The waist circumference of risk in black South african men is lower than in men of European ancestry.

BACKGROUND: Central obesity measured by waist circumference is a cardiovascular disease (CVD) risk factor; however, the waist circumference of risk in populations of African descent has not been identified. The International Diabetes Federation currently suggests that cutoffs established in men of European descent be applied to sub-Saharan men-a waist circumference ≥94 cm. SUBJECTS AND METHODS: Participants were 203 South African black men with type 2 diabetes mellitus (T2DM). They were divided into quartiles of waist circumference (>88 cm, 88-94 cm, 95-103 cm, >103 cm). Cardiovascular risk factors, including insulin resistance (IR), measured by modified homeostasis model assessement of IR (HOMA-IR), and the triglycerides-to-high-density lipoprotein cholesterol (TG-to-HDL-C) ratio, were compared across quartiles. RESULTS: Age, duration of diabetes, glycosylated hemoglobin (HbA1c), blood pressure, urinary albumin excretion, and smoking were similar across waist circumference quartiles. Overall, for both lipids and measures of IR, there was variation across waist circumference quartiles, but no significant differences between quartiles 2 and 3. Therefore, data from these two quartiles were pooled. Between the first and second+third (88-103 cm) quartiles, there were significant differences in HDL-C (1.30±0.43, 1.10±0.43 mmol/L, P=0.003), TG (medians 1.10, 1.60 mmol/L P<0.001), low-density lipoprotein cholesterol (LDL-C; 2.40±0.93, 2.85±1.03 mmol/L, P=0.01), non-HDL-C (3.05±1.18, 3.70±1.16 mmol/L, P=0.002), HOMA-IR (medians 0.90, 2.10, P<0.001), and TG-to-HDL-C ratio (medians 0.89, 1.17, P<0.001). Additional comparisons were made between men with waist circumference <90 cm and 90-93 cm. Values for each lipid and for IR parameters were more favorable in the <90-cm group (all P<0.05). CONCLUSIONS: For black South African diabetic men, CVD risk substantially increased with waist circumference >90 cm. The waist circumference cut point of >94 cm has the potential to misclassify many black South African diabetic men at risk for CVD.

[The quality of oral healthcare for edentulous individuals]. / De kwaliteit van de zorgverlening voor edentaten.

Fabricating removable complete dentures is a rather complicated treatment. The quality of the care delivered is broadly determined by 2 factors: the technical result and the way in which the individual patient experiences and evaluates the treatment. Healthcare professionals who carry out this treatment are subject, with respect to their capability, to the Dutch Individual Healthcare Professions Act. In cases of persisting complaints or problems, edentulous individuals are often treated with an overdenture on oral implants. Several oral healthcare providers are then involved in the treatment. In order to clarify procedures, a trajectory of care is presented in which all of these oral healthcare providers are located. It is expected that the number of edentulous individuals will decline and that the degree of treatment complexity will increase. To guarantee future efficiency and quality of care delivery, a number of regionally distributed national centres of expertise should be established.

[An immediate removable complete denture for the transition from a natural to a prosthetic occlusal system]. / Een immediate volledige gebitsprothese voor de overgang van een natuurlijk naar een prothetisch occlusiesysteem.

During the process of losing teeth, the fabrication of an immediate removable complete denture usually plays an important role. The path from a natural to a prosthetic occlusal system separates itself into a phased and a non-phased treatment. Various patient-related factors are of importance in the decision-making process for a phased or a non-phased treatment, such as the patient's time available, the medical indication, the complexity of the natural occlusal system, and the motivation for treatment. A positive result can be more confidently predicted in the case of a phased treatment than a non-phased treatment. Placement of an immediate removable complete denture requires immediate aftercare. Particularly in the case of non-phased treatment, the fabrication of a new complete removable denture will be required within 1 year.

[Improvement of a removable complete denture by relining or rebasing]. / Verbetering van een gebitsprothese door middel van relining of rebasing.

When the fit of a removable complete denture is diminished as a result of progressive alveolar bone reduction, relining or rebasing might be indicated. In clinical practice, a degree of confusion exists concerning the concepts relining, and rebasing. Relining is resurfacing the tissue side of a denture with a new material to fill the space which exists between the original denture contour and the altered tissue contour. Rebasing is resurfacing the fitting surface of a denture by replacing the entire denture base with new material, also to fill the space which exists between the original denture contour and the altered tissue contour. In particular, attention is given to 3 specific forms ofrelining and rebasing which serve to restore the maxillomandibular relationship, to extend effectively the palatal denture surface of the maxillary denture and to reline or rebase an implant-supported overdenture.

