Plasma rich in growth factors injection effectiveness for myofascial pain treatment in masticatory muscles. Randomised controlled trial.

BACKGROUND: Myofascial pain in masticatory muscles is one of the most common temporomandibular disorder. Nowadays, the most usable treatment methods are based on the muscle taut band cell membrane disruption, which releases the taut band. Platelet-rich plasma, made with PRGF Endoret® method, gives an opportunity to use platelet-derived growth factors in treatment processes. It has been proven that platelet-derived growth factors can relief pain and activate muscle regeneration. OBJECTIVE: To test a hypothesis that PRGF injections can be effective for treating myofascial pain in masticatory muscles. METHODS: Fifty adult patients participated in the study. Participants were randomly divided into two groups. The first group received 1-mL lidocaine injections to trigger point in their masseter muscle. The second group of patients received 1-mL PRGF injections. The patients' pain was measured by using visual analogue scale (VAS). RESULT: Statistically significant difference in pain levels before the procedure and 4 weeks after it was found in both groups. There was no statistically significant difference between groups in pain levels before the procedure (P = .063) and 2 weeks after it (P = .123); however, statistically significant difference was noticed 4 weeks after the procedure (P < .001). Four weeks after the procedure, patients' average pain in lidocaine group was 3.4 on VAS, and it was 0.9 in PRGF group. CONCLUSIONS: PRGF injections in masseter muscle affected by myofascial pain syndrome are an effective treatment method. PRGF injections more effectively relief myofascial pain in masseter muscle than lidocaine injections.

Randomized and Controlled Clinical Trial of Bone Healing After Alveolar Ridge Preservation Using Xenografts and Allografts Versus Plasma Rich in Growth Factors.

The aim of this study was to compare bone regeneration in the anterior maxilla between bone substitutes and autologous platelet concentrate in alveolar ridge preservation. Forty patients requiring tooth extraction in the anterior maxilla were randomly allocated to the following 4 treatment modalities: spontaneous healing (control), natural bovine bone mineral covered with resorbable native collagen membrane (BBM/CM), freeze-dried bone allograft covered with resorbable native collagen membrane (FDBA/CM), and plasma rich in growth factors (PRGF) alone. Bone biopsies and histomorphometrical analysis were performed after 3 months of healing. The following parameters were assessed: newly formed mineralized tissue, newly formed nonmineralized tissue, and residual bone-grafting material (if applicable). Statistical analysis was performed to provide descriptive analysis and to compare the parameters of the bone regeneration between the study groups. Histomorphometrical analysis revealed the highest new mineralized tissue formation in the PRGF group. Statistically significant differences in new mineralized tissue formation were found between control/PRGF (46.4% ± 15.2% vs 75.5% ± 16.3%), control/(BBM/CM) (46.4% ± 15.2% vs 20.3% ± 21.9%), control/(FDBA/CM) (46.4% ± 15.2% vs 7.2% ± 8.6%), PRGF/(BBM/CM) (75.5% ± 16.3% vs 20.3% ± 21.9%), and PRGF/(FDBA/CM) (75.5% ± 16.3% vs 7.2% ± 8.6%) groups. The new mineralized tissue formation was in the following order: PRGF > control > BBM > FDBA. Alveolar ridge preservation in the esthetic zone with PRGF was the most effective for bone regeneration of the alveolar ridge.

Short (6-mm) dental implants versus sinus floor elevation and placement of longer (≥10-mm) dental implants: a randomized controlled trial with a 3-year follow-up.

