Probiotic yogurt in the elderly with intestinal bacterial overgrowth: endotoxaemia and innate immune functions.

A study was conducted in healthy elderly living independently in senior housing to assess the impact of a probiotic yoghurt supplement on small intestinal bacterial overgrowth. Twenty-three participants with positive and thirteen participants with negative hydrogen breath test were studied before and after a period of 4 weeks of probiotic yoghurt administration. Intestinal permeability, plasma endotoxin levels, phagocytic activity of leucocytes, cytokine production by monocytes and free radical response of neutrophils were determined. Intestinal permeability was similar for the two groups and was unaffected by probiotic treatment. Both plasma endotoxin levels and the basal phagocytic activity of leucocytes decreased after yoghurt intake in the two groups. Exposure of monocytes and neutrophils ex vivo led to an increased cytokine response and free radical response, respectively. The normalisation of the various cytokine responses was more apparent in the group with positive breath test. In addition, the plasma levels of lipoplysaccharide binding protein and soluble CD14, lipoplysaccharide pattern recognition receptors and surrogate markers of lipoplysaccharide permeability were diminished by the end of the study. In conclusion, probiotic administration in the elderly normalises the response to endotoxin, and modulates activation markers in blood phagocytes, and therefore may help reduce low-grade chronic inflammation.

Facial esthetics in adolescents and its relationship to "ideal" ratios and angles.

INTRODUCTION: Many guidelines, norms, and ideal ratios and angles for attractive faces have been proposed in the literature. The aim of this study was to test the hypothesis that facial attractiveness in adolescents is related to ideal angles and ratios, as indicated in the literature. METHODS: Seventy-six laypeople viewed sets of photographs of 64 adolescents and rated them on a visual analog scale (VAS) from 0 to 100. The facial esthetic value of each subject was calculated as a mean VAS score. Three observers recorded the positions of 61 landmarks, and 45 were found to have acceptable reproducibility. Based on these 45 landmarks, 27 ideal ratios on frontal photographs and 26 ideal angles on lateral photographs were identified in the literature. These ratios and angles were calculated on each photograph, and their deviation from the ideal targets in the literature were determined. Each deviation was related to the VAS score. RESULTS: Two ratios and 3 angles had a significant negative correlation with the VAS scores, indicating that beautiful faces have less deviation from the ideal target than less beautiful faces. Together, these variables explained 28.7% of the variance. CONCLUSIONS: Few "ideal" ratios and angles have a significant relationship with facial esthetics in adolescents.

Putative golden proportions as predictors of facial esthetics in adolescents.

INTRODUCTION: In orthodontics, facial esthetics is assumed to be related to golden proportions apparent in the ideal human face. The aim of the study was to analyze the putative relationship between facial esthetics and golden proportions in white adolescents. METHODS: Seventy-six adult laypeople evaluated sets of photographs of 64 adolescents on a visual analog scale (VAS) from 0 to 100. The facial esthetic value of each subject was calculated as a mean VAS score. Three observers recorded the position of 13 facial landmarks included in 19 putative golden proportions, based on the golden proportions as defined by Ricketts. The proportions and each proportion's deviation from the golden target (1.618) were calculated. This deviation was then related to the VAS scores. RESULTS: Only 4 of the 19 proportions had a significant negative correlation with the VAS scores, indicating that beautiful faces showed less deviation from the golden standard than less beautiful faces. Together, these variables explained only 16% of the variance. CONCLUSIONS: Few golden proportions have a significant relationship with facial esthetics in adolescents. The explained variance of these variables is too small to be of clinical importance.

Atraumatic restorative treatment and dental anxiety in outpatients attending public oral health clinics in South Africa.

