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

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

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

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

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

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

Cefadroxil in the treatment of susceptible infections in infants and children.

The efficacy and safety of cefadroxil in the treatment of paediatric patients with a wide variety of infections were evaluated in a multicentre clinical trial. This study included 395 infants and children with Group A streptococcal pharyngitis, sinusitis, otitis media, bronchitis, pneumonia or bronchopneumonia, urinary tract infections and acute gastroenteritis. Cefadroxil was given as a suspension in a daily dose of 30 to 50 mg/kg in 2 divided doses every 12 hours to all but 76 patients; 50 patients with acute otitis media were given 100 mg/kg/day in 2 doses and 26 patients with urinary tract infections received 25 mg/day once daily. Of 317 patients with respiratory tract infections and 78 with urinary or gastrointestinal infections, 95 and 100%, respectively, were clinically cured following treatment with cefadroxil.

New progeroid disorder.

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

Bacterial etiology of acute myringitis in children less than two years of age.

BACKGROUND: Acute myringitis is an inflammation of the tympanic membrane that occurs alone or in association with external otitis or otitis media. The two clinical entities, based on physical examination, are bullous myringitis and hemorrhagic myringitis. OBJECTIVES: To investigate the association of concomitant middle ear disease with acute myringitis and to analyze the bacteriologic findings of the middle ear fluid in children with acute myringitis. METHODS: A prospective longitudinal cohort study of 2028 children age 7 to 24 months at primary care level in the Finnish Otitis Media Vaccine Trial. Matched case-control design for analysis of bacterial pathogen distribution. RESULTS: There were 82 children in whom 92 ears were diagnosed with acute bullous myringitis and 37 children in whom 40 ears were diagnosed with hemorrhagic myringitis during the follow-up. Middle ear disease was associated with bullous myringitis in 97% of ears and with hemorrhagic myringitis in 82% of ears. Bacterial pathogen distribution was similar to that of acute otitis media, although a higher proportion of Streptococcus pneumoniae was detected in both bullous and hemorrhagic acute myringitis. CONCLUSIONS: Middle ear fluid was present in vast majority of ears with acute myringitis in young children. The same etiologic bacteria were found in acute myringitis as in acute otitis media, but S. pneumoniae was the major pathogen. Acute bullous myringitis should be treated as acute otitis media in children <2 years of age.

Local IgA-class antibodies against respiratory viruses in middle ear and nasopharyngeal secretions of children with secretory otitis media.

The presence of antibodies against some important respiratory viruses in the middle ear and nasopharyngeal secretions of 52 children with secretory otitis media (SOM) was investigated in order to find out about the role of these viruses in the development of SOM. The method employed was a sensitive radioimmunoassay test. Antibodies to adeno, syncytial, and parainfluenza 3 viruses were detected in about 50%, 50% and 20% of the patients, respectively. In eight patients the middle ear secretion/nasopharyngeal secretion titer ratio of antibodies to one virus was selectively increased in comparison with the other viruses tested, indicating an active local production of specific antibodies in the middle ear. Further studies are required to determine the cause of such an active antibody synthesis and its possible role in the etiopathogenesis of SOM.

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

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

Endoscope-guided round window fistula repair.

OBJECTIVE: Endoscope-guided round window membrane repair was performed to evaluate whether the approach is feasible in the treatment of a round window fistula. STUDY DESIGN: Retrospective case review. SETTING: Tertiary care academic center. PATIENT: A 27-year-old man had been scuba diving 6 days previously in the Australian Great Barrier Reefs. He had poor hearing with tinnitus in the left ear and a vertiginous sensation. INTERVENTION: A myringotomy was incised, and a tympanoscope was introduced into the middle ear cavity. With the patient under general anesthesia, the middle ear and the oval and round window areas were examined with a tympanoscope. In endoscopic visualization, a round perforation could be seen in the round window membrane. After detection of the round window perforation, a small piece of temporal fascia was obtained to seal the membrane perforation. RESULTS: One month after the operation, the patient's hearing was significantly better. The myringotomy had healed. CONCLUSION: A transmyringeal endoscopic procedure for round window fistula repair is feasible and combines the best features of minimally invasive surgery and aural endoscopy.

Rhinovirus in otitis media with effusion.

We studied rhinovirus in the middle ear fluid of 61 children with subacute or chronic otitis media with effusion. Rhinovirus was recovered from the middle ear fluid of 5 children with subacute otitis media with effusion. The minimum duration of effusion was 32 to 60 days. Additionally, 1 patient had middle ear fluid that was positive for adenovirus. Bacterial pathogens were cultured from the middle ear fluid of 20 of 61 patients. Our finding that rhinovirus can be isolated from middle ear fluid after an asymptomatic period of several weeks suggests its possible role in the development of otitis media with effusion.

Pediatric bronchoscopy during a 17-year period.