OBJECTIVES: To investigate whether short (6-mm) dental implants could be an alternative to sinus floor elevation (SFE) and placement of longer (≥10-mm) implants in the posterior maxilla. MATERIALS AND METHODS: Over a 3-year period, all patients presenting with partial edentulism in the posterior maxilla were considered for inclusion in this randomized controlled trial. Patients were randomly chosen either to receive short (6-mm) implants (test group [TG]) or to undergo SFE with simultaneous placement of standard-length (≥10-mm) implants (control group [CG]). SFE was performed using the lateral technique. In both groups, tapered implants (AnyRidge, MegaGen, Gyeongbuk, South Korea) were placed. All implants were loaded after 4 months of healing. At each annual follow-up session, clinical and radiographic parameters were assessed. Primary outcomes were implant survival, stability (measured with the implant stability quotient [ISQ]), marginal bone loss (MBL), and complications; secondary outcomes were patient satisfaction and treatment time and cost. RESULTS: Thirty-three patients were assigned to the TG and 20 to the CG. Forty-five implants were inserted in each group. At 3 years, implant survival rates were 100% and 95.0% for the TG and CG, respectively; this difference was not statistically significant (P = 0.38). The mean ISQ values of the TG and CG did not differ at placement (68.2 vs. 67.8, P = 0.1), at delivery of the final restoration (69.5 vs. 69.4, P = 0.9), and after 1 year (71.0 vs. 71.5, P = 0.1); at 3 years, the CG had a significantly higher mean ISQ than the TG (72.4 vs. 71.6, P = 0.004). Mean MBL was significantly higher in the CG than in the TG, both at 1 year (0.14 mm vs. 0.21 mm, P = 0.006) and at 3 years (0.20 mm vs. 0.27 mm, P = 0.01). A few complications were reported. Surgical time and cost were significantly higher in the CG than in the TG (P < 0.0001). Patient satisfaction was high in both groups. CONCLUSIONS: In this randomized controlled trial, results for short (6-mm) implants were similar to those for longer (≥10-mm) implants in augmented bone. Short implants might be preferable to SFE, because the treatment is faster and less expensive. Long-term randomized controlled trials are required to confirm these results.

Clinical efficacy of main radiological diagnostic methods for odontogenic maxillary sinusitis.

The objective of the study was to compare the ability of dental, ENT and radiology specialists to identify the dental cause of maxillary sinusitis with conventional computed tomography, dental and panoramic radiographs. Out of 34 dental records from subjects treated at ENT and Oral and Maxillofacial Surgery Department, LUHS Kaunas Clinics, 22 females and 12 males with the diagnosis of odontogenic maxillary sinusitis, periapical (DPA), panoramic (DPR) and computed tomography (CT) images of posterior maxilla were selected for further studies. In total, 39 sinuses with an odontogenic and 37 sinuses with only rhinogenic cause (control group) were included in the study. Sinuses with mucosal thickening less than 3 mm were excluded from the research. Each image was evaluated by 5 endodontologists, 5 oral surgeons, 6 general dentists, 6 otorhinolaryngologists and an experienced oral radiologist. DPR and DPA views were not evaluated by ENT specialists. The dental cause of maxillary sinusitis was marked according to the given scale. Intraclass correlation coefficient and ROC curve statistical analysis were performed. The best accuracy was observed when CT views were evaluated by experienced oral radiologist and oral surgeons: the AUC was 0.958 and 0.859, respectively. DPR views showed the best accuracy when evaluated by oral surgeons (0.763) and DPA-by endodontologists (0.736). The highest inter-rater agreement was observed between experienced oral radiologist and oral surgeons/otorhinolaryngologists (0.87/0.78) evaluating CT. Sensitivity and specificity of CT were 89.7 and 94.6%, DPR-68.2 and 77.3%, DPA-77.9 and 67%. Identification of dental cause of maxillary sinusitis sometimes is a challenge, which depends on radiological method and, more importantly, on evaluator's experience.

Oral Behaviors and Parafunctions: Comparison of Temporomandibular Dysfunction Patients and Controls.

The aim of this study is to evaluate the frequency of oral behaviors in patients with temporomandibular disorders (TMD) and a control group without TMD.In this baseline case-control study, 260 controls and 260 subjects with TMD completed the oral behaviors checklist defined as a "self-report scale for identifying and quantifying the frequency of jaw overuse behavior" and underwent clinical examinations using the DC/TMJ international examination form (version May 12, 2013). Relationships of oral parafunctions' frequencies between groups were examined. The statistical analysis was performed with IBM SPSS Statistics 23 software.Age and gender distribution in the study groups did not reveal statistical differences (P > 0.05). Multivariate logistic regression analysis was conducted to establish system of independent oral behaviors for prognosis TMD. The stepwise regression analysis demonstrated that very frequent expression of holding, tightening, or tense muscles is associated with 10.83 times (P < 0.05) higher risk of TMD, grinding teeth together during waking hours with 4.94 times (P < 0.05) higher risk, and sustained talking with 2.64 times (P < 0.05) higher risk of TMD. By contrast, it was determined that 3 oral behaviors were less common in the TMD patients compared with the control group: clenching teeth together during waking hours, facing grimaces, and yawning (P < 0.05). The individuals with TMD reported a significantly higher frequency of 10 behaviors (P < 0.05), 3 of which may be regarded as independent risk factors for TMD. In addition, 3 oral behaviors were more frequently observed in the healthy subjects than in the TMD patients.