OBJECTIVES: This study was undertaken to test the hypotheses that using the atraumatic restorative treatment (ART) approach results in lower patient anxiety and that lower anxiety leads to higher restoration/extraction ratios. METHODS: The test group of dental operators (n = 9) was trained in ART The control group (n = 11) was not, and did not apply ART The Short Form of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-SF) and Corah's Dental Anxiety Scale (DAS) were used to assess patient anxiety after ART (test group) and after traditional restorations (control group). The restoration/extraction ratio calculated for primary (children) and permanent dentitions (adults) per operator was based on 12-month treatment statistics. Dental anxiety assessments were analysed using ANOVA. Differences were compared using the t-test and corrected for confounding factors (ANCOVA). The Pearson correlation coefficient was used to measure the correlation between dental anxiety levels and restoration/extraction ratios. RESULTS: The mean CFSS-SF score for test-group children was statistically significantly lower than for the control-group children. The mean DAS score for test-group adults was statistically significant lower than the control. No significant correlation was observed between dental anxiety level and restoration/extraction ratio per operator for both dentitions in both groups. CONCLUSION: The first hypothesis was accepted; the second, rejected. Although dental anxiety scores were lower both in child and in adult patients treated by ART than in those who received traditional restorative treatments, this positive effect had not resulted in higher restoration/extraction ratios.

Caries preventive effect of occlusal sealant extension to ART restorations compared with non-extended amalgam restorations.

PURPOSE: To estimate the survival of retention of sealant extension to occlusal ART restorations over 6.3 years; and to test the null-hypothesis that there is no difference in dentine caries lesion development in sealant extension to ART restorations in comparison with sealant free extensions to amalgam restorations in occlusal surfaces over 6.3 years. MATERIALS AND METHODS: In a parallel group design, 318 and 254 grade 2 children were randomly assigned to the ART and amalgam group respectively. Eight dentists placed 925 evaluatable single- and multiple-surfaces restorations. A total of 424 sealed extensions to occlusal ART and 284 sealant free extensions to occlusal amalgam restorations were available for analyses. The modified actuarial method was used to estimate survival percentages. The jackknife method was applied to calculate the SE in the cumulative survival percentages. RESULTS: After 6.3 years, 11.2% (SE = 2.2%) of sealant extensions were fully retained and 16.7% (SE = 2.8%) were partially retained. After 6.3 years, 86.4% (SE = 2.2%) of the sealed pits and fissures adjacent to occlusal ART restorations and 89.9% (SE = 2.4%) of non-sealed pits and fissures adjacent to occlusal amalgam restorations were free of dentine caries lesions. Neither this difference nor those at earlier evaluation years were statistically significant (p > 0.05). CONCLUSION: Sealing pits and fissures adjacent to occlusal ART restorations did not result in a caries preventive benefit over non-sealed pits and fissures adjacent to occlusal amalgam restorations in this group of children over 6.3 years.

Caries preventive measures used in orthodontic practices: an evidence-based decision?

INTRODUCTION: Although it is well known that treatment with fixed appliances increases the risk of enamel demineralization, little information is available about preventive measures that orthodontists actually use. This study was executed to survey measures used in orthodontic practices to prevent decalcifications during fixed appliance treatment, and to compare these measures with the available evidence-based information. METHODS: A questionnaire was sent to all privately practicing orthodontists in the Netherlands who were affiliated with the Dutch Dental Association. RESULTS: Of 229 orthodontists, 178 (78%) returned the questionnaires. Most of the orthodontists had a basic practice protocol for preventing demineralizations at the start of treatment. This protocol nearly always included oral hygiene instructions. If demineralizations occurred, 99% of the orthodontists took extra measures. Comparing the measures applied in the orthodontic practices with the evidence from a systematic review, a number of differences became apparent. The additional use of chlorhexidine or toothpaste with a high fluoride concentration (which has been demonstrated to have an inhibitive effect) is rarely prescribed. Fluoride rinse is prescribed most often, although there is not any high-quality, long-term study that demonstrates a caries preventive effect in orthodontic patients. Sixty-eight percent of the orthodontists considered it necessary to develop a practice guideline for preventing demineralizations. CONCLUSIONS: Orthodontists do not implement the available evidence in order to prevent enamel demineralizations during fixed-appliance treatment. A practice guideline incorporating this information should be developed.

