[Minimally invasive treatments and open joint surgery for disorders of the temporomandibular joint]. / Minimaal invasieve behandelingen en opengewrichtschirurgie voor aandoeningen van het kaakgewricht.

The initial treatment of symptomatic disorders of the temporomandibular joint typically consists of a conservative approach, in which medication (painkillers and muscle relaxants), orofacial physiotherapy and splints are most important. In most cases, minimally invasive treatment options, such as arthrocentesis, arthroscopy or joint injections, are only considered when conservative methods provide insufficient symptom reduction. There is, however, an ongoing debate about the optimal treatment strategy due to an increasing body of evidence concerning the superior effectiveness in symptom reduction of minimally invasive treatment options with regard to conservative treatments. If these minimally invasive treatment options are also ineffective, open joint surgery may be considered as a last option for a select group of patients.

Success rate of sialendoscopy. A systematic review and meta-analysis.

OBJECTIVE: To perform a systematic review and meta-analysis on the efficacy and safety of sialendoscopy in the treatment of obstructive diseases of the major salivary glands. MATERIALS AND METHODS: We searched four databases for literature. The primary outcome assessed was the success rate. Secondary outcomes included the use of supportive devices, number of sialadenectomies and complications. Risk of bias was assessed. Meta-analyses with subgroup analysis were performed. RESULTS: In total, 91 studies were included, comprising 8218 patients undergoing 9043 sialendoscopic procedures. The majority of studies had a medium or high risk of bias. The incidence of sialadenectomy varied from 0% to 14%. No major complications were reported. Meta-analysis revealed a weighted pooled success rate of 80.9%. Subgroup analyses showed the weighted pooled success rate in patients with sialoliths (89.6%), stenoses (56.3%), submandibular glands (88.3%), parotid glands (81.2%), patients treated by an endoscopic-assisted transoral removal of a sialolith (86.3%), patients treated by a combined approach of the parotid gland (78.2%), patients with JRP (67.0%) and with RAIS (45.8%). CONCLUSION: The success rate of sialendoscopy did not considerably change in the last 9 years. Sialendoscopy is an efficient and safe procedure for the treatment of major salivary gland obstructive disease.

Augmented Reality Visualization for Image-Guided Surgery: A Validation Study Using a Three-Dimensional Printed Phantom.

BACKGROUND: Oral and maxillofacial surgery currently relies on virtual surgery planning based on image data (CT, MRI). Three-dimensional (3D) visualizations are typically used to plan and predict the outcome of complex surgical procedures. To translate the virtual surgical plan to the operating room, it is either converted into physical 3D-printed guides or directly translated using real-time navigation systems. PURPOSE: This study aims to improve the translation of the virtual surgery plan to a surgical procedure, such as oncologic or trauma surgery, in terms of accuracy and speed. Here we report an augmented reality visualization technique for image-guided surgery. It describes how surgeons can visualize and interact with the virtual surgery plan and navigation data while in the operating room. The user friendliness and usability is objectified by a formal user study that compared our augmented reality assisted technique to the gold standard setup of a perioperative navigation system (Brainlab). Moreover, accuracy of typical navigation tasks as reaching landmarks and following trajectories is compared. RESULTS: Overall completion time of navigation tasks was 1.71 times faster using augmented reality (P = .034). Accuracy improved significantly using augmented reality (P < .001), for reaching physical landmarks a less strong correlation was found (P = .087). Although the participants were relatively unfamiliar with VR/AR (rated 2.25/5) and gesture-based interaction (rated 2/5), they reported that navigation tasks become easier to perform using augmented reality (difficulty Brainlab rated 3.25/5, HoloLens 2.4/5). CONCLUSION: The proposed workflow can be used in a wide range of image-guided surgery procedures as an addition to existing verified image guidance systems. Results of this user study imply that our technique enables typical navigation tasks to be performed faster and more accurately compared to the current gold standard. In addition, qualitative feedback on our augmented reality assisted technique was more positive compared to the standard setup.?>.