Validation of Therapeutic Anatomy-Oriented Classification in Endosseous Dental Implant Treatment: A Pilot Study.

BACKGROUND: The purpose of the study was to validate a newly proposed therapeutic anatomically based clinical and radiological classification for dental implant treatment. METHODS: Eighty-one patients with at least 1 edentulous jaw segment (EJS) from 2 dental clinics were included in this study. Both clinical and radiological parameters were assessed in aesthetic and nonaesthetic zones. The data were then compared at preoperative, intraoperative, and postoperative (subdivided into early and late stage) study stages. RESULTS: Based on the hard and soft tissue support, EJSs were divided into 3 types. The outcomes were then validated at preoperative, intraoperative, and early postoperative stages. Data were then analyzed using paired sample t test and the Wilcoxon signed ranks test. No statistically significant difference (P > 0.05) was identified between any the measurements. CONCLUSIONS: The proposed therapeutic anatomically based clinical and radiological classification for the dental implant treatment seems to be reproducible, objective, and helpful in planning dental implant treatment. Future studies with a larger sample size are needed to further validate the outcome obtained in this pilot study.

Relationship between the mandibular cortical index and calcaneal bone mineral density in postmenopausal women.

BACKGROUND AND OBJECTIVE: In clinical practice, a comparative analysis of bone mineral density (BMD) is carried out by examining different skeletal bones. This is useful for screening of postmenopausal osteoporosis (OP). The objective of this study was to determine the relation between the mandibular cortical index (MCI) and calcaneal BMD among postmenopausal women. MATERIALS AND METHODS: The study sample included 129 randomly selected postmenopausal women aged 50-77 years. The participants were examined using panoramic radiography for the analysis of the cortical layer in the mandibular base for MCI determination and using DXL for the examination of calcaneal BMD. According to T scores, the subjects were divided into three groups (Groups 1, 2, and 3). The panoramic radiographic examination of the mandible was performed; the MCI was determined and distributed into groups (C1; C2; C3). The MCI validity in determining the calcaneus BMD status was analyzed. RESULTS: The differences in BMD were statistically significant between Groups C1 and C3 (P<0.01), Groups C2 and C3 (P=0.01), and between the calcaneal BMD groups (P<0.001). There was a statistically significant inverse correlation between the MCI and calcaneal BMD (r=-0.3; P<0.001). The changes characteristic of Group C2 were documented more frequently than those of other morphological groups. The analysis of the MCI validity in BMD status showed low sensitivity (69.4%) and specificity (53.9%). CONCLUSIONS: The relation between MCI and calcaneal BMD was determined. The diagnostic discrimination of the MCI was found to be not sufficient in screening the women with postmenopausal osteoporosis and its application in clinical practice might be limited.

Relationship of clinical and microbiological variables in patients with type 1 diabetes mellitus and periodontitis.

BACKGROUND: The aim of the study was to analyze how metabolic control of type 1 diabetes is related to clinical and microbiological periodontal parameters. MATERIAL AND METHODS: The study involved 56 subjects aged from 19 to 50 years divided into 2 groups: healthy subjects (the H group), and diabetic (type 1 diabetes) patients with chronic untreated generalized periodontitis (the DM group). The glycosylated hemoglobin value (HbA1c) was determined using the UniCel DxC 800 SYNCHRON System (Beckman Coulter, USA), and the concentration in blood was measured by the turbidimetric immunoinhibition method. A molecular genetic assay (Micro-IDent plus, Germany) was used to detect periodontopathogenic bacteria in plaque samples. Periodontitis was confirmed by clinical and radiological examination. RESULTS: Fusobacterium nucleatum, Capnocytophaga species, and Eikenella corrodens were the most frequently found bacteria in dental plaque samples (77.8%, 66.7%, and 33.4%, respectively), whereas Aggregatibacter actinomycetemcomitans was identified 40.7% less frequently in the DM group than in the H group. The strongest relationship was observed between the presence of 2 periodontal pathogens - F. nucleatum and Capnocytophaga spp. - and poorer metabolic control in type 1 diabetes patients (HbA1c) and all clinical parameters of periodontal pathology. CONCLUSIONS: Periodontal disease was more evident in type 1 diabetic patients, and the prevalence of periodontitis was greatly increased in subjects with poorer metabolic control.