The atraumatic restorative treatment (ART) approach for managing dental caries: a meta-analysis.

The number of publications reporting on the survival of ART sealants and ART restorations has increased considerably in recent years. A systematic investigation of their longevity is therefore warranted. Based on three exclusion criteria, a literature search in the electronic libraries Pubmed and Medline revealed 28 eligible publications for inclusion in a meta-analysis. High mean survival rates for single-surface ART restorations using high-viscosity glass-ionomer in primary dentitions over 3 years were found (95% after 1 year to 86% after 3 years). These rates were statistically significantly higher than for those of multiple-surface ART restorations in primary dentitions (p<0.0001). High mean survival rates for single-surface ART restorations using high-viscosity glass-ionomer in permanent dentitions over 6 years were found (97% after 1 year to 72% after 6 years). The mean annual failure rates for single-surface ART restorations using high-viscosity glass-ionomer in primary and permanent dentitions and for multiple-surface ART restorations in primary dentitions are 4.7%, 4.7% and 17%, respectively. The number of studies reporting on the retention and caries preventive effect of ART sealants was low. It is concluded that single-surface ART restorations using high-viscosity glass-ionomer in both primary and permanent dentitions show high survival rates. Medium-viscosity glass-ionomer should not be used for ART restorations.

Dental maturation in short and long facial types. Is there a difference?

OBJECTIVE: The purpose of this investigation was to study the relationship between vertical skeletal growth pattern and dental maturation in children with long or short anterior facial height. MATERIALS AND METHODS: The sample consisted of the records of 312 Dutch children (153 boys and 159 girls, aged 9-12.9 years, with a mean chronological age of 11.3 years). The subjects were selected according to their lower anterior facial height as a percentage of the total facial height. Two groups, one with long and the other with short anterior facial height, were formed for further comparison. Dental age, according to Demirjian's dental maturity score, was determined for each subject. The power of the study was 79% (2-sided test) and 87% (1-sided test). RESULTS: There was no statistically significant difference in dental age score between the two extreme groups. The subjects with short anterior facial height demonstrated a slight tendency toward more advanced dental age. CONCLUSIONS: The difference in dental age between long and short facial types is not big enough to be clinically relevant.

Growth inhibition by glucocorticoid treatment in salt wasting 21-hydroxylase deficiency: in early infancy and (pre)puberty.

In patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, adult height is below target height. This may result from growth inhibition by glucocorticoid treatment. Previous studies suggest that glucocorticoids have a dose-dependent negative effect on growth in CAH patients and that this effect is age dependent. This study analyzed the correlation between glucocorticoid dose and growth in these patients. A retrospective study was carried out on growth data from 48 patients with classic salt-wasting 21-hydroxylase deficiency who all had been diagnosed in the first year of life and treated from the moment of diagnosis with glucocorticoids and mineralocorticoids. Analysis of the effect of prescribed glucocorticoid dose on growth was performed in age intervals, by analysis of covariance (ANCOVA). The dependent variables height for age z-score (HAZ), weight for age z-score (WAZ) (both corrected for secular trend), and weight for height z-score (WHZ), at 10 selected ages (1, 2, 4, 6, 8, 10, 12, 14, 16, and 18 yr) were explained by 1) mean daily glucocorticoid dose per body surface in the preceding age interval; 2) HAZ, WAZ, or WHZ value at the beginning of the age interval; 3) HAZ, WAZ, or WHZ value 1 yr before the beginning of the considered age interval; and 4) midparental height (only for HAZ). ANCOVA showed that the daily glucocorticoid dose had significant negative effects on HAZ between the ages of 6 and 12 months and between the age of 8-10 and 12-14 yr (and a trend toward significance between 10-12 yr). The negative glucocorticoid effect on HAZ in the age interval of 12-14 yr was as large as in the interval between 6 and 12 months of age. Weight and weight for height were not significantly influenced by glucocorticoid dose in any of the age intervals. We conclude that in CAH patients in the first year of life and between the ages of 8 and 14 yr, there is a dose-dependent negative effect of glucocorticoids on linear growth. Therefore, the daily glucocorticoid dose in these periods should be sufficient to avoid androgen excess, but as low as possible to allow optimal linear growth and adult height.

