The effect of adenoidectomy on occlusal development and nasal cavity volume in children with recurrent middle ear infection.

OBJECTIVES: The aim of the study was to examine the effect of adenoidectomy on occlusal/dentoalveolar development and nasal cavity volume in children who underwent tympanostomy tube insertion with or without adenoidectomy due to recurrent episodes of middle ear infection. METHODS: This prospective controlled study consisted of two randomly allocated treatment groups of children, younger than 2 years, who had underwent more than 3-5 events of middle ear infection during the last 6 months or 4-6 events during the last year. At the mean age of 17 months tympanostomy tube placement without adenoidectomy (Group I, n=63) tympanostomy tube placement with adenoidectomy (Group II, n=74) was performed. At the age of 5 years 41 children of the original Group I (14 females, 27 males, mean age 5.2 yrs, SD 0.17) and 59 children of the original Group II (17 females, 42 males, mean age 5.2 yrs, SD 0.18) participated in the re-examination, which included clinical orthodontic examination defining morphological and functional craniofacial status and occlusal bite index to measure upper dental arch dimensions. Acoustic rhinometry and anterior rhinomanometry was made by otorhinolaryngologist at the same day. RESULTS: No statistically significant differences were found between the groups in the frequencies of morphological or functional characteristics or upper dental arch measurements or in the minimal cross-sectional areas or inspiratory nasal airway resistance measurements. CONCLUSION: Combining adenoidectomy with tympanostomy tube insertion in the treatment of recurrent middle ear infection at an early age (under the age of 2 years) does not seem to make any difference in occlusal development in primary dentition at the age of 5 years as compared to tympanostomy tube insertion only. Since adenoid size was not evaluated, the findings do not allow interpretation that hypertrophic adenoids should not be removed in children with continuous mouth breathing or sleep disordered breathing.

Gender differences in self-assessed clinical competence--a survey of young dentists in Finland.

INTRODUCTION: Newly licensed dentists are a promising group to evaluate the compatibility of dental education with working life. The aim of this study was to evaluate gender differences amongst young dentists in their self-assessed competence and perceived compatibility of their undergraduate education with working life. MATERIALS AND METHODS: This study was a part of a national survey of young dentists. Altogether, 90 young dentists (46%) answered the questionnaire; 72 women (80%) and 18 men (20%). For this study, two questions from the questionnaire were analysed. RESULTS: Undergraduate dental education has met the needs of dental practice in almost every field of dentistry. Females wished for more education in paediatric dentistry, oral and maxillofacial surgery and oral medicine, whilst males wished for more in preventive dentistry and cariology. The results also implicated that female dentists felt that they would have benefitted from more time spent learning clinical skills. When asked about confidence in doing certain dental procedures, male dentists were more confident in most of the procedures, the most significant differences being in surgical procedures and competence to make a 3-4-unit fixed partial denture. The only area where male dentists were more often unsure was in diagnosis of malocclusions in developing dentition. CONCLUSIONS: The gender differences in young dentists' confidence-which favoured male dentists-require further inquiries. More attention should be paid in dental education to constructively support students with differences in learning clinical skills.

Profile and competences for the graduating European dentist - update 2009.

This paper presents the profile and competences for the European Dentist as approved by the General Assembly of the Association for Dental Education in Europe at its annual meeting held in Helsinki in August 2009. A new taskforce was convened to update the previous document published in 2005. The updated document was then sent to all European Dental Schools, ministries of health, national dental associations and dental specialty associations or societies in Europe. The feedback received was used to improve the document. European dental schools are expected to adhere to the profile and the 17 major competences but the supporting competences may vary in detail between schools. The document will be reviewed once again in 5 years time. Feedback to the newly published document is welcomed and all dental educators are encouraged to draw upon the content of the paper to assist them in harmonising the curriculum throughout Europe with the aim of improving the quality of the dental curriculum.

Curriculum structure: principles and strategy.