Oral health-related quality of life after dental general anaesthesia treatment among children: a follow-up study.

BACKGROUND: Many young paediatric patients with severe dental caries receive dental treatment under general anaesthesia. Oral health-related quality of life (OHRQoL) can be evaluated to assess the outcome of dental general anaesthesia (DGA) treatment. The aim of our study was to examine the OHRQoL of young Lithuanian children in need of DGA treatment and analyse the impact of DGA treatment on children's OHRQoL. METHODS: We carried out a prospective clinical follow-up study on OHRQoL among all young Lithuanian child patients who received DGA treatment at the Lithuanian University of Health Sciences Hospital during 2010-2012. The study consisted of clinical dental examinations of patients younger than six years, data collected from their patient files, and an OHRQoL survey completed by their parents prior to the child's dental treatment. We conducted a follow-up OHRQoL survey one month after the DGA treatment. The Early Childhood Oral Health Impact Scale (ECOHIS) and its effect size (ES) served to evaluate children's OHRQoL, and the Wilcoxon signed-rank test served for statistical analyses. RESULTS: We obtained complete baseline and follow-up data for 140 and 122 participants, respectively (84.7% follow-up rate). Pain and eating problems among children and parents feeling upset and guilty were the most frequently reported impacts at baseline. The parents reported greater impacts on boys than on girls. The ECOHIS score decreased significantly (69.5%, p < 0.001) after DGA treatment, revealing a large ES for the child (1.6) and family (2.4) sections of the ECOHIS. CONCLUSIONS: The OHRQoL of young Lithuanian children requiring DGA treatment is seriously impaired. Dental general anaesthesia treatment results in significant improvement of the children's OHRQoL. The children's parents also greatly appreciate this treatment modality for its positive impact on the family's quality of life.

Treatment under dental general anesthesia among children younger than 6 years in Lithuania.

BACKGROUND AND OBJECTIVE: Dental general anesthesia (DGA) is an efficient treatment modality for young pediatric dental patients. The aim of this study was to identify the reasons for DGA, characteristics of patients receiving treatment under DGA, and treatment performed under DGA for children under school age in Kaunas, Lithuania. MATERIAL AND METHODS: The study population comprised all patients younger than 6 years treated under GA for dental reasons (n=144) at the University Hospital during a 3-year period from 2010 to 2012. The data were collected by means of clinical dental examinations, a survey of the parents, and the patients' dental records and included personal background, reasons for DGA, dental status, and treatment provided. RESULTS: More than half (54%) of the children were younger than 4 years; 40% of them resided in cities. The dental caries experience was high: the mean dmft and d were 12.9 (SD, 3.5) and 12.1 (SD 3.9), respectively. The majority (81%) of the children had multiple reasons for DGA, with the need for excessive treatment (93%), followed by dental fear and uncooperativeness (66%), being the most common. The extent of treatment increased with age and was greater among patients from rural areas. Of the 1975 primary teeth treated under GA, 50% were restored, 32% extracted, and 18% targeted with preventive procedures. CONCLUSIONS: Young children with very high levels of untreated tooth decay are treated under DGA at the Lithuanian University of Health Sciences Hospital. The need for complex treatment as well as dental fear and uncooperativeness are the major reasons for DGA. Multiple caries treatments and extractions are performed for these patients. This study highlights a great need to develop the healthcare system with regard to the appropriate management of caries among young children and postoperative DGA care.

Odontogenic sinusitis: causes, symptoms and treatment. A review of current literature and concepts.