[Development of MALT-lymphoma in Sjögren syndrome]. / Ontstaan van MALT-lymfomen bij het syndroom van Sjögren.

Important characteristics of Sjögren syndrome include a sensation of dry mouth, reduced saliva secretion and swelling of the large salivary glands, usually the parotids. Sjögren patients also run a significantly increased risk of developing a non-Hodgkin lymphoma, generally a so-called mucosa associated lymphoid tissue (MALT) lymphoma. Such a MALT lymphoma often develops in the parotid gland. In 2 cases patients presented with recurrent swellings of the parotid glands who developed both Sjögren syndrome and a MALT lymphoma in both of their parotid glands.

[Medicaments and oral healthcare. Mechanisms of interaction between medicaments]. / Serie: Medicamenten en mondzorg. Mechanismen van interacties van medicamenten.

Interactions between medicaments or between a medicament and another product used by the patient may result in a medicamentbecoming inactive or in an increase in the side effects. By proper historytaking, a dentist will often know which medicaments a patient uses and can take this into account in prescribing a medicament. Self-care medications and specific foods are often not spontaneously reported by a patient but can still interact with a medicament prescribed. A dentist should be aware of the interactions a prescribed medicament can have with other medicaments and products used by the patient. Therefore dentists have to ask directly about such medicaments and products, and record them in the patients' file.

[Mandibular function after a condylectomy for unilateral condylar hyperplasia]. / Mandibulaire functie na condylectomie voor unilaterale condylaire hyperplasie.

Unilateral condylar hyperplasia is a rare growth disorder originating in the growth centre of the mandibular condyles and resulting in facial asymmetry. Primary treatment consists of condylectomy. In this cross-sectional research, limitations in mandibular function and oral health related quality of life were measured with the Mandibular Function Impairment Questionnaire and the Oral Health Impact Profile (NL49). The study included 17 patients who underwent treatment for unilateral condylar hyperplasia with a condylectomy in the University Medical Center Groningen between 1997 and 2012. The median (IQR) scores of the Mandibular Function Impairment Questionnaire (8,0 [1,0; 15,0]) and the Oral Health Impact Profile (25,0 [3,0; 53,0] were low compared to other conditions involving the mandible. A higher age was associated with increased limitations in mandibular function (rs = 0,588 (p = 0,013)). After a condylectomy for unilateral condylar hyperplasia the functional impairment of the mandible and the decrease in oral health related quality of life are low.

Measuring the social impact of dental research: An insight into the most influential articles on the Web.

OBJECTIVES: To identify the most discussed dental articles on the Web and to assess the association between the intensity of online attention, publication characteristics, and citations. MATERIALS AND METHODS: An Altmetric Explorer search was conducted for articles published in the 91 dental journals included in 2015 InCites™ Journal Citation Report® and mentioned online at all times. The 100 articles with the highest online attention, as measured by the "Altmetric Attention Score" (AAS), were screened for journal title, quartile of impact factor distribution (Q1-Q4), publication date, origin and affiliation of first author, article topic, type, and access. Citation counts were harvested from Scopus. RESULTS: The top 100 articles presented a median AAS of 119 and were mostly discussed on news outlets, Twitter, and Mendeley. Forty-one articles were published in Q1 journals, 24 in Q2 journals, 32 in Q3 journals, and three in Q4 journals. AAS was significantly higher in articles of Q2 journals (median AAS = 398, range = 70-513) than in articles of Q1. A weak reverse correlation existed between AAS and time since publication (r = -.25, p < .05). No correlation was detected between AAS and other publication characteristics or number of citations. CONCLUSIONS: Increased social impact of dental articles is not significantly associated with high citation rates.

Bacterial colonization of the peri-implant sulcus in dentate patients: a prospective observational study.