This report provides general guidelines for the structure of a curriculum, followed by specific advice on the principles of learning and teaching, the process of restructuring and change leadership and management. It provides examples of several educational philosophies, including vertical and horizontal integration. It discusses the use of competence, learning outcomes, level of degree and assessment and provides a number of recommendations. It does not seek to be prescriptive of time allocation to disciplines within a curriculum. Although this report has been written primarily for those who will develop an undergraduate curriculum, the information may be sufficiently generic to apply to the recent development in graduate entry ('shortened dental' or 'accelerated') courses and to postgraduate degree planning and higher education certificate or diploma courses for other dental care professionals (auxiliaries). The report may have a European bias as progress is made to converge and enhance educational standards in 29 countries with different educational approaches - a microcosm of global collaboration.

[The temporo-mandibular articulation]. / L'articulation temporo-mandibulaire.

The standing posture of humans has created both morphological and functional adaptations in the temporo-mandibular joint and the masticatory function. This biped state is the one of the most important characteristic of human evolution. It is furthermore the agent determining most of the functional changes in the whole body. This survey will be carried out in several levels including, a descriptive anatomy, biomechanics, radiological imaging, functioning in the articulation of TMJ. The descriptive anatomic picture will be obtained by the traditional dissection techniques. 20 TMJ joints are dissected from 10 cadavers: 7 cadavers, 65-75 year old, 3 cadavers, 60-65 year old. The x-rays are lateral view and the subjects of the radiological imaging are young's, adults and olds: 1, 3 y-old Male; 1, 7 y-old Female; 1, 14 y-old Female; 10, 19-23 y-old Male; 1, 26 y-old Female; 1, 34 y-old Male; 1, 75 y-old Female. The anatomic elements in the TMJ well resembled the ones described in the literature of the capsule, the ligament, the masticator muscles (masseter, temporal, medial and lateral pterygoids). The temporo-mandibular ligament proved to be difficult to separate from the capsule in some of the specimens. Sometimes it was not always found after a dissection.

Motivation for and satisfaction with orthodontic-surgical treatment: a retrospective study of 28 patients.

Motivation for starting treatment and satisfaction with treatment results were evaluated on the basis of replies to a 14-item questionnaire and clinical examination of 28 orthognathic patients from 6 months to 2 years after treatment. The most common reasons for seeking professional help were problems in biting and chewing (68 per cent). Another major reason was dissatisfaction with facial appearance (36 per cent). Many patients also complained of temporomandibular joint symptoms (32 per cent) and headache (32 per cent). Women (8/19) were more often dissatisfied with their facial appearance than men (2/9), but the difference was not statistically significant. In agreement with earlier studies, the results of orthognathic treatment fulfilled the expectations of almost every patient. Nearly 100 per cent of the patients (27/28) were satisfied with treatment results, although 40 per cent experienced some degree of numbness in the lips and/or jaw 1 year post-operatively. The most satisfied patients were those who stated temporomandibular disorders as the main reason for seeking treatment and whose PAR-index had improved greatly. The majority of the patients experienced the orthodontic treatment as painful and as the most unpleasant part of the whole treatment, but all the patients were satisfied with the pre-treatment information they were given on orthodontics. Orthodontic-surgical therapy should be of a high professional standard technically, but the psychological aspects are equally important in the treatment protocol. The professionals should make efforts to understand the patient's motivations for and expectations of treatment. Patients should be well prepared for surgery and supported for a long time after to help them to adjust to post-surgical changes.

Tissue-separating capacity of growth cartilages.

The tissue-separating capacity of chondral structures has been debated for more than 30 years, and one aspect that has particularly been questioned is whether the secondary cartilage of the mandibular condyle is comparable to primary growth cartilage, e.g. the epiphyseal growth plate. The present report summarizes information gained by using a specific interosseal transplantation method. These findings lead to the conclusion that all the structures examined, i.e. the proximal epiphyseal cartilage of the tibia, the cartilage of the costochondral junction of the ribs, the basicranial synchondroses, the medial cartilage of the clavicle and the mandibular condyle, have the capacity to separate adjoining skeletal structures. The changes induced by the transplanted structures in the recipient area vary, however, suggesting a hierarchial arrangement of cartilages with regard to their tissue-separating capacity. It is suggested that the tissue-separating capacity is a basic phenomenon in the function of growth, not only of primary growth cartilages, but of secondary cartilages as well.