OBJECTIVE: Diagnosis of odontogenic maxillary sinusitis (OMS) often is misdiagnosed as rhinosinusitis, the main symptoms of these diseases are the same: facial pain, postnasal discharge, and congestion. However, OMS and rhinogenic sinusitis require different treatments. Without addressing dental factors in odontogenic sinusitis, conventional rhinitis treatment will often fail, and symptoms will persist. This review aims to assess the most recent literature about OMS causes, symptoms, and treatment. MATERIAL AND METHODS: Literature analysis was carried out on the basis of PRISMA guidelines. Eligible articles no older than 5 years were included, with a few exeptions. An electronic search was performed using MEDLINE (PubMed), The Cochrane Library, and ScienceDirect databases. RESULTS: More than one possible cause for the development of OMS has been identified. The literature indicates that anaerobic microorganisms are found in the case of sinusitis, but there is no consensus regarding the initial exact causative bacteria of this disease. Symptoms of OMS can be one-sided facial pain, purulent anterior rhinorrhoea, headache, cacosmia, pressure or nasal congestion, post-nasal drip. For better diagnostic of OMS imaging modalities are used. Management of OMS requires dual treatment. The treatment of the disease should begin with the need to remove the causative factor. Antibiotic therapy alone is not used for the treatment of odontogenic sinusitis, but can be used to relieve symptoms. It should be prescribed in accordance with the antibiogram after causative factor is removed. When the dental and medical treatment is not enough for sufficient management of OMS surgery is required. CONCLUSION: It is evident that the etiology of OMS includes more than one etiological factor, just as the causative agents of this pathology are various bacteria. Therefore, one of the key elements in choosing the treatment of OMS should be a proper diagnosis.

Effect of (1→3),(1→6)-ß-glucan on in vitro production of cytokines by leukocytes of patients with periodontitis.

BACKGROUND. The aim of the study was to investigate the effect of (1→3), (1→6)-ß-glucan on the production of interleukin 10 (IL-10) and tumor necrosis factor α (TNF-α) in vitro by peripheral blood leukocytes of patients with periodontitis. MATERIAL AND METHODS. In total, 20 patients suffering from untreated severe chronic generalized periodontitis were enrolled in this study. Periodontitis was confirmed by clinical and radiologic examination. Besides, 20 periodontally healthy patients served as a control group. Peripheral venous blood was sampled from the patients, and isolated leukocytes were treated with (1→3),(1→6)-ß-glucan from yeast at different concentrations. The levels of IL-10 and TNF-α secreted by the leukocytes unstimulated and stimulated with unopsonized E. coli in vitro were determined by the enzyme amplified sensitivity immunoassay method. RESULTS. Our data showed that (1→3),(1→6)-ß-glucan induced a significant decrease (P<0.05) in the TNF-α level and a significant increase (P<0.001) in the IL-10 level in the media of unstimulated and stimulated leukocytes of the patients with periodontitis in comparison with those of the healthy subjects. CONCLUSIONS. The present in vitro study showed that (1→3),(1→6)-ß-glucan modulated the response of leukocytes of the patients with periodontitis differently in comparison with those of the healthy subjects. It increased the release of IL-10, which is protective of the tooth-supporting tissues in patients with periodontal disease, but decreased the release of TNF-α, which is mainly responsible for the destruction of the tooth-supporting tissues during periodontal disease.

Surgical treatment methods of medication-related osteonecrosis of the jaw. A systematic review.

OBJECTIVE: Relevance of the problem and the aim: A variety of surgical treatment modalities are analyzed to treat medication-related osteonecrosis of the jaw, using different adjuvant therapies (fluorescence-guided surgery, autologous platelet concentrates) and thus to improve bone and mucosa healing in the postoperative period and reduce the risk of recurrence of osteonecrosis. The purpose of the present systematic review is to compare the effectiveness of different surgical treatments for medication-related osteonecrosis of the jaw (with applications of autologous platelet concentrates, fluorescence guidance, or without adjuvant measures). MATERIALS AND METHODS: The protocol for the systematic review was prepared according to the PRISMA and Cochrane guidelines for systematic reviews. Electronic databases used: PubMed, The Cochrane Library, Science Direct, Wiley Online Library. The review includes articles investigating surgical treatment methods for medication-related osteonecrosis of the jaw. RESULTS: Twelve scientific articles were included in the review. The studies evaluated the efficacy of autologous platelet concentrates, fluorescence-guided surgery, or standard surgical treatment techniques without adjuvant therapies. The efficiency of curettage, sequestrectomy, and the use of autologous platelet concentrates have been found to range from 80% to 96.7%. The efficiency of fluorescence-guided surgery varied from 83.3% to 94.4%. The highest efficiency range of treatment results was determined by evaluating the surgical treatment without adjuvant therapies, which can reach from 22.22% to 93.2%. CONCLUSIONS: The best and most stable results in the surgical treatment of medication-related osteonecrosis of the jaw are achieved by the application of autologous platelet concentrates after surgical removal of necrotic bone or fluorescence-guided surgery.