[Influence of a maxillary complete denture on taste perception Patients regularly report an alteration in taste perception after the insertion]. / De invloed van een gebitsprothese op de smaakgewaarwording.

Patients regularly report an alteration in taste perception after the insertion of a maxillary complete denture. It is generally accepted that changes in temperature and texture perception of the food induced by covering the hard palate are the principalfactors contributing to this alteration. Besides temperature and texture, other factors contributing to taste perception are smell, age and saliva composition.

[Treatment planning in patients with a severe reduced dentition]. / Behandeling van een sterk gemutileerde dentitie.

Because loss of teeth many people have a reduced maxillary and mandibular dentition. The appropriate prosthetic rehabilitation is dependent on whether or not a standard mutilation of the dentition can be achieved. In this article, the focus is on treatment of a remaining mandibular dentition combined with an edentulous maxilla, whether or not with a reduced residual alveolar ridge. In the literature, there is no consensus on the appropriate prosthetic treatment if implant-supported overdentures are not applicable. The amount of bone loss in already during some time edentulous maxillary and mandibular alveolar ridge segments as well as the available vertical space for the removable (partial) denture are important decision-making factors.

Autogenous femoral head as grafting material for mandibular augmentation.

Bone grafting is commonly used for augmentation of the atrophic edentulous maxilla and mandible. Although bone substitutes and allogeneic frozen bone grafts have been applied successfully, fresh autogenous bone grafts remain the 'gold standard' in maxillofacial reconstructive surgery. A disadvantage of harvesting autogenous bone is the resulting donor-site morbidity. The authors present a case in which an autogenous femoral head, which was removed because of a prosthetic hip replacement, was used for augmentation of the extreme atrophic mandible. Using this procedure avoids donor-site morbidity.

The metabolic syndrome, insulin resistance, and its surrogates in African and white subjects with type 2 diabetes in South Africa.

BACKGROUND: Coronary heart disease (CHD) is rare in diabetic Africans in South Africa, unlike diabetic African-Americans, despite moderate levels of conventional risk factors, with absence of the usual male predominance. Because the metabolic syndrome and insulin resistance (IR) are associated with CHD, we have analyzed the prevalence and severity of the metabolic syndrome, and IR, in African and white subjects with type 2 diabetes. METHODS: A total of 500 African and 254 white diabetic patients were evaluated for features of the metabolic syndrome (International Diabetes Federation [IDF] definition); insulin resistance (homeostasis model assessment-insulin resistance [HOMA-IR]) was calculated in subgroups. RESULTS: In men, Africans had a lower body mass index (BMI) and smaller waists than white subjects (p < 0.0001); the metabolic syndrome was present in 46.5% and 74.1% of African and white patients respectively (p < 0.0001). In women, frequencies of the metabolic syndrome were similar, but severe metabolic syndrome (4 or 5 criteria) was more frequent in the white group (73.1%) than in the Africans (52.9%) (p = 0.0003). The prevalence of hypertriglyceridemia was lower in African men and women (p < 0.0001) and contributed to their lower prevalence of the metabolic syndrome/severe metabolic syndrome. Compared with the white patients, in African subjects HOMA-IR was 40% lower (p < 0.0001), and correlated with the triglyceride:high-density lipoprotein cholesterol ratio (TG:HDL-C) (r = 0.409, p < 0.0001). CONCLUSIONS: In diabetic Africans, in comparison with white patients, the lower prevalence of the metabolic syndrome in men and severe metabolic syndrome in women, and lesser insulin resistance, might contribute to their lower risk of CHD; the higher prevalence in women might contribute to the reversal of the male:female ratio. The TG:HDL-C ratio appears to be a valid estimate of insulin resistance in diabetic Africans.

Parotid gland biopsy compared with labial biopsy in the diagnosis of patients with primary Sjogren's syndrome.