OBJECTIVES: The aim of the present study was to compare the composition of the periodontal microflora at baseline (T0) with the submucosal microflora at least 1 year after implant placement (T1) in periodontally healthy patients. MATERIAL AND METHODS: For all 169 consecutive patients that visited our clinic during 1 year, we determined their periodontal parameters, implant mucosal index, and presence of implant calculus. At T0, self-reported smoking status was recorded and subgingival and submucosal biofilm samples were obtained and analyzed for the presence and numbers of selected periodontal pathogens. All measurements were repeated at T1. RESULTS: One hundred twenty patients completed the study. Periodontal parameters were stable or had improved at T1. The total bacterial load was lower at implant sites (P < 0.05). The prevalence of Porphyromonas gingivalis was low at baseline, but at T1, detection rate and numbers were higher at implant sites compared to dentate sites. At T1, the frequency of detection of P. gingivalis (P = 0.01), Parvimonas micra (P = 0.018), and Fusobacterium nucleatum (P = 0.035) was higher in smoking patients (n = 23) than in non-smokers (n = 97). CONCLUSIONS: Colonization of the submucosal peri-implant area is similar to the composition of subgingival microbiota. Smoking has a measurable effect on the colonization of implant-associated biofilms and may select for P. gingivalis, P. micra, and F. nucleatum. CLINICAL RELEVANCE: The colonization of implants by well-known periodontal pathogens is very similar to that in normal dentition, also in a healthy cohort. Smoking status was related with the prevalence of periodontal pathogens where smokers harbored more often periodontal pathogens such as P. gingivalis, P. micra, and F. nucleatum.

[Localised (juvenile) spongiotic hyperplasia of the gingiva; a less common laesion]. / Gelokaliseerde (juveniele) spongiotische hyperplasie van de gingiva: een minder bekende aandoening.

A 49-year-old woman presented with a superficial, ulcerative laesion of approximately 7x3 mm of the marginal labial gingiva of the first upper incisor right. The laesion had returned twice after limited surgical excision. On the basis of a new, extensive excisional biopsy, additional investigation was carried out by the pathologist, which led to a diagnosis of localised (juvenile) spongiotic gingival hyperplasia (LJSGH). The aetiology of LJSGH is still unclear. A typical characteristic is the localised and solitary presence of the laesion. Localised (juvenile) spongiotic hyperplasia of the gingiva is most often seen on the marginal labial gingiva of the maxilla. The laesion can disappear spontaneously, but surgical excision is generally indicated due to the negative cosmetic effect and influence on oral hygiene. The risk of recurrence is high, particularly when the laesion is not radically removed.

[A PhD completed 9. The value of oral foci screening in oncology patients]. / Hora est 9. De waarde van tandheelkundig focusonderzoek bij oncologiepatiënten.

In both patients who undergo radiotherapy because of a tumour in the head and neck region and patients who are treated with high doses of chemotherapy because of haematological disorders, prior to treatment an oral foci screening is carried out. The aim of this focus investigation is to identify oral abnormalities, the so-called oral foci. Such foci can lead to oral problems during or post-treatment. A careful oral foci screening, conforming to protocol, appears to be very relevant for patients who have to undergo head and neck radiotherapy. Particular attention must be devoted to the evaluation of the perodontium, because the chance of disorders affecting the bone-healing that appear post-radiotherapy in the head and neck region is increased in patients with periodontitis. In patients with a haematological disorder, asymptomatic, chronic foci do not require treatment prior to or during the oncological treatment because such oral foci do not increase an extra risk of infectious complications, despite what was hitherto believed.

Effect of leaving chronic oral foci untreated on infectious complications during intensive chemotherapy.