Management of bisphosphonate-related osteonecrosis of the jaw using teriparatide treatment: A systematic review.

OBJECTIVE: To systematically review the current literature and determine whether the additional TPTD administration for patients with BRONJ is an effective treatment modality. MATERIAL AND METHODS: The systematic review was registered in the PROSPERO (CRD42021242796) and conducted according to the PRISMA statement. An electronic search was performed using MEDLINE (PubMed), ScienceDirect, The Cochrane Library and LILACS databases using a combination of the keywords "Bisphosphonate-Associated Osteonecrosis of the Jaw"[Mesh], "treatment" to identify studies published from 2010. RESULTS: The authors found 8 articles that met the inclusion criteria of this systematic review. According to two studies, TPTD was statistically significantly associated with a greater BRONJ lesion resolution, compared to control group (p<0.05). However, one article showed no significant difference in proportion of resolved lesions (p=0.478). Regarding the effectiveness of TPTD treatment according to administration frequency, daily injection group showed no significant changes in the clinical stage of BRONJ, no difference in the percentage of bone formation on patients osteolysis, compared to weekly injections. Concerning bone resorption/regeneration markers, all the included studies showed that bone resorption markers significantly increased after 3-month TPTD administration. In a study which used multivariate analysis between TPTD and non-TPTD groups using age, BMI, duration of BP usage, the difference in s-OC values after 3 months of the treatment was significant (p<0.05). CONCLUSION: This review provides evidence for the potential benefits of additional TPTD administration for patients with BRONJ being an effective treatment modality.

Total antioxidant capacity of venous blood, blood plasma, and serum of patients with periodontitis, and the effect of Traumeel S on these characteristics.

INTRODUCTION: Periodontal diseases are among the most common chronic infections in humans. Chronic low-level bacteremia and a septicemic inflammatory response have been suggested as a pathogenetic link between periodontal disease and atherosclerosis, diabetes and other systemic diseases. All this significantly increases the relevance of the search for the means for treatment and prevention of periodontal diseases. The aim of the present study was to evaluate blood count and the antioxidant capacity of venous blood, blood plasma, and serum in patients with periodontitis and control subjects with healthy periodontal tissues, and to investigate the effect of the homeopathic medication Traumeel S on the antioxidant capacity of venous blood, plasma, and serum. MATERIAL AND METHODS: The study was performed using venous blood of 21 individuals with chronic periodontitis and 22 healthy subjects. Reduction properties of venous blood, blood plasma, and serum were investigated using the method of reduction of nitroblue tetrazolium, proposed by Demehin et al. RESULTS: The data showed that there was no significant difference in venous blood hemoglobin levels or erythrocyte counts between the groups, while significantly higher leukocyte counts were observed in the periodontitis group (P<0.05). The antioxidant capacity of blood plasma was significantly higher in the periodontitis group than it was in the controls (P<0.05). Meanwhile, the antioxidant capacity of serum was significantly lower in the periodontitis group as compared with controls (P<0.05). The preparation Traumeel S had no effect on the antioxidant capacity of venous blood or blood plasma in the studied groups. CONCLUSIONS: Compared to healthy individuals, the antioxidant capacity of blood plasma in patients with periodontitis was higher, while the antioxidant capacity of serum was lower. The homeopathic medication Traumeel S had no effect on the antioxidant capacity of venous blood, blood plasma, or serum. Our findings concerning the elevated leukocyte counts in venous blood of patients with periodontitis confirm the presumption that periodontal diseases cause low-grade systemic inflammation induced by the host response to periodontal bacteria.

An analysis of etiological factors for traumatic mandibular osteomyelitis.

