[Complex Regional Pain Syndrome (CRPS) - State of the Art in Diagnostics and Therapy]. / Complex Regional Pain Syndrome (CRPS).

The complex regional pain syndrome (CRPS) usually occurs within a few weeks in 2-5% of all patients after trauma or surgery or subsequent measures of the distal extremities. There are certain risk factors for its occurrence but no "CRPS personality", instead there are factors that negatively influence the course. The prognosis is generally good ("rule of thirds"), but remaining limitations are common. The diagnosis is clinically possible according to the "Budapest criteria". Additional examinations are possible in case of doubt but are neither conclusive nor exclusive. Corticoids and bisphosphonates are used alongside drugs that have an effect on neuropathic pain. Invasive therapies do not have good evidence and have therefore lost their importance. The rehabilitative therapy is carried out actively and with a lot of self-exercises at an early stage. Invasive anesthetic, passive therapies are obsolete. Special forms of treatment are "graded exposure" (GEXP) in the case of dominant anxiety and, e.g., "graded motor imagery" (GMI) in case of neglect-like symptoms. In addition to educational and behavioral therapy elements, psychotherapy for CRPS also includes participation as part of graded exposure.

C-Nail versus plate osteosynthesis in displaced intra-articular calcaneal fractures-a comparative retrospective study.

BACKGROUND: Locking plate osteosynthesis via an L-shaped lateral approach is the gold standard in treating displaced intra-articular calcaneal fractures. High complication rates are known for this approach. The most frequent complications are wound edge necrosis and superficial wound infections. To reduce complication rates, a locking intramedullary nail (C-Nail) was developed that can be implanted minimally invasively via a sinus tarsi approach. We compared the postoperative complication rate and the outcome of plate osteosynthesis versus C-Nail in displaced intra-articular calcaneal fractures. METHODS: All patients with calcaneal fractures who received osteosynthesis with either plate or C-Nail between January 2016 and October 2019 in our institution were retrospectively analyzed. A subgroup analysis was performed with matched pairs (matching Sanders type, age, Böhler's angle postoperative in normal range, 33 pairs). Endpoints were postoperative complication rate, bone healing, full weight-bearing and functional outcome. Treatment groups were compared using Fisher's exact test for binary data, and Mann-Whitney U-test for continuous data. A p-value < 0.05 was considered statistically significant. RESULTS: One hundred and one calcaneal fractures were included (C-Nail n = 52, plate n = 49). Patients with C-Nail developed significantly less postoperative complications (p = 0.008), especially wound edge necrosis (p < 0.001). Screw malposition was found more often in the C-Nail group. The rates of achieving full weight-bearing as well as bone healing were comparable in both groups, but in each case significant faster in the C-nail subgroup. The results of the matched-pairs analysis were comparable. CONCLUSIONS: The postoperative complication rate was significantly lower in the C-Nail group. The C-Nail appears to be a successful alternative in the treatment of calcaneal fractures, even in Sanders IV fractures because of the minimal-invasive implantation as well as the high primary stability. Long-term analysis of this new implant including elaboration on functional outcome is planned. TRIAL REGISTRATION: Deutsches Register Klinischer Studien (DRKS) DRKS00020395 . Date of registration 3 January 2020.

Aetiology of severe demarcated enamel opacities--an evaluation based on prospective medical and social data from 17,000 children.

During the 1970s dentists reported an increasing prevalence of a "new" type of enamel disturbance.The disturbance was very specific, with areas of demarcated hypomineralised enamel, and was mostly found in permanent first molars and incisors. Several studies have tried to reveal the aetiology behind the enamel disturbance but sofar no clear factors correlated have been found. The aim of the present study was to evaluate aetiological factors to severe demarcated opacities (SDO) in first permanent molars in a large cohort of children enrolled in the "All Babies in Southeast Sweden" (ABIS) project. ABIS is a prospective study of all children in five Swedish counties born between Oct 1, 1997 and Oct 1, 1999, in all about 17,000 children.They have been followed from birth with recording of a large number of factors on nutrition, diseases, medication, infections, social situation etc. With help from 89 Public Dental Service clinics in the same area preliminary examinations of the children, born between Oct 1,1997 and Oct 1,1999, reported 595 children with severe demarcated opacities (SDO) in first molars.These children and a randomly selected age matched group of 1,200 children were further invited to be examined by specialists in paediatric dentistry. At these examinations 224 severe cases were identified as well as 253 children completely without enamel disturbances among children registered in ABIS.These two groups were analysed according to any correlation between SDO and variables in the ABIS databank. The analyses showed no association between SDO and pre-, peri-, and neonatal data. However, we found a positive association between SDO and breastfeeding for more than 6 months (OR 1.9; 95% CI 1.1-3.2), late introduction of gruel (OR 1.9; 95% CI 1.1-2.9), and late introduction of infant formula (OR 1.8; 95% CI 1.2-2.9). A combination of these three variables increased the risk to develop SDO by more than five times (OR 5.1; 95% CI 1.6-15.7). No significant associations were found to other environmental, developmental, or medical factors. We conclude that nutritional conditions during first 6 months of life may influence the risk to develop severe demarcated opacities in first permanent molars.