OBJECTIVE: To assess the value of the parotid biopsy as a diagnostic tool for primary Sjögren's syndrome (pSS), and to compare the parotid biopsy and the labial biopsy with regard to diagnostic value and biopsy-related morbidity. METHODS: In 15 consecutive patients with pSS and 20 controls, the parotid biopsy was assessed as a diagnostic tool based on the presence of lymphocytic foci, benign lymphoepithelial lesions and lymphoid follicles. These new histological criteria were compared with established diagnostic criteria for the labial biopsy in 35 consecutive patients suspected for pSS who underwent simultaneous biopsies from both sites. In addition, both biopsies were compared for morbidity. RESULTS: The first analysis revealed a focus score of >or=1 or lymphocytic infiltrates (not fulfilling the criterion of a focus score of 1) combined with benign lymphoepithelial lesions as diagnostic criteria for pSS. When comparing the parotid biopsy with the labial biopsy sensitivity and specificity were comparable (sensitivity 78%, specificity 86%). Level of pain was comparable and no loss of motor function was observed. No permanent sensory loss was observed after parotid biopsy, while labial biopsy led to permanent sensory loss in 6% of the patients. Malignant lymphoma was detected in one parotid biopsy by chance, without involvement of the labial salivary gland. CONCLUSION: A parotid biopsy has a diagnostic potential comparable with that of a labial biopsy in the diagnosis of pSS, and may be associated with less morbidity.

Progression of salivary gland dysfunction in patients with Sjogren's syndrome.

BACKGROUND: Salivary gland dysfunction is one of the key manifestations of Sjögren's syndrome. OBJECTIVES: (1) To assess prospectively loss of function of individual salivary glands in patients with primary and secondary Sjögren's syndrome in relation to disease duration and use of immunomodulatory drugs. (2) To study changes in sialochemical and laboratory values and subjective complaints over time. METHODS: 60 patients with Sjögren's syndrome were included in this study. Whole and gland-specific saliva (parotid and submandibular/sublingual (SM/SL)), samples were collected at baseline and after a mean of 3.6 (SD 2.3) years of follow-up. Disease duration was recorded for all patients. RESULTS: Patients with Sjögren's syndrome with short disease duration had significantly higher stimulated flow rates at baseline than those with longer disease duration (p<0.05). When compared with healthy controls, the decrease in SM/SL flow rates at baseline was more prominent than that in parotid flow rates (p<0.05). Over time, there was a significant further decrease of stimulated flow rates, especially of the parotid gland, accompanied by increasing problems with swallowing dry food (p<0.05). The decrease was independent of the use of corticosteroids or disease-modifying antirheumatic drugs (DMARDs). Sialochemical variables remained stable. CONCLUSIONS: Early Sjögren's syndrome is characterised by a decreased salivary gland function (parotis>SM/SL), which shows a further decrease over time, regardless of the use of DMARDs or steroids. Patients with Sjögren's syndrome with longer disease duration are characterised by severely reduced secretions of both the parotid and SM/SL glands. These observations are relevant for identifying patients who would most likely benefit from intervention treatment.

Differences in coronary heart disease prevalence and risk factors in African and White patients with type 2 diabetes.

Coronary heart disease (CHD) is rare in sub-Saharan Africans; there are few data in African diabetic populations. We therefore evaluated the prevalence of CHD and conventional risk factors in 744 consecutive African (A, n=448) and White European (W, n=296) subjects with type 2 diabetes. CHD was present in 4% of A and in 23% of W (p<0.001). Compared with W, the A groups had lower total cholesterol (TC) and triglyceride (TG) levels: men: TC-W, 5.76 (S.D., 1.36) and A, 4.98 (1.29)mmol/l; TG-W, 2.10 (IQR,1.40-3.00) and A, 1.60 (1.10-2.55)mmol/l; women: TC-W, 5.85 (1.31) and A, 5.20 (1.24); TG-2.00 (1.40-2.90) and A, 1.40 (1.00-2.03)mmol/l (p< or =0.0022 for each comparison). The A had significantly lower TG:HDL-C ratios (an index of insulin resistance) (p=0.004) and were less likely to have (estimated) small dense LDL-C particles (p< or =0.038). In subjects with established CHD traditional risk factors were similar in A and W. Regression analysis revealed that CHD associated in A with serum creatinine (p=0.0015) and TC (p=0.038) and with TG in W (p=0.0072). We conclude that the rarity of CHD in diabetic Africans can be explained by contributions of low TC levels and probably lesser insulin resistance and its consequences; renal disease may be an important additional risk factor.

[A schizophrenic patient with loss of teeth]. / Een schizofrene patiënte met verlies van gebitselementen.

A 53-year-old woman, known with a schizophrenic disorder and a history of drug addiction, was referred because of progressive hematomas of the lower extremities and fatigue. Her medical history included hyperplastic gums, tooth hypermobility and anaemia. Scurvy was diagnosed as a result of an insufficient diet due to drug addiction and a paranoid psychosis. After suppletion of vitamin C and starting highly nutritious food a rapid amelioration of the scurvy related complaints was observed. While dreaded and often fatal in earlier eras, in the 21st century scurvy is easily treatable if this diagnosis is recognised.