OBJECTIVE: The aim of this study was to analyze the factors that were associated with the development of osteomyelitis during the treatment of mandibular fractures. MATERIAL AND METHODS: The data of 3188 patients with mandibular fractures treated during 2002-2009 were analyzed. Traumatic osteomyelitis of the mandible was diagnosed in 207 patients. The background factors of complications were studied and compared with the control group (100 patients) not having complications after treatment of mandibular fractures. The data of clinical, roentgenologic, microbiological, and immunological investigations were analyzed. A logistic regression model was developed to identify the factors for osteomyelitis development. RESULTS: The treatment in 6.5% of patients was complicated with osteomyelitis; 88.5% of these patients were men, and more than 80% of patients were younger than 50 years. In 86.8% of cases, Staphylococcus species were isolated, with Staphylococcus aureus accounting for 69.1% of cases. The following factors were found to be associated with osteomyelitis development: immunity dysfunction, caries-affected teeth at the fracture line, mobile fractured bones, bone fixation after more than 7 days following trauma, healthy teeth at the fracture line, insufficient bone reposition, and bone fixation after 3-7 days following trauma. CONCLUSION: Comparative analysis of factors influencing the treatment results revealed a great importance of immunological and dental status and microflora at the affected site. Insufficient or late reposition and fixation of fractured bone fragments play a significant role in the healing process.

Associations between chronic pain and depressive symptoms in patients with trigeminal neuralgia.

UNLABELLED: Trigeminal neuralgia (TN) is a rare neuropathic disorder with an excruciating facial pain. The unpredictable pain attacks may result in anxiety and depression. The aim of this study was to determine and to evaluate the level of chronic facial pain and its association with the appearance of anxiety and depression. MATERIALS AND METHODS: A total of 30 patients with TN and chronic facial pain (group A, 25 women and 5 men; mean age, 64.2±3.2 years) and 30 with atypical facial pain (group B, 26 women and 4 men; mean age, 64.8±1.9 years) were examined. A standardized diagnostic protocol was applied to all of them, which consisted of the following: 1) demographic data and estimation of overall pain on a visual analog scale; and 2) evaluation of emotional status using the Sheehan Disability Scale, Covi's Anxiety Scale, and Beck Depression Inventory. RESULTS: The intensity of facial pain was much higher in the group A than the group B (89.7±2.5 versus 44.0±2.9, P<0.0001). Besides, the group A reported increased scores on the disability and anxiety symptom scales (17.4±1.3 and 9.7±0.3 vs. 6.4±0.7 and 3.6±0.1, respectively, P<0.0001). Severe (46.7%) or moderate (30%) levels of depression were documented in the majority of patients in the group A, while the group B did not show depressive symptoms (P<0.0001). CONCLUSIONS: Patients with TN and chronic facial pain had a significantly higher level of pain perception, and they presented the higher level for anxiety and depression than those with atypical facial pain. A multidisciplinary approach is needed for the additional assessment of emotional status of patients in order to improve the efficacy of treatment and patients' quality of life.

Microflora of the oral cavity in patients with xerostomia.

OBJECTIVE: The aim of this study was to evaluate the dependence of the condition of the microflora of the oral cavity on the etiology of xerostomia, patients' sex, age, degree of hyposalivation, and duration of the sense of dryness. MATERIAL AND METHODS: A total of 64 patients with complaints of oral dryness referred to the Clinic of Oral and Dental Diseases, Hospital of Lithuanian University of Health Sciences, for consultation during the period from 2003 to 2005 were selected for the study. The etiological factors of xerostomia were as follows: radiotherapy (PRT) to the maxillofacial area, Sjögren's syndrome (SS), and xerogenic medications, tricyclic antidepressants (TCAs). RESULTS: There were 50 women and 14 men. Their mean age was 60.5 ± 1.6 years. All the patients in the PRT group had high counts of Candida spp. as compared with percentages of patients in the TCA and SS groups (100% vs. 66.7% and 56.2%, P<0.05). Patients' age and sex in different etiology groups had no significant impact on the condition of their oral microflora. There were equal percentages of patients with deficient and normal salivation in the TCA group (44% in both the groups; P<0.01). All the patients in the PRT group had pronounced hyposalivation (P<0.002). A significantly greater percentage of patients with severely reduced salivation had high counts of Lactobacillus spp. (P<0.01). Significantly greater percentages of patients with the clinical duration of xerostomia of up to 6 months had high counts of Lactobacillus spp. and Candida spp. colonies. CONCLUSIONS: In patients with xerostomia, the condition of the microflora of the oral cavity and impairment of major salivary gland function varied according to the etiology of the disease. The level of hyposalivation and the duration of xerostomia were found to have a significant impact on the microflora of the oral cavity.