Comparison of implant-retained mandibular overdentures and conventional complete dentures: a 10-year prospective study of clinical aspects and patient satisfaction.

PURPOSE: The aim of this prospective randomized clinical trial was to evaluate 10 years of treatment of patients receiving a mandibular implant-retained overdenture (IRO) or a conventional complete denture (CD). MATERIALS AND METHODS: One hundred twenty-one edentulous patients were treated with an IRO (2 endosseous implants, n = 61) or a conventional CD (n = 60). Clinical aspects and patient satisfaction were evaluated. One year after placement of the denture, unsatisfied patients of the CD group were given the opportunity to receive implants. RESULTS: In the IRO group, 4 implants were lost during the first year and 4 implants were lost during the next 4 years. Between 5 and 10 years, no implants were lost (survival rate: 93%). In the CD group, 24 patients (40%) chose an IRO between 1 and 10 years. DISCUSSION: Patients in the IRO group were significantly more satisfied than patients in the CD group after 1 year (satisfaction score 8.3 versus 6.6 on a scale of 1 to 10), after 5 years (7.4 versus 6.4), and after 10 years (7.7 versus 6.8). CONCLUSION: The mean satisfaction score of the CD group (including patients who later received implants) was still lower than that of the IRO group, in spite of the opportunity for retreatment with IROs. Endosseous implants had a high survival rate after 10 years of follow-up.

Effects of glass ionomer sealants in newly erupted first molars after 5 years: a pilot study.

OBJECTIVES: The aim of the study was to investigate the caries-preventive effect of high-filled glass ionomer sealant in newly erupted first molars in a high-risk group. This investigation is part of a larger study amongst eight hundred and thirty-five 6-7-year-old Syrian children. METHODS: Children that had 1, 2 or 3 just erupted or erupting and at least one unerupted first molar (control) were enrolled in this pilot study. A total of 60 children fulfilled the inclusion criteria. There were 49 children with a total of 83 sealants available for examination at the evaluation year 5. RESULTS: Almost two out of the three sealants (69%) had disappeared between evaluation years 2 and 3. 1.2% (SE = 1.2) of the sealants survived were fully retained and 10.3% (SE = 3.3) of the sealants survived were fully and partially retained at the evaluation year 5. Caries prevalence of the children in the study group at the evaluation year 5 was 55%. The Odds ratio concerning sealed and control group at year 5 was 2.6 with 95% confidence limits of 1.2 and 5.7, implying a relative risk (RR) of 2.1. Unsealed unerupted first molars had 2.1 times higher chance than sealed newly erupted first molars to develop dentinal lesions in this child population after 5 years. CONCLUSIONS: It is concluded that sealing newly erupted first molars with high-filled glass ionomer may be a caries-preventive measure in high-risk children. However, a well-designed clinical trial should be implemented to confirm the initial findings.

Emergence of permanent teeth in Tanzanian children.