Specialist paediatric dentistry in Sweden 2008 - a 25-year perspective.

International Journal of Paediatric Dentistry 2010; 20: 313-321 Background. Paediatric dentistry in Sweden has been surveyed four times over the past 25 years. During this period postgraduate training, dental health, and the organization of child dental care have changed considerably. Aim. To investigate services provided by specialists in paediatric dentistry in Sweden in 2008, and to compare with data from previous surveys. Design. The same questionnaire was sent to all 30 specialist paediatric dental clinics in Sweden that had been used in previous surveys. Comparisons were made with data from 1983, 1989, 1996 and 2003. Results. Despite an unchanged number of specialists (N = 81 in 2008), the number of referrals had increased by 16% since 2003 and by almost 50% since 1983. There was greater variation in reasons for referrals. The main reason was still dental anxiety/behaviour management problems in combination with dental treatment needs (27%), followed by medical conditions/disability (18%), and high caries activity (15%). The use of different techniques for conscious sedation as well as general anaesthesia had also increased. Conclusions. The referrals to paediatric dentistry continue to increase, leading to a heavy work load for the same number of specialists. Thus, the need for more paediatric dentists remains.

Caries prevalence and distribution in individuals aged 3-20 years in Jönköping, Sweden, over a 30-year period (1973-2003).

BACKGROUND: Oral health status of individuals aged 3-80 years in the city of Jönköping, Sweden, has been assessed in a series of epidemiological studies over a 30-year period. AIM: To analyse the changes in caries prevalence and caries distribution in child population sample groups, based on studies performed in 1973, 1978, 1983, 1993, and 2003. DESIGN: Each time point included 500 randomly sampled individuals, divided into age groups of 3, 5, 10, 15, and 20 years. Results. Thirty-five per cent of 3-year-olds were caries free in 1973, compared with 69% 30 years later. Decayed and filled primary (dfs) and permanent surfaces (DFS) were reduced by 50-80% between 1973 and 2003. Adolescents aged 10 and 15 years exhibited the most pronounced reduction in DFS on the occlusal surfaces. By 2003, 90% of the proximal carious lesions in 15-year-olds were initial carious lesions. In 2003, about 60% of 15-year-olds had a DFS of < or = 5, while about 7% exhibited a DFS of > or = 26. CONCLUSIONS: Despite the dramatic decline in the prevalence of caries, caries remains a health problem among children, particularly those of preschool age. Continuous epidemiological studies are recommended to evaluate preventive measures.

Oral health of individuals aged 3-80 years in Jönköping, Sweden during 30 years (1973-2003). I. Review of findings on dental care habits and knowledge of oral health.

The aim of the present study was to compare data on dental care habits and knowledge of oral health in four cross-sectional epidemiological studies carried out in 1973,1983,1993, and 2003. The 1973 study constituted a random sample of 1,000 individuals evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, and 70 years. The same age groups with addition of a group of 80-year-olds were included in the 1983, 1993 and 2003 studies, which comprised 1,104, 1,078, and 987 individuals, respectively. A questionnaire about dental care habits and knowledge of oral health was used in connection with a clinical and radiographic examination. The same questions were used in all the four studies. An addition to the 1993 and 2003 investigations were questions concerning ethnic background. In 2003 approximately 90-95 per cent of all individuals were visiting the dentist on a regular basis every or every second year. The 30- and 40-yea r-olds, however, did not visit a dentist as regularly in 2003 as in 1993. In these age groups 21-24 per cent of the individuals, respectively, reported that they had not visited a dentist in the last 2 years. Almost all children 3-15 years old received their dental care within the Public Dental Service (PDS). During the period 1973-2003 an increase in percentage of individuals aged 20-50 years treated by the PDS was seen compared to private practice, while among 60-80 year-olds there were only minor changes. Most so-year-olds and older received their dental care by private practitioners. About 70-80 per cent of all adults in 2003 were enrolled in a recall system on the dentist's initiative while in 1973 most appointments were based on the patient's own initiative. The number of individuals who were frightened, 5-17 per cent, or felt discomfort at the prospect of an appointment with the dentist was more or less the same during the whole period. The knowledge of the etiology of dental diseases did not changed much between 1973 and 2003. The frequency of toothbrushing increased since 1973 and in 2003 more than 90 per cent of all individuals brushed their teeth twice or once a day. The use of dental floss and toothpicks decreased in 2003 compared to 1983 and 1993. Almost all individuals in 2003 used fluoride toothpaste. It was obvious that the dental team constituted the main source of dental health information. For the age groups 20 and 30 years information from friends and relatives was also important. In the age groups 3-20 years up to 45 per cent of the individuals were consuming soft drinks every day or several times a week.

Oral health of individuals aged 3-80 years in Jönköping, Sweden during 30 years (1973-2003). II. Review of clinical and radiographic findings.