Does persistent idiopathic facial pain relate to mood (affective) disorders.

OBJECTIVE: Persistent idiopathic facial pain (PIFP) is a condition in the absence of clear pathology. Pathogenesis is still enigmatic, although comorbidity with mood/affective disorders is observed. The aim of this study was to investigate the association between personality traits, mood and sleep disorders, and PIFP; and to compare them with posttraumatic chronic orofacial pain. METHOD AND MATERIALS: A cross-sectional, single-center study was designed to evaluate patients diagnosed with PIFP according to ICOP (International Classification of Orofacial Pain) diagnostic criteria through Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Five Factor Model, and visual analog scale indexes. Data were analyzed and compared with patients suffering from organic pathology - unilateral chronic mandibular fracture pain. RESULTS: A total of 67 respondents enrolled as the experimental group and 28 participants as a control group. Pain scores were higher in the experimental group (P < .001) and had positive correlation with depression (r = .44, P < .001) and sleep index scores (r = .415, P < .001). Personality trait scores did not differ between the groups. However, neuroticism correlated with depression (r = .466, P < .01) and anxiety (r = .634, P < .01) scores in the experimental group. Depression (P = .002) and anxiety scores (P = .007) were higher in the experimental group, as well as sleep indexes (P = .038). Depression (r = .609, P < .001) and anxiety (r = .655, P < .001) scores had positive correlation with sleep index scores. Sleep scores in the experimental group positively correlated with neuroticism score (r = .442, P < .001). PIFP increases the chance of experiencing depression (OR 10.688; 95% CI 1.355-84.309, P = .006) as well as poor quality of sleep (OR 3.389; 95% CI 1.023-11.228, P = .006). CONCLUSIONS: The results suggest that personality traits (neuroticism), anxiety, depression, and sleep disorders are associated with PIFP.

The relationship between panoramic radiomorphometric indices of the mandible and calcaneus bone mineral density.

OBJECTIVE: The aim of the study was to determine the relationship between bone mineral density in the calcaneus measured using the dual x-ray and laser osteodensitometry technique and bone mineral density in the mandible calculated using the panoramic radiomorphometric indices obtained by applying linear measurements in panoramic radiograms of postmenopausal women. MATERIAL AND METHODS: The participants of this study were postmenopausal women (n=129) aged 50 and more. The subjects underwent panoramic radiography of the mandibles, followed by the calculation of the panoramic radiomorphometric indices indicating bone mineral density of the mandible. The dual x-ray and laser osteodensitometer DXL Calscan were used for the measurements of bone mineral density in the calcaneus. Statistical analysis was preformed to find the relationship between bone mineral density measurements in the two anatomically different bones. RESULTS: Following the diagnostic criteria for osteoporosis recommended by the World Health Organization (1994), the subjects were distributed according to the calcaneus bone mineral density T-score into the normal bone mineral density (group 1), osteopenia (group 2), and osteoporosis (group 3) groups. Mean bone mineral density in the calcaneus in the general studied population was 0.38+/-0.07; the mean value of bone mineral density of the calcaneus in the group 1 (n=34) was 0.47+/-0.04 (g/cm(2)), in the group 2 (n=65) was 0.37+/-0.03 (g/cm(2)), and in the group 2 (n=30) was 0.29+/-0.03 (g/cm(2)). Differences in bone mineral density between the groups were determined using the analysis of variance (ANOVA) F=285.31; df=2; P<0.001 (T1 vs. T2, P<0.001; T1 vs. T3, P<0.001; T2 vs. T3; P<0.001). A statistically significant correlation was found in the general group between the mental index and bone mineral density in the calcaneus (r=0.356, P<0.001), and between the panoramic mandibular index and bone mineral density in the calcaneus (r=0.397, P<0.001). CONCLUSION: Bone mineral density in the calcaneus and the mandible measured using dual energy x-ray and laser osteodensitometer DXL Calscan and by applying panoramic radiography reflect general changes in the mineralization of these bones, characteristic of the postmenopausal period.