rather than replacing defective restorations. It is a follow‐up to the FDI World Dental Federation publication on MID, of 2000. The dental profession currently is faced with an enormous task of how to manage the high burden of consequences of the caries process amongst the world population. If it is to manage carious lesion development and its progression, it should move away from the ‘surgical’ care approach and fully embrace the MID approach. The chance for MID to be successful is thought to be increased tremendously if dental caries is not considered an infectious but instead a behavioural disease with a bacterial component. Controlling the two main carious lesion development related behaviours, i.e. intake and frequency of fermentable sugars, to not more than five times daily and removing/disturbing dental plaque from all tooth surfaces using an effective fluoridated toothpaste twice daily, are the ingredients for reducing the burden of dental caries in many communities in the world. FDI's policy of reducing the need for restorative therapy by placing an even greater emphasis on caries prevention than is currently done, is therefore, worth pursuing.     

Fixed dilated pupils and tacrolimus toxicity in paediatric liver transplant patients

Westrope C, Rowlands H, Morris K, Gupte GL. Fixed dilated pupils and tacrolimus toxicity in paediatric liver transplant patients.
Pediatr Transplantation 2011: 15: E96–E99. © 2010 John Wiley & Sons A/S. Abstract: We report a case series of four children who developed fixed dilated pupils associated with high tacrolimus levels (>30 nanograms/millilitre [ng/mL]) in the immediate post‐operative period following isolated liver or liver and small bowel transplantation.     

16‐Year follow‐up of an avulsed maxillary central incisor after replantation following 10‐h storage: An unusual case

Tooth avulsion is a type of dental injury defined as the complete displacement of a tooth out of the alveolar socket, and the lack of prompt treatment measures can result in the loss of function, poor quality of life, and psychological and social problems. However, several factors may not permit the immediate replantation of an avulsed tooth; therefore, delayed replantation has emerged as an alternative to meet the esthetic, functional, and psychological demands of patients. Here it was described that the successful replantation of an avulsed maxillary central incisor in a 9‐year‐old boy who presented at the clinic with the tooth stored in unfavorable conditions as dry and then in olive oil‐milk mixture almost 10 h after the event. The tooth has remained in its socket healthy for 16 years after treatment. The patient was satisfied with both esthetics and function.     

Dynamic Systems (Complexity) theory as a new conceptual model for researching PBL in dental education

Although problem‐based learning (PBL) was introduced into dental education some 20 years ago, there have been relatively few well‐designed studies carried out to clarify whether, how or why it works in a dental context. This paper introduces the Dynamic Systems (Complexity) theory as a new and potentially productive theoretical framework for researching PBL in dental education. This framework emphasises the importance of emergent self‐organisation, perception and brain plasticity in learning. In this paper, a brief overview of the history of PBL in dentistry is presented and then the fundamentals of a Dynamic Systems Approach (DSA) are explained, drawing on two recently published papers advocating the DSA in medical education and teacher education. We focus on three key points related to this new approach: emergent self‐organisation rather than simple construction of knowledge; the notion that perception drives the learning process; and the brain as the substrate of all learning. The paper also suggests how the DSA can help us move forward, both in terms of the future application of PBL in dental education and also in relation to posing new types of research questions.     

Effect of finish line design on stress distribution in bilayer and monolithic zirconia crowns: a three‐dimensional finite element analysis study

This study evaluated the influence of different finish line designs and abutment materials on the stress distribution of bilayer and monolithic zirconia crowns using three‐dimensional finite element analysis (FEA). Three‐dimensional models of two types of zirconia premolars – a yttria‐stabilized zirconia framework with veneering ceramic and a monolithic zirconia ceramic – were used in the analysis. Cylindrical models with the finish line design of the crown abutments were prepared with three types of margin curvature radius (CR): CR = 0 (CR0; shoulder margin), CR = 0.5 (CR0.5; rounded shoulder margin), and CR = 1.0 (CR1.0; deep chamfer margin). Two abutment materials (dentin and brass) were analyzed. In the FEA model, 1 N was loaded perpendicular to the occlusal surface at the center of the crown, and linear static analysis was performed. For all crowns, stress was localized to the occlusal loading area as well as to the axial walls of the proximal region. The lowest maximum principal stress values were observed when the dentin abutment with CR0.5 was used under a monolithic zirconia crown. These results suggest that the rounded shoulder margin and deep chamfer margin, in combination with a monolithic zirconia crown, potentially have optimal geometry to minimize occlusal stress.