OBJECTIVE: The aim of the present study was to investigate the emergence of permanent teeth among Tanzanian children. METHODS: A total of 869 Tanzanian children were recruited from 16 schools in age groups 3.5-5, 6.5-8, 9.5-11 and 15-16 years of whom 428 (49%) were boys and 441 (51%) were girls. The effects of age and gender on the emergence stages of the dentition were determined for the four age groups. RESULTS: Girls, but not boys, had some permanent maxillary canines, second premolars and mandibular and maxillary second molars as early as at the age of 6.5-8 years. Permanent teeth of both the first and the second transitional periods were already emerging at the age of 3.5-5 years and 6.5-8 years, respectively. At 3.5-5 years, 9% of the permanent teeth belonging to the first transitional period were already in occlusion. Emergence of incisors and first molars was more advanced in girls than in boys in age groups 3.5-5 and 6.5-8 years. CONCLUSIONS: Parallel to earlier reports on different ethnic groups, the results of this study indicate that the permanent teeth of Tanzanian children erupt earlier in girls than in boys, and the mandibular teeth erupt earlier than the corresponding maxillary teeth. The difference between boys and girls was found in both the first and second transitional period. Permanent teeth in Tanzanian children clearly emerge earlier than in Caucasian children.

A meta-analysis of the prevalence of dental agenesis of permanent teeth.

OBJECTIVE: To gain more insight into the prevalence of dental agenesis. METHODS: Data from Caucasian populations in North America, Australia and Europe were included in a meta-analysis. For the prevalence of African American, Chinese and Arab groups only indications could be reported because of a limited number of studies. RESULTS: Agenesis differs by continent and gender: the prevalence for both sexes was higher in Europe (males 4.6%; females 6.3%) and Australia (males 5.5%; females 7.6%) than for North American Caucasians (males 3.2%; females 4.6%). In addition, the prevalence of dental agenesis in females was 1.37 times higher than in males. The mandibular second premolar was the most affected tooth, followed by the maxillary lateral incisor and the maxillary second premolar. The occurrence of dental agenesis was divided into three main groups: common (P2(i) > I2(s) > P2(s)), less common (I1(i) > I2(i) & P1(s) > C(s) & M2(i)) and rare (M2(s) & M1(s) > C(i) > M1(i) & I1(s)). Unilateral occurrence of dental agenesis is more common than bilateral occurrence. However, bilateral agenesis of maxillary lateral incisors is more common than unilateral agenesis. The overall prevalence of agenesis in the maxilla is comparable with that in the mandible, but a marked difference was found between both jaws regarding tooth type. Absence of one or two permanent teeth is found in 83% of the subjects with dental agenesis. A practical application of the results of the meta-analysis is the estimation of dental treatment need.

Patient orientation and professional orientation of Dutch dentists.

By providing dental health care, dentists dedicate themselves to the preservation and/or improvement of oral health in their patients. By adequately carrying out this care providers' role, dentists will gain recognition, esteem and respect from both patients and colleagues. This analysis aims to assess the patient and professional orientation of dentists and investigate which of their personal and practice characteristics can be regarded determining for these two aspects of their role as care providers. In the year 2000, data was collected via a written questionnaire sent to a random, stratified sample of 790 dentists, of whom 607 (77%) responded. Multivariate regression analysis shows that the preventive treatment concept, professional satisfaction and the number of hours per week that household tasks are performed are positive determinants for dentists' patient orientation. Also, the longer dentists are active in their profession, the more patient oriented they will be, and with more hours per week support from oral hygienists they are less patient oriented. As for professional orientation, dentists' preventive treatment concept and their professional satisfaction can also be considered positive determinants. Furthermore, dentists are more profession oriented when their partner works in the practice, with more hours per week support from oral hygienist(s) and with more collaboration contacts with other care providers. Compared to men, women are on average less profession oriented. Among Dutch dentists, there exist clear differences in the way they take on their role as care providers with regard to patient orientation and professional orientation.

Chewing ability of subjects with shortened dental arches.