From 1969 through 1985, 1032 pediatric bronchoscopies were performed on a total of 748 children under 16 years of age. Of the children 27.4% were under 6 months of age and the smallest patient weighed 600 g. Rigid bronchoscopes with a diameter ranging from 2.5 to 6 mm were used. A flexible fiberoptic bronchoscope with a diameter of 3.5 mm was used only occasionally, mostly for the diagnosis of laryngeal dynamics. All the endoscopies were performed under general anesthesia, except for some laryngoscopies performed with a flexible bronchoscope. The most common indications for bronchoscopy were suspected foreign body (16.7%), stridor (14.5%), recurrent respiratory infections (12.3%) and dyspnoe (9.6%). Laryngomalacia was observed in 13.8% of the children investigated and in patients with inspiratory stridor laryngomalacia was diagnosed in 39.8% of the cases. Subglottic stenosis was confirmed in 7.0% of the children. Tracheal compression was found in 10.8% and tracheal stenosis in 2.5% of the cases. Bronchiectasis was observed in 2.5% and tuberculosis in only 0.5% of the cases. Bronchoscopy was completely normal in only 10.6% of the patients investigated. The complications of pediatric bronchoscopy in this series were infrequent.

Acute bronchial obstruction: an experimental rabbit model study.

An animal model of bronchial obstruction was developed to radiologically follow up the development of postobstructive pulmonary changes. The study material consisted of 21 healthy rabbits (New Zealand White) of which 5 animals served as controls. A piece of Surgicel (Ethicon) shaped as a 3 x 3 x 10 mm cylinder was placed endobronchially through a 3-mm bronchoscope. The animals were followed up radiologically and endoscopically during the first 30 min after which the bronchoscope was extracted. Sixteen animals were followed up for at least 4 h and, in 4 animals, the foreign body (FB) was removed after 24 h. During follow-up, total collapse of the lung was observed after 1-4 h in all but 2 animals with obstruction of the main brochus. After extraction of the FB, atelectasis of the respective lung had resolved within 24 h. The animal model developed in the present study seems to be rather physiological resembling the development of pulmonary atelectasis in pediatric patients.

Diagnostic value of tympanometry in infants in clinical practice.

One hundred and twenty-one visits of 58 infants (2-11 months of age) were evaluated in the Finnish Otitis Media Vaccine Trial. Infants were examined with tympanometry (Grason-Stadler GSI 38 Autotymp) and pneumatic otoscopy by one study doctor. Diagnosis of otitis media was verified by myringotomy in 74% of cases. Tympanometry was technically successful in 94% of ears. The success rate was statistically significantly higher (P < 0.05) among infants less than 7 months of age than those above 7 months. The sensitivity of tympanometry (type B) to detect ears with middle ear fluid was 0.70 and the specificity 0.98 with a positive predictive value of 0.93 and negative predictive value of 0.94. The sensitivity was somewhat lower in the younger age group (0.61); specificity and positive and negative predictive values were good in both age groups. The high success rate and high negative and positive predictive values of tympanometry make it a useful aid for assuring the correct diagnosis of otitis media in infants in routine clinical practice.

Saccular cyst of the larynx in infants.

A saccular or congenital cyst of the larynx is a mucus-filled dilatation of the laryngeal saccule and can distort the aryepiglottic fold, the false cord or the laryngeal ventricle. The most common symptom of the laryngeal cyst is respiratory distress with inspiratory stridor and the diagnosis can usually be made by laryngoscopy. Treatment includes incision and drainage together with extirpation of the cranial wall of the cyst through a laryngoscope. Sometimes tracheostomy is also needed. Usually there are no complications afterwards and the development of these infants is perfectly normal. Our 3 cases and clinical features of this very unusual disorder are presented.

Foreign body in the airways of children.

During the years 1969-1981 57 children with inhaled foreign bodies in the tracheobronchial tree were treated at Turku University Hospital. Of the patients 91% had a history of foreign body inhalation and 25% had a radiopaque foreign body which was seen in the X-ray of the chest. In 9% of 57 patients a foreign body was found unexpectedly at bronchoscopy. The foreign body was removed by bronchoscopy from all the patients but one, who required a segmentectomy due to a fragment of a spike in the lung parenchyma. The patients presented no major complications, and they were all discharged from the hospital in good condition.

Negative pressure tympanograms in children less than 2 years of age--different bacterial findings in otitis media by tympanometric results.