New progeroid disorder.

We report on a 10-year-old Caucasian male with a prematurely aged appearance, delayed bone maturation and dental development, pronounced acro-osteolysis with brachydactyly, and distinctive cutaneous findings including hard, confluent skin lesions with some clinical and histologic resemblance to those of juvenile hyaline fibromatosis (JHF). He also had hyperopia, sensorineural hearing loss, and elevated TSH. Linear growth and intellectual functions were normal. We believe that this patient represents a new progeroid disorder.

Initiation of secondary cartilage in the mandible of the Syrian hamster in the absence of muscle function.

The functioning lower jaw is a prerequisite of the ongoing secondary chondrogenesis in the mammalian mandibular condyle. Does the articular function also initiate secondary chondrogenesis in the mandible? The angular process of the fetal mammalian mandible possesses a large secondary cartilage without any apparent articular function. Past studies have shown that the anlage of the lower jaw of the mouse embryo grown in organ culture produces condylar and angular cartilages as in vivo. In order to clarify further the capacity of the mandibular anlage to initiate secondary chondrogenesis in a non-functional environment, mandibular arch explants taken from the prenatal hamster before any cartilage or bone formation was apparent were grown in organ culture. Both primary and secondary cartilage could be found in them within 9-10 days. The results thus indicate that initiation of the condylar and/or angular secondary cartilaginous development in the rodent mandible occurs in the absence of jaw-opening function, although the pertinent literature indicates that function maintains cartilaginous differentiation in the condyle.

Secondary cartilage in the auditory bulla of the hamster.

The auditory bulla, the bony capsule enclosing the middle ear, has been extensively studied in dry skulls and fossils, but detailed histological descriptions of the connective tissues involved are lacking. In rodents the membraneously ossified tympanic bone forms the major part of the enlarged auditory bulla. This study demonstrated fairly extensive secondary cartilage formation on the developing tympanic bone of the hamster. The first sign of the secondary cartilage was visible with Alcian blue staining on the 5th postnatal day. The amount of cartilage diminished after 15 days of age, but some cartilage was still present on the tympanic bone at the end of the observation period (25 days of age). While the secondary cartilage was present, a great amount of translative growth occurred in the bony coverage of the tympanic cavity, not only to accommodate the enchondrally growing cochlea within the cavity, but also to create space for the enlarged auditory bulla as an adaptation to low-frequency sensitivity in hearing. The tympanic bone is a derivative of the angular bone in the reptilian lower jaw. The mammalian mandible, a derivative of another membraneous bone of the reptilian lower jaw, the dentary, possesses secondary cartilages in the angular and condylar processes. Do the reptilian dentary and angular utilize secondary cartilage in the process of their transformation to the mammalian phylogenetic level?

Ultrasonic investigation of the circumoral musculature.

Real-time ultrasound with a high frequency probe is used to image the circumoral musculature with the lips relaxed and contracted. The ultrasonic images show that muscle tissue makes up only a part of the total thickness of the lip, and varies among individuals in shape, transonicity (clearness) and thickness. The muscle layer in the upper lip is sandwiched between layers of facial and lingual connective tissue, while the muscle image in the lower lip lies close to the lingual surface. In a relaxed state the muscle layer in the lower lip is significantly thicker than that in the upper lip, and a mean difference also occurs in contraction, but to a considerably lesser degree. Thus the upper lip muscle appears to increase in thickness during contraction relatively more than does that of the lower lip. Furthermore, the contraction in the upper lip seems to occur fairly uniformly along the lip from left to right. The muscular changes in the lower lip are more complex, even though embryologically complexity is ascribed properly to the upper lip. In the lower lip contraction seems to occur in the lateral parts and in the mentalis muscle, but in the midline the orbicularis oris muscle remains quite inactive. More complex arrangements are essential merely to ensure support of the lower lip against gravity.