Bond strength of resin composite to differently conditioned amalgam.

Bulk fracture of teeth, where a part of the amalgam restoration and/or the cusp is fractured, is a common clinical problem. The aim of this study was to evaluate the effect of different surface conditioning methods on the shear bond strength of a hybrid resin composite to fresh amalgam. Amalgams (N=84) were condensed into acrylic and randomly assigned to one of the following treatments (N=6): (1) Alloy primer + opaquer, (2) Air-particle abrasion (50 micro m Al(2)O(3)) + alloy primer + opaquer, (3) Silica coating (30 micro m SiO(x)) + silanization + opaquer, (4) Opaquer + pre-impregnated continuous bidirectional E-glass fibre sheets, (5) Silica coating + silanization + fibre sheets, (6) Silica coating + silanization + opaquer + fibre sheet application. Non-conditioned amalgam surfaces were considered as control group (7). The mean surface roughness depth (R(Z)) was measured from the control group and air-abraded amalgam surfaces. The resin composite was bonded to the conditioned amalgam specimens using polyethylene molds. All specimens were tested under dry and thermocycled (6.000, 5-55 degrees C, 30 s) conditions. The shear bond strength of resin composite to amalgam substrates was measured in a universal testing machine (1 mm/min). Surface roughness values for the non-conditioned control group (R(Z) approximately 0.14 micro m) and for air-particle abraded surfaces with either Al(2)O(3) or SiO(x) (R(Z) approximately 0.19 micro m and R(Z) approximately 0.16 micro m, respectively) did not show significant differences (p=0.23) (One-way ANOVA). In dry conditions, silica coating and silanization followed by fibre sheet application exhibited significantly higher results (14.8+/-5.6 MPa) than those of the groups conditioned with alloy primer (2.2+/-0.7 MPa) (p<0.001), air-particle abrasion+alloy primer (4.4+/-2.0 MPa, p<0.001), silica coating+silanization alone (6.2+/-0.8 MPa, p=0.009) or non-conditioned group (1.4+/-0.6, p<0.001). Silica coating and silanization followed by additional fibre sheets with opaquer application (23.6+/-6.9 MPa) increased the bond strength significantly compared to those of other groups (group 5 vs group 6, p=0.007; other groups vs group 6, p<0.001). Thermocycling decreased the bond strengths significantly for all of the conditioning methods tested (for group 1, p<0.001; for group 2, p=0.013; for group 3, p=0.002; for group 4, p=0.026; for group 5, p=0.002; for group 6, p<0.001 and for group 7, p<0.001).

Morbidity of chin bone transplants used for reconstructing alveolar defects in cleft patients.

OBJECTIVE: The aim of this study was to evaluate the objective and subjective morbidity of symphyseal chin bone harvesting used for reconstruction of alveolar defects in young cleft patients. DESIGN: All patients who had undergone chin bone harvesting for alveolar cleft reconstruction in the period from 1992 through 2000 at the Department of Oral and Maxillofacial Surgery of the University Hospital Groningen, Groningen, The Netherlands, were invited to participate in this retrospective study.Patients' acceptance, perioperative and postoperative morbidity were evaluated. A survey of the medical records was performed. In addition, the patients completed a questionnaire for their appreciation of the procedure. They were also subjected to a clinical and radiographic examination. PATIENTS: Thirty patients (21 males and 9 females; mean age 11.8 +/- 3.6 years) participated in this study. RESULTS: Neither the medical records nor the experiences of the patients showed significant morbidity. The procedure was appreciated with 6.8 +/- 3.5 (scale 0 to 10). Postoperative pain was scored as 1.2 +/- 2.5 (scale 0 to 10). Three patients reported transient sensory disturbances at the donor site. Two patients showed a slight sensibility disorder in the symphyseal region. In three patients, an endodontic problem had developed in a lower incisor. CONCLUSION: This study showed that chin bone harvesting for reconstructing alveolar cleft in young patients is a well-accepted procedure with low objective and subjective morbidity. Notwithstanding this low morbidity, the patients (and their parents) have to be informed about the risk of objective and subjective disturbances of the sensibility in the donor region and the risk of dental pulp necrosis.

[Bruises, loose teeth and fatigue in a patient with schizophrenia]. / Blauwe plekken, uitvallende tanden en vermoeidheid bij een patiënte met schizofrenie.