OBJECTIVE: The interpretation of negative pressure tympanograms as indicators of the presence of middle ear fluid has been ambiguous. Our purpose was to assess the occurrence and implications of negative pressure tympanograms and to study their association with bacterial pathogens in otitis media. METHODS: Altogether 329 infants were enrolled at a well-baby clinic for the Finnish Otitis Media Cohort Study, a longitudinal prospective cohort study. The children were closely followed in a special study clinic from 2 to 24 months of age for respiratory diseases, especially acute otitis media. Children were examined at the study clinic with tympanometry and pneumatic otoscopy whenever visiting the study clinic for respiratory disease. Myringotomy with aspiration was performed if middle ear fluid was suspected in otoscopy. Occurrence of middle ear fluid in ears with negative pressure tympanograms (less than -100 daPa) was assessed. Nested case control design matched by visit type (acute or follow-up visit) and month of visit was used for analysis of association of bacterial pathogens and tympanometric results. RESULTS: Middle ear fluid was encountered in 15% of ears with negative tympanometric peak pressure, a lower proportion than described previously. In otitis media with a negative tympanometric peak pressure, 71% of bacterial cultures remained negative for the main pathogens, compared to 36% in matched controls (P<0.001). Especially Streptococcus pneumoniae but also Haemophilus influenzae were rarely found in samples from negative pressure ears. Moraxella catarrhalis was equally often found. CONCLUSIONS: Negative pressure tympanogram is a poor indicator for the presence of middle ear fluid. Furthermore, if otitis media is diagnosed with negative tympanometric peak pressure negative middle ear bacterial culture for the main pathogens is highly probable. Expectant follow-up might be more appropriate than routine antibiotic treatment.

Early post-tympanostomy otorrhea in children under 17 months of age.

A total number of 281 consecutive children with recurrent acute otitis media (RAOM) or otitis media with effusion (OME) was treated with ventilation tubes (VT), inserted under local anesthesia. Patients were prospectively followed-up for post-tympanostomy otorrhea, classified as "early" if observed within 7 days of the tympanostomy procedure. The age of children ranged from 5 to 16 months (average 10.1 months). VT were placed bilaterally in 279 of 281 children. The average length of otitis media (OM) history prior to tympanostomy was 3.4 months. An episode of OM had been diagnosed 1-2 times in 18.9%, 3-4 times in 68.0%, and at least 5 times in 13.1% of the children. Middle ear effusion (MEE), most often classified as mucoid was present in 65.8% of the ears. Cultures were positive for bacteria in 41 of the 185 ears with MEE (22.2%). The mastoid air cell system was radiographically normal in 9.6% and markedly clouded in 56.6%. Early post-tympanostomy otorrhea was observed in 16.0% of ears, occurring more often when MEE, especially mucopurulent, was present at tympanostomy (p < 0.01). The risk of otorrhea was significantly increased by a positive culture for pathogenic bacteria in MEE (p < 0.01) and highly significantly by the advanced opacification of the mastoid air cell system (p < 0.001). It is concluded that early post-tympanostomy otorrhea in young children is caused by the advanced infectious process in the middle ear cleft, including mastoid cell system rather than by the tympanostomy procedure itself. It may indicate the need for more active treatment in this age group.

Myringotomy in the treatment of acute otitis media in children.

The treatment of acute otitis media was studied in 158 children. All children (mean age 4 years) received penicillin orally 80 000--100 000 IU per day for 10 days. Myringotomy was performed on 68 children at the time of the diagnosis. The other 90 children were treated with penicillin and ear drops. The bacteriological findings from the nasopharynx at the time of diagnosis were equivalent in both groups. After 2 weeks, 42% of the children without myringotomy and 71% of the children with myringotomy were cured. The children who were not cured were treated with amoxicillin for 10 days. Four weeks after diagnosis 71% and 90% of the children respectively were cured. The differences between the two groups are significant. The observations indicate that myringotomy clearly accelerates the recovery from acute otitis media.

Endoscopy and otomicroscopy in the estimation of middle ear structures.

In order to study the variation within and between endoscopy and otomicroscopy a Gage repeatability and reproducibility design was created, with which the middle ears were studied of eight cadaver temporal bone blocks through the ear canal three times in random order using both methods. A Zeiss OPMT-1 operating microscope and Olympus endoscopes were used. The data were analysed in accordance with the analysis of variance principle, where the total variation was divided into different components. The anatomical areas were counted and registered via quadrants. There was a distinct difference between the results of the two methods in favour of the endoscopes. Furthermore, the variation between the methods and between the trials was analogous.

Epidemiology and aetiology of middle ear cholesteatoma.

A total of 500 patients with cholesteatoma diagnosed and operated during 1982-91 in the region of Tampere University Hospital and Mikkeli Central Hospital in Finland were analysed retrospectively. The mean annual incidence was 9.2 per 100,000 inhabitants (range 3.7-13.9) and during the study period the annual incidence decreased significantly. The incidence was higher among males under the age of 50 years. There was no accumulation of cholesteatoma diseases in lower social groups. The majority (72.4%) of cholesteatoma patients had suffered from otitis media episodes. Tympanostomy was carried out in 10.2% and adenoidectomy or adenotonsillectomy in 15.9% of all cholesteatoma ears prior to cholesteatoma surgery. Cholesteatoma behind an intact tympanic membrane with no history of otitis media was verified in 0.6% of patients and in cleft palate patients in 8%. In this study, 13.2% of patients had ear trauma or ear operation in anamnes.