OBJECTIVES: The objective was to study chewing ability in subjects with shortened dental arches in Tanzania. METHODS: A sample of 725 adults with shortened dental arches comprising intact anterior regions and 0-8 occluding pairs of posterior teeth and 125 adults with complete dental arches were recruited. Subjects were classified into nine categories according to arch length and symmetry. Chewing ability was investigated by interview on chewing complaints and on perceived difficulty of chewing 20 common Tanzanian foods, 12 soft, and 8 hard. RESULTS: Categories with extreme shortened arches (0-2 pairs of occluding premolars) reported most frequent (95-98%) and most severe complaints ('cannot chew all foods' or 'have to use special or specially prepared food'). Categories with intact premolar regions and at least one occluding pair of molars had nearly no complaints (95-97%). The other arch categories had an intermediate volume of complaints (33-54%). Perceived difficulty of chewing deteriorated with a decrease of occluding pairs of teeth. Subjects with 0-2 pairs of occluding premolars had major difficulties with chewing. Subjects with 3-4 pairs of occluding premolars or asymmetric arches comprising a short side with none or one pair of premolars and a long side including at least one occluding pair of molars had more difficulties with chewing compared to subjects with more complete dental arches. As a whole, they perceived for hard foods, 'minor problems, not adapted'. CONCLUSIONS: Shortened dental arches with intact premolar regions and at least one occluding pair of molars provide sufficient chewing ability. Shortened arches with 3-4 pairs of occluding premolars and asymmetric arches with a long side result in impairment of chewing ability, especially for hard foods. In extremely shortened arches comprising 0-2 occluding premolars, chewing ability is severely impaired.

Panel perception of change in facial aesthetics following orthodontic treatment in adolescents.

The aim of the study was to evaluate the influence of the characteristics of panel members, the effects of gender and Angle Class of adolescent patients on their change in facial aesthetics following orthodontic treatment, and to assess the optimal panel size for epidemiological studies on changes in facial aesthetics after orthodontic treatment. A panel of 74 adult laymen (35 males and 39 females) and a panel of 87 orthodontists (37 males and 50 females) evaluated sets of three post-treatment standardized photographs (one frontal, one three-quarter smiling, and one lateral) of 64 adolescent orthodontic patients in relation to the pre-treatment sets of the same patient on a five-point scale. The main effects of professional background, age, gender, and geographic region of the panel members on the aesthetic scores, as well as their first order interactions were evaluated by multilevel models. Professional background, age, gender, and geographical region of panel members have an influence on the evaluation of the change of facial aesthetics following orthodontic treatment. The effect of gender and Angle Class of the patients on the scores was evaluated by two-way analysis of variance. There was no difference in the mean scores for boys and girls. Improvement of facial aesthetics by orthodontic treatment was significant for Class I, Class II division 1, and Class II division 2 patients, but not for Class III patients. Based on the intraclass correlation coefficient, a panel of nine randomly selected orthodontists, a panel of 14 randomly selected laymen, or a mixed panel of 13 individuals is sufficient to obtain reliable results in the aesthetic evaluation of adolescent faces, using photographs and a five-point scale.

Identification of cephalometric landmarks in unilateral cleft lip and palate patients: are there alternatives for point A, ANS, and PNS?

OBJECTIVE: To test the reliability of some cephalometric measurements in unilateral cleft lip and palate patients. Measurements with A, ANS, and PNS, were compared to measurements performed with alternatives for point A, ANS, and PNS: A1, A2, ANS1, ANS2, and PNS1. PATIENTS: One hundred sixty-four children with complete unilateral cleft lip and palate (UCLP), with a lateral head film taken at age 4 to 6 years. MEAN OUTCOME MEASURES: Intraobserver and interobserver reliability for cephalometric measurements including A, ANS, PNS or their alternatives: Dahlberg errors, systematic errors, and Pearson correlation coefficients were calculated. RESULTS: The measurements using ANS and PNS or their alternatives, were comparable. The systematic error between observers for measurements using A2 was less than for measurements using A or A1. The scatterplot of point A showed a slightly better distribution of the points than the plots of A1 and A2. CONCLUSIONS: Although the landmarks A, ANS, and PNS are hard to trace in UCLP patients with tooth germs in the anterior maxilla, no better landmarks were found in this study. Cephalometric studies using A, ANS, and PNS in UCLP patients should be interpreted with caution.