A 53-year-old woman was referred because of progressive haematomas of the lower extremities and fatigue. Her medical history included hyperplastic gums and tooth loss. Scurvy was diagnosed; this was the result of an insufficient diet due to a paranoid psychosis. There was a dramatic improvement within a few days after addition of vitamin C and starting highly nutritious food. Scurvy is easily treated, but is not a disease of the past.

Effective and accurate screening for diabetic retinopathy using a 60 degree mydriatic fundus camera.

UNLABELLED: OBJECTIVES. To establish whether an experienced endocrinologist could screen accurately for diabetic retinopathy using mydriatic 60 degree fundus photographs compared with a reference standard, viz. the combined highest scores of two experienced ophthalmologists. DESIGN: Retrospective review of 60 degree colour transparency photographs taken over a 6-year period. Retinopathy was graded in a standardised way. SETTING: Patients attending the diabetic clinic at Johannesburg Hospital, South Africa. SUBJECTS: Fifteen hundred and seventeen patients (2446 eyes) formed the basis for the study. Patients were included if there was more than 50% readability of the fundus photographs. OUTCOME MEASURES: Outcome measures were prevalence of any retinopathy and presence of referable (severe) retinopathy. Interobserver agreement was measured using the kappa statistic, and sensitivity and specificity of the screener were evaluated. RESULTS: The prevalence of retinopathy at the clinic was approximately 30%, but only about 12% was severe enough to warrant referral to the ophthalmology outpatient department. The endocrinologist was very accurate in determining cases requiring referral; there was 97% agreement with the reference standard, viz. the combined highest score of two experienced ophthalmologists (gold standard). Correlation on the determination of any retinopathy was less accurate (80% agreement), mostly owing to the endocrinologist reporting more isolated microaneurysms than the ophthalmologists. The screening method used gave a sensitivity of 83% and specificity of 99% which are within recommended standards. CONCLUSIONS: The screening strategy using a mydriatic fundus camera at the diabetic clinic was found to be effective and accurate and greatly reduced the number of possible referrals to the ophthalmology outpatient department.

Effect of three surface conditioning methods to improve bond strength of particulate filler resin composites.

The use of resin-based composite materials in operative dentistry is increasing, including applications in stress-bearing areas. However, composite restorations, in common with all restorations, suffer from deterioration and degradation in clinical service. Durable repair alternatives by layering a new composite onto such failed composite restorations, will eliminate unnecessary loss of tooth tissue and repeated insults to the pulp. The objective of this study was to evaluate the effect of three surface conditioning methods on the repair bond strength of a particulate filler resin-composite (PFC) to 5 PFC substrates. The specimens were randomly assigned to one of the following surface conditioning methods: (1) Hydrofluoric (HF) acid gel (9.5%) etching, (2) Air-borne particle abrasion (50 microm Al2O3), (3) Silica coating (30 microm SiOx, CoJet-Sand). After each conditioning method, a silane coupling agent was applied. Adhesive resin was then applied in a thin layer and light polymerized. The low-viscosity diacrylate resin composite was bonded to the conditioned substrates in polyethylene molds. All specimens were tested in dry and thermocycled (6.000, 5-55 degrees C, 30 s) conditions. One-way ANOVA showed significant influence of the surface conditioning methods (p < 0.001), and the PFC types (p < 0.0001) on the shear bond strength values. Significant differences were observed in bond strength values between the acid etched specimens (5.7-14.3 MPa) and those treated with either air-borne particle abrasion (13.0-22.5 MPa) or silica coating (25.5-41.8 MPa) in dry conditions (ANOVA, p < 0.001). After thermocycling, the silica coating process resulted in the highest bond values in all material groups (17.2-30.3 MPa).

[Dissertations 25 years after date 3. Dentures finally happy ventures!]. / Proefschriften 25 jaar na dato 3. Het kunstgebit uiteindelijk een blij bezit!

Twenty-five years ago the PhD-thesis 'Dentures happy ventures?' of Kalk described the problems and reasons for (dis)satisfaction with complete dentures. In this article an overview is given of different PhD-theses in The Netherlands which have further elaborated and analyzed the problems of the compromised edentulous patient. More insight was gained in the aetiology and the background of edentulism and dissatisfaction with complete dentures. Nowadays, it is known which treatment strategies can retard bone loss and it is also known that pre-prosthetic surgery is less effective in resolving severe alveolar bone loss than expected. In The Netherlands, randomized clinical trials have shown that a mandibular overdenture retained by two or four implants is very effective in compromised edentulous patients.