BACKGROUND: Leukaemic patients receiving intensive chemotherapy and patients undergoing autologous stem-cell transplantation (ASCT) are routinely screened for oral foci of infection to reduce infectious complications that could occur during therapy. In this prospective study we assessed the effect of leaving chronic oral foci of infection untreated on the development of infectious complications in intensively treated haematological patients. METHODS: We included and prospectively evaluated all intensively treated leukaemic patients and patients undergoing ASCT who were referred to our medical centre between September 2012 and May 2014, and who matched the inclusion/exclusion criteria. Acute oral foci of infection were removed before chemotherapy or ASCT, whereas chronic oral foci were left untreated. RESULTS: In total 28 leukaemic and 35 ASCT patients were included. Acute oral foci of infection were found in 2 leukaemic (7%) and 2 ASCT patients (6%), and chronic oral foci of infection in 24 leukaemic (86%) and 22 ASCT patients (63%). Positive blood cultures with microorganisms potentially originating from the oral cavity occurred in 7 patients during treatment, but were uneventful on development of infectious complications. CONCLUSIONS: Our prospective study supports the hypothesis that chronic oral foci of infection can be left untreated as this does not increase infectious complications during intensive chemotherapy.

Is YouTube useful as a source of information for Sjögren's syndrome?

OBJECTIVES: To quantitatively and qualitatively assess the characteristics of YouTube videos dealing with Sjögren's syndrome. MATERIALS & METHODS: A comprehensive electronic search was performed for 'Sjögren's syndrome' in YouTube. After excluding duplicates, irrelevant videos, and non-English-language domains, 70 videos were included for analysis. Videos were classified as useful, misleading, or personal experience. The overall quality of videos was scored according to the Global Quality Scale (GQS). Useful videos were assessed for reliability and comprehensiveness based on two 5-point scales. Key points of the misleading videos were explored and patients' personal experiences were further investigated. RESULTS: Thirty-six videos (51.4%) were classified as useful, 6 (8.6%) as misleading, and 28 (40%) as patient's personal experience. Independent users tend to upload videos with personal experience, while university channels/professional organizations share useful videos with evidence-based information. Significant difference was observed in GQS among useful, misleading videos, and patient's experiences. The mean reliability, comprehensiveness, and GQS scores of useful videos were 2.5 (s.d.:1.2), 2.6 (s.d.:1.4), and 3.4 (s.d.:1.0), respectively, whereas only six videos (16.7%) were rated as complete vis-à-vis content. The most frequently misleading topics were etiology and treatment. CONCLUSIONS: Specialists should refer their patients to validated e-information resources and actively participate in the development of video-sharing platforms.

[Medicines and oral healthcare 3. Insurance coverage and qualification to prescribe]. / Medicamenten en mondzorg 3. Vergoeding en bevoegdheid tot voorschrijven.

On the advice of the National Health Care Institute in the Netherlands and the institute's Board of Scientific Advisors, the minister of Health, Welfare and Sport decides whether a certain drug will or will not be included in the list of drugs covered by the basic health insurance plan mandated for all Dutch citizens. In making this decision emphasis is placed on the therapeutic value of that particular drug compared to that of the standard drug for that disorder, the impact that the inclusion of the drug would have on the budget and the drug's cost-effectiveness. In the case of disorders that do not respond or respond insufficiently to the standard treatment, however, one comes up against the limitations of this system and in some cases a necessary treatment is not reimbursed. With respect to prescribing medications, dentists are qualified to prescribe, provided they are enrolled in the so-called BIG register [that recognises the qualifications of healthcare professionals in the Netherlands]. Dental hygienists, by contrast, are not qualified to prescribe and have to limit themselves to at most recommending over-the-counter medicines. In prescribing medicines, dentists are of course limited to those about which they have comprehensive knowledge and sufficient experience. If a dentist wants to prescibe a drug that is outside his or her own experience, then he or she should consult with an oral and maxillofacial surgeon, general practitioner or medical specialist to determine whether the medication can be prescribed and if so, by whom.

Internet information on xerostomia: what should patients expect?