Presurgical orthopedics and satisfaction in motherhood: a randomized clinical trial (Dutchcleft).

OBJECTIVE: To study the effect of infant orthopedics on satisfaction in motherhood. DESIGN: Prospective two-arm randomized controlled trial in parallel with three participating academic cleft palate centers. Treatment allocation was concealed and was performed by means of a computerized balanced allocation method. SETTING: Cleft palate centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. PATIENTS: Two groups of infants with complete unilateral cleft lip and palate and no other malformations. INTERVENTIONS: Group IO+ (n = 27) wore passive maxillary plates during the first year of life, group IO- (n = 27) did not. MAIN OUTCOME MEASURE(S): Mean satisfaction scores were obtained from completed questionnaires at 6, 24, and 58 weeks of age. A 4-point scale was used (1 = very satisfactory to 4 = very unsatisfactory). RESULTS: The range of the mean scores for the individual items on the questionnaires for both groups ranged between 1.1 and 2.4. No differences were found between groups. Mothers appear to be satisfied in motherhood, least satisfied with the available time for themselves, and very satisfied with hugging and walking their babies. No differences were found between groups. CONCLUSIONS: Results from the present study show that infant orthopedics, with a passive plate during the first year of life, in children with a unilateral cleft lip and palate has no influence on the mothers' satisfaction in motherhood.

Chlorhexidine varnish for preventing dental caries in children, adolescents and young adults: a systematic review.

This systematic review aimed to determine the caries-inhibiting effect of chlorhexidine (CHX) varnishes on the permanent dentition of children, adolescents and young adults, and to explore two possibly related factors, namely application frequency and the time between evaluation and the last application. The literature search identified 14 publications of randomized controlled trials or controlled clinical trials where the effect of CHX varnish was compared with placebo controls or controls that received no preventive treatment. To obtain uniform outcome effects, the prevented fraction and 95% confidence intervals of caries increment were calculated. Owing to insufficient data presentation, only eight publications were included. Another two publications were included after receiving additional data from the authors. This systematic review did not result in a meta-analysis as an overall prevented fraction could not be computed because of the large variation of outcome results. The variation could not be explained by the time between evaluation and last application but might be explained by application frequency. It is tentatively concluded that CHX varnish has a moderate caries-inhibiting effect when applied every 3-4 months. However, this effect seems to have diminished by around 2 yr after the last application. There is no evidence for a caries-inhibiting effect of CHX varnish with longer intervals between applications.

Infant orthopedics and facial appearance: a randomized clinical trial (Dutchcleft).

OBJECTIVE: To study the effect of infant orthopedics on facial appearance. DESIGN: Prospective two-arm randomized controlled trial in parallel with three participating academic cleft palate centers. Treatment allocation was concealed and performed by means of a computerized balanced allocation method. SETTING: Cleft Palate Centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. PATIENTS: Infants with complete unilateral cleft lip and palate, no other malformations. INTERVENTIONS: One group (IO(+)) wore passive maxillary plates during the first year, the other group (IO(-)) did not. MAIN OUTCOME MEASURE(S): Two metrical response modalities were used (i.e., visual analog scales and reference scores) to score facial appearance. Full face and cropped photographs were compared with reference photographs and were judged. The photographs were judged by 45 judges, 24 laypeople, and 21 professionals. Transformation of the scores into z scores was applied to compare and to pool both response modalities. The validity of each individual judge was evaluated, as was the reliability of the scales. Differences between the treatment groups were evaluated by means of t tests. RESULTS: Photographs were available of 41 subjects, 21 with and 20 without infant orthopedics. No significant differences were found between groups. Mean z-score values for the full-face photographs were: group IO(+) = 0.10 (SD = 0.73) and group IO(-) = -0.03 (SD = 0.48); for the cropped photographs were: group IO(+) = 0.12 (SD = 0.71) and group IO(-) = -0.06 (SD = 0.55). CONCLUSIONS: Infant orthopedics have no effect on facial appearance.