Severity of periodontal disease in individuals chewing betel quid with and without tobacco.

BACKGROUND: The deleterious effects of chewing betel quid (BQ) with or without tobacco on periodontal health are poorly addressed. The aim of this study was to investigate the severity and extent of periodontal disease among individuals chewing BQ with and without tobacco. METHODS: One hundred twenty individuals (70 BQ chewers: 35 with tobacco and 35 without tobacco) and 50 control individuals (non-chewers) were included in this study. Sociodemographic data and information regarding BQ chewing habit were collected using a questionnaire. Plaque index, bleeding on probing and probing pocket depth were measured. Numbers of missing teeth were recorded and marginal bone loss was measured on panoramic radiographs. Statistical analyses were performed using 1-way analysis of variance and Bonferroni post hoc test. RESULTS: The socioeconomic status of subjects in the control group was significantly higher as compared with those chewing BQ either with or without tobacco. Plaque index, bleeding on probing and probing pocket depth were greater in subjects chewing BQ with tobacco than in those chewing BQ without tobacco and the controls. Subjects chewing BQ with tobacco had fewer teeth than those chewing BQ without tobacco and the controls. Marginal bone loss was higher in subjects chewing BQ with tobacco than in those chewing BQ without tobacco and the controls. CONCLUSIONS: The severity of periodontal disease is enhanced in subjects chewing BQ with tobacco as compared with those chewing BQ without tobacco. Subjects with a low socioeconomic status and poor education are significantly more likely than others to develop periodontal disease.

Paradigm shifts in the management of osteoradionecrosis of the mandible.

Osteoradionecrosis (ORN) of the mandible is a significant complication of radiation therapy for head and neck cancer. In this condition, bone within the radiation field becomes devitalized and exposed through the overlying skin or mucosa, persisting as a non-healing wound for three months or more. In 1926, Ewing first recognized the bone changes associated with radiation therapy and described them as "radiation osteitis". In 1983, Marx proposed the first staging system for ORN that also served as a treatment protocol. This protocol advocated that patients whose disease progressed following conservative therapy (hyperbaric oxygen (HBO), local wound care, debridement) were advanced to a radical resection with a staged reconstruction utilizing a non-vascularized bone graft. Since the introduction of Marx's protocol, there have been advances in surgical techniques (i.e. microvascular surgery), as well as in imaging techniques, which have significantly impacted on the diagnosis and management of ORN. High resolution CT scans and orthopantamograms have become a key component in evaluating and staging ORN, prior to formulating a treatment plan. Patients can now be stratified based on imaging and clinical findings, and treatment can be determined based on the stage of disease, rather than determining the stage of disease based on a patient's response to a standardized treatment protocol. Reconstructions are now routinely performed immediately after resection of the diseased tissue rather than in a staged fashion. Furthermore, the transfer of well-vascularized hard and soft tissue using microvascular surgery have brought the utility of HBO treatment in advanced ORN into question.

[Complications after third molar extractions: retrospective analysis of 1,213 teeth]. / Complications après extraction de dents de sagesse. Etude retrospective de 1 213 cas.

BACKGROUND: This retrospective study was conducted to analyze per and postoperative complications associated with third molar extraction. Our objective was to determine the appropriate moment for extraction. MATERIAL AND METHODS: The study included 367 patients, selected randomly among the population treated between January 1992 and December 1996. A total of 1213 third molars were extracted: 603 under local anesthesia in 83 men and 136 women, mean age 24.9 years (range 11-70); 610 under general anesthesia in 44 men and 104 women, mean age 19.9 years (range 12-62 years). The patients were divided into three groups by age: 11-18 years, 19-30 years, and 31 years and over. Extractions were performed by senior (n=4) and junior (n=7) surgeons who used the same standard operative technique for all patients. RESULTS: The overall complication rate for extractions conducted under local anesthesia was 12.6% for lower third molars and 2% for upper third molars. The most frequent complication was secondary infection (3.6%) for the mandible and fracture of the tuberosity and bucco-sinus communication for the maxillary. The overall complication rate for extractions conducted under general anesthesia was 8.2% for lower third molars and 1.5% for upper third molars. Complications were more frequent, for the entire cohort, when the operator was less experienced, the subject was older, and the tooth was deeply embedded. DISCUSSION: These results are in agreement with data in the literature. Based on our experience, we propose extraction of third molars during adolescence when the x-ray indicates normal eruption cannot be expected due to lack of space or an abnormal position.

Does a parasite have a better chance of survival if an Inuit or a Mayan spits on it?

An earlier puzzling observation [Shields and Mann, J Craiofac Genet Dev Biol, 16:126-136, 1996] that the prevalence of a polymorphic male predominate, major salivary gland-associated, static lesion of the mandible increased exponentially from the Arctic to the Tropics was explained by both positive and negative selection (balancing) on major salivary gland endocrine and exocrine factors. Additional prevalence rates presented here identified three high prevalence high-Temperate zone cultures that were unusually exposed to alimentary parasites. A correlation between macroparasite exposure and the mandibular lesion helped refine the potential selective forces that fashioned major salivary gland size variation. The data suggests that positive selection occurred for androgen-induced enlargement of the suite of major salivary glands and consequently increased quantities of factors. Increased quantities of salivary gland biologically active factors enhance innate protection against infestation of macroparasites per se, especially gut parasites. The data further suggests that negative selection against enlarged salivary glands occurred as protection against electrolyte imbalances in electrolyte stressed environments and in females.