OBJECTIVE: To assess the qualitative standards of the information distributed via the Internet regarding xerostomia. MATERIALS AND METHODS: A comprehensive electronic search was performed for 'xerostomia' and 'dry mouth' separately using four search engines. The first 30 results from each search term-engine combination were pooled for analysis. After excluding promotional product sites, discussion groups, video feeds, scientific articles, non-operative sources, sites with denied direct access through password requirement, non-English language domains, and online medical dictionaries, 50 Web pages were evaluated in terms of readability, accessibility, usability, and reliability using recommended research methodology the Flesch Reading Ease Score and the LIDA instrument. Author and information details were also recorded. RESULTS: The results revealed a variable quality of the available Internet information on xerostomia. The Web sites required advanced reading skills, while LIDA scores for accessibility, usability, and reliability ranged from medium to low with average scores extending from 29.1% to 81.3%. CONCLUSIONS: The quality of information about xerostomia among Web sources presents high variability. The existing discrepancy should be alleviated by referring patients to evidence-based education materials on the Internet. Improvement in xerostomia information e-resources will contribute to a more advanced quality in oral health care.

Diagnostic properties of ultrasound of major salivary glands in Sjögren's syndrome: a meta-analysis.

OBJECTIVE: To perform a systematic review and meta-analysis on studies examining the properties of ultrasonography of major salivary glands for diagnosing Sjögren's syndrome. MATERIALS AND METHODS: We searched for the literature on eight databases. The quality of included articles was assessed with the QUADAS-2 tool. Publication bias, pooled sensitivity, specificity, diagnostic odds ratio, and 95% confidence intervals (95%CI) were calculated. Meta-regression analysis was performed. RESULTS: We identified 37 studies and 33 ultrasonographic scoring systems. High risk of bias was observed in 'patient selection', 'conduct and interpretation of ultrasound', and 'flow of patients and timing of tests' in 78%, 70%, and 51% of the studies. We included 29 studies in the meta-analysis. Publication bias was highly probable. Pooled sensitivity was 0.69 (95%CI: 0.67-0.71), specificity 0.92 (95%CI: 0.91-0.93), and diagnostic odds ratio 33.89 (95%CI: 20.75-55.35). Significant heterogeneity was detected between studies. Meta-regression analysis showed that studies with high risk of bias in 'conduct and interpretation of ultrasound' and studies evaluating only parenchymal homogeneity had higher log diagnostic odds ratio (1.09 and 2.49, respectively, p < 0.05). CONCLUSIONS: The quality of current studies is low, thus not allowing to judge the likelihood of salivary gland ultrasonography as a reliable and practical tool in diagnosing Sjögren's syndrome.

Abatacept treatment reduces disease activity in early primary Sjögren's syndrome (open-label proof of concept ASAP study).

OBJECTIVE: To assess the efficacy and safety of abatacept in patients with early and active primary Sjögren's syndrome (pSS). METHODS: All 15 patients (12 women, three men) included in the open-label Active Sjögren Abatacept Pilot study met the revised American-European Consensus Group criteria for pSS and were biological disease-modifying antirheumatic drug-naive. Patients were treated with eight intravenous abatacept infusions on days 1, 15 and 29 and every 4 weeks thereafter. Follow-up was conducted at 4, 12, 24 (on treatment), 36 and 48 weeks (off treatment). Disease activity was assessed with European League Against Rheumatism (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI) and EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI). Several other functional, laboratory and subjective variables were analysed. Generalised estimating equations were used to analyse parameters over time. RESULTS: ESSDAI, ESSPRI, rheumatoid factor and IgG levels decreased significantly during abatacept treatment and increased post-treatment. Salivary and lacrimal gland function did not change during treatment. Fatigue and health-related quality of life (HR-QoL) improved significantly during treatment. No serious side effects or infections were seen. CONCLUSIONS: In this open-label study, abatacept treatment is effective, safe and well tolerated, and results in improved disease activity, laboratory parameters, fatigue and HR-QoL in patients with early and active pSS. TRIAL REGISTRATION NUMBER: 2009-015558-40.

Arthroscopy versus arthrocentesis and versus conservative treatments for temporomandibular joint disorders: a systematic review with meta-analysis and trial sequential analysis.

The aim of this systematic review was to assess the efficacy of arthroscopy compared to arthrocentesis and to conservative treatments for temporomandibular joint disorders. Thirteen controlled studies on various patient outcomes were included after a systematic search in seven electronic databases. Meta-analyses were conducted separately for arthroscopic surgery (AS) and arthroscopic lysis and lavage (ALL), and short-term (<6 months), intermediate-term (6 months to 5 years), and long-term (≥5 years) follow-up periods were considered. No significant differences in pain reduction and complication rates were found between AS or ALL and arthrocentesis. Regarding improvement in maximum mouth opening (MMO), both AS at intermediate-term and ALL at short-term follow-up were equally efficient when compared to arthrocentesis. However, at intermediate-term follow-up, ALL was superior to arthrocentesis for MMO improvement (mean difference 4.9 mm, 95% confidence interval 2.7-7.1 mm). Trial sequential analysis supported the conclusion of the meta-analysis for MMO improvement for ALL versus arthrocentesis studies at intermediate-term follow-up, but not for the other meta-analyses. Insufficient evidence exists to draw conclusions regarding other patient outcomes or about comparisons between arthroscopy and conservative treatments. Due to the low quality of the primary studies, further research is warranted before final conclusions can be drawn regarding the management of temporomandibular joint disorders.

Reliability and validity of handheld structured light scanners and a static stereophotogrammetry system in facial three-dimensional surface imaging.

Several new systems for three-dimensional (3D) surface imaging of the face have become available to assess changes following orthognathic or facial surgery. Before they can be implemented in practice, their reliability and validity must be established. Our aim, therefore, was to study the intra- and inter-system reliability and validity of 3dMD (stereophotogrammetry), Artec Eva and Artec Space Spider (both structured light scanners). Intra- and inter-system reliability, expressed in root mean square distance, was determined by scanning a mannequin's head and the faces of healthy volunteers multiple times. Validity was determined by comparing the linear measurements of the scans with the known distances of a 3D printed model. Post-processing errors were also calculated. Intra-system reliability after scanning the mannequin's head was best with the Artec Space Spider (0.04 mm Spider; 0.07 mm 3dMD; 0.08 mm Eva). The least difference in inter-system reliability after scanning the mannequin's head was between the Artec Space Spider and Artec Eva. The best intra-system reliability after scanning human subjects was with the Artec Space Spider (0.15 mm Spider; 0.20 mm Eva; 0.23 mm 3dMD). The least difference in inter-system reliability after scanning human subjects was between the Artec Eva and Artec Space Spider. The most accurate linear measurement validity occurred with the Artec Space Spider. The post-processing error was 0.01 mm for all the systems. The Artec Space Spider is the most reliable and valid scanning system.

[Oral medicine 3. Anatomy, physiology and diagnostic considerations of taste and smell disorders]. / Oral medicine 3. Anatomie, fysiologie en diagnostische overwegingen bij smaak- en reukstoornissen.

Taste and smell perception are closely related. The taste perception is performed by taste buds which can distinguish salt, sour, sweet, bitter, and umami. Moreover, 2,000-4,000 smells can be recognized. Many taste disorders are in fact smell disorders. Saliva affects taste perception because it serves as a solvent for taste substances and as a protecting agent for the taste receptors. Therefore, hyposalivation leads to a reduction in taste perception, in which the concentration of zinc ions and specific proteins in saliva play an important role. In addition, zinc and iron deficiencies may cause diminished taste and smell perception.

[Oral medicine 4. Clinical aspects and treatment of taste and smell disorders]. / Oral medicine 4. Klinische aspecten, gevolgen en behandeling van smaak- en reukstoornissen.

Taste and smell perception are closely related. Many chemosensory disorders which result in faulty taste are in fact smell disorders. Causes ofchemosensory disorders which call for attention are ageing, medication, natural proteins, burning mouth syndrome, nerve injuries, aerate disorders in the neighbourhood of the sense ofsmell, damage to the smell epithelium, and oncologic diseases or their treatment. A chemosensory disorder has implications for food delight and psychological well-being, may lead to weight loss or increase and to deficient intake of vitamins and minerals. A chemosensory disorder can be treated by medication, surgical intervention, improvement of oral health, smell rehabilitation, and dietary advice.