The aim of this epidemiological study was to analyze various clinical and radiographic data on oral health and compare the results to those of three cross-sectional studies carried out in 1973 and 1983, and 1993. In 1973, 1983, 1993, and 2003 a random sample of 1,000; 1,104; 1,078; and 987 individuals, respectively, were studied. The individuals were evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, 70, and 80 years. In 1973 80-year-olds were not included. All subjects were inhabitants of the City of Jönköping, Sweden. The clinical and radiographic examination assessed edentulousness, removable dentures, implants, number of teeth, caries, restorations and overhangs, oral hygiene, calculus, periodontal status, endodontic treatment, and periapical status. The number of edentulous individuals in the age groups 40-70 years was reduced from 16 per cent in 1973 to 8 per cent in 1993, and to 1 per cent in 2003. The mean number of teeth increased, and up to the age of 60 years, individuals had more or less complete dentitions. During the 30-year period,the number of carious lesions and restorations decreased in general. In the 15-year-olds the decrease in number of restored tooth surfaces was 900 per cent and the corresponding figure for 30-year-olds was 79 per cent. The age groups 60-800 years showed an increase in number of restored tooth surfaces and had as a mean 50 filled tooth surfaces. The oral health among 3-5-year-olds improved markedly between 1973 and 1993. In 2003, however, there was no further improvement in 3- and 5-year-olds compared to 1993. Generally, restorations in 2003 exhibited a high quality and 90-95 per cent had no proximal overhangs. In 1973 this figure was about 60 per cent. In the age groups 20-50 years there were continuously fewer teeth fitted with crowns or bridges during the 30-year period. In 1973 the 50-year-olds had a mean of 24.5 per cent of the teeth crowned and in 2003 6.8 percent. Compared to data from 1973 there was a reduction by half concerning occurrence of plaque and gingivitis in 2003. The frequency of individuals with one or more periodontal pockets (> or = 4 mm) increased with age. In 2003 the bone level at the age of 60 years corresponded to the bone level at the age of 40 years in 1973. The percentage of endodontically treated teeth was lower in 2003 in all age groups compared to 1973, 1983, and 1993. The percentage of endodontically treated teeth with periapical orjuxtaradicular destructions was generally lower in 2003 than in the earlier surveys, about 20 per cent in 2003 compared to 25-30 per cent in 1973,1983, and 1993. The comparison of the four studies shows that there has been a great overall improvement in oral health over this 30-year period.

Clinical evaluation of a resin composite and bonding agent in Class I and II restorations: 2-year results.

OBJECTIVE: The purpose of this study was to evaluate the clinical performance and longevity of Tetric Ceram and Syntac Sprint restorations in stress-bearing areas performed in general practice. METHOD AND MATERIALS: The light-curing resin composite Tetric Ceram in combination with the bonding material Syntac Sprint were used as restorative materials in three public dental health clinics. All the restorations were done by general practitioners in an ordinary patient pool attending a public health clinic. Before starting, the general practitioners were instructed and trained in performing the restorations according to a standardized clinical procedure, and the evaluations were done according to United States Public Health Service criteria. One hundred forty-eight restorations (27 Class I, 121 Class II) were done in 123 patients. After 2 years, 140 restorations (95%) could be assessed. Color slides and bitewings were taken to supplement the clinical evaluations of color match, marginal discoloration, secondary caries, and marginal adaptation. Wear of the restorations was evaluated according to the Leinfelder method. RESULTS: After 2 years, 7 out of 148 restorations had failed, giving a failure rate of 5% of the tested materials. Five restorations failed due to hypersensitivity, one to secondary caries, and one to fracture. The wear rate was low (mean 37 microm) and did not result in any replacement. CONCLUSION: This 2-year study showed that clinically satisfactory results could be obtained using resin composite Class I and II restorations in stress-bearing areas done in general practice on an ordinary clientele when the clinical procedure is standardized.

Attitudes to dental care among parents of uncooperative vs. cooperative child dental patients.

The aim of this cross-sectional questionnaire study was to investigate four aspects of parents' attitudes to dental care (knowledge, child's oral health behavior, priorities and responsibility). One study group (n = 50) of parents of uncooperative child dental patients (aged 8-12 yr) was compared to a reference group (n = 113) of parents of ordinary child dental patients of similar age, and to a second study group (n = 36) of parents of uncooperative younger child patients (aged 4-7 yr). Study group parents had significantly lower socio-economic status and a higher level of dental fear as compared to parents of ordinary child patients. We found indications of a poorer dental knowledge and a differing responsibility-taking profile among study group parents. Their children also had sweets more often. As compared to parents of younger children, the older study group parents had lower socio-economic status and showed a lower responsibility-taking related to the child's treatment refusal. In conclusion, parents of uncooperative children differ from parents of ordinary child dental patients, not only in socio-economic status and dental fear, but also in aspects such as dental knowledge and responsibility-taking. These differences were partly related